Post-grad pharmacist currently engaged in further pharmacy training with residencies and fellowships.
Pharmacy Dispensing Sites
Medications are commonly used by many patients on a daily basis. This occurs both on an inpatient (e.g., hospital) and outpatient (e.g., home) environment. However, the process for getting these medications to patients is different for each destination. This article will go over the process of filling medications in the community setting, and will not discuss filling medications in a hospital or mail-order center.
How Medications are Filled
Steps to Fill Medications in the Community
Most community pharmacies have a work-flow to help fill prescriptions that they receive. The work team consists of pharmacists and their technicians that they oversee. Daily tasks outside of filling prescriptions include:
- Management of inventory
- Checking inventory for outdates (eg. making sure roll-over on medications close to expiration)
- Managing overall pharmacy operations (differs by organisation)
- Outreach to the community (eg. brown-bags or health fairs)
- Answering patient and prescriber questions
Overall, a majority of the opening hours of a pharmacy is dedicated towards the filling of the prescriptions. Pharmacist act as the overall manager and final check point prior to dispensing of the medications and responsible for any medical related issues (eg. drug information, education, recommendations, etc). Technicians are responsible for ensuring prescriptions are entered, billed to insurance, filling the medications, and selling the prescription to the patient.
Often patients wonder why it takes so long to fill a prescription, and to be honest, its often because many are not aware of the process. The reasons for pharmacy role is due to laws in place to ensure patient safety and responsible dispensing of medications to the community. As such, taking the time to fill and check prescriptions is a professional obligation to reduce possible medication errors for patients (eg. wrong drug, interactions, side effects, etc). Here is an outline of the timetable for filling medications in the pharmacy:
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- Entering the prescription once received (2-10 mins): this can be longer depending on the billing process and how complicated the prescription ordered
- Filling the medication (3-15 mins): this may take longer depending on the type of medication and storage. A medication stored in a safe requires more time and detailed accounting of stock (due to laws in place for controllled substances). This can also take a lot longer if the medication needs to be re-constituted or compounded.
- Checking the prescription (3-10 mins): this depends on the number of prescriptions in queue (how many prescriptions are being prepared at the same time). However, the essence is that the pharmacist will ensure it is the right drug prescribed, that the dose is correct, that there are no significant drug interactions with other prescriptions on the patients profile, that the prescription shows no signs of forgery or alterations (especially with controlled substances), what issues that the patient should be instructed on (eg. storage, how to take it, etc) and that there are no overall large issues. This can take more or less time depending on the medication and the patients profile and history.
- Checkout (3-5 mins): the person selling the prescription will make sure to double check they are selling the right prescription to the right person (there are very similar names in a community!), and will offer to have the pharmacist consult or educate the patient if desired. In addition, if the pharmacist had any special notices to be conducted when the patient picked up the prescription will be addressed (such as if the pharmacist wanted to make the patient aware of certain issues with the medication).
Where Filling of Medications Break Down
Why Prescriptions May Take Longer to Fill
Sometimes, things do not go as expected. The sad part is that it can be a propagation of issues that may lead to issues that delay the dispensing of medications to patients. As shown in the figure, there are many points on the steps to fill medications that delays can set in. This can slow the dispensing of medications, or stop the filling process overall. Some common issues are:
- Error in the prescription: It must be acknowledged that everyone makes mistakes, and this can happen when simply entering or writing a prescription. The issue is that then this makes the prescription un-fillable until the pharmacist can clarify the issues. This requires contacting the prescriber, which may take more time.
- Lag time: If a prescriber says they will call in or e-prescribe a prescription, there may be some lag. Even I am guilty of this. When prescribing prescriptions for my patients I may not do it right after they leave or when I enter a prescription it may take some time to be sent, and as such the patient may end up driving to the pharmacy and waiting longer. Clear communication and understanding that there are some lag time in sending over a prescription is desirable.
- No refills: This is very common, and unfortunately until the pharmacy receives a new prescription they cannot refill the drug.
- Refill to early: This happens commonly when a patient uses an insurance to cover partial cost of the prescription. The pharmacy is only allowed to refill the drug within so much time as the insurance will allow.
- Billing: Third-parties may not cover the prescription prescribed or may require prior authorization by the prescriber. Again, this will take time and clarification with the presciber and communication with the insurance company. This can be quick, or may take days.
- Inventory issues: Some medications prescribed may not be available, as they may be rare and not usually carried by the pharmacy. Other issues may consist of shortages (such as current medication shortages) or as stocks may run out if multiple people are filling the same drug that day.
- Prescription check: The pharmacist may notice some issues when they are checking the medication that may take time to resolve or involvement with a prescriber. This is often the case if their are significant drug interactions possible.
This is just a small sample of common issues that crop in the pharmacy, and there are multiple issues a pharmacy must address a day in order to ensure the safe dispensing of prescriptions to their patients a day.
How Can You Help?
There are several things that patients can do to ensure a quick and easy visit to the pharmacy:
- Make sure you have refills available
- If you are in a rush and do not want to wait for a presciber to call or fax a prescription, request a written script
- If you are taking a new medication that may be rare, call ahead to a pharmacy to make sure they have it in stock
- Make sure your medication history is up-to-date at your pharmacy
- Try to minimize the number of pharmacies you visit (helps reduce billing issues and increases safety)
- Always make the pharmacy aware in any changes in your insurance when you drop off a prescription (eg. new card or company)
- Keep the pharmacy aware of your allergies
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.