This is Part II in a 2-part series on Verifying Prescriptions.
As it was mentioned in Part I, nothing is more critical to patient safety, and the success of medication therapy than an accurately verified prescription. However, in my opinion, too little time is spent teaching the next generation of pharmacists this vital skill. As such, I am sharing my personal approach to the verification step in prescription fulfillment.
There are 6 steps I go through for each patient. We discussed steps 1-3 in the previous article. Now I would like to discuss steps 4-6.
4. Compare. It is now time to hold the prescription in your hand, and compare it to what was written by the prescriber, and what we can know about the patient through the computer profile. You will sometimes be reading an electronic prescription, sometimes a handwritten prescription, sometimes a printed or faxed prescription, and sometimes a phoned-in prescription. The information will not always be easily found. Your eyes will have to jump around and scan the document. But 1 by 1, every piece of information on the written prescription must be accurately replicated on the filled prescription. This includes the correct patient, drug, directions, prescribing physician, refills and much more.
This is also the point at which you can determine if the prescription is reasonable, given what you now know about the patient’s gender, allergies, comorbidities, and age. You are asking yourself: “Is this the right medication, and right dose for THIS specific patient, based upon what I know.” As pharmacists verifying a prescription, we often do not know the ICD-10 code for the condition, but we can make reasonable assumptions based on their profile and draw conclusions.
5. Drug & Therapy Interactions. Having confirmed that the prescription was accurately interpreted by the inputting technician, it is now time to consider any relevant drug or therapy interactions or duplications. Your software will probably help you a little with this, but don’t depend on it!
You must think about the clinically significant interactions or duplications that might be going on. Some may be significant enough to merit a phone call. Others might just require a consultation with the patient. At times, you may have to review previously filled prescriptions and notes written by a pharmacist on a previous fill. Was an unusually high dose dispensed before? Was a call already made, and documented? Look over the profile.
You must also take into consideration any warnings or information transmitted back to the pharmacy by the insurance plan. How, exactly, do you handle the many dozens of potential interactions and duplication warnings that you get when verifying a prescription? This is maybe the hardest thing to teach because every pharmacist is a bit different. The bottom line is this: you are making a professional judgment, and you will have to be accountable for it. If you believe it merits a call to the prescriber, then call. Is it something to talk to the patient about? Then do so. And document all your actions.
Your decision to fill the prescription will also be based on what you can know about the patient from their profile. Review previously filled medications, and determine if the current prescription makes sense based on their history.
6. Right drug and right billing. Finally, we have to check to make sure that the actual drug in the vial is the one prescribed. The label may be perfect, and the directions superb, but it could be the wrong tablets or capsules inside. Most computer systems today allow the pharmacist to see an actual image of the medication to compare to what is in the bottle. In fast-paced pharmacies where stock bottles may not get returned to the shelf immediately, the potential for this error is significant. I recently read a report of a patient who was supposed to get Gabapentin 600mg, but the pharmacy accidentally put Gemfibrozil 600mg in the bottle.
Also, I also take a quick peek at the billing. Is the copay reasonable? Was an insurance billed at all? If anything looks abnormal, it may prompt the need for a call to the patient to prepare them for steps they may need to take.
To err is human. But when it comes to dispensing prescriptions we must do all we can to minimize and eliminate mistakes that could harm our patients.