Pharmacy Technician Career Environments Retail Pharmacy Retail pharmacy, also know as community...
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Pharmacy Technician Career Environments Retail Pharmacy Retail pharmacy, also know as community based pharmacy or community pharmacy, is a very common environment in which pharmacy technicians are employed. These pharmacies provide prescription services and an outlet for the sales of commonly purchased good and services. Retail pharmacies consists of independent pharmacies and chain pharmacies. In general, the major benefit of retail pharmacies is accessibility. Often the patient will go to see the pharmacist at a retail store first before seeking medical attention for which they may have limited access to or no insurance to help cover the costs.
Pharmacy Technician Career Environments Retail Pharmacy Retail pharmacy, also know as community based pharmacy or community pharmacy, is a very common
Pharmacy Technician Career Environments Retail Pharmacy Retail
pharmacy, also know as community based pharmacy or community
pharmacy, is a very common environment in which pharmacy
technicians are employed. These pharmacies provide prescription
services and an outlet for the sales of commonly purchased good and
services. Retail pharmacies consists of independent pharmacies and
chain pharmacies. In general, the major benefit of retail
pharmacies is accessibility. Often the patient will go to see the
pharmacist at a retail store first before seeking medical attention
for which they may have limited access to or no insurance to help
cover the costs.
Slide 2
Independent Pharmacy Owned as a sole proprietorship by one or a
few owners. Provide prescription filling along with other ancillary
services (surgical supplies, vitamins, hallmark) Often provide
personal services Major benefit: familiarity of the pharmacists
with the customers Disadvantage: may not have the pricing power of
larger chain stores.
Slide 3
Chain Drug Stores National franchises like Walgreens, CVS, Rite
Aid, and Duane Reade (east coast) have many stores around the US
and/or in a regional area Offer convenience with many stores
operating 24/7 Major advantages: pricing power, convenience, and
accessibility. Disadvantages: lack of personalized service between
pharmacist and patient.
Slide 4
Retail Staff Supervising pharmacist: a full time pharmacist who
is in charge of the legal and administrative aspect of the pharmacy
Store Manager: a person, who may or may not be a pharmacist, that
is in charge of the operation of the store in general Typically the
store is divided into front end and back end. Front end deals with
OTC issues and other non medication issues a customer may have Back
end contains the pharmacy Stores the legend medications Stores
other restricted meds and higher priced devices Blood glucose
strips, blood pressure monitors, Plan B, and products that contain
pseudoephedrine. Combat Methamphetamine epidemic act of 2005
requires removal of pseudoephedrine products from the public area
and mandates record keeping with the per transaction limit of 3.6
grams per patient.
Slide 5
In addition to other areas of the pharmacy, HIPAA mandates that
pharmacies have a counseling area for a patient counseling. Area
can be a part of the pharmacy but must be relatively private.
Slide 6
Regulatory Agencies State Boards of Pharmacy regulates the
practice of pharmacy which in NYS are contained in the education
law of the board of regents article 137, the public health law
article 33 for controlled substances, and the NYSRR title 10 among
others. SBOP conducts inspections of pharmacy facilities. Centers
for Medicare and Medicaid Services: CMS regulates the federal
programs of Medicare and Medicaid along others. CMS conducts
inspections to ensure compliance with federal regulations. Third
Party Payers: Third party insurance companies also may conduct
inspects of pharmacy establishments to determine if contractual
agreements are kept between insurance payer and the pharmacy.
Slide 7
The Prescription The pharmacy technician is often the first
person to examine the patients prescription for completeness and
other issues. Due to this it is very important that a pharmacy
technicians understands the basic elements of the prescription to
save time and to ensure customer satisfaction. This is probably the
technicians primary function in the retail setting.
Slide 8
The Elements of the Prescription Patients name, address, and
age. Prescribers name, address and phone. Date it was written Name,
strength, and quantity of drug Directions for use Signature of the
prescriber. Route of administration Product selection permitted (if
brand or generic permitted)
Slide 9
Probably the most important element on the prescription is the
signature of the prescriber. Whether electronic or hard copy the
signature must be there for the prescription to be valid. In NYS,
according to article 137 of the education law 6802 electronic
prescriptions are allowed in NYS. An electronic prescription is a
prescription that is created and generated by the prescriber and
sent electronically (E prescribing). Prescriptions for controlled
substances are not permitted to be electronically generated.
Section 6810 states that in addition to the signature, the stamped
or imprint name of the prescriber must be on the prescription
Slide 10
In NYS, the pharmacist is permitted to clarify and enter data
on the prescription to include all information with the exception
of the signature. If a prescription is filled without the signature
the pharmacist will be guilty of professional misconduct under Part
29.7 of the board of regents. In addition, the date cant be added
on an Rx for a controlled substance If the patients information
and/or the prescribers information is readily retrievable in the
pharmacy computerized records, the physical presence of this
information on the prescription is not necessary (NYS) The face of
the prescription must be signed or initialed by the pharmacist with
the date filled; refills must be documented on the back with the
date filled along with the Pharmacists initials. Records of refills
may be stored electronically (NYS) Remember, CII cant be refilled.
CIII can be refilled 5 times or 6 months CIV and CV for 11 refills
or one year.
Slide 11
Prescription Elements Continued Other elements on the
prescription may include Prescribers license number and
registration number Prescribers DEA number (required to write a
controlled substance prescription) Prescribers NPI or national
providers identification number.
Slide 12
DEA Numbers Any entity handling controlled substances in the US
from prescribing, dispensing and manufacturing requires
registration with the DEA of the US Department of Justice. Consists
of two letters A or B followed by the first letter of the
prescribers last name following by a seven digit number. One way to
determine if a DEA is fraudulent is the calculate the sum of digits
1,3, and 5 and add it to twice the sum of 2,4,and 6. The result
will have a digit which should match the check digit of the DEA
number, the last digit
Slide 13
NPI numbers The NPI is a ten digit number that was created by
HIPAA act of 1996. The NPI is a unique identifier that is used by
CMS to identify healthcare providers for the purposes of
administrative issues and reimbursements. Often other third party
payers utilize this number to file claims and payments to
pharmacies. Often an adjudication is denied because of lack of
prescribers NPI. The NPI for various providers can be found at:
https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forwa
rd=static.npistart
Slide 14
Who can write prescriptions? MD NP DO DVM DPM Ophthalmologists
DDS PA Physicians assistants can in general write for prescriptions
so long as their primary supervising physician name, address, and
registration number is on the prescription. Often the PA will use
his/her physicians prescription blank so long as the PA signs the
Rx and stamps his/her name on it with his registration number.
Physician Assistants, as of 2007, can write for prescriptions for
CII and other scheduled drugs. In this case he/she would use his
own Rx blanks with their own DEA numbers.
Slide 15
NYS Official Prescription Program Public Health Law 21 requires
all prescriptions for controlled drugs and other legend drugs to be
issued on an official NYS prescription which contains all required
information on it with the NYS seal, and a serialized number on the
lower right hand corner. Issued in an attempt to discourage doctor
shopping and to monitor prescription drug usage patterns in the
state. When using electronic prescribing official Rx not
required.
Slide 16
Filing Prescriptions Most states require hard copy Rx to be
stored for a 5 year period. Further federal regulations require
that controlled substance Rxs be filed in such a way as to be
easily retrievable by law enforcement. Option 1: three separate
cabinets for CII, CIII-CV, and other legend Rxs. Option 2: two
drawer system: CII-CV with CIII-CV marked with a C in the lower
right corner in one drawer and all other prescription in second
drawer.
Slide 17
Prescription Transfers A refill may be transferred from one
pharmacy to another either in the same state or different states. A
pharmacist is to handle Rx transfers. Some states allow transfer of
all of patients Rx refills. In NY only one transfer at a time is
allowed.
Slide 18
Other Technician duties Handling Deliveries Inventory
management Record keeping Stock rotation and others Remember,
counseling is the pharmacists duties. One area where technician can
offer advise is in the use of medical devices like blood pressure
monitors, glucose testing equipment, etc.
Slide 19
Health System Pharmacy Pharmacy setting where patients reside
at the facility where the pharmacy is located Includes acute care
hospitals Long term care facilities-provides skilled nursing
services to patients in need of long term rehabilitative services
Hospices-facilities that provide end of life palliative care to
terminally ill patients. Nursing Homes-facilities that provide
skilled nursing care to elderly people who can no longer care for
themselves due to chronic illness Correctional
Facilities-prisons
Slide 20
Hospital Staff Includes pharmacists, nurses, physical
therapists, respiratory therapists, nutritionists, etc DO- doctor
of osteopathy is a medical doctor that can practice conventional
medicine and tends to use musculoskeletal manipulation to assist
the patient. MD- doctor of medicine who practices conventional
medicine. Physician Assistant- a licensed individual who is trained
to work with and under the supervision of a physician in the care
of patients. Nurse Practitioner- a licensed individual who has
rights similar to a physician assistant RN- a licensed individual
who is trained to provide and administer medical therapy (including
medications) to patients under the order of a DO or MD LPN- similar
to an RN, however, works under the supervision of an RN. Certified
Nursing Assistant- CNA works under the supervision of an RN;
however medication administration is not allowed
Slide 21
Regulatory Agencies in the Hospital Joint Commission on the
Accreditation of Healthcare Organizations Called Joint Commission
or JCAHO for short Provides accreditation to hospitals, Long term
care facilities and other organizations Site inspections conducted
every three years Passing of site inspections required for
accreditation Accreditation required for CMS funding by the
government
Slide 22
State Board of Pharmacy State board of pharmacy typically
monitors community pharmacies; but in the hospital setting monitors
the staff in the hospital and not the department as a whole.
Slide 23
State Health Departments State health departments directly
governs hospitals, including the pharmacy department. Directly
charters a hospital and grants its privilege to operate in the
state.
Slide 24
Medication Dispensing System Floor Stock Distribution. A system
where a complete compliment of medication inventory is keep at the
nursing station. System is prone to diversion and is not used
anymore in most hospitals, except in cases of ADC. Unit Dose
System: A system where a unit of medication is dispensed for a 24
hour period to a patient at any given time. System is more common
and discourages diversion. Prepacking works hand in hand with such
a system.
Slide 25
Medication Orders in the Hospital An order usually contains
patient name, DOB, and MRN. Date and hour the order is written.
Name of Drug, dose, frequency and if routine, STAT or PRN. Route
Name of the prescriber and the pager Can be a paper order sent to
the pharmacy or an order entered into a CPOE.
Slide 26
Pharmacy Technicians Duties in the Hospital Data collection
(information on drug turnover and usage) Survey and inspections
(nursing station inspection) Education (training new technicians)
Maintenance (restock of omnicell and pyxis, monitoring and
replacement of crash cart items) Dispensing/inventory management
(assist with preparation of drug products, and in some states
parenteral medications)
Slide 27
Prepackaging of medications An operation in which a medication
in bulk is processed into a smaller unit by the institution. Works
well with a unit dose system Normally in most states once a
medication is dispensed a pharmacy is prohibited from placing the
medication back into stock if the dispensed drug is returned. If a
drug is dispensed in a tamper resistant prepacked blister pack (in
case of tablets) then the medication is permitted to be put back
into stock. Thus prepacking is a very cost efficient process
Normally done by pharmacy technicians and checked by pharmacists.
Most states provide a guideline of a one year maximum expiration
date or 50% of the lapsed time to manufacturers expiration. This
dating has been shown to prevent unintentional loss of
potency.
Slide 28
A word about NDC numbers When manufacturers package their
medications federal law mandates a unique identifier known as a
national drug code (NDC) Has three parts: a five digit first part
which indicates its manufacturer, a second three digit part which
indicates the drug, its strength, and dosage form. Finally the
third number indicates its package size. Part of the barcode on the
container of the drug product.
Slide 29
Technology in the Pharmacy Counting Machines Uses an electronic
eye to detect or count tablets or capsules i.e. McKessons Baker
Universal 2010 and Kirby Lester KL15df
Slide 30
Drug Dispensing Robotics McKesson Baker Cells and Scriptpro 200
Larger institutions tend to have such robots Consists of a
mechanical arm that can pivot along a track to retrieve drugs from
preselected drug cassettes Very expensive and not commonplace
Slide 31
Automated Dispensing Machines Examples include Acudose ,
Omnicell, Pyxis Consists of medication storage area and a central
keyboard terminal Pharmacist profiles a medication for a patient
which is electronically transmitted to the ADM or ADC. Nurse
retrieves the medication at the required time and helps to decrease
TAT. ADC are very cost effective and helps to maintain inventory
and assists with billing by charging issues and crediting
returns
Slide 32
Bar Code Systems Provides for medication checks to increase
medication safety. Bedside Bar-coding act as a final check in the
medication verification process. RN scan the barcode on his/her ID
badge, then scans the patients wristband ID barcode and finally
scans the barcode of the medications packaging. The transaction is
recorded in the patients MAR. Ensures the five rights of medication
administration commonly used systems are Intellidot and Patient
Safe Solutions