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PRESCRIPTION PATHWAY

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by

Angela Cayon

on 22 October 2018

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Transcript of PRESCRIPTION PATHWAY

Community Pharmacy Practice
Data Entry
Read RX

Calculate (QTP, QTE, DT, DOSE)

Insurances
Private
RAMQ

Software - use of codes
Print necessary documents
Preparation
Dispensing methods

Types of products

Verification
Conclusion
Greeting
Ask the right
questions!
Be courteous
Be concise
Payments
Billing
Answer questions related to insurances
PUBLIC INSURANCE - RAMQ
Standard plan for the population
PRIVATE INSURANCE

plans may differ depending on insurance company

Cash - payment
Types of payments: credit, debit, etc
Allows
The pharmacist to properly analyze the patient’s file
In order to prevent any contraindications


Phone number
Birthday (day, month and year)

PATIENT GREETING
NEW RX
By Angela Cayon, PTA

Particular situations


Who is the prescription for?
What is the patient’s address (including postal code)?



Who is the Rx for?

Does the person have an existing file?
Insurance card
RAMQ
Private
Phone number
Address
Date of birth
Allergies
Health problems
Intolerance
Are you taking any other medication on a regular basis?
OTC drugs?
Natural products?
Analyze if:
first time taking Rx
generics
CHILDREN
Antibiotics

Weight

Type of infection
PREDNISONE
Calendar

decreasing dose

treatment started at hospital
ANTI-TOBACCO
TREATMENT
number of cigarettes / day

if RAMQ: explain program and renewals
12 weeks max
once a year
continuous treatment

WOMEN
(12 TO 50 YEARS OLD)
ask if :
pregnant
breastfeeding
taking contraceptives
ask if tobacco intake
CREAMS AND OINTMENTS
Ask area to be covered
calculate quantity
calculate duration
PATICULAR SITUATIONS
Interpretation of a prescription
Generalities of processing a prescription

All is a question of interpretation
Knowledge/experience
Reference tools
Other sources of information
In case of doubt, do not second guess
Ask for a 2nd opinion
Make a note to the pharmacist with the
details of all doubts

Pharmaceutical form
Quantity prescribed
Duration of treatment
Posology
Renewals
Signature and License number
of doctor

Components of a prescription

Name of clinic/hospital
Name of patient
Date
Medication name
Strength

Date

Be careful with prescriptions that are older than a year

Be careful with antibiotic prescriptions that are too old

Controlled or targeted substance = 1 year

?

?

?

A patient has a bad sore throat. He had consulted a doctor that had prescribed him an antibiotic and the patient ends up not taking it at that point. 4 months later, this patient shows up saying he has symptoms that sound like possible bacterial infection.
However, this time he did not consult a doctor.
Should you serve him this antibiotic?

Unreadable medication
name

Patient file
Search over similar medications

Think of homonyms and homophones
Accutane / Accupril
Allopurinol / halopéridol
Quinine / Quinidine
Paxil / Pariet
Losec / Lasix
Mogadon / Modulon
Lopid / Lozide
Unreadable medication
name
Use other information on the prescription

Specialization of doctor
(gynecologist, gastro-intestinal, etc)
Quantity prescribed
Duration of treatment
Pharmaceutical form
(drops, cream, ointment, etc)
Posology
Strength/concentration


Unreadable medication
name

Computer software
Use the first 3-4 letters
NS and then enter in the first
3-4 letters of medication name
ICP
EPP

Unreadable medication
name
Patient
Ask if they know what the medication is that the doctor prescribed
Ask why the doctor prescribed this medication

Colleague
Ask a colleague what they think they see on the prescription
Avoid telling them what you think you see

Unreadable medication
name
Pharmacist
After asking a colleague
Might have to call the doctor

Missing strength

Zithromax ii co stat then i co die x 4d


Be careful with commas
 If the medication already exists in the patient file, use the same strength
If it is not written, use your knowledge and experience. For example:


This would mean Zithromax 250 mg

Pharmaceutical Form

Be careful, general doctors do not always know the different pharmaceutical forms 

Pay attention to little extras
(XL, XR, SR, CR, etc…)  

Only the medications that have the same route of administration can be substituted with each other

Pharmaceutical Form

CD = Controlled Delivery
CR = Controlled Release
EC = Enteric Coated
ER = Extended Release
LA = Long Acting
MR = Modified Release
PA = Prolonged Action
SR = Slow Release
XL = Extended Release
XR = Extended Release
RD = Rapid Disintegrate

Quantity prescribed/Duration of treatment

Calculate the quantity prescribed based on the posology and duration of treatment

Amox 500 mg tid x 7d = 21 caps

Calculate the duration of treatment based on the posology

Gen Glybe 5 mg 1 co bid #60 = 30 days

Posology
Indicate precisely the dose to be taken each time
For liquids, if you use spoons, indicate the quantity in mL
ex. 2 teaspoons (10 mL)
For insulin, indicate the quantity in units
ex. 18 units

Number of times in a day

Root of administration (except per os)

Renewals
Correspond to the number of times the quantity prescribe can be repeated

Number of renewals (ex. Rep. 3 times)
In this case, enter that number as renewal

Duration (ex. 1 year, 6 months, …)
In this case, enter 99 and indicate the date the prescription is valid until

If it’s written NR, enter NR as renewal
If nothing is written, then enter 0 as renewal

Signature and License number

Prefixes that identify health care professionals

94 = podiatrist
1 = doctor
2 = dentist
32 = veterinarian
3 = optometrist
4 = pharmacist
5 = resident doctors
6= Specialist out of Quebec
7 = Dentist out of Quebec
93= Mid wife


Signature and License number
AssystRx allows

Create a health care professional
VM
MM
On,PH


Unreadable Doctor License Numbers

Name of doctor written on prescription
Verify if other health care professional
Instead of a doctor (dentist, etc…)
Enter the first couple letters of last name of doctor
Enter the first few numbers of license
Check over old prescriptions in patient file

Unreadable Doctor License Numbers
Ask other people:

Patient
Other pharmacy technicians
Pharmacist
Call the health care establishment (the nurse or receptionist can check over the patient file)
Call the RAMQ if it’s a new doctor


Unreadable Doctor License Numbers
Enter a temporary number
111111 (doctor out of Quebec)
Warn the pharmacist
Some elements to verify in case
of doubt of a false prescription
Ink

Missing license number

Aspect of the prescription

How the numbers are written (compare)

Writing

Elements that suggest it is a photocopy

Client’s attitude: talking too much to distract you, making up a big story, nervousness
Public insurance plan
- Different categories
Maximum contribution:
- $87,16/month
- $52,16/month
- $ 0
The price or contribution payed
by the patient refers to :

- deductible = $19,45/month
it is charged with the first(s)
medications taken in a month.

- co-insurance = 34,8% /Rx/service

Check the unit price
The prices are established
in the RAMQ list
Calculate the quantity prescribed (QTP)
In this case, the posology is:
Calculate total price of medication
Multiply the QTP by the unit price.
Add dispensing fee to the price
The dispensing fee (in a form of a code
O
or
N
. It is established based on the type of Rx.

Celebrex =
code N
$20.76 +
($0.35 X 30 days) =
31.76

Ref: RXpharmaLAB.com
RAMQ price calculation
(per medication)
Celebrex 200mg
bid

Ren: 6 months

Dr. Fawaz H.
Example:
apo-celecoxib 200mg
1 cap = $0.3460
Celebrex 200mg
bid

Ren: 6 months

Dr. Fawaz H.
1 cap x 2 x 30 days =
60 capsules
Celebrex 200mg
bid

Ren: 6 months

Dr. Fawaz H.
60 capsules x $0.3460 =
$20.76
Celebrex 200mg
bid

Ren: 6 months

Dr. Fawaz H.
insulin
compounds
Drops
Inhalers
Syringes
Holders of a claim slip
65 or over who receive 94% to 100% of the Guaranteed Income Supplement (GIS)
Children under 18 of persons between 18 and 25 who are spouseless, live with their parents and are full-time students.

Submit to RAMQ
Minus
deductible
$31.76 -
$ 19.45
= $11.81

Calculate
co-insurance
$11.81 X 34,8% =
$4.11

The patient will pay:
Deductible + co-insurance
$19.45 + $4.11
= $23.56
Celebrex 200mg
bid

Ren: 6 months

Dr. Fawaz H.
$9/rx
$0.30/day
Count medication correctly
Select product
Count required quantity
Check for
Name
Form
Strength
DIN (4 last digits)
**Respect principles of health and safety**
Vials and jars
Secured
Non secured (VNS)
Pill packs (pilluliers)
Dispills
Dosette
Compounds
Sterile
Non sterile
Different forms
Per Os, IV, SC, IM, Cr, Oint, Supp, etc.
Storage conditions
refrigerated
...
Select the right container
Size
secured, VNS
Amber bottles
...
Affix the label
Clean
Straight
Auxiliary labels if necessary

Must be done by the PTA before handing in the basket to the pharmacist for final check.

DCCV (delegation of container-content verification) -
Under specific conditions and for certain types of renewals - the final check may be a delegated task to pharmacy technicians.

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