7.11 Dispensing to the Patient

After the final verification and filing of the original prescription, the medication is available for immediate or future distribution to the patient.

Pre-Pickup Storage

Completed prescriptions are stored alphabetically for patient pickup. Patients generally have seven days to pick up the prescription before the insurance claim is reversed, and the drug is returned to stock. Patients may elect to have the prescription status sent to an email address or to a cell phone via a text message.

Some medications—in particular, insulins, injections, and some eye drops and suppositories—should be stored in the refrigerator once the final verification by the pharmacist is completed until patient pickup. If you cannot find a customer’s medication, make sure that you check the refrigerator or freezer. It could have been placed in one of these places correctly or by mistake.

Patient Pickup Options

Customers may pick up their medications at the pharmacy window inside the store or, in some cases, at a drive-through window. Before presenting the medication, check the patient address and/or birth date. This ensures that the right patient is receiving the prescription. Many independent pharmacies request that the person picking up the medication sign a receipt (which is filed by date) or a computerized signature pad. A signature is absolutely required for controlled substances, especially C-II drugs, along with a government issued ID for address and photo validation. If the person picking them up is not the patient, a verifying phone call must occur. (These procedures are addressed more in Chapter 14.)

images Pharm Fact

Medical errors often occur at pickup, when patients are presented with the wrong prescription package, so be careful!

In the cases of a “partial fill” or a “change of manufacturer,” you must relay this information to the patient along with the reasons. For a partial fill, provide the patient with a promised time for pickup of the remainder. If half-tablets have been prescribed, you may recommend that the customer purchase a tablet splitter to more easily divide the tablets, especially if the tablets are not scored.

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A tablet splitter is a safety and convenience device for prescribed half-tablet doses.

When handing the prescription to the patient, make sure to ask if they understand how to take the medication correctly. Point out the labeled information (including auxiliary labeling) and any accompanying patient information inserts, including the Medication Guide. Politely ask, “Do you have any other questions? Would you like to talk to a pharmacist?” The technician must legally (by OBRA-90 law) offer the individual the opportunity to talk to the pharmacist about the drug to make sure that all the use instructions and potential side effects or drug interactions are understood. You may have to have the patient sign an electronic prompt screen or a receipt to indicate that they had been given the invitation to talk to the pharmacist (see Table 7.8).

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When a technician provides a prescription to the patient, they must be warm and pleasant, and provide all the drug information needed, asking if there are any questions for the pharmacist.

Counseling is especially important for all new prescriptions. Most pharmacists try to make an extra effort to talk to these patients and be available for any questions on refill medications. The packaging or the look of the drug may have changed, prompting questions. If there is a change in dose, schedule, or a possible allergy or interaction, the pharmacist often will take the initiative to approach the patient. The pharmacist will also commonly ask to talk to the patient if there is a duplicate therapy, potential side effect, or a drug-drug interaction warning that appeared during the prescription filling process. Sometimes a computer reminder for mandatory counseling may be prompted from a DUR.

images IN THE REAL WORLD

In Gallup polls over the years, the pharmacist is commonly named as either the number 1 or number 2 most trusted healthcare practitioner among patients. The pharmacist is much more accessible than most other healthcare providers, does not generally require an appointment, and provides accurate information on medications at no charge! Pharmacists will also assist patients with medication-related questions over the phone—again, at no charge. Many patients also seek the counsel of the pharmacist on the proper selection of an OTC drug, vitamin, dietary and herbal supplement, or homeopathic drug for themselves or a family member. Because technicians assist in filling prescriptions, pharmacists are able to provide information or counseling on the following issues:

  • name and type of the medication or supplement and how it works on the body or mind

  • best form of administration and proper dose

  • duration of drug therapy

  • action to take after a missed dose

  • common severe side effects or adverse effects

  • interactions and therapeutic contraindications, including preventive steps and actions to be taken if they occur

  • methods for self-monitoring of the drug therapy

  • proper storage and refill information

  • special directions and precautions for preparation, administration, and use of the drug by the patient

Table 7.8 General Tips for Reducing Medication Errors

Tips for Technicians

  • Verify information with the patient or caregiver when the prescription is received at the pharmacy and when the filled prescription is sent out of the pharmacy.

  • Observe, listen to, and report to the pharmacist pertinent information that may affect the safety or effectiveness of drug therapy.

  • Always keep the prescription and the label together during the filling process.

  • Know the common look-alike and sound-alike drugs and keep them stored in different areas.

  • Keep dangerous or high-alert medications in a separate storage area of the pharmacy.

  • Always question illegible handwriting.

  • Check that prescriptions and medication orders contain accurate information, including the correctly spelled drug name, strength, appropriate dosing, quantity or duration of therapy, dosage form, and route. Obtain any missing information from the prescriber.

  • Use the metric system. A leading X or 0 (zero) should always be present in decimal values less than one (e.g., 0.3).

  • Question prescriptions and orders that use uncommon abbreviations. Avoid using abbreviations that have more than one meaning, and verify with the pharmacist or the prescriber any abbreviations of which you are unsure.

  • Be aware of insulin mistakes. Insulin brands should be clearly separated from one another while stored in the refrigerator. Always educate patients about the described proper use of various insulin products at the time of purchase.

  • Keep the work area clean and uncluttered. Keep only those drugs that are needed for immediate use close at hand.

  • Always verify information at each step of the prescription-filling process.

  • Be sure that at least two people compare the label with the original prescription and NDC number.

  • Regularly review work habits and actively look for actions to take that improve safe and accurate prescription filling.

Tips for Pharmacists

  • Take all DUR alerts seriously and respond with cautionary actions

  • Check the original prescription, the NDC number, and the drug stock bottle.

  • Cross-reference prescription information with other validating sources.

  • Encourage documentation of all medication use, including OTC medications and dietary supplements, in patient profiles.

  • Document all clarifications on orders.

  • Inspect the product in the bottle before initialing the prescription and the container.

  • Maintain open lines of communication with patients, healthcare providers, and caregivers.

Most state boards of pharmacy now require that the pharmacist engage in an education interchange with the patient at the prescription pickup, most particularly for Medicaid. Unfortunately, no additional Medicaid reimbursements are provided for this mandatory counseling. In fact, as state Medicaid programs attempt to balance budgets in challenging economic times, reimbursements to pharmacists have not kept pace with inflation. This adds additional challenges to pharmacies, requiring pharmacists to depend even more on technicians.