Behind the Scenes: Pharmacy Edition

Edited by Lauren Dayes



After a patient sees their doctor, goes to a lab for tests, and maybe gets a referral or two, they head to the pharmacy as the last point of contact before managing conditions independently. As a result, it is an essential aspect of pharmacies to be on the lookout for any errors or overlooked details to ensure that patients are well-informed about their conditions and medications. Pharmacies also tend to see many more patients than any other health care environment – some pharmacies see upwards of 600+ patients with unique medications daily. It is a common misconception that all pharmacies need to do is “put a label on it” or “put pills in a bottle.” On the contrary, the process of dispensing a prescription consists of many intricate steps to ensure patient safety and ensure that medications are safe, indicated, and effective. This article will discuss what happens in a pharmacy from the time a new prescription is dropped off to when it is ready for pickup.



First, let’s discuss who you will find working on a pharmacy team:


Pharmacists: Medication management experts – they complete a professional degree (Bachelor of Science in Pharmacy or Doctor of Pharmacy) from an accredited university, successfully pass adequate exams to be licensed to practice in their country and/or province/state, and continuously learn about new medications and medication management strategies. In some provinces, pharmacists can prescribe, order and interpret lab tests, give vaccinations, and initiate drug therapy where needed.


Pharmacy Technicians: Pharmacy technicians are regulated health care professionals. They complete an accredited training program and must pass an exam to be qualified to practice in their province/state. Pharmacy technicians can verify medication orders, check the accuracy of filled prescriptions, perform sterile compounding, and perform many other tasks to keep a pharmacy operating smoothly.


Pharmacy Students: Pharmacy students are enrolled in an accredited university and are studying to be pharmacists.


Pharmacy Interns: Recently graduated pharmacy students who haven’t completed their licensing exam yet. In some jurisdictions, this could be a pharmacist from another country who hasn’t been licensed in their new country/province.


Pharmacy Assistants: Pharmacy assistants ensure that a pharmacy runs smoothly. Some of their tasks include accepting prescriptions, answering phone calls, refilling medications, creating patient files, packaging medications, and releasing prescriptions to patients.



Move through the pharmacy with your prescription!


Let’s discuss a generalized overview of the steps that a prescription goes through before it is released back to you. Note that some pharmacies have additional steps built into their order of operations, and some pharmacies use different software that might set up the workflow differently.



1. Prescription Drop-off and Data Entry


When you first approach the pharmacy with a prescription, you will be met by a member of the pharmacy team. If you have not been to this pharmacy before, the team member will ask you series of questions to create a patient file for you on their pharmacy computer software. These questions can include your name, address, sex, phone number, health care number, date of birth, medical conditions, allergies, and insurance information. If you have any updates in your insurance information, the pharmacy team member will be able to change it on your file. They will then enter the medication information that is on your prescription into the pharmacy software. You may be asked a few questions regarding the medication on the prescription, and the team member will note down your answers for the pharmacist to review later. After this, the team member will give you an estimated waiting time and will send the work order of your prescription forward to the next step.



2. Data Entry Verification and Clinical Verification


The pharmacist will now make sure that all the information that was entered at drop-off is correct. This serves as a double check to make sure that the correct medication, dose, directions, doctor, and days supply was entered. The pharmacist will then review any notes that have been written on the prescription and ensure that the medication that has been prescribed is appropriate, safe, and effective. Depending on the province, the pharmacist can also pull up your electronic health records to look at lab values, previous medical records, or any notes from physicians. If there is an issue with your prescription, such as a dose being too high or a medication not being appropriate for the condition it is meant to treat, the pharmacist will make an informed decision to either adapt the prescription, cancel the prescription and refuse to dispense it, or contact the doctor and wait for their reply. The pharmacist’s decision regarding any problems with drug therapy must include a rationale, and they must convey their rationale and decision to you, either via phone or in-person. Once the pharmacist is satisfied that the prescription is entered correctly and is clinically appropriate, the pharmacist will verify the work order and send it forward to the next step.


Note that in some pharmacy workflows, a prescription is not clinically verified until after it has been packaged.



3. Billing


Once all the information on the prescription is verified, your prescription will be adjudicated. This means that the prescription is processed through any insurance you provided at the time of prescription drop-off, including provincial health plans if you are eligible. Some pharmacies may not be able to complete this step and will ask you to submit a claim to your insurance provider; however, a large majority of pharmacies are able to bill for your medications directly so that you are only required to pay the amount that your insurance does not cover. Any errors in insurance billing are printed on your prescription receipt so they can be conveyed to you. It is important to note that you must notify your pharmacy if you get a new insurance card. Once the prescription has been billed, it is sent forward to the next step.



4. Packaging


A pharmacy team member will either receive a prescription label or will print one off for the work order. They will then find the correct medication in the pharmacy and bring it to their workstation. The team member will verify that it is the correct medication by double checking the Drug Identification Number (DIN) (known as the National Drug Code in the USA). Most pharmacies have a barcode scanning system embedded into the packaging step of the workflow. This will serve as a double check to ensure that the correct medication has been grabbed from the pharmacy shelf. Once it is confirmed that the correct medication has been selected, the team member will enter the expiration date and lot number of the medication into the pharmacy software. The medication will then be counted on a medication counting tray, or in an automated medication counter. The medication is then placed into a vial or box and is labelled appropriately. Once the medication is packaged, it is sent forward to the next step.



5. Packaging Verification


Once the medication has been packaged, it is sent forward to a pharmacist or pharmacy technician for packaging verification. The medication label will be checked against the scanned prescription to ensure that all the information on the label is correct. The medication inside the vial will be visually inspected to ensure it is the correct medication and is clean and safe to use. Sometimes the medication is counted again to make sure that the correct amount is being dispensed, especially for narcotics and controlled medications. Once the pharmacist or pharmacy technician feels confident in dispensing the medication to the patient, it is sent forward to the next step.



6. Bagging and Placing


Once the medication has been verified for correct packaging, it is placed into a basket or bag and is then stored on a shelf, waiting to be picked up. Some pharmacies use a software where the medication is scanned, and a corresponding bag or bin is scanned. The software then links the medication that you are picking up with a specific bag or bin, so that pharmacy team members know exactly where your medication is placed in the pharmacy. Note that some medications are stored in the fridge or in a safe.



7. Pickup


Once you arrive to pick up your medication, a pharmacy team member will ask questions to verify your identity and ensure that the correct patient has been selected on the software, such as your date of birth, address, and phone number. The team member will then be able to locate your medication in the pharmacy by referring to the bag or bin number. They will then double check that all the information on the prescription label and prescription receipt are consistent with the information on your patient file. You may be asked for ID when picking up certain types of controlled medications. Once the team member is confident that they are giving you the correct medication, they will scan the receipt and ask you to pay any outstanding charges for the prescription. You may be asked to sign the prescription or a form to indicate that you have picked up the medication.


If it is the first time you have been prescribed this medication, or if the pharmacist has indicated that they would like to speak with you before releasing the medication to you, you will be directed to the patient counselling area. If the pharmacist has not indicated that they need to provide counselling before releasing the medication, the pharmacy team member will ask if you would like to speak to the pharmacist. The prescription work order is then marked as “completed” on the pharmacy software.


Note that although you have picked up the prescription, a record of the entire process, from drop-off to pick up, will be retained on your patient file for a period of time indicated by the Standards of Practice for the Operation of Pharmacies in your jurisdiction.



Final Words


The journey of a prescription in a pharmacy, from drop-off to pick up, ensures patient safety by incorporating double checks at every stage. The time it takes for the entire process depends on many factors, including any clinical issues that your pharmacist may need to resolve prior to releasing the medication, the time it may take to contact your physician to discuss your medication therapy, and how busy the pharmacy is. Your pharmacy team works hard to ensure that you can get your medication as quickly as possible without compromising on your safety.



 


References

  1. The Pharmacy Examining Board of Canada: https://pebc.ca

  2. American Society of Health System Pharmacists: https://www.ashp.org