Reading 11

Question 1

Define “prescription”.

Answer 1

“an order for medication which is dispensed to or for an ultimate user but does not include an order for medication which is dispensed for immediate administration to the ultimate user (e.g., an order to dispense a drug to a bed patient for immediate administration in a hospital is not a prescription).”

Question 2

True or false: a medication order in a facility is considered a type of prescription.

Answer 2

false

Question 3

Define “prescription issuance”.

Answer 3

“the decision-making process that goes into deciding what drug, strength, quantity, and directions the patient needs.”

Question 4

Explain the corresponding responsibility doctrine (CRD).

Answer 4

the responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription

Question 5

Define “patient-prescriber relationship”.

Answer 5

one “where a prescriber has taken a patient history, conducted an assessment, developed a treatment plan, and documented these steps.”

Question 6

Red flags may be ________-, ________- ________-, or ________-specific.

Answer 6

patient; prescriber; situation; prescription

Question 7

What are the 13 red flags for prescription review?

Answer 7

1. A prescriber writes more prescriptions compared to other prescribers in the area.
2. A prescriber writes larger prescription quantities than other prescribers in the area.
3. A patient comes into the pharmacy to fill their prescription too frequently.
4. A prescriber writes prescriptions for antagonistic drugs (stimulants and depressants) at the same time.
5. A patient presents prescriptions written in the names of other people.
6. Multiple patients come into the pharmacy simultaneously or within a short time, with similar prescriptions from the same prescriber.
7. Patients who are not regular patrons of your pharmacy or are not residents of your community present prescriptions from the same prescriber.
8. The prescription looks “too good;” the prescriber’s handwriting is too legible.
9. Quantities, directions, or dosages differ from usual medical usage.
10. The prescription does not comply with the acceptable standard abbreviations or appears to be textbook presentations.
11. The prescription appears to be photocopied.
12. Directions are written in full with no abbreviations.
13. Prescription is written in different color inks or written in different handwriting.

Question 8

A pharmacist can only be penalized through CRD if they knowingly fill a fraudulent/unsafe prescription. What is the legal definition of “knowingly”?

Answer 8

“a pharmacist recognizing the possibility of wrongdoing but consciously refusing to conduct a proper investigation.”

Question 9

What must be included on a controlled substance prescription?

Answer 9

• date of issuance
• full name and address of patient
• drug name, strength, and form
• quantity prescribed
• directions for use
• name, address, and DEA number of the prescriber/institutional DEA number and assigned suffix
• prescriber signature

Question 10

What implements can be used to write paper prescriptions?

Answer 10

• ink
• indelible pencil
• typewriter
• computer printer

but MUST be manually signed by the practitioner

Question 11

What must prescriptions issued under DATA 2000 include?

Answer 11

the physician’s DATA-waived DEA number and prescriptions issued for GHB must include the medical need of the patient

Question 12

What can pharmacies correct on a CIII-V prescription?

Answer 12

• patient address (upon verification)
• dosage form*
• drug strength*
• drug quantity*
• directions for use*
• issue date*

*after speaking with prescriber and documenting on the face of the prescription

Question 13

Although we cannot alter the patient name, controlled substance name (except in generic substitution), and prescriber’s name, we can still correct if there is an error. How do we do this?

Answer 13

call the prescriber and convert the written prescription to an oral, telephoned prescription and change the information

Question 14

What is the general consensus on making changes to C-II prescriptions?

Answer 14

we can make changes as long as state laws/policies allow it

Question 15

If there is an error with a C-II prescription relating to the patient name, substance, or prescriber’s name/signature, what must be done to change it?

Answer 15

patient must go back to the prescriber and have a new prescription written or new electronic prescription sent

Question 16

Who is entitled to fill a controlled substance prescription?

Answer 16

“a prescription for controlled substances may only be filled by a pharmacist, acting in the usual course of their professional practice and either registered individually or employed in a registered pharmacy, a registered central fill pharmacy, or a registered institutional practitioner.”

Question 17

When discussing who is allowed to fill controlled substance prescriptions, the term “pharmacist” includes which entities?

Answer 17

pharmacists licensed by the state, interns licensed by the state