PROCESSING PRESCRIPTIONS

RECEIVING PRESCRIPTIONS Indelible written Date Within 3 months for funding, 6 months valid Patient First initial and surname, residential address DOB if under 13 years Patient code (correct) and NHI number Doctor Name and address Registration number Personally signed Medicine Special authority, CHEM, exemption authorities On stock or available Dispensing Duration Delivery or pick up stamp Date and dispensed by and checked by DISPENSING PRESCRIPTIONS Patient Check name or NHI number If new : new patient Family members should be grouped together For fax/tel Flag prescription Doctor Check name or registration number If new: new doctor Medicine Check history, possibly copy it Hold scripts ? Repeats (not to be given in last 20d) ? Check medicine, name and strength and correct amount STAT/ Non-STAT/ repeats / CC/ certified or access exemption - check treatment period Directions (external freq./how internal freq./dose) C&A Labels and expiry date + addit. coloured labels Pharmac : restrictions , additional charges, specialists recommendation Interactions changes to previous medication Substitution yes or no Hold items Already hold scripts (filed in box) or new on hold (file) copy original, stamp with certified true photocopy, later be dispensed from copy Repeats Outstanding repeats? No. of repeats ? interval? Medication Dispense in appropriate containers (CRP),label them Scripts Label with prescription number+date, quantity, per item Sign at dispensed by Annotations if necessary: dispensed amount, owings, holds, calculation, add CHEM Checked by pharmacist / including the receipt GIVING OUT PRESCRIPTIONS Checked by pharmacist+ annotate if new med./changes Patient Right patient ? (name, address, NHI number) Advice, new medicine/dose changes, receipt Record the sale

CODES on prescriptions A = Adult $3 PHO/DHB registered A1= 3$ with C.S.C card A3= 15$ no C.S.C card, Dentist are nearly always A3 or private hospitals (e.g. Southern Cross) A4= 3$ prescriber from the PHO, the person is registered with J = under 16years $3 PHO/DHB registered Y = under 6years no charge O= oral contraceptive, max 3$ 1 = CSS Community services card, depends on your income (#) 3 = others Z = HUHC High (Health) user card, submitted by a GP (12visits in 12months) Z1=Z3=ZJ3= Normally $3, after 20items $2 SuperGoldCard includes community service card and discounts, for over 65years When the prescription is not coded, check if patient is eligible for funded medicine (NZ passport) prescriber is approved for $3 payments X= PSC Prescriptions/Pharmaceutical subsidy card for a family unit (parents+children under 18 y???) no further charges after 20items and until the following 31.01 X1=no X4=no X2=2$ X3Z=2$

CSS # reduces costs for after hours doctor visits, to another doctor, emergency dental care, public hospitals. Prescription fees (provider without a Ministry,DHB,PHO contract, private specialist) PHO primary health care organisation DHB district health board

F270 Form= doctors green form or MPSO H572 Form=for all controlled drug prescriptions, except Methadone Summary: Most scripts are A4, even dentist in a state hospital Private hospitals, specialists, optometrits, dentists are A3 CSC card is A1 and reduces fee for A3 scripts Z is High User card and reduces fee for A3 scripts as well

Dispensing fee is 8 $, 1$ for box Unsubsidised medicine under 30$ 50%, 30-100$ 30%, 100-200$ 25% Over 200$ 15% + dispensing fee 5$ or 8$ for mixtures

PRESCRIPTIONS PROCESSES
Copying directions CTRL+c and insert it with CTRL+v TELEPHONE Dial 9 for calling outside Press:hold key, mobile (left side, hold is shown), key beneath is for loudspeakers -Look up customer under the street address Always read the NOTES: institution, weekly Often ordering repeats: after 20 days or 2/3 of the time // expired repeats are grey, can be bought NS - check if blister packed charge for medico pack !!! Earlier possible for inhalers,

- Borrows mostly from BHBC and ask for a replacement, write it in the book under Check desk - NHI and CHEM number can be looked up (middle Computer), our number 6301 Star before the medicine means new medicine, check always history for previous brands as well.... CHECK AND READ THE NOTES, institution, weekly, medico packs Star stamp means new patient Flag faxes/telephones scripts after Patient Code (F4 ), print fax barcode: stay on main site, F10 f for fax F8 for FaxRX label Fax fee: next item, then instead of patient code NS doctor bar medicine fax when a special authority is required it will show : F10 other (there you can type in the CHEM number) If spezial authority is expired, we can do like an owing and give an 72h emergency supply (all given in under the doctor....) BUT put through without a made-up special authority number of course the customer can not pay it -- therefore we leave that open to pay. When special authority is come through, we can change the owing and give in the right number (under F10 and Special Authority) - put the script into the tray, so that it can be followed up Only for regular customers Annotations When another brand is given as written on the prescription

When strength is changed because then it can be given immediately When everything is given stat and doctor has written in repeats without signing When repeats are given, annotate the amount 2+2repeats When drops, liquids, inhalers or pens are given, annotate the amount Always look if the correct amounts are on the script ! When parents request other dosage form, e.g. instead liquid tablets, has to be annotated When something seems to be wrong, but doctor confirms it verbally CAVE e.g. Temazepam 40 tabl is written once daily 30 + 10 repeat, since non-stat Budesonide spray, when doctor keeps it vage dispense like script, but non-stat IMPORTANT Never more than for 90days STAT, e.g. ampoules every 2months, mitte 3 vials 2=max annotate on script !! Never more than for 30days NON-STAT Controlled drug group B max.supply for 10days except Methylphenidate,De... (30days) Dose and age if under 12 has to be written on script when there is not enough from the medicine (stock is in red beside the quantity) an owing window will open: write the owed amount annotate on the script given ......../ owe....... sign beside given for dispensing and later on it is filed in the owing box. In the history owings and repeats and holds are seen. A repeat can be dispensed after 20days: either repeat F5 or repeat all, then all repeats are printed. (2/3 of the time ) It can be dispensed a little bit earlier, when it is in line with every three months. NS repeat 180days Medicine repeat 90days CD repeat 30days (repeat after 7days possible) Oral contr.repeat 120days Normally 2 repeats, except creams (could be more,e.g. 3 repeats) F9 there you can vary the repeats and the dispensed amounts = e.g. for reconstituted antibiotics 160+68 due to stability e.g. zyban, first 3 days 1t, then 2t , so the other 2 repeats have to be varied Some drug are allowed to be dispensed at once, even when repeats are written. Exemption Doctor signs after repeat or annotate cc When printing out repeats, then sign on the left side of them A repeat can be given earlier when someone is traveling, then print out F10 Access excemption, write down the reason and use special stamp. Even 2 repeats can be given all at once in case of travelling, for controlled drugs as well Repeats should be inactivated when directions have changed or medication or to keep it in line Click on the 1.repeat F2 F2 Edit, then F10 V inactivate, F12 accept, then F4 no label, end edit. Repeats can also be deleted, F2 F2 Edit, then F10 delete repeat Expired repeats can be bought NS, Doctor Bar and paid full

Holds are made, when 1.there is an another repeat from a previous script open or 2.the patient want to redeem only part of the prescription. 1. edit the medicine and mark it on hold (H annotate), then dispense the repeat (hold script is shown on the label) CAVE if dose has changed, then repeat has to be inactivated , edit the other medicines on the script. Make a photocopy of the script (certified true photocopy ) and file it in the on hold box. 2. Edit the medicine he doesnt want to redeem and mark it on hold (H annotate), edit the other medicines. Make a photocopy of the script (certified true copy) and file it in the on hold box. DISPENSE FROM THE COPY ????? FIRST FROM THE ORIGINAL Redeeming the holds: with F9 make sure the cursor is on the right date. Scripts on hold never put a fax fee on them Certified true photocopy is different to certified true copy (PharmacyProceduresManual p.14) copy it+stamp it+pharmacist has to sign it Case: inhaler were on hold and new prescription was faxed through, delete the old one and dispense the new one ( after asking a pharmacist) If be mistake, an item was forgotten to put it on hold, it can be F2 F2 and F10 Hold and then it is put on hold instead of be dispensed A script can always be changed: Something with F2 edit.... until it is red.......then F2 again and then change print an additional label for in-and outside (not for vaginal creams.....) F8 Print label label aceept- F8 label then it is grey, with cursor up- and down select other medicines print ??? accept. Multi labels are for several packages, normally they are in the system, when the drug is given in F6 Multi label F7 Show hidden will give you the older brands F5 Flip medicine, when brand name is given in, generic name will be shown or otherwis CHILDREN calculate the right dose according to the weight CD scripts for A and B drugs Not older than 7 days, signed, directions handwritten, age if under 12 Supply for 10 days and not more than for 1 month Annotate the amount Write the script number on the right side, manually Always write the dispensed amount per repeat and put on the label CD scripts with repeats are filed in the owing box. Finished scripts have to be filled under the first dispensing (pull of the white sheet...) First dispensing can be done as 1 and 1 repeat, if there is not enough stock on hand. ( not for Methylphenidate, Dexamphetamine) CD from hospital: patient and address should be handwritten Hospitals are not allowed to write methadone scripts (must be on CD form) No telephone script possible, but it may be allowed to give out by a doctor Excemtion C drug: buprenoprphin, does require CD form and stored in safe, but 90days

and not to be entered in register Methylphenidate: chem number and recommended paediatrist has to be added Miss is a female child Ms is a not married woman Mrs is a married woman Mast should be written as Master J smith or smith,j : name or address ,,49 + street search for street only, could be 149 249 1/49 ,r,street looks for first names with r in the street m,r,street looks for last n. with m, first n with r in the street do not get confused with names, e.g. sua was a last name, do not use the wrong patient: always check NHI or street.......NHI numbers can be look up on the internet, date of birth can be checked etc. New patient name, street, suburb, chch, NHI numer (family ???) Address can be looked up, F7 address look up New doctor name, medical center name and address Doctors can be looked up on the internet, give in registration numer, then F10 Internet.......then F3 new In the end add where he works, e.g. Christchurch Hospital If one doctor is in the Computer with several adressses, check if he has changed work look the (Praxis) up on the yellow pages. Fix if wron doctor, go to one medicine F2 F2 then fix doctor: give in the right doctor, press fix doctor and it will be asked fort he whole day labels and receipt will be printed out automatically Fix RX code goes the same way Excemption CARDS for customers If amount is achieved, then press L and give in the number from the card. Cards from other pharmacy can be given in, edit patient ....give in number and click extermal KEEP IN MIND CSC and OTHER INSURANCE CARDS can be given in as well. Emergency supply possible, e.g over the weekend or if doctor not available depends on the pharmacist only for 72 hours not for controlled drugs, no matter which class has to be paid full (NS, doctor emergency supply) details recorded, best when it is a regular customer otherwise he should have been to the doctor the last 3 months regarding this medication - ONLY for NZ citizen, not any tourists even when they are doctors Practitioner supply orders: Patient name of the doctor Code PS then in green MPSO will be shown Doctor doctor Print on the labels Batch No........ Expiry Date......... NS scripts for non-residents

Price mark-up look in book + 5 $ dispensing fee, edit the price ADVICES Take Do not swallow Spread thinly Put two drops into Place a patch Inhale TWO puffs TWICE a day Swallow whole Dissolve under the tongue (sublingual tabl) Chew

SEARCHING FOR SCRIPTS Is it a fax ? May be filed under the date, even hold or owings Script can filed under the first name and not the surname Script can be in the weekly or medico esternal folder Script can be in the to do tray or on the bench Script can one of chris patients or of the resthomes Script can be in the folder to be undone

IMPORTANT ABBREVIATIONS
NCL = doctors want no C&A Labels INHALERS label in- and outside (wing labels cut beneath Repeat for sprays, otherwise pharmacy adress on the metal container) Seretide and Duolin not labelled inside Often 120 doses (4 doses for 1month) or 200 doses (6 doses for 1month) Controller: /k Shw rins reg Shake gently before use (not a turbohaler) shake well Rinse your mouth well after each use regularly for the prevention of asthma /k 1p bd reg. rins shw and 2p bd reg. rm ster or rm, rins Relievers: prn rel qrs Rinse mouth out after use when required for the relief of asthma every 4 hours

/k then 2p every 4 to 6 hours prn rel. Swa 2p qqh prn rel.

12p 1dose sob whc

inhale one ort wo puffs give one dose shortness of breath to relieve wheeze or cough

max 6 packs for 90days script: flixotide 2p + repeat= 4p , max 1p a months so that is 1+1+1 Nasal sprays: Flixonase /k d90 discard after 90 days (add. label 7 Do not use.....after) ns nasal spray: use regularly for best effect 12s use one or two sprays 2pn use two sprays in each nostril ien in each nostril /k and 1s ien bd asd ns ...d90 Spiriva Itc 1 c per day using Handihaler device

Turbohaler tw Twist to load dose. Use two doses... Swa Swai Swbu Swg Swt shake well and shake well and inhale shake well before use shake well and give shake well and take

inhaler bronchodilator prn up to 1200doses will be paid per 3months (6=2+2+2 etc) more than 1200doses annotated by prescriber steroid inhaler fixed scheme TABLETS/CAPSULES Packed either in skillets (box) or vials (brown) or tablet bottles wadded (white) 1t / 1c t h to 1t tqt mane nocte hs d pm 1t bd(bid) tds(tid) qds(qid) od om ean take one tablet or take one capsule take a half to one tablet tabl

at bedtime in the evening take one tablet twice a day three times a day four times a day once daily each morning each night

eam bt 23d 2tst

each morning bedtime two to three times daily take two tablets at once, then

1TMN 1t alt die 1H 12C 1HT 12D q2h q4h/qqs q6h q8h 68h uf. / f ab. ab ah ai ad asd mdu mds stat 2tst A1D abm abn /b cc ccw ac pc pd pdi pdf fev /a w /ae soc1 /e gw fol disp

take one tablet each morning and one tablet at night take one tablet on alternate days/ every other day (levothyroxine, no1/2t) one and a half take one or two capsules take one and a half tablets once or twice daily

every....hours every six to eight hours until finished. Antibiotic !! (antibiotic) antihistamine anti-inflammatory as directed as directed by Doctor as directed as directed by docotor at once take two tablets at once, then as a single dose best taken in the morning (cortison,levothyroxin) best taken at night (statins) with food with food with food and a glass of water (Diclofenac, for als NSAIDS)

for pain relief for pain and inflammation for pain or fever for pain and fever relief swallow whole, do not crush or chew (enteric coated, prolonged release) swallowed whole swallow whole with a glass of water suck or chew 1 tabl with a glass of water take with a glass of water follow each dose with a large glass of water (lact) may be dispersed in water and taken as a liquid

l4h cod

leave at least 4 hours between doses (Codeine) may cause constipation

sos for sleep when necessary for sleep prn when required ab ah ai antibiotic anthistamine anti-inflammatory

pt po pv pr sl aa ex aq 1sach 1sl max8 max4 4max

for the cough orally in the vagina in the rectum under the tongue of each in water Dissolve the contents of one sachet in a glass of water.... Dissolve one tablet under the tongue take give take

oral contraceptive watch for O and then normally code O4 or otherwise avoid broken packs unless it is absolutely vital !! STAT 6mths, even when written 3mths and 1repeat, except signature of Dr. or cc Rounding from 90 tablets to 84 tablets, since they are calendarpacks. Clozapine : special rules Only writte by a psychiatrist (usually Hereford center), can also prescribe other psych meds and comedication like laxsol No telephone scripts allowed (as for CD as well) Accupril label8 for doses over and 25mg, wasnt it HCT ??? Omeprazole put one desiccant in bottle Pradaxa dont open the bottle Lithium CAVE tablets and bottles Olanzapin CAVE tablets and orodispersible tablets MTX 1t at the same time of the week. Drink at least 8 glasses of water a day on taking the medication ( 8 for light).Wash hands after taking the drug. Laxsol write for constipation Omeprazole almost never LOSEC !!! Paracetamol max8 tabl max4 susp. 240 tabl SIZE8 140 tabl SIZE6 similar for ibuprofen levothyroxine not to be cut, take 1t at alternative days ????

levothyroxine: 3 on week days,2 on weekends:19tabl per week, 3months are 13weeks levothyroxine 2 alt 3t OD, for 3months 2x90=180 and 1x445=45 max 225 tabl Flucloxacillin 1c on an empty stomach (one hour before food ort wo hours after food) qid uf. (ab) label 4 es=empty stomach Diphenoxlat after each loose bowel movement Etidronate 1t bd for 14 days in a 90day cycle mitte 42 (maximum ist 28) Nrtloz 12loz 12gum slowly dissove ONE lozenge in the mouth when you feel the urge to smoke. Do not swallow lozenge whole. Do not take more than 12 lozenges in any 24hour period. maximum of 12 in any 24hour period (336 for 28d, -4x12 out of pack)

nrtgum Nrt Apply ONE patch daily.(remove patch before going to bed,) Rotate application site to avoid irritation. Do not aplly to breasts. War Alc Ang Asp Amoc Aug Bucc Cafe Cafe2 Cafer Champ Colch Dulc Elec Fosa Gees Imig Imodiu Lat Maxalt Mini Niva Paludr Para Paramax Riza Roxi150 Ural nicotine often 2 providers either quitline or quitcard provider

take tablets according tp blood test (INR) results as directed by your doctor. For example 1t n and war for metronidazole Place one tablet under the tongue and allow to dissolve

Place one tablet high along top gum and allow to dissolve. all for cafergot

use no more than 2 injections in 24 hours take two capsules four times dialy.... Hysite take 1t daily, at the same time each day take 2t weekly. Take on the same day each weak, begin....Malaria Paracetamol

Noriday directions 2t for 10 days each cycle, prescribed 60, give 56 (do not cut off) Progynova 90tabl, give 90 tabl Nb next bloods due by....

green sticker label for each antibiotic: This preparation is an antibiotic. The entire course should be completed and always until finished.

Codein dose max 300mg cod=constipation sig (never more than 150 for 60mg) 12t qd (prn) l4h sd Paracetamol dose max 4000mg (per month max 240tablets) 2t q68h or qd prn max8 sd Ibuprofen dose max 1200mg 2t td prn ccw sd Tramadol sd Boxes can be adhered to each other, except CD !!! or more than 2 or 3 ??? Then multilabel You may take an extra dose prn asd Erythromycine and buscopan are both prokinetics CREAMS Frontline: FOR EXTERNAL USE (ext) and coloured label NOT TO BE TAKEN (ntbt) repeats for dermatologist scripts give in 99 repeats for 99 days this gives you an indefinite amount of repeats for the next 99 days Packed in ointment pots additional label CAUTION NOT TO BE TAKEN inside of vaginal creams are not labelled ap apply

Cortison: Aaa d for 1 week asd (frontline ext) apply thinly to the affected area(s) daily for one week as directed by doctor. (external use only) always write how often, when nothing is written on script aaa up to tds or asd. Base non ionic cream: Ap aa frequently as a moisturiser asd (frontline ext) apply to the affected area(s) freq.... aaa aa apt moso Uss Ussm

use freely as a moisturiser and/or soap substitute use as a soap substitute use as a soap substitute and moisturiser

Lemmy fatty is now fatty health cream Clotrimazole/Miconazole :cur continue to treat for 14days after apparent cure. Amphotericin B lozenges: cure2 continue to treat for 48hours after apparent cure. A-scab: Bact Bat Apply lotion thoroughly to the whole body except for the head and face. Leave on for 8 to 14 hours. apply to the infected wounds as directed. for Batrafen, is an additional sundry label that has to be printed !!

New Apo-Batrafen: ap od to the affected nails...... Dakt Derbac Diffl Lyc Mal Quell Sebexol is now A-lices, for head lices Difflam gargle Apply to the whole body from neck down.... Apply to the whole body from neck down..... (for adult scabies) apply to entire skin surface and leave on for 24hours... use as a shampoo as directed. Please note: repeats are not free.

Example: Collapsible Tube (if defined as OP in the Pharmaceutical S chedule): Locoid Lipo cream Apply bd 15g. Even though the prescription only calls for 15g, the pharmacist can claim 1OP or 30g. If the Locoid prescription had called for 50g, the pharmacist can claim 2OP or 60g.

EYE DROPS Discard after 30 days (the same with EAR drops) // shake well (cortison) 5ml last 30days with 2 drops ear1 into each ear ear1l iaea affected ears ioint oc is an ointment, usually applied at night eye1r eye1l eye1b eye1a iae affected eyes iee in each eye i1 instil 1 drop i12 iae qid prn Exp d30 /l r l B Ire Ead Lat DO NOT USE AFTER Instil 1 drop into the operated eye qid for 1 week . discard 30 days after opening (add. label 7 Do not use....after) ***Discard after 30 days*** right left both into the right eye each day (Hysite) store unopened bottles in fridge 2.5ml are 80 drops (otherwise 1ml 12 drops)

Often cortison eye drops shake well before use Fridge Dripper Tipp press the tear duct 5 minutes between different drops 2drops in the eye is unusual, ask pharmacist if this is too much check history

Eye drops, per month 1 container at least 12d=1ml 60d=5ml LIQUIDS Children mcd = may cause drowsiness Paracetamol 250mg/5ml 5ml for 17kg

Packed in mission bottles (often with CRP child resistant package/ safety cap) for suspension SHAKE THE BOTTLE /j stb fpf d14 10mlST ***Shake the bottle*** shake the bottle for pain and fever discard after 14 days take ten ml at once, then

stb and g Linfen 5ml (5ml) tds uf. (antibiotic for infection) d14 stb and g Linfen 5ml (5ml) q4h prn fpf max 4. (paracetamol) TWO AND A HALF ML (2.5ml) s5 shake well and give 5mls s10 shake well and give 10mls swg shake well and give Paracetamol more than 17kg 5ml 250mg is okay (SUNDRY LABEL par...) antibiotics amount can be adjusted, e.g. 105ml is rounded to 100ml, because 1Op is 100ml, if antibiotic is not reconstituted, give extra bottle with marks for how much water to add. write instructions on label (bottle provided) and directions expiry dates: curam 7days ospamox 14days(no fridge) lactulose (CAVE when it is written 10ml per day, give not 1500ml (max 900) 20ml bd. fol Take 20ml (twenty ml) twice daily follow each dose with a large glass of water 1015ml 10mlst 1TSP 2.5ml dra sh gle max4 myc Nit Nit2 Elec Fleet Amos take ten to fifteen ml take ten ml at once, then... take one teaspoonful (5ml) take 2.5ml (TWO and a HALF ml) discard any remainder after... shake well do not swallow, spit out take no mare than FOUR doses in any 24hour period measure 1ml using the dropper, then swirl around the mouth before swall. spray one puff (glytrin) spray two puffs 5ml td

MIXTURES or OTHER PREPARATIONS Creams and ointments expiry date 3 months (Externol use only ) Except something like cetrimide, which works as a preservative Internal preparations without a preservative 7days Internal preparations with a preservative 14days External preparations diluted from a pre formulated product 14days External preparations extemporaneously compounded 1month (with a preserv.) Suspensions always Stb ??? SHAKE THE BOTTLE Go to Mixture, then already saved mixtures can be seen New mixture name it (%), cream or ointment, g or ml Give in each ingredients, tap water is often a hidden mixture !

SOLID DOSAGE FORMS mucilaginous laxatives teaspoon= 7g , teaspoonsful (!) dessertspoon= 14g tablespoon= 28g take stirred into a glass of water or juice NOT TO BE TAKEN suppository unwrap and gently insert ONE suppository into the rectum insert one suppository into the rectum apply to the affected area(s) rectally

Met

Frontline ntb s supp 1sup rect

ap aa rectally vag vag1 vagcr can can1 i / ins f3n f6n iap

into the vagina carefully insert..... for thrush insert ONE applicaturful high into the vagina insert ONE applicaturful high into the vagina at night until finished insert ONE pessary high into the vagina at night until finished insert at night for 3 consecutive nights at night for 6 consecutive nights insert one applicatorful high into the vagina

Insert the contents of one applicatorful.... Pess insert one pessary high into the vagina Pred insert the contents of one enema rectally Prog apply one flat spoonfull to thin areas of skin.... Femt Est Estp Ovest Apply one patch once weekly (Rotate skin site weekly, do not apply to breasts) FEMTRAN /CLIMARA Apply one patch twice weekly ( - -) ESTRADERM/ESTRADOT Apply one patch twice weekly..... Take ONE tabl daily fort he first.... normally twice weekly, calculated the right amoun 1 application is 0.5g 1 tube contains 30 applications

....or apply locally for external symptoms asd (two courses) INJECTABLES / AMPOULES 3ml are 300 units, for 1 month 10 units a day 10ml 1000 units, for 1 month 33 units a day Insulin vials/cartridges monthly, except certified exemption 3months supply at least 3 vial/cartridge, because it has to be discarded after one month D30 / exp cart discard each cartridge 30 days after opening subc give by subcutaneous injection inject.............. sgi shake gently then inject (for mix-ins.: humalog mix, penmix, protaph) test strips mbg b12 use to monitor blood glucose

one vial to be injected monthly or asd (never sc.)

NEW DISPENSING RULES Reduce the amount of repeats...even when it was done monthly before, as long as it is not a safety medicine (e.g. patient on weekly triazolam paracodeine disp. stays monthly) Some medicine can be endorsed by pharmacist and dispensed 3monthly, e.g. gabapentin insulin etc

STOCK CONTROL
For medicine recalls F4 maintain medicine - ...... medicine log: you know who got it For adjusting stock - Expired stock: patient Dead Stock, IS instead A4, Doctor barringtion Calculate the cost at WS+15% and give in the exact amount Then go to maintain medicine, edit medicine, F4 stock and tick on Defer until dispensed, to avoid reordering (in case we do not need it) For order either new order and then send it with F9 send order Edit order: all orders are listed, go through them, find the right one Receive order, but exclude backorder items ! Receive part of the order: go into the order, mark the item :F2 edit order, then F3 Backorder: then give in 0 since nothing is on backorder anymore, when the whole amount of the item is received, F12 accept, receive order exclude backorder items Sometimes an order was already received, before the stock comes in (check stock in toniq and on the shelf) Send an order New order with 1.new order Blank, then add items and the amount Name it like Fri pm

Create daily order according to stock level 1.new order daily order, accept, it will be then generated (with esc it will not be send) normally 7days are ordered, if possible outer packs afternoon order costs $5 if under $300 Doing a full stocktake in the dispensary: stock check (main menu, reports, stock reports, stock check....A-B) if stock is - , usually an owing or ordered for someone check stock: sometimes brand changes occur, stock is low: usually with a note case: stock of chlorhexetidin 4% was wrong in shop, stock 2 but on toniq 1 = so manually increased stock in disp toniq from 0 to 1.

OTHERS
Sundry labels are labels for compounding items. Under 1. Prescription and edit label You can check if a medicine was charged and be paid, so it must have been picked up Paper/paper towels and a few other items are ordered from office max: Go onto the website (all details are on the back of the telephone.....) Order per number and if cartidge is changed aktualisieren green (right on the top) Then agree click on the right enter your name and off we go

MEDICO PACKS, new sleeves are beneath the resthome printer (foil printer) no fax fee for blister packed scripts front size adjust to make it smaller or bigger 0 normal normally up tp 6 -1 to fit more items on it (up to ) -2 weekly CANNOT BE GIVEN IN ADVANCE !!! look at the notes can be seen at the dispensed amount 28,56 search chart in the archer (WEEKLY PATIENTS) should always have a prescription Friday do the weeklies for SAT/SUN and MON # check shelves before, if it is collected MON; SAT SUND; CD box # process weeklies -check if right customer MON SAT/SUN - prescriptions there Look at the notes !!! e.g FAULKNER dispense Mad,Amant loose e.g. DROWLEY note to organise scripts, if no repeats

prescriptions are giving in like normal prescriptions, firstly do the repeats for printing out the labels , remember to charge for medico pack...... (check history) when no repeat left, then ask: telephone scripts can be done (telephone: mark as telephone.....copy the previous repeats, normally go the 11.one, but dose changes may have occured,e.g madopar check that !!!!! copy everyone manually, then accept it.....) then go to dose pack (if blister packed) and o change start date (normally+7days, day stays the same (except when note (e.g.vita d3...) o choose the right dose pack, normally weekly, evt. Prn....... o old weeklys have to be deleted and the new ones will be replaced F8 Replaxe RX o check if everything is all right, same amount of medicines o variable, like cholecalciferol print the different weeks, look at the note, otherwise 1 o print it, double check the correct date

# collect labels - receipts - foil (right start date) and stick it together a new prescription comes in, is it for a weekly and blister packed or not?? check folder with the dose charts give in the prescription like a normal one, anything changed ? if not and there are still repeats to be done, put everything on hold and then ??? if not and no repeats are left, annotate the script if yes : blisterpacked ones: when does the blister pack has to start? Monday weekly, pack starts sometime Tuesday or Wednesday, so how many doses has to be given loose or has the pack to be changed? ....see under monthly monthly packs only if blister packed, then it is in the folder for medico external Richmond Trust is there as well !! charged to this institution, medico richmond charge (no receipt will come out, when printed manually it has no bar code) will not be signed on prescription after first dispensing, sign on label case: a new prescription came in for a monthly blister pack dose changes for metformin: questions was whend did the pack started (look at dose chart) then count how many doses to the next pack have to be given loose script is written like metformin 3months supply cc monthly: first month extra doses to be given loose (new directions 2-2-2, previously 2-0-2) 40 + 168 + 168 this has to be given in 40+2repeats and vary the repeats and the directions !!! pick up the chart, talk to the customer if lunch dose now loose or blister packed (costs $7 more) if blisterpacked - do not change the start date, but replace RX and metformin 40 will be in, then check and change directions form 2-0-2 to 2-2-2 and accept the next time the repeat and blister pack will be right (other thing add rx item and then look for it, click it on) do not to forget to print out a new dose chart, go into the customer and F10,

click on the medicines and double check the directions, change the directions of metformin resthomes new inhabitants (give everything in, do not forget to link it to the institution Edit Patient) Hostel Labels arent send, sign only on the labels ??? Stepping Stone on the shelf, Samyers army Stepping Stone daily in the weekly tray Bridge Pathways ( different street adresses (divided in 2 folders) and mobile) Richmond Trust Usually monthly ?, charged to the trust Stepping Stone ( daily, Trust.......?) - case with daily Cheryl Milnar phoned and asked for her Ventolin to send it, this was okay. Come to deliver on MON and THUR Sachet labels are use to dipense one ort wo days of dose to avoid blister packs. e.g. the bridge is normally collected Tuesdays, they need doses for Sun evening and the whole Monday (evening and breakfast), blister pack starts Tuesday give in the prescription, but dispens less for the first week (only doses for 1 day) vary then the repeats (2+14+14+14) repeats every 28days (for 3 months it is 84days) set up the dose chart ......weekly...tick.....start date..... add rx.... give in directions..... then F9 Print 1.Sachet label (count start day of the cycle, start date, day 6,7) Clozapine, blood results have to be monitore regularly, only then Clozapine is allowed to be dispensed (label) pro pharma website carelink passwords:unichem ba pharmacist - first and last name blood history has to be checked monthly

SHORT INFO SCRIPT PROCESSING 1. any remarks on the script ? date ? signed ? 2. name ( do not confuse first and sur name) , check address or date of birth , NHI

3. ANY NOTES ?!?!?! 4. A4 A1 A3 X private hospitals or specialists (dentists)

5. medication new medication ? any repeats or holds or owings ? change in directions? which brand (levothyroxine, lamotrigine, omep., lansop., met. Amount or period of time (amount has to be on the script) max. 90days STAT or NON-stat, reduce number of repeats Directions (ntb.... child.....use med log for suggestions)

Always which maximum amount is to be given Pack start date, always ask for that

For information always look at the history !!! Read the notes

PHARMACIST ONLY DRUGS Buccaline redo every 3 months, every month in severe cases possible Not when you have a cold Oracort dab on, do not rub in

PREPARED MEDICATIION Alphabetically stored, Mc under Mc and OBrian under O Weeklies on top and under the day of the pick up Monthlies under name Clozapin and controlled drugs lower shelf Medicines are also on the bench, larger bags or pathways pick up ( look fort he streets and pathcways mobile) Methadone is sometimes collected by a nurse, normally the packed medicines in the try FILING of the prescriptions Todays date check stamp date all labels there Prescription all right, signatures.. No faxes and no telephone scripts (mostly not signed then) No hold prescription, signed with copied or have to be checked No owings No CD scripts except , when they are completed on todays date (no rep.) Filed under todays date Faxes - check if fax label on it, otherwise check if it was done correctly View edit to flag fax for every item, only print fax label (press F4 no label) Filed in Fax file alphabetically at the back If original script is attached to it, then file it under the stamped date Case:original script with faxed on it: labels on it and signed etc. then file it . sometimes the original script comes in, before dispensing Before: check if fax ok: go to the first dispensing and then you can see that it is okay. FAX goes before EVERYTHING; holds...owings...etc

Other scripts - sort per date, prescription all right Completed CD scripts with repeats, (CHECK IF COMPLETED !!!) CDs and owings always filed under the date of the first dispensing Methadone scripts under the stamp date and not the first dispensing, if different Faxes together with their original prescription Filed under their dates at the back of this day Telephone scripts are in the box (wooden), filed under the doctors name, except Barrington Medical Centre Bridge Programme is filled under B Basically no where else otherwise case: telephoned script from doctor, fax will be sent, then fill in fax box CD scripts very important, pharmacy copy is filed in CD box, the other two go with the normal scripts. Always 4 batches each month (1-7, 8-15, 16-23, 24-30/31)

CHECKING SCRIPTS 1. script stamped, date ok, signed by doctor ? 2. patients name all right NEW PATIENT (visible bag) address all right (if not check if it is the right patient) doctors name correct patient code (A4, CAVE specialist or Australians, CSC ???) 3. medicine check medicine and strength, compare label is it the right medicine??? Right amount ???? Amount all right, annotated on the script !!!! Annotate brand amount different strength (e.g. ibuprofen) different form NEW MEDICINE (visible bag) Directions ok, everything on the label....... 4. receipt or not ? can be seen on the label as well sometimes it is charged to an account (pathways, stepping stone etc) EVENINGS Change stamp date Daily codeine in safe (6numbers) Methadone and CDs (dispensed) in safe (start, 4numbers, start) Waste disposal Everything in order Shut of balance and radio Computer shut down, except resthome pc (esc-esc-exit without backup) (backup 8 Backup, then 3 ??? start) Tie prescriptions together WINZ report Before processing charge $2 for single, $4 for familly on the customer, give it in name and doctor bar, article is report go to 3.Reports 4.. patient reports 1. patients ISS, insurance held then give in patients name report type: press scpace bar Income support services report period : normally 12 months tick the first and the last two (tick family additionally if for family) print then sign by certified by and write in title: pharmacy technician then pack it like a prescription

PROCESSING PRESCRIPTIONS
RECEIVING PRESCRIPTIONS Indelible written Date Within 3 months for funding, 6 months valid Except CD 7days Patient First initial and surname, residential address DOB if under 13 years Patient code (correct) and NHI number mostly A4, Specialists are A3 (except Hospital specialists), if CS card A1 (edit Patient) Name and address Registration number Personally signed Special authority, CHEM, exemption authorities On stock or available Duration Delivery or pick up Date and dispensed by and checked by

Doctor

Medicine Dispensing stamp

DISPENSING PRESCRIPTIONS Patient Check name or NHI number If new : new patient Edit patient(Prescription subsidy card,CS card, Southern Cross Card) Family members should be grouped together Flag prescription Check name or registration number If new: new doctor Check history, possibly copy it Hold scripts ? Repeats (not to be given in last 2/3 times) ? First dispense repeats, no more than 3months, put other scripts on hold (add prescription date) Check medicine, name and strength and correct amount STAT/ Non-STAT/ repeats / CC/ certified or access exemption - check treatment period (max3months or 6months OC) Double check and annotate amounts, non stat only for 1month, except certified exemption non stat inhalers, give not more than prescribed check expiry date reconstituted antibiotics repeats can be varied (vary repeats) Directions. external freq./how : creams (ext) or ntb (eye drops (exp date),vag,rect internal freq./dose :

For fax/tel Doctor

Medicine

C&A Labels and expiry date + addit. coloured labels Pharmac : restrictions , additional charges, specialists recommendation (name and year , call GP) special authority number (change, f2,f2,.....) Interactions changes to previous medication (doses?) Substitution yes or no Hold items Already hold scripts (filed in box) or new on hold (file) copy original, stamp with certified true photocopy, later be dispensed from copy Outstanding repeats? No. of repeats ? interval? Access exemption ???? Dispense repeat earlier, let it sign Print certified repeat copy and travel stamp, inhalers can be usually dispensed earlier dispense 2 repeats at once, make1 out of 2 repeats Medication Scripts Dispense in appropriate containers (CRP),label them Label with prescription number+date, quantity, per item Sign at dispensed by Annotations if necessary: dispensed amount, owings, holds, calculation, add CHEM Checked by pharmacist / including the receipt

Repeats

GIVING OUT PRESCRIPTIONS Checked by pharmacist+ annotate if new med./changes Patient Right patient ? (name, address, NHI number) Advice, new medicine/dose changes, receipt Record the sale