Chapter 15 community pharmacy

The Pharmacy The Pharmacy Technician 4ETechnician 4E

Chapter 15Chapter 15

Community PharmacyCommunity Pharmacy

Chapter OutlineChapter Outline

Community PharmacyCommunity Pharmacy OrganizationOrganization Customer ServiceCustomer Service Processing PrescriptionProcessing Prescription Preparing the PrescriptionPreparing the Prescription Customer Pick-UpCustomer Pick-Up Using a Cash RegisterUsing a Cash Register Other DutiesOther Duties

Community PharmacyCommunity Pharmacy A A retail pharmacy retail pharmacy practice that services prescriptions practice that services prescriptions

directly to the public.directly to the public. Sell Sell over-the-counter (OTC)over-the-counter (OTC) products. products.

Approximately Approximately two thirds two thirds of all prescription drugs in of all prescription drugs in the U.S. are dispensed by community pharmacies. the U.S. are dispensed by community pharmacies.

More technicians and pharmacists are More technicians and pharmacists are employedemployed in in community pharmacies than any other area. community pharmacies than any other area.

The role of community pharmacist and in counseling The role of community pharmacist and in counseling and education patients is steadily increasing.and education patients is steadily increasing. Adds more responsibility to dispense by Adds more responsibility to dispense by

technicians.technicians.

Types of PharmaciesTypes of PharmaciesIndependent PharmaciesIndependent Pharmacies

Owned by the pharmacist or groups of Owned by the pharmacist or groups of pharmacists.pharmacists. A pharmacist owner makes his or her own A pharmacist owner makes his or her own decisions regarding the practice of pharmacy.decisions regarding the practice of pharmacy. Most compounding of prescriptions is done in Most compounding of prescriptions is done in this type of pharmacy.this type of pharmacy.

A A franchise pharmacyfranchise pharmacy, also called, also called apothecary, apothecary, is a member of a small chain of is a member of a small chain of professional community pharmacies that are professional community pharmacies that are independently owned.independently owned.

Types of PharmaciesTypes of PharmaciesChain PharmacyChain Pharmacy

A community pharmacy consisting of several similar A community pharmacy consisting of several similar pharmacies in the region (or nation) that are corporately pharmacies in the region (or nation) that are corporately owned.owned.

Examples: CVS, Examples: CVS, Rite-Aid, WalgreensRite-Aid, Walgreens Located to allow for large-volume dispensing utilizing Located to allow for large-volume dispensing utilizing pharmacy technicians and automation.pharmacy technicians and automation. Administrative decisions are made at the corporate Administrative decisions are made at the corporate level.level.

Types of Community Pharmacies Types of Community Pharmacies Others TypesOthers Types

Mass Merchandiser PharmaciesMass Merchandiser Pharmacies A regional & national community pharmacy that A regional & national community pharmacy that

sells mass merchandise with in-store pharmacies.sells mass merchandise with in-store pharmacies. Examples: Examples: Costco, KMart, TargetCostco, KMart, Target, , WalmartWalmart

Food Store PharmaciesFood Store Pharmacies Regional or national food store chains Regional or national food store chains Examples: Examples: A&P, Eagle, Giant, Kroger's, PathmarkA&P, Eagle, Giant, Kroger's, Pathmark

Role of Pharmacy Technician in a Role of Pharmacy Technician in a Community PharmacyCommunity Pharmacy

Pharmacy technicians employed in a community Pharmacy technicians employed in a community pharmacy typically pharmacy typically

Aid the pharmacist in the filling, labeling, and Aid the pharmacist in the filling, labeling, and recording of prescriptions.recording of prescriptions.

Operate and responsible for the pharmacy cash Operate and responsible for the pharmacy cash register.register.

Stock and inventory prescription and over-the-Stock and inventory prescription and over-the-counter (OTC) medications.counter (OTC) medications.

Maintain computerized patient records. Maintain computerized patient records. Prepare insurance claim forms. Prepare insurance claim forms. Order and maintain parts of the front-end stock.Order and maintain parts of the front-end stock.

Patient ConfidentialityPatient Confidentiality• Respect the Customer’s Privacy

• A pharmacy technician must be sensitive to maintaining patient privacy, confidentiality of medical information, and compliance with all state and federal HIPAA regulations.

• Health Insurance Portability and Accountability Act• All healthcare facilities that access, store, maintain,

or transmit patient identifiable medical information must comply with these regulations.

• Failure to do so can result in severe civil and criminal penalties.

Patient IdentifiersPatient Identifiers•NameName

•Address and ZIP codeAddress and ZIP code

•RelativesRelatives

•EmployerEmployer

•Date of birth Date of birth

•Telephone number or fax numberTelephone number or fax number

•E-mail addressE-mail address

•Social security numberSocial security number

•Medical record numberMedical record number

•Health plan ID numberHealth plan ID number

•Account numberAccount number

•Vehicle IDVehicle ID

•Certificate or license numberCertificate or license number

•URL or IP addressURL or IP address

•Fingerprint or voiceprintFingerprint or voiceprint

•PhotoPhoto

HIPPAHIPPA Some practical ways of protecting patients’ privacy Some practical ways of protecting patients’ privacy

include:include: NeverNever discussing patients outside of the pharmacy discussing patients outside of the pharmacy

setting.setting. Shredding documentsShredding documents, papers, or labels with patient , papers, or labels with patient

information (instead of discarding in regular trash).information (instead of discarding in regular trash). Speaking to patients Speaking to patients and other healthcare and other healthcare

professionals in the most professionals in the most private area private area possible.possible. Never Never discussing patients with any individual unless discussing patients with any individual unless

the patient has provided written authorization to do the patient has provided written authorization to do so.so.

OrganizationOrganization Prescription counterPrescription counter Transaction windowTransaction window StorageStorage SinkSink RefrigerationRefrigeration EquipmentEquipment Computer systemComputer system Prescription bins or shelves Prescription bins or shelves

Customer ServiceCustomer Service

Good customer service requires:Good customer service requires: PresentingPresenting in a calm, courteous, and professional in a calm, courteous, and professional

manner.manner. Listening to and understanding Listening to and understanding customer requests customer requests

for service.for service. Fulfilling those requests Fulfilling those requests accurately or explaining accurately or explaining

to the customer's satisfaction why the request to the customer's satisfaction why the request cannot be serviced.cannot be serviced.

At the CounterAt the Counter

Techniques for interacting with customers at the Techniques for interacting with customers at the counter include:counter include: Listening carefully.Listening carefully. Making eye contact.Making eye contact. Repeating what the customer said.Repeating what the customer said. Using positive rather than negative language to Using positive rather than negative language to

describe what you can do.describe what you can do. Calling the patient by name.Calling the patient by name.

On the PhoneOn the Phone Techniques for interacting with customers at on the Techniques for interacting with customers at on the

telephone include:telephone include: Using a pleasant and courteous manner.Using a pleasant and courteous manner. Stating the name of the pharmacy and your name.Stating the name of the pharmacy and your name. Following the standard procedure indicated for Following the standard procedure indicated for

your pharmacy.your pharmacy. Referring all calls that require a pharmacist’s Referring all calls that require a pharmacist’s

judgment to the pharmacist.judgment to the pharmacist.

Personal Service In The Contemporary Pharmacy

• Good Customer Service involves:Good Customer Service involves:• Dressing and grooming oneself neatly.Dressing and grooming oneself neatly.• Maintaining a constant lookout for customers in Maintaining a constant lookout for customers in

need of assistance.need of assistance.• Knowing the layout of the store and the location of Knowing the layout of the store and the location of

its merchandise.its merchandise.• Smiling and using courteous language.Smiling and using courteous language.• Providing explanations as necessary to customers, Providing explanations as necessary to customers,

being sensitive to language differences.being sensitive to language differences.

Personal Service In the Contemporary Personal Service In the Contemporary PharmacyPharmacy

• Interprofessionalism includes:Interprofessionalism includes:• Listening carefully.Listening carefully.• Making eye contact. Making eye contact. • Repeating what the customer has said. Repeating what the customer has said. • Using positive language to describe what you can Using positive language to describe what you can

do.do.• Remember the patient come to a pharmacy Remember the patient come to a pharmacy because because

they are sick and not feeling well.they are sick and not feeling well.• DO NOT DO NOT provide medical advice and direct those provide medical advice and direct those

questions to the pharmacist.questions to the pharmacist.

Prescription-Filling ProcessPrescription-Filling Process

Step 1: Receive Prescription and Review Patient ProfileStep 1: Receive Prescription and Review Patient Profile Initial check Initial check of all key pieces of information is vital. of all key pieces of information is vital.

Thoughtful and thorough initial review reduces the Thoughtful and thorough initial review reduces the chances that an unidentified error will continue chances that an unidentified error will continue through the filling process.through the filling process.

Legibility Legibility to make sure information is easily read and to make sure information is easily read and understood.understood. Clarify any questions.Clarify any questions.


ValidityValidity to make sure the prescription is valid. to make sure the prescription is valid. Requirements may vary from state to state.Requirements may vary from state to state.

Every technician should be familiar with the Every technician should be familiar with the definition of valid prescription for the state in definition of valid prescription for the state in which they practice.which they practice.

Do not fill the prescription on invalid prescriptions.Do not fill the prescription on invalid prescriptions. A prescriber’s signatureA prescriber’s signature is required for a prescription is required for a prescription

to be considered valid.to be considered valid.

Prescription-Filling ProcessPrescription-Filling Process Patient information Patient information includes:includes:

Full name of patientFull name of patient AddressAddress Telephone numberTelephone number Date of birthDate of birth Any allergies to medicationAny allergies to medication

Physician information Physician information should:should: Be written byBe written by a licensed prescriber along with their contact a licensed prescriber along with their contact

information, information, Contain a signature of the prescriber.Contain a signature of the prescriber.


Step 2: Enter Prescription into the ComputerStep 2: Enter Prescription into the Computer AccuracyAccuracy is imperative. is imperative.

Make sure the patient is receiving the correct and Make sure the patient is receiving the correct and appropriate medication. appropriate medication.

An inaccurate prescription could cause the patient An inaccurate prescription could cause the patient serious serious harmharm or death.or death.

Concentration and focus are very important.Concentration and focus are very important. Prescription information should be compared with Prescription information should be compared with

choices from the computer menuchoices from the computer menu The form or formulation must match the route of The form or formulation must match the route of

administration. administration. Confirm that information entered into the computer Confirm that information entered into the computer

matches the original prescription.matches the original prescription.



Step 3: Generate Prescription LabelStep 3: Generate Prescription Label Check the accuracy of any technology in the Check the accuracy of any technology in the

prescription filling process.prescription filling process. Cross-check Cross-check the label output from the computer the label output from the computer

with the original prescription.with the original prescription. Check that no Check that no typing error typing error or inherent program or inherent program

malfunction altered the information.malfunction altered the information. Check that the Check that the patient name patient name is correctis correct on the on the

label. label. Check that the Check that the drug, dose, concentration, and drug, dose, concentration, and

route route information is identical to the original information is identical to the original prescription.prescription.

Prescription-Filling ProcessPrescription-Filling ProcessStep 4: Retrieve MedicationStep 4: Retrieve Medication Products can contribute to errors with Products can contribute to errors with

Look-alike labels.Look-alike labels. Similarities in brand or generic namesSimilarities in brand or generic names Similar pill shapes or colors.Similar pill shapes or colors.

Use NDC numbersUse NDC numbers, drug names, and other , drug names, and other information to verify selection of the correct information to verify selection of the correct product.product. Use both the original prescription and the Use both the original prescription and the

generated label when selecting a manufacturer’s generated label when selecting a manufacturer’s drug product from the storage shelf.drug product from the storage shelf.

Use NDC numbers as a cross-check.Use NDC numbers as a cross-check.


Accidental substitution of one drug or ingredient for Accidental substitution of one drug or ingredient for another is one of the most serious events that can another is one of the most serious events that can occur in pharmacy practice.occur in pharmacy practice.

Most pharmacy practices possess a computer-based Most pharmacy practices possess a computer-based “pill identification” program “pill identification” program and use a shelf labeling and use a shelf labeling system to organize inventory.system to organize inventory. Visually compareVisually compare the medication dispensed with a the medication dispensed with a

picture picture of the medication.of the medication.


Calculation and substitution errors Calculation and substitution errors are sources of are sources of medication errors.medication errors. Write out the calculation and have a second Write out the calculation and have a second

person check the answer.person check the answer. Take care when reading labels and preparing Take care when reading labels and preparing

compounded products.compounded products.

Prescription-Filling ProcessPrescription-Filling Process Medication errors Medication errors occuroccur

When using more than one container of product.When using more than one container of product. When preparing more than one product at a time.When preparing more than one product at a time. When distractions and interruptions intrude.When distractions and interruptions intrude.

All equipment should be maintained, cleaned, and calibrated All equipment should be maintained, cleaned, and calibrated on a regular basis.on a regular basis. Potential for serious harm to a patient occurs if the Potential for serious harm to a patient occurs if the

residue or dust from an allergy-causing medication residue or dust from an allergy-causing medication contaminates the patient’s prescription.contaminates the patient’s prescription.

Clean the counting tray with alcohol after each drug is Clean the counting tray with alcohol after each drug is dispensed.dispensed.

Prescription-Filling ProcessPrescription-Filling Process ContainersContainers

All prescription vials and bottles must have a All prescription vials and bottles must have a SAFETY SAFETY CAP CAP oror child child resistant capresistant cap, unless , unless the patient the patient requests an requests an EASY-OPEN CAPEASY-OPEN CAP. .

Some elderly or arthritic patients have extreme Some elderly or arthritic patients have extreme difficulty opening child- resistant caps.difficulty opening child- resistant caps.

If preparing a If preparing a liquid medicationliquid medication, select an appropriate , select an appropriate size bottle and pour the correct volume of liquid into size bottle and pour the correct volume of liquid into the bottle.the bottle.

For creams and ointments For creams and ointments that are not pre-packaged, it that are not pre-packaged, it is necessary to transfer the product with a spatula to an is necessary to transfer the product with a spatula to an ointment jar of the correct size.ointment jar of the correct size.


Counting trayCounting tray is is a tray designed for counting pills a tray designed for counting pills from a stock bottle into a prescription vial.from a stock bottle into a prescription vial.

Safety cap Safety cap is a child-resistant cap.is a child-resistant cap. Auxiliary labelsAuxiliary labels are labels indicate specific warnings, are labels indicate specific warnings,

foods or medications to avoid, potential side effects, foods or medications to avoid, potential side effects, and other cautionary interactions.and other cautionary interactions.


Caution and warning labels Caution and warning labels on a prescription on a prescription container serve as reminders to patients about container serve as reminders to patients about drug handling or administration.drug handling or administration.

Computerized systems generate caution and Computerized systems generate caution and warning labels with the prescription label.warning labels with the prescription label.

Prescription-Filling ProcessPrescription-Filling ProcessStep 6: Review and Approve PrescriptionStep 6: Review and Approve Prescription

The pharmacist must be the one to review and The pharmacist must be the one to review and approve the prescription.approve the prescription. They verify the quality and integrity of the They verify the quality and integrity of the end end

product.product. Providing the pharmacist with all resources ensures Providing the pharmacist with all resources ensures

accurate verification for patient safety.accurate verification for patient safety.


Determine what information and resources are Determine what information and resources are important to the pharmacist.important to the pharmacist. Ask whether the information provided with the Ask whether the information provided with the

medication filled allows the pharmacist to medication filled allows the pharmacist to retrace retrace the technician’s steps in filling the prescription.the technician’s steps in filling the prescription.

The pharmacist determines the prescription is The pharmacist determines the prescription is valid, patient information is accurate, and valid, patient information is accurate, and medication is correctly prepared.medication is correctly prepared.

Prescription-Filling ProcessPrescription-Filling ProcessStep 7: Store Completed PrescriptionStep 7: Store Completed Prescription

Ensuring the integrity of medication is an important Ensuring the integrity of medication is an important part of medication safety.part of medication safety.

Many medications are Many medications are sensitive to light, humidity, or sensitive to light, humidity, or temperature.temperature. Failure to properly store medications may result in Failure to properly store medications may result in

loss of drug potency or effect.loss of drug potency or effect. Improper storage of a drug may result in a degraded Improper storage of a drug may result in a degraded

product that causes serious harm.product that causes serious harm. Well-organized and clearly labeled storage systems Well-organized and clearly labeled storage systems

help to keep a patient’s medications together and help to keep a patient’s medications together and separate from other patients.separate from other patients.

Step 8: Community vs. Hospital Pharmacy PracticeStep 8: Community vs. Hospital Pharmacy Practice

In the In the hospitahospitall setting, medications are reviewed by setting, medications are reviewed by nurses. They provide:nurses. They provide: Extra opportunity to prevent medication errors.Extra opportunity to prevent medication errors. An additional source of potential medication errors.An additional source of potential medication errors.

Notify the nurse that a newly prescribed medication Notify the nurse that a newly prescribed medication has been delivered to the floor.has been delivered to the floor.

In the In the communitycommunity setting medications are dispensed setting medications are dispensed directly to the patient and there are directly to the patient and there are NONO extra extra opportunityopportunity to catch errors. to catch errors.


Customer Pick-UpCustomer Pick-Up Locate the prescription which is filed Locate the prescription which is filed alphabeticallyalphabetically by by

the last name the last name of the patient.of the patient.

When a prescription is located for a family member, When a prescription is located for a family member, DO NOT DO NOT askask “Would you also like to pick up your “Would you also like to pick up your daughter’s prescription while you are here?”daughter’s prescription while you are here?”

Signature logsSignature logs

Customers sign a log to record the prescription was Customers sign a log to record the prescription was picked-up. picked-up. Serves as a proof to a third party payer.Serves as a proof to a third party payer. Common for third party payer to review the Common for third party payer to review the

signature log when signature log when conducting an audit conducting an audit at at pharmacies. pharmacies.

For schedule IIFor schedule II, and sometimes for Schedule III, IV and , and sometimes for Schedule III, IV and V, prescriptions, pharmacies may require that the V, prescriptions, pharmacies may require that the person person show a driver’s license. show a driver’s license. The driver license number may be recorded.The driver license number may be recorded.

Cash RegisterCash Register

Computerized cash registers Computerized cash registers automatically enter automatically enter products using bar code scanners.products using bar code scanners.

It is often the responsibility of the technician to ring up It is often the responsibility of the technician to ring up prescriptions and OTC products and accepting prescriptions and OTC products and accepting payments. payments.

When receiving cash payment, it is important to When receiving cash payment, it is important to count count the payment within the customer's line of sight the payment within the customer's line of sight and to and to confirm the amount orally to the customer. confirm the amount orally to the customer.

If If change is necessarychange is necessary, , the amount should be counted the amount should be counted out loud and placed into the customer’s hand. out loud and placed into the customer’s hand.

Other Duties - OTC ProductsOther Duties - OTC Products

The pharmacy technician should know The pharmacy technician should know The names and locations of the various OTC and The names and locations of the various OTC and

other products carried in the pharmacy. other products carried in the pharmacy.

The technician should The technician should NOTNOT recommend OTC recommend OTC products to pharmacy customers.products to pharmacy customers. For exampleFor example, many cough and cold preparations , many cough and cold preparations

contain ingredients that may increase blood contain ingredients that may increase blood pressure and worsen a diabetic condition. pressure and worsen a diabetic condition.

The technician should refer patients asking about The technician should refer patients asking about OTC products to the pharmacist.OTC products to the pharmacist.

Other DutiesOther Duties Ordering stock Ordering stock is done by transmitting the order to a is done by transmitting the order to a

drug wholesaler via a telephone line.drug wholesaler via a telephone line. ReceivingReceiving orders from the drug wholesaler. orders from the drug wholesaler. UnpackingUnpacking the order. the order. CheckingChecking all items on the invoice. all items on the invoice. InspectingInspecting for any damagefor any damage and expiration dates.and expiration dates. KeepingKeeping the pharmacy clean, neat and in proper the pharmacy clean, neat and in proper

working order. working order.

Retail ConceptsRetail Concepts Shelf stickers Shelf stickers

Stickers with bar codes that can be scanned for Stickers with bar codes that can be scanned for inventory identification.inventory identification.

Mark-upMark-up The difference between the retailer’s purchase The difference between the retailer’s purchase

price and their sale price.price and their sale price.

Unit price Unit price The price of a unit of medication, such as one The price of a unit of medication, such as one

ounce of a liquid cold remedy.ounce of a liquid cold remedy.

Disease State ManagementDisease State Management Disease state management Disease state management

Designed to provide one-on-one pharmacist/patient Designed to provide one-on-one pharmacist/patient consultation session targeted toward consultation session targeted toward management of a management of a chronic disease chronic disease or condition such as diabetes. or condition such as diabetes.

Pharmacists use a Pharmacists use a private office private office to do the counseling.to do the counseling.

Fees for these service Fees for these service Are either billed directly to the patient or to the patient’s Are either billed directly to the patient or to the patient’s

insurance.insurance.

The pharmacy tech may coordinate the billing, schedule The pharmacy tech may coordinate the billing, schedule appointments, and take patient information.appointments, and take patient information.

Terms to RememberTerms to Remember

1. Automated filling machines 1. Automated filling machines 2. Auxiliary labels 2. Auxiliary labels 3. Counting tray3. Counting tray4. Interpersonal skills4. Interpersonal skills5. Mark-up5. Mark-up6. Safety caps6. Safety caps7. Shelf-stickers7. Shelf-stickers8. Signature8. Signature9. Transaction windows9. Transaction windows10. Unit price10. Unit price

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Chapter 15 community pharmacy