Community Pharmacy Practice Chapter 8

Community Pharmacy Practice

• Types of community pharmacies:
  • Sole proprietorship: Independent pharmacy, services provided depend on pharmacist, location, and patient population.
  • Franchise: Authorization to operate under a well-known trade name, e.g. Medicine Shoppe, Good Neighbor Pharmacy.
  • Chain pharmacy: Corporate-owned, standardized business practices, e.g. CVS, Walgreens.

Role of the Pharmacy Technician

• Provide customer service, take information needed to fill a prescription, and answer phone calls.
• Input data into pharmacy information system, including patient and prescriber information.
• Compound prescriptions, perform calculations, and prepare medication for dispensing.
• Package and label prescriptions, count and select medications, and apply labels.
• Organize inventory, alert pharmacists to shortages, and perform pharmacy housekeeping tasks.

Prescription Laws and Regulations

• Prescriptions: Orders for medication issued by licensed practitioners, including physicians, dentists, and nurse practitioners.
• Classifications of medications: Prescription or over-the-counter (OTC), with or without prescription.
• Federal legend: No dispensing without a prescription.
• Combat Methamphetamine Act: Restrictions on OTC medications containing pseudoephedrine.

E-Prescribing

• Computer transfer of prescription data, including messages, refill requests, and prescription fill status.
• Involves multiple participants in the healthcare system.
• Advantages: Reduces errors, enables prescribers to receive drug-specific dosing information, and expedites refills.

Prescription Information

• Necessary information: Patient name, address, DOB, allergies, physical condition, prescription drug card info, and list of medications.
• Patient profile: Includes prescription history, allergic reactions, and medication list.

Prescriber Information

• Prescriber's name, office address, telephone number, DEA number, and license number.

Prescription Processing

• Intake: Verifying patient and prescriber information.
• Data entry: Entering medication, supply, and directions for use.
• Refills: Entering approved number of refills from prescriber.
• Generic substitutions: Dispensing generic medication if authorized.

Prescription Drug Benefits

• Prescription drug benefit: Defines drug coverage provided to the member.
• Prescription drug card: Contains group number, subscriber number, and person code.

Medication

• Entering medication information: Name, strength, quantity, and number of refills.
• Calculating day's supply: Total quantity dispensed divided by total quantity taken per day.

Direction for Use

• Begins with a verb, identifies dosage form, and indicates route of administration.
• No abbreviations, uses everyday language.

Prescription Refills

• Entering approved number of refills from prescriber.
• "PRN" refills: Handling "as needed" refills.

Generic Substitution

• Dispensing generic medication if authorized.
• "Dispense as written" or "brand name medically necessary" in certain states.

Dispense as Written (DAW) Codes

• Numeric codes used when entering prescriptions into the computer.
• Correct use ensures proper reimbursement.

Prescription Adjudication

• Electronic submission of prescription to third-party provider for reimbursement.
• Rejection may occur due to medication not covered, refill requested too soon, or invalid card holder.

Drug Utilization Evaluation (DUE)

• Prospective drug use review, comparing medications in profile.
• Evaluates factors such as drug overutilization, therapeutic duplication, and drug-drug interactions.

Scanning the Prescription and Prescription Labeling

• Digital copy of prescription available upon refill.
• Labeling includes name, address, phone number, prescription number, and directions for use.

Auxiliary Labels

• Additional information for patients, such as best time to take medication, potential side effects, and reminder to discard medication.

Patient Product Information

• Ensures patients have information for proper use, including clinical pharmacology, indications, and use.

• Includes contraindications, warnings, and precautions.### Prescription Preparation

• Count dosage in multiples of five to prevent errors.

• Clean the counting tray after each use to prevent contamination.

Packaging the Prescription

• Various types of medication containers are used in community pharmacies:
  • Round vials for solid dosages (tablets, capsules, caplets)
  • Prescription bottles for liquids
  • Dropper bottles for ophthalmic, otic, nasal, or oral liquids
  • Applicator bottles for topical medications
  • Ointment jars and collapsible tubes for ointments, creams, and gels
• Containers are amber in color to protect medication from sunlight.
• Containers can be made of plastic or glass.
• The Poison Prevention Packaging Act (PPPA) requires safety closures on containers.

Checking the Prescription

• The pharmacist is responsible for checking the final prescription before dispensing.
• Verification includes:
  • Patient's name
  • Prescription's directions for use
  • Prescription number
  • Date
  • Prescriber's name

Filling Prescriptions

• The pharmacy's information system maintains an electronic record of all filled and refilled prescriptions.
• The pharmacy is required by law to maintain a "hard copy" of the prescription.
• The Controlled Substances Act provides for two methods of filing prescriptions:
  • Three separate files for schedule II, III, IV, and V controlled substances, and non-controlled drugs.
  • Two separate files for schedule II controlled substances and all other drugs.

Patient Counseling

• OBRA 90 requires an offer to counsel every patient who receives a new prescription.
• The pharmacist is responsible for identifying and resolving problems involved with medication use.
• Only the pharmacist is legally permitted to counsel a patient.

Prescription Payment

• Payment options are typically cash, check, or credit card.
• The pharmacy technician is often responsible for collecting payment.

Prescription Refilling

• Refills can be done electronically or by fax.
• The pharmacy technician may contact the prescriber's office for authorization.
• A refill request should include:
  • Patient's name and phone number
  • Prescription name, number, and strength
  • Physician's name
• Refills are treated as new prescriptions and begin with data entry.

Transferring a Prescription

• Transferring a prescription requires:
  • Date and all information for the receiving pharmacy
  • Name of the pharmacist and number of refills
  • National Association of Boards of Pharmacy (NABP) and DEA number of the receiving pharmacy
• This information must be recorded by both the transferring and receiving pharmacies.

Pharmacy Layout

• Typical areas in a pharmacy include:
  • Intake window area
  • Bench (pharmacy work area)
  • Stock area
  • Non-sterile or sterile compounding area
  • Pharmacy order check-in area
  • Reconstitution area
  • Pharmacy layout can vary depending on the pharmacy.

Communication

• Effective communication is essential in pharmacy practice.
• Communication involves:
  • Verbal and non-verbal communication
  • Active listening
  • Empathy
  • Clarity and concision

Interacting with the Pharmacist

• Communication with the pharmacist should be:
  • Clear and concise
  • Based on proper terminology
  • Empathetic
  • Patient-centered

Elderly Patients

• Elderly patients may:
  • Experience chronic conditions
  • Process information at a slower rate
  • Have bodily changes or hearing impairments
  • Have difficulty with communication
• Communication strategies for elderly patients include:
  • Using simple sentences
  • Avoiding medical jargon
  • Using written information

Mentally and Terminally Ill Patients

• Mentally ill patients may:
  • Not want to speak with the pharmacist
  • Have a poor self-image
  • Be hesitant to interact with others
• Staff may have difficulty relating to mentally ill patients.
• Terminally ill patients need supportive relationships.

Patients with Health Literacy Issues

• Health literacy is the ability to read, understand, and act on health care information.
• Low health literacy is a major health care issue.
• Pharmacy staff should be aware of patients with health literacy issues and adapt communication strategies accordingly.

Caregivers

• Caregivers play a crucial role in patient care.
• Pharmacy staff should demonstrate empathy and understanding towards caregivers.
• Caregivers may have difficulty discussing certain topics.
• Pharmacy staff should develop trustworthiness by being friendly, ethical, and fair.

Customer Service

• Customer service is essential in pharmacy practice.
• Pharmacy staff should provide information to maximize therapeutic effects of medications.
• The five rights of medication administration are:
  • Right patient
  • Right medication
  • Right time
  • Right dose
  • Right route of administration

Working with Health Care Teams

• Pharmacy staff should:
  • Maintain a professional appearance
  • Stay up-to-date with pharmacy knowledge
  • Be efficient and accurate
  • Help out when needed

Immunizations

• Immunizations can only be administered by pharmacists.
• Pharmacy technicians can help with:
  • Documentation
  • Billing
  • Reporting adverse events
  • Obtaining cardiopulmonary resuscitation training and certification

Medication Therapy Management (MTM)

• MTM is a comprehensive service that includes:
  • Patient assessment
  • Comprehensive medication review
  • Formulating a medication treatment plan
  • Monitoring efficacy and safety
  • Enhancing medication adherence
  • Documenting and communicating MTM services

Home Health Care

• Home health care is defined as health care services and health-related products provided to the patient at home.
• Home health care services are offered for various reasons, including:
  • The growing need for elderly patients
  • Patient preference
  • Cost-effectiveness
  • Maintenance of independence
  • Advancements in technology

Long-Term Care Services

• Some community pharmacies have contracts with long-term care facilities to provide medications.
• Long-term care services include:
  • Sub-acute care facilities
  • Correctional facilities
  • Assisted living facilities
  • Board and care homes
• Pharmacy technicians may be responsible for:
  • Entering computer data
  • Repackaging and labeling medication
  • Packaging and labeling prescriptions
  • Ordering and stocking medications and supplies
  • Processing returned medications
  • Maintaining repackaging equipment
  • Providing necessary forms to the long-term care facility