The Prescription Filling Process

Results of an Interview with a Pharmacist
Health care practitioners are frequently required to engage in interprofessional collaboration in order to provide optimal patient care (Poling, Wilson & Finke, 2016). Because the vast majority of inpatients will receive some type of pharmaceutical as part of their health care regimen, collaboration between tertiary care pharmacists and nurses as well as other health care providers is an ongoing need (Angel & Friedman, 2016; NLN releases a vision for interprofessional collaboration, 2016). This paper presents the results of a face-to-face interview with a pharmacist employed in a major medical center operated by the U.S. Department of Veterans Affairs (VA), including a description of the process of filing a prescription, some of the more common reasons that pharmacists call providers to clarify orders, the information contained on a proper prescription, and some of the more common omissions that pharmacists experience when they receive prescriptions. Finally, a description of common medication errors pharmacists encounter and a discussion concerning the prior authorization (par) process and common par medications are followed by a summary of the research and a reflection concerning how this information will help prescription writing in the conclusion.
The process of filling a prescription
A prescription is transmitted to the pharmacy either as a hand-written hard-copy order or electronically. Upon receipt, the information on the prescription is entered into the pharmacy’s database and checked for contraindications with other prescribed medications and known patient allergies, the drug is dispensed or formulated from the pharmacy’s stores, transferred to an appropriate container and labeled. Finally, the patient’s identification is verified and the drug is dispensed.
Common reasons pharmacists call providers to clarify orders
Despite the increased use of electronic medical record systems that allow the filing of prescriptions digitally, pharmacists still receive large number of hand-written prescriptions. In the case of the former, pharmacists typically call providers in order to clarify orders only in those instances where the prescribed pharmaceutical is contraindicated for the patient for various reasons, including other prescribed medications or allergies. In the case of the latter, harried physicians and advanced practice nurses may omit some important piece of information (see frequent omissions below) or their writing is illegible to the point where the pharmacist must clarify the prescription.
What is on a proper prescription?
In general, prescriptions should include the name, address and telephone number of the issuing provider, the provider’s Drug Enforcement Agency (DEA) number and signature, the patient’s name and date of birth, the date, and description of the prescribed drug and its dosage as well as the frequency and path of administration.
Common omissions on prescriptions they receive.
Many of the omissions on prescriptions pharmacists receive involve the so-called “Five Rs” (i.e., the right patient, the right drug, the right dose, the right route, and the right time), but other common omissions include the providers’ signatures and the date of issuance.
Medication errors pharmacists encounter
With thousands of drugs in a typical pharmacy’s formulary, there is always a significant potential for adverse interactions between contraindicated drugs. In addition, dosage abbreviations are frequently expressed incorrectly (or illegibly) and decimals points may be misplaced. Likewise, pharmacists routine encounter instances where an incorrect but similarly sounding drug names are used on prescriptions, necessitating clarification with the health care provider.
The prior authorization (par) process and common par medications
The VA recently implemented a prior authorization process for several drugs on the VA National Formulary (VANF), including benzocaine, lidocaine, and various preparations of insulin, among dozens of others (VHA Directive 1108.08, 2016). The use of a prior authorization process confers a number of benefits for VA pharmacists, providers and patients alike. For instance, according to the Academy of Managed Care Pharmacy, the prior authorization “gives the prescriber the opportunity to justify the therapeutic basis for the prescribed medication. Guidelines and administrative policies for prior authorization are developed by pharmacists and other qualified health professionals” (Prior authorization, 2012, p. 1).
Conclusion
The results of the face-to-face interview with a VA pharmacist and supplementary research confirmed that the prescription writing and filling process is fraught with opportunities of errors of all sorts, including the omission of vital information or the inaccurate expression of dosages or frequencies of administration. Although the responsibility for ensuring that a prescription contains all of the information needed by a pharmacy to process the order appropriately begins with the health care provider, pharmacists play an important role in ensuring that dispensed drugs are not contraindicated for patients due to allergies or other medications and that the understand the requirements of their unique prior authorization system in order to take advantage of the cost savings and other benefits this process provides.



References
Angel, V. M. & Friedman, M. H. (2016, July 1). Integrating bar-code medication administration competencies in the curriculum: Implications for nursing education and interprofessional collaboration. Nursing Education Perspectives, 37(4), 239-243.
NLN releases a vision for interprofessional collaboration in education and practice. (2106, January-February). Nursing Education Perspectives, 37(1), 58.
Poling, D. B., Wilson, M. & Finke, L. K. (2016, November 1). Interprofessional research guidelines for health care students. Nursing Education Perspectives, 37(6), 345-349.
Prior authorization. (2016, April). Academy of Managed Care Pharmacy. Retrieved from http://www.amcp.org/prior_authorization/.
VHA Directive 1108.08. (2016). U.S. Department of Veterans Affairs. Retrieved from file:///C:/Users/hp/Downloads/1108_08_D_2016-11-02%20(1).pdf.