Department of Pharmacy Policies & Procedures

Number: 5:01.3.1

Effective Date: July, 1999

Revisions: 10/08

Approval: October, 1999

Subject: PROCESSING AND DISPENSING OF OUTPATIENT PRESCRIPTIONS

  1. Policy

·  The UAMS Outpatient Pharmacy may, at the request of the patient, fill prescriptions written for clinic and hospital discharge patients and prescriptions for UAMS employees and their immediate family.

·  A patient is defined as one who has been seen by a UAMS physician either in the hospital or in one of the UAMS clinics. A person who is routinely a UAMS patient, but who is seen in a non-affiliated clinic is not considered a patient, even if a UAMS physician in the non-UAMS clinic saw them. A person may also be defined as a patient if they are a UAMS employee, student or a retiree from the UAMS system, or their immediate family. Immediate family is determined by using Internal Revenue Services guidelines for determining who and who is not a dependent.

·  A physician’s order is required for all medications and supplies dispensed directly to patients. This includes over-the-counter items.

  1. Procedures

    1. Prescription Intake

     

    1. All prescriptions must originate from a physician’s office or clinic and the patient must qualify as a patient as defined above.
    2. Prescriptions may be written on any readable paper stock but it is preferred that they be entered into the outpatient electronic medical record, printed and faxed  or electronically transmitted to the pharmacy. Medicaid patient prescriptions, if on paper stock, must be on tamper resistant paper.
    3. Prescriptions are received in the Outpatient Pharmacy by way of telephone, FAX, voice mail or by direct drop-off by the patient, or their representative. They may also be received by electronic transmission.
    4. Prescriptions for Schedule II orders may be faxed, but the medication will not be dispensed without the pharmacy first obtaining the original prescription.
    5. A pharmacist or pharmacy student reviews the prescription for the following:

    ·         The order must be signed by a physician or advanced practical nurse.

    ·         Faxed prescriptions may be signed by a nurse, just as an order received via telephone may be called in by anyone authorized by the physician to do so.

    ·         The order must include the patient name and pertinent demographic information, i.e. date of birth, medical record number, in order to identify the patient.

    ·         The order must be complete to include the name of medication, dosage, and directions. Specific numbers should be used for the quantity dispensed, particularly for ‘’prn’’ medications.

    ·         Orders for controlled substances must include the physician’s DEA number. Orders written by UAMS residents who do not have their own DEA number must include the resident’s four-digit, UAMS I.D. number and the DEA number of the hospital.

    1. The order is screened for appropriateness of drug, dose, frequency, route of administration, therapeutic duplications, drug-drug interactions, allergies, and formulary status.
    2. If an order is incomplete, illegible, unclear or questionable due to problems identified, a pharmacist or pharmacy student will contact the physician to clarify or change the order.
    3. Financial considerations are also taken into consideration to help determine the patient’s ability to obtain the medication.
    4. Delivery of the prescription is offered to UAMS employees.
    5. Time estimation for the completion of the order is given after it has been determined if the patient is going to wait at the pharmacy for the prescription to be filled.

    2. Prescription Processing

    • The prescription is placed in the input area where prescriptions are entered into the pharmacy computer system.
    • Prescription is screened again for inaccuracies or interactions and an urgency code is assigned.
    • The prescription is entered into the pharmacy system and the prescription is imaged using the flat bed scanner, at which point it transfers to the Pharmacy 2000 Automated Dispensing System.
    • Pharmacy technicians, pharmacy students or pharmacists fill and label the prescription at the filing station. The label contains all the required elements as set forth by the Arkansas State Board of Pharmacy. The orders are processed according to the urgency codes assigned and the orders are sent to the checking station.
    • Pharmacists check prescriptions using the Pharmacy 2000 system, according to urgency. The prescriptions are organized by family I.D. and are not checked until all the prescriptions for that family ID have been filled. When the prescription is checked, the patient’s last name and first initial are displayed on a board in the pharmacy waiting area indicating that the prescription is ready.
    • The checked prescriptions, along with the pertinent patient information, are placed in bags and taken to the front to be dispensed.
    • If the patient is present they are given the medication, counseled and directed to the pharmacy cashier.
    • The cashier completes the transaction and the patient’s name is removed from the display board in the waiting area.

     

    3. Non-Formulary Drugs

     

    • Drugs that are not on the UAMS hospital formulary are not stocked by the Outpatient Pharmacy.
    • Non-formulary drugs can be ordered at the request of an employee and will be filled when the order arrives.
    • If the entire amount of an employee’s prescription for a non-formulary drug cannot initially be filled, the pharmacy will dispense what it has available and fill the remainder when it arrives.  Delivery of the prescription will be offered.
    • Patients with prescriptions for non-formulary antibiotics and other medications that should be promptly started, will be referred to another pharmacy.