Dispensing notes PDF

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first year pharmacy dispensing...

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Daniel Paul Dispensing & Patient Care

A. Prescription form 1. Be in ink 2. Signed by prescriber 3. Dated by prescriber 4. Contain following info: i. Address of prescriber (unless PCRS medical card prescriber) ii. Clear indications of prescriber’s name (illegible signature not sufficient) iii. Doctor / dentist / nurse – qualifications suffice – IMC no. for doctors iv. Patient’s name v. Patient’s address vi. Patient’s age / dob if under 12 yrs ***Pharmacist may dispense product where the prescription lacks only one of the above four, exercise due diligence & care – obtain info from patient / prescriber B. Pharmacy records a) Date of dispensing b) Date on prescription c) Name & quantity of product (form / strength) d) Name of prescriber e) Name & address of patient f) Repeat prescription – previously dispensed in another shop – name, address & ref. no. of shop C. Prescription check 1. Clinical problems  Patient correct?  IS the drug the most appropriate one for the patient? o Contra-indications – age, gender, disease, allergy, other therapies o Interactions o Therapeutic duplications – multiple products with same drug / class  Dose – too high/low  Dosage schedule appropriate – No. of doses per day, timing, relationship to mealtimes  Dosage form & route appropriate  Any evidence of or likelihood of drug abuse/ misuse 2. Check prescription is legally valid 3. Check for administrative problems – Product under desired health scheme? 4. Check for ethical/ professional problems  Inappropriate use  Confidentiality issues  Drug wastage  Contravene PSI code of conduct  Difficulty with waste disposal e.g. needles  Dependence to therapy

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D. Counselling points 1. Name & description of medicine 2. Dosage form, method & route of admin. 3. Duration of therapy 4. Therapeutic benefit expected from use 5. Special directions/ precautions/ admin. / use 6. Major side effects / adverse drug reactions / interactions / contra-indications 7. Self-monitoring techniques 8. Storage 9. Prescription repeat info 10. Action if dose missed 11. Disposal 12. Admin. Matter – reclaim payment etc. E. Question referring to “dispensing on foot of this prescription”  What you would dispense to patient at that time  Checklist: 1. Product name 2. Brand + manufacturer 3. Strength 4. Quantity dispensed (not quantity required possible excess) – total even if some owed 5. Number of occasions it would be dispensed (any owed/phasing) 6. Frequency/ interval of dispensing F. Preparing 100ml antibiotic suspension (general) – look up SPC for specific product to confirm** 1) Tap container of bench – dislodge dry powder 2) Measure 66 ml water in graduated cylinder – read bottom of meniscus at eye level 3) Add half water + shake well 4) Add second half + shake well again – no powder remains on base of container __________________________________________________________________________________

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Daniel Paul Health Care schemes

Medical card patients A. Primary care reimbursement service scheme (PCRS scheme)  €2.50 levy per item  Maximum of €25 per month per family unit  Payment made to pharmacy = cost price + dispensing fee   Prescriptions must be written of special duplicate forms o Copy is forwarded by pharmacy to the PCRS for reimbursement  Preparations must have PCRS code or else patients pay in full for the product  Ordinary forms = non-repeatable o 3- part forms available for 3 time repeats o Select GR scheme [7] on software  Only GPs with a PCRS contract may write PCRS prescriptions o Prescription for prescriber not participating in scheme must be rewritten by GP onto PCRS form o Except in exceptional circumstances B. Dental Treatment service scheme (DTSS)  Avoid need for medical card patients >16yrs to bring dental prescriptions to their GP  Dentist must be signed up with HSE for DTSS  Special DTSS forms  Same €2.50 levy as PCRS  Payment made to pharmacy = cost price + dispensing fee  Qicscript software o Enter patient when setting up as GMS – with regular GP as default o When processing prescription – change [7] to DE- Dental treatment o Also then change prescriber to dentist C. Emergency PCRS dispensing of hospital prescriptions  May dispense a hospital prescription for PCRS item  Levy €2.50 per item, same cap applies  Limited circumstances: o In-patient of an acute general public hospital or attended A&E o Impossible or very inconvenient to get script copied onto PCRS form o Emergency supply must be made on day of issue of hospital prescription o Hospital prescription must use generic name of drugs, name of prescriber + medical card no. of patient o Irrespective of quantity – no more than 7 days dispensed  Pharmacist submits claim form signed by patient, showing med. Card no., registered PCRS no. of GP and details of items provided & photocopy of script  Qicscript software o Enter patient with default GP preferably o Change prescriber for this prescription only to name of hospital o Change [7] to EM – Hospital Emergency scheme Page 3 of 8

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D. Phased dispensing  Reasons: o 889xx = request of the patient’s physician o 888xx = due to the inherent nature of the medicinal product – product stability / shelf life o 887xx = Patient is commencing new drug therapy with a view to establishing patient tolerance / acceptability before continuing on full treatment o 886xx = Exceptional circumstances – patient is incapable of safely & effectively managing his medication regimen  Last two digits (xx) = no. of extra dispensings after initial one o E.g. two lots = 01 / twelve lots = 11  Item should be PCRS coded as usual  Qicscript o Enter Rx as normal – total quantity to be dispensed over phased period, not instalment o Press Alt + P – changes owed medication automatically  No. of instalments  Reasons for phasing (5-digit code)  Whether admin is to be supervised  Day of administration – default any day, select’4’ to change day  Indicate whether assemble all instalments today – usually select ‘N’  Quantity dispensed today E. Non-dispensing  Item not dispensed for reasons stemming from pharmacist’s professional judgement  Code 79999 – written in PCRS code space  No quantity should be filled  Reason for not dispensing should be written on the form  Qicscript o Alt + N Drug Payment Scheme (DPS)     

Not entitled to medical card Prescribed drugs payment cap of €144 per month for themselves + dependents e.g. family Each month patient pays any one pharmacy for prescription up to €144 as they arise Every prescription, form generated – signed by recipient & retained by pharmacy Pharmacy must recoup additional cost from HSE-PCRS, if more than €144 is dispensed to a family unit any month

Health Amendment Act, 1996 Scheme (HAA scheme)      

Certain health services free of charge Patients – contracted hepatitis C directly/ indirectly from state’s negligence Eligible – card valid for life Free prescribed medication + medical appliances Pharmacy claims cost of items from HSE-PCRS Patient makes no payment + not restricted to a single pharmacy within any one month Page 4 of 8

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Does not cover other family member -solely eligible patient

Long-Term Illness (LTI) Scheme 

Chronic conditions:

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Patient applies to HSE – issued with LTI book o Patient registration no. o Pages for prescriptions to treat relevant condition Free at any pharmacy on presentation of LTI book Pharmacy claims payment by submitting an itemised, coded form, signed by patient to confirm dispensing – blue ‘universal claim form’ ATC system = Anatomical Therapeutic Chemical classification o Each drug 7-character code – letter/2-digit no./letter/letter/ 2-digit no.

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High Tech (HT) Medicinal Products Scheme       

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Covers limited no. of expensive high tech prep Preparation not permissible to dispense under any other scheme Patient nominate the pharmacy where they wish to obtain their supplies Pharmacy paid a monthly ‘patient care fee’ = €62.03 Prescription written on special form Pharmacy obtains drugs from wholesaler free of charge o Wholesaler is paid by HSE If patient has a medical card / HAA car / HT medicine is for LTI treatment, then patient pays nothing o Otherwise, pays maximum of €144 a month o Also covers all other (non-HT) mediation on private script for family unit Patient may not obtain medicine for pharmacy in a certain month o E.g. Last week in January – 6 week regimen – no dispensing required during Feb. o Pharmacy can claim a half-fee = €31.02  Claim date between commencement & est. completion  Supplies brief explanation why no HT product was supplied that month  Patient not deceased Page 5 of 8

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May not be claimed if haven’t dispensing product for more than 3 consecutive months Should notify local HSE liaison officer if patient’s HT therapy has ceased

Visitors to Ireland 

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Short term visitors – Another EU member state o Entitled to urgent PCRS-allowable medical treatment o Patient pays €2.50 levy o IF attend GP in GMS scheme – must be correct script form  Name / country of origin  EIHC written in medical card no. space o If item has no PCRS code – must pay in full for the item Short term visitors – outside of EU o Charged for any treatment provided o Reciprocal health agreement with Australia – assistance towards cost of medicines Long- term visitors to Ireland o Same bases as Irish residents o Eligibility for certain schemes

Hardship scheme   

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Also known as discretionary hardship arrangements or non-GMS essential items scheme Enable low income individuals to obtain expensive prescribed items which they cannot get through medical scheme National application form – HD1 o Approval to obtain items under hardship scheme o Section A – patient o Section B – Doctor (costs by pharmacist) If approval granted – supplied for €2.50 per item o Max. €25 per family unit per month Pharmacy paid remainder by HSE o Payment = reimbursement price + dispensing fee (sliding scale) + VAT Payment claim made by submitting standardised claim form (HD2) to local health office o Submitted on monthly basis o Deadline 3rd of each month ***Make sure to change default GMS to hardship scheme***

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Value-added tax (VAT)  

Non-oral medicines (and prescription fees) including injection & topical preparations – subject to VAT at 23% Also Pregnancy tests and mouthwashes

Tax refunds Medical expenses including the cost of prescribed medicines can be set against income tax. Claims for tax relief may be made annually, and the taxpayer may claim for his own expenses and expenses incurred by others (see below) for whom he has paid, if any. Tax relief can not be claimed for any expenses which have been or will be reimbursed (e.g. as part of an injury compensation claim). The claim is made on form MED1, obtainable from the local tax office. It may also be completed via the Revenue's online service. For dental expenses, the MED2 form is also required. Receipts need not be sent with the claim but should be available on request if the claim is selected for detailed examination, and patients commonly request retrospective printouts of receipts or statements of prescriptions dispensed during the past year. QicScript software 1. 2. 3. 4.

Reports Administration reports MED1 patient report Enter (part of) the patient's surname just as you would when entering a prescription, and select the patient from the menu. 5. Repeat for additional patients (typically additional members of the same family) if required: up to 10 in total. 6. If...