WASHINGTON STATE BOARD OF PHARMACY

WASHINGTON STATE BOARD OF PHARMACY Review Form

PHARMACY TECHNICIAN TRAINING PROGRAMS

Type of approval: New Program Re-approval/Renewal: Date program expired:

Program Type:

On-the-Job (OJT):

Formal/Academic:

Online:

Facility/ Institution name:

Tri-Area Pharamcy

Credential # (if applicable):

Location Address :

93 Oak Bay Road, Port Hadlock WA 98339

Mailing Address (if different:

Name of Program Director : Cielo Tan Phone Number: 360-379-9800

Email Address for Director:

[email protected]

Corporate /institution Contact Information:

Staff Recommendation: Approved

YES NO

Requirements for all program types:

Multicultural health awareness and education effective July 1, 2008 -New requirement RCW 43.70.615

See page 5 of this form for complete info.

1. The training program must adequately prepare the trainee to pass an approved national pharmacy technician certification examination, such that the trainee successfully passes prior to license application.

x

WAC 246-901-060 states proof of passing an NCCA-accredited national certification exam is required for licensure (effective 1/1/09).

2. Prior to starting an OJT training program in Washington, the trainee is required to show proof of high school graduation or a high school equivalency certificate, such as a GED.

x

3. Minimum of 8 hours of instruction is designated for review of relevant Washington state pharmacy law. This must include access to and use of the WA Pharmacy Commission’s website to obtain the most current information. This is in addition to a review of all other applicable state and federal laws.

x

Out-of-state applicants must submit a completed ‘Verification of Law’ form that is signed off by a pharmacist who is licensed in WA (but does not have to reside here & can have licenses in more than one state).

4. Trainee is registered with the Pharmacy Commission as a pharmacy assistant prior to starting an OJT program or an externship through an academic program in Washington state.

x

This does not apply to trainees who are in or have completed out-of-state technician training programs that are not physically located in WA.

5. Director of the program is a registered pharmacist. For WA x Program directors of WA state

state – the director must also be a licensed preceptor. WAC 246-901-050 states that the “director shall be a pharmacist.” Pharmacists directing or supervising the training of pharmacy technicians must meet the same requirements as those of pharmacy intern preceptors. The program direction or delegates must sign off on an applicant’s application verifying successful completion of the program.

programs must also be licensed as preceptors. [WAC 246-858] The Board must be notified immediately of any changes in program director or delegates and must have an updated list at all times.

6. Specify the names, license numbers, and training experience of the Director and all program instructors. Describe training responsibilities and functions

x

7. Length of the program is 12 months or less for whatever is sufficient to meet the requirements in hours and/or credits for either OJT or academic programs. Note that there are 3 types of programs that are recognized: (1) OJT programs at licensed pharmacies; (2) academic programs; & (3) online programs. NOTE: Anyone who works in a pharmacy in WA must be licensed in WA. Trainees are licensed as pharmacy assistants and can only work as technicians

x Eg, 520 hours for OJT programs to include didactic training & supervised work experience training at the pharmacy. 30 credits for academic, vocational, technical, online, and similar types of programs.

8. The training and resource materials are current, relevant and are listed by title and publication date, with a description of how they will be used.

x

9. The minimum passing score for a final exam other than the PTCE or ExCPT is 75%. However, an option is to use proof of passing an NCCA-accredited national technician exam as your program’s final examination.

x The passing scores for the PTCE and ExCPT are each calculated in different ways and not by percentage.

10. The Pharmacy Commission must be notified in writing or email prior to any significant changes to the program, including change in the Director, course content, and time frames.

x Changes in director and/or other training personnel do not require resubmission of the entire program for approval.

11. All student-specific records must either be retained on-site and kept for a minimum of 2 years, as well as be made available within 72 hours upon request.

x

These records must be readily retrievable.

Additional requirements for OTJ programs: Yes No

1. The program consists of 520 total hours of supervised work experience which includes: didactic instruction and 12 hours of individualized instruction provided when the trainer is not working ‘on-line’. All work experience within this time frame must be supervised by pharmacists and be part of the training program requirements.

x

The requirement for 12 hours of individualized instruction is specific for pharmacies licensed in WA.

2. The program must also include training on job functions that are unique to a particular practice setting (eg, preparing parenteral products; extemporaneous compounding; providing long term care services; etc.). These job functions must be documented on the ancillary utilization plans submitted for review.

x

Ancillary personnel utilization plans are required of all pharmacies licensed in WA. [RCWs - 18.54.011, 18.64A; & WACs – 246-863, -869, -901]. http://www.doh.wa.gov/hsqa/Professions/Pharmacy/defaul

http://www.doh.wa.gov/hsqa/Professions/Pharmacy/default.htm


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3. The utilization plans for ancillary personnel are included, namely, pharmacy assistants and technicians. [See the web document on ‘Developing a Pharmacy Technician Training Program’ for resources.]

x

These plans must describe the manner in which ancillary personnel will be utilized. This requirement only applies to pharmacies licensed in WA.

Additional requirements for academic programs: Yes No

1. The academic program consists of a minimum of 2 quarters equal to 30 quarter credits (or equivalent in semester hours) and includes a mandatory externship of a minimum of 160 hours.

2. The vocational program consists of a minimum of 800 hours of instruction and includes a mandatory externship of a minimum of 160 hours.

3. A comprehensive training manual is provided and includes the following: list of faculty (names, licenses, training experience, & program responsibilities); institutional policies & procedures; description of the Advisory Committee functions & list of members; complete curriculum description & goals; training and testing methods; description of facilities (eg, drug preparation labs, computer labs, etc.) & equipment used; description of the quality assurance program; and anything else relevant to the program and its administration and operations.

4. The externship is described by practice site and number of hours spent at each site, as well as description of tasks, expectations and required outcomes. Students in externships are evaluated by their externship site supervisor and their academic program instructor (based on a midterm and final clinical evaluation form, as well as the student’s work reports, attendance and performance). Students evaluate their externship experience and include a self-evaluation of each experience. The program’s policy and procedure for dealing with negative evaluations of students and by students is included.

5. Program requirements and expectations are included with a description of what constitutes misconduct and how it is handled. One example would be the criteria for expulsion from the program.

6. If the vocational or academic institution is accredited by an accreditation organization and/or licensed in a state, provide this information.

Additional requirements for online programs: Yes No

1. Online programs must meet the same requirements as academic programs.

2. Program staff must be available to students on a 24-hour basis daily, with a policy & procedure in places for this.

INCLUDE THE POLICY & PROCEDURE FOR THIS.


ADDITIONAL REQUIREMENTS

1. All programs are approved for a 5-year period and must be submitted for renewal before their

expiration date. Typically programs that are submitted for renewal do not have to be presented at a board meeting for re-approval. However, if such a program is completely revamped, a determination will be made if formal board approval will be necessary, at which time your program would be notified.

2. For OJT programs offered through pharmacies that are licensed in Washington and for

academic/vocational programs based in Washington, the documented director (or delegates) of a training program must sign the ‘Director’s Certification’. The director may designate delegates who can sign this section of the application on his or her behalf, but a letter must be submitted to the board by the director of the program stating who these delegates are and the effective dates. Any changes to this document must be submitted in writing. If either a director’s or delegate’s names are not on record with the board, this will cause delays in the processing of applications.

3. For pharmacies licensed in Washington, you must maintain an on-site file containing all

documentation related to your approved technician training program, including your most current approved ancillary utilization plans. This documentation will be requested as part of the inspection process.

4. Anyone who works in a pharmacy in WA must be licensed in WA. Trainees must first be licensed as pharmacy assistants and can only work as technicians-in-training when they are being trained! Trainees cannot ‘fill in’ as technicians ‘as needed’. Their work experience must be part of the approved training program. And, since proof of passing one of the NCCA-accredited national certification exams is a requirement for licensure, trainees should be preparing for an exam while they’re in training. The training program should be preparing them to take an exam. The national exam should be taken sooner rather than later, meaning that your trainee can’t be a tech-in-training indefinitely, especially after they have completed the training program. At the latest, trainees should be ready to take a national exam when they have just completed a training program.

5. Always remember to access the Board of Pharmacy website for the most current pharmacy technician or assistant applications, as the applications are periodically updated. The same applies for the most current information on Board of Pharmacy laws, rules, policies, guidelines, and the like.

6. Training programs that are reviewed as part of a specific applicant’s application process will only be approved for that applicant. Out-of-state training programs that are interested in obtaining board approval must submit all the documentation requirements listed in the review form above.

Note: ‘Formal’ academic programs include the following settings: universities; community colleges; technical colleges; technical/community colleges; vocational/technical schools. These are institutional-based programs, whereas OJT programs are employer-based.

http://www.doh.wa.gov/hsqa/Professions/Pharmacy/forms.htm - Pharmacist Preceptor Application Packet and Experiential Training Manual.

NEW REQUIREMENT FOR ALL TRAINING PROGRAMS APPROVED in WASHINGTON

Cultural Competency Resources

The legislature finds that it shall be a priority for the state to develop the knowledge, attitudes, and practice skills of health professionals and those working with diverse populations to achieve a greater understanding of the relationship between culture and health and gender and health. By July 1, 2008, each program with a curriculum to train health professionals for employment in a profession credentialed by a disciplining authority under chapter 18.130 RCW shall integrate into the curriculum instruction in multicultural health as part of its basic education preparation curriculum.

The Washington State Department of Health (department) is pleased to announce a new resource to help health care providers serving diverse populations of patients. A law passed in 2006 requiring all health care providers licensed by the department to receive multicultural health awareness education and training. The

Cultural Competency in Health Services and Care – A Guide for Health Care Providers is a tool in that effort. The law did not mandate anything more specific than this. There are no requirements for how the training is conducted, what resources should be used, and number of contact hours or credits. There are many resources for this. A sampling of resources is listed on the review form.

This guide is intended to increase the knowledge, understanding, and skills of those who provide health care in cross-cultural situations. The guide is available on our Web page. We hope it will broaden your awareness of health disparities, provide a better understanding of why cultural competency is important, and illustrate some of the resources available to you. There are several online resources that offer continuing education credits. There are also resources with important information and statistics on the populations you serve.

http://www.doh.wa.gov/hsqa/Professions/Pharmacy/forms.htm

http://www.doh.wa.gov/hsqa/Professions/Pharmacy/documents/PharmPreceptor.pdf

http://www.doh.wa.gov/hsqa/Professions/Pharmacy/documents/PharmPreceptor.pdf

http://www.doh.wa.gov/hsqa/Professions/Pharmacy/Documents/etmanual.pdf

http://www.doh.wa.gov/hsqa/Professions/Publications/documents/CulturalComp.pdf

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The complete program of study including resource materials, content of instruction, and detailed program administration must accompany this application as well as a description of the criteria for admission or selection into the training program, and details on how the program will measure the students proficiency.

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I certify that I have received, read, understood, and agree to comply with state laws and rules regulating education and training programs. I also certify that the information herein submitted is true to the best of my knowledge and belief.

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RE: Ancillary Personnel Utilization Plans

TECHNICIANS sZ

A. Operates credit cards transactions and cash register for customers.

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2. Patients requesting refill of a prescription number.

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3. Calls to wholesalers with the ordering of prescription medications and OTC's.

6. Calls regarding pharmacy business hours or delivery services.

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3. Cails from physician's or other authorized medical health profession's office authorizing refills providing no changes to the prescription involved.

4. Caiis'ffom patients relating to prescriptions last filled, refills left, if refillable, and price information on last copay, cash price, if delivery arrived, how long will it take to fill prescription(s) and if medication is In stock.

D. Performs nonprofessional phone calls to/hom:1. Calls to physician’s, ARNP’s, dentist's, naturopathic physician's or podiatrist's office

for refill authorization shall be allowed stating the patient's name and date of birth, medication and strength, directions, medication and strength, quantity and date of prior refills or last fill at another pharmacy. Additionat inquiries from medical office concerning prescription must be the responsibility of the pharmacist on duty.

C. When pickup for distributing proper medications is asked for, patient's name, address, phone number or date of birth is mandatory. Counseling is necessary and patients have to acknowledge yes or no for each prescriptions and noted on pharmacy record receipt or future signature signpad. Prescriptions are then released upon pharmacist approval only.

Tri-Area RX, LLC65 Oak Bay RdPort Hadlock, WA 98339 (360) 379-9800

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E. Counts and pours from medication stock bottles for specific and Individual prescriptions. This Is under direct supervision of licensed pharmacist on duty, who will review and triple check for accuracy of the specific prescription content Involve. Licensed pharmacist must initial all prescriptions filled.

F. Reconstitution of liquid antibiotics, must be reviewed by licensed pharmacist on duty to determine specific quantity of distilled water or proper diluent for amount measured is 100% accurate prior to mixing. Licensed pharmacist on duty must check and initial accuracy of the technician.

B. Files completed prescriptions alphabetically and properly bags them on shelf for patient pickup.

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H. Under direct pharmacist's supervision, technician responsibilities will be;

1. Transcribe orders must be checked ^d initialed by licensed pharmacist for accuracy.

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RECEIVED r

JUL 0 7 7070 doh/hsqa/ocs

3. Monitors label printing, obtaining prepackaged, labeled medication for prescriptions, obtainS/Stock bottles for prescription filling (counting capsules or tablets or pouring liquids).

I. Ries completed prescriptions properly in three different prescription folders: legends prescription medications, Schedule H, and Schedule lll-V. Ries and retrieves all other pharmacy records as required.

2. Reviews patient profile for IRS tax reports, medication history and prints reports when requested with patient's individual ID (HIPPA) and pharmacist's signature.

J. Receives, unpacks, labels with proper pricing stickers on each individual OTC's and prescription stock bottle involved.

G. Inputs accurate prescription data for each individual patient: Proper name, street address, date of birth, allergies, drug plan or cash, easy open vial if requested and signs the proper record, caregiver information or power of attorney if patient authorizes another person to pick up their medications.

K. Maintain assigned work areas and equipment in a sterile, dean and orderly condition. \

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F. Maintain assigned work areas and equipment in a sterile, dean and orderly condition.

RECEIVED

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3. Cails from physician's or other authorized medical health profession's office, authorizing refills providing no changes to the prescription involved.

E. Receives, unpacks, labels with proper pricing stickers on each individual OTC's and prescription stock bottle involved.

1. Cails to physidan's, ARNP's, dentist's, naturopathic physician's or podiatrist's office for refill authorization shall be allowed stating the patient's name and date of birth, medication and strength, directions, medication and strength, quantity and date of prior refills or last fill at another pharmacy. Additional inquiries from medical office concerning prescription must be the responsibility of the pharmacist on duty.

4. Calls from patients relating to prescriptions last filled, refills left, if refillable, and price information on last copay, cash price, if delivery arrived, how long will it take to fill prescription(s) and if medication is in stock.





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Tri-area Pharmacy Technician On The Job Training Course Summary

Section L Director and Other Instructors

RECEIVEDJUL 0 7 2070

DOH/HSQA/OCS

Cielo Kathiyn Tan, owner and Pharmacist In Charge will be the director of the Technician On the Job Training Program for Tri-area Pharmacy. She will be responsible for managing the program and training pharmacy assistants to become certified pharmacy technicians.

Steven Willden, PharmD will be one of the Preceptors and Instructor in the program. His experience heavily emphasizes practicing in a smaller community pharmacy setting. He has management and preceptor experience with many companies including Safeway, Hagen, Albertsons and multiple independent pharmacies.

Cielo has been a pharmacist preceptor for 13 years and has mentored pharmacist interns, pharmacists and pharmacy assistants in training in numerous Riteaid locations she has worked at from 2007 to 2015. She also taught Pharmaceutical Calculations and General Chemistry at the College of Pharmacy from 2002-2003 at Adamson University in the Philippines. Her expertise in the field of community pharmacy will be truly helpful in training future technicians under this program.

Steven Willden93 Matheson St #1410 Port Hadlock, WA 98339801-6800977PH60709419 (Preceptor’s license)PH60575492

Cielo Tan786 NE Ellinor WayPoulsbo, WA 98370360-9908283PH60009044 (Preceptor’s license)PH00064262

Steven has been a licensed pharmacist in WA for 5 years and has worked in the Pharmacy industry for 10 years. His focus on education and attention to individual learners will help students progress steadily through the modules and activities to produce outstanding healthcare professionals.

Section IL Facility and Resources

Facilities:

Resources:


DOH/HSQA/OCS

• Tri-area pharmacy employee handbook (enclosed)• Tri-area Pharmacy Ancillary Personnel Utilization Plan (enclosed)• PassAssured Pharmacy Technician Training program (https://nassassurcd.com/)• Washington Pharmacy law (online)• Ball, Leah, et al. Pharmacy Certified Technician Training Manual. Lansing: Michigan

Pharmacist Association, 2015.• Ball, Leah, Dianne E. Miller. Pharmacy Certified Technician Calculations IVorkhook.

Lansing: Michigan Pharmacist Association, 2015.• http://gnpu.leaniercommunity.com/ (online)• www.wsparx.org• https://alison.com/courses/diploma-in-pharinacv-tcchnician/content

Bainbridge Island Community PharmacyPHAR.CF.60742402124 Winslow Way WestBainbridge Island, WA 98110206-7807809Type A [email protected]

Tri-area pharmacy PHAR.CF.6074238593 Oak Bay Street Port Hadlock, WA 98339 360-3799800 Type A Pharmacy [email protected]

Section III, Instruction and Program Administration

Content of Instructions:

HoursWeekl

3

3

2Week 2

RECEIVEDnil 07 ?n?o

DOH/HSQA/OCS

238

Efficiently prepare and dispense medications.Safely practice within the Pharmacy Technician's scope of practice.

Training Program Objective:After completing the Tri-area Pharmacy Technician On The Job Training Program Participants will be able to:

The Tri-area Pharmacy Technician On The Job Training Program will be no less than 520 hours total. This will include online learning, individual tutoring, on the job training and instructing between trainee and instructor. There will be no less than 8 hours allotted for State and Federal Law subject and no less than 12 hours of individual instruction conducted outside or away from the prescription area where the instructor is not directly responsible for the operation of the pharmacy. The program is to be completed in less than 12 months.

74 4 4 6 4 2.52.52.5 42

Orientation in the Pharmacy (lecture) Orientation (Pass Assured - online) Federal Law (Pass Assured - online) Federal and State Law (Instructor discussion Module 1 and 2} Federal and State Law(Instructor discussion Module 3 and 4) Federal and State Law (Instructor discussion Module 5)

Doses and Terminology (Pass Assured - online) Basic Anatomy (Pass Assured - online)Central Nervous System (Pass Assured - online) Peripheral Nervous System (Pass Assured - online) Hormones (Pass Assured - online)Cardiovascular (Pass Assured - online)Renal (Pass Assured - online)Anti-infectant (Pass Assured - online)Cancer Chemo (Pass Assured - online) Blood and blood formationInstructor Review and Discussion

PassAssured Pharmacy Technician Training Program (web-based modules) With Instructor Discussions, Reviews and ActivitiesSee Appendix A

Activity 1Week 3

Week 4

Weeks

Week 6

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DOH/HSQA/OCS

10.58.5

441.5 96 4

5.256.51.55

Virtual RX - activity/test (Pass Assured - online) Aseptic Technique (Pass Assured - online) Syringes (Pass Assured - online) Parenterals (Pass Assured - online)

842

16.5 12 1 3 3 21

44 2.158

Metric System (Pass Assured - online)Abbreviations (Pass Assured - online)Roman Numerals (Pass Assured • online)Fraction, Decimals and Percent (Pass Assured - online) Temperature Conversions (Pass Assured - online) Ratio and Proportions (Pass Assured - online)Quantities, Dilutions and Concentrations (Pass Assured - online)Doses and Dose regimens (Pass Assured - online)

Vitamins (Pass Assured - online)Top 200 drugs (Pass Assured - online) Memory match (Pass Assured ** online)Roman numerals (Pass Assured - online)Study Table (Pass Assured ~ online)Sigs (Pass Assured - online)Abbreviations (Pass Assured - online)Virtual RX Activity/Test (Pass Assured - online)Instructor Review and DiscussionActivity 2

Calculation of IV Flow Rates (Pass Assured - online) Powder Volumes (Pass Assured - online) Pricing (Pass Assured - online)Instructor Review and Discussion Activity 4Basic Facts in Pharmacy (Pass Assured - online) Assisting the Pharmacist (Pass Assured - online) General Prescriptions (Pass Assured - online) USP 795 (Pass Assured - online)

21.5 1.5 1.5

Techniques for Sterile Compounding (Pass Assured - online) 3 22 2

Solutions (Pass Assured - online)Parenteral Antineoplastic agents (Pass Assured - online)Stability Considerations in Parenteral products(Pass Assured - online)USP 797 (Pass Assured - online)USP 800 (Pass Assured - online)Instructor Review and DiscussionActivity 3

Week?

240 hoursTotal:

Good Neighbor Pharmacy University (web based learning)

5 hours

8 hours

8 hours

On the Job Training

Information covered during On The Job training:

RECEIVED

JUL 0 7 2020DOH/HSQA7OCS

L

462

Instructor-student lecture and discussions on Federal and State Law See Appendix B

7.757.757.51.250.751.251

11111

Total:Washington Law for Pharmacy Technician Online Training available through www.wsparx.org

Medication Distribution Inventory (Pass Assured - online)Third Party Reimbursement (Pass Assured - online) Medication Safety (Pass Assured - online) Cash Register Activity (Pass Assured - online) Interview (Pass Assured - online)Effective Communication (Pass Assured - online) HIPAA Regulations (Pass Assured - online) Instructor Review and DiscussionActivity 5Pre-final (Pass Assured - online)Final (Pass Assured - online)

Blood Borne Pathogen In the PharmacyMedicare Parts C and D FWA Compliance training 2020HIPAA training for PharmacyMethGuardOSHA - HazCom and SDS Standards

• Pharmacy Computer System (data entry)• Technician responsibilities - ancillary utilization plan• Labeling requirements• Drug product ordering• Drug product recalls• Drug product receiving procedures• OTC• Inventory guidelines• Pharmacy Security• Customer Service Standards

260 hoursTotal:

Program Administration:

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DOH/HSQA/OCS

Training Program OrientationAll applicants must provide proof of high school graduation or GED and has a current Pharmacy Assistant license from the WA Board of Pharmacy.

Didactic Content of Technician Training ProgramTri-area Pharmacy Technician Training Program relies on the online multimedia training program offered by Pass Assured. The web-based training through PassAssured Pharmacy Technician Training Program is outlined in Appendix A, which includes time allotted for each module and information about performance evaluation quizzes and exams. 'The Director and preceptors are able to control the Pass Assured web environment through the Educator Control Panel, where they will sec the trainee's progress and scores.

Practicum ContentTechnician Trainees are required to complete practicum training at either Tri-area Pharmacy or Bainbridge Island Community Pharmacy. A complete review of the Technician Trainees Practicum requirements is outlined in Appendix C. The Director will meet with the Technician Trainee weekly to review online course progress, provide feedback on didactic and practicum progress and answer trainee questions. There will be activities for the trainee to finish all throughout the practicum training.

Professional standard of conductDrug product pricingPrescription returns and refundsGeneric substitutionPatient consultation and offer to counselPrescription accuracy standardsPrescription filling - selecting NDC numbersPrescription refillsPrescription safety containersAudits and InspectionsHIPAAPatient records releaseRecord retentionThird party billingExpired medicationsDrug product storage

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doh/hsqa/ocs

Documentation Required:The web-based training provided by PassAssured Pharmacy Technician Training Program will provide documentation on the written quizzes and exams. The Director and Trainee will document practicum experiences and hours. A template of the trainee’s timesheet is attached in Appendix C.

Evaluation of test scores and other pertinent information related to the progress of the student will be kept on the premises and be made available to the state board investigator for review for a period of 2 years following completion of the program.

Tri-area Pharmacy will notify Board of Pharmacy of any significant changes to the program before implementation.

Orientation

Federal Law

RECEIVED

JUL 07 20?nDOH/HSQA/OCS

Appendix A:Synopsis of Pass Assured^s Pharmacy Technician Training Program

The Exams and RecertificationThis sub-section discusses the two national exams, PTCB and the ExCPT. The requirements to sit for these exams, test structures and time allowed for exams are reviewed. Recertification requirements are also discussed in this sub-section.

Pharmacy Law and TimeThis sub-section provides different laws and legislation that affect the Pharmacy Industry, when they were enacted and their importance.

Federal Law and Drt^sThis sub-section discusses the importance of the Controlled Substance Act of 1970. This sub-section shows how this act regulated the manufacturing, distribution and dispensing of controlled substances based on abuse potential.

Rules for Controlled Substances

This sub-section outlines filing procedures, maintaining records according to State and Federal Laws, and drug substitution requirements.

DEA Number VerificationThis sub-section illustrates how a Doctor’s DEA Number is determined and its purpose. An interactive display gives the student instructions on how to determine if a DEA Number is valid.

Schedule B Drugs

Orientation introduces the student to basic terms and definitions. This section discusses the national exams and their founding organizations. Re-certiflcation details are provided with easy to follow steps for maintaining certification. Each sub-section is suf^lemented with a Windows Learn File accessible at any time from the audio drive.

Certfication, Licensure, RegistrationThis sub-section introduces basic definitions die student needs to know in regards to pharmacy technician certification. Definitions of these basic terms are a must.

Federal Law focuses on legislation that affects the Pharmacy Industry. From Food and Drug Administration (FDA) laws to die Poison Prevention Act (PPA), Federal Laws that have guided the Pharmacy industry are presented. The method used in determining a valid DEA number is studied. The sub-section does not cover state and local laws. (State and local laws vary greatly, thus, providing die material in this product is not practical.) The national certification exams will only cover Federal Law.

Medical Review

Stth-i

RECEIVED

JUL 0 7 2020DOH/HSQA/OCS

Medical Review Section introduces to the future Pharmacy Technician to Pharmacology. The study guide focuses on maintaining the proper instructional level suited for a Pharmacy Technician. The varied types of drugs, prescription types, medication dosage forms, and medical devices are discussed. Drug interaction on the human body's major systems such as the central nervous system, peripheral nervous system, cardiovascular system and other systems of the human body is introduced. This study concentrates on commonly used drug classes that would be of most concern to the Pharmacy Technician.

This sub-section discusses storage requirements for Schedule 11 Drugs. bivestigational DrugsTTiis sub-section defines the four phases of Investigational Drugs.

Doses and TerminologyDiscusses the different terms used in pharmacology. In-depth review of the different types of medication dosages, such as tablets, caplets, liquids, creams, emulsicms, etc. The sub-section also describes the different types of administration devices for certain medications and dosages. Basic AnatomyThis section briefly discusses the human body systems, their functions and disease states. The overview of systems are the Cardiovascular System, Digestive System, Endocrine System, Integumentary System, Lymphatic System, Muscular System, Nervous System, Renal System, Reproductive System, Respiratory System and Skeletal System.Central Nervous SystemThis section reviews drugs which affect the Central Nervous System. Drug interactions and the mechanism of action for CNS drugs are reviewed. Components of the central nervous system are briefly discussed.Peripheral Nervous SystemThis section is a review of drugs which affect the Peripheral Nervous System. Drug interactions, mechanism of action and manufacturer named drugs are reviewed as well as the Components of the Peripheral Nervous System.HormonesA review of drugs classified as hormones are discussed in this sub-section. This agent significantly influences emotions and a person's quality of life. Drug interactions, mechanism of action and manufacturer named drugs are reviewed. Various hormonal drugs and uses of each are reviewed. Local and systemic hormone uses are studied. All of the male and female hormones are discussed. Cardiovascular DrugsThis section is a review of drugs that affect the Cardiovascular System. Basic definitions of terms used in cardiovascular treatment are studied. Drug interactions, mechanism of action and manufacturer named drugs are reviewed. Components of the Cardiovascular System are briefly studied. The student will study the differences between various drugs used to treat cardiovascular illnesses.Renal Drugs


DOH/HSQA/OCS

A review of drugs classified as Chemotherapy drugs are studied in this sub-section. Drug interactions, mechanism of action and manufacturer named drugs are reviewed. Therapeutic classes used in the treatment of cancer are detailed. Personal safety and safe handling procedures for these dangerous agents are reviewed.Blood and Blood FormationA medication review of blood and blood formation drugs are included in this sub-section. Drug interactions, mechanism of action and manufacturer named drugs are reviewed. Basic definition referencing to blood and blood formation abnormalities are given. VitaminsA medication review of Vitamins is studied. Drug interactions, mechanism of action and manufacturer named drugs are reviewed. Fat-soluble and water-soluble vitamins are discussed. A study acronym is illustrated to assist the student in remembering which vitamins are fat-soluble. Herbal products and homeopathy are briefly discussed as well.

DefinitionsThe definitions module explores basic terminology and environmental contamination concerns in performing aseptic techniques procedures. Laminar airflow hoods, air filtration systems and inspection requirements are highlighted. A review of vertical airflow hoods, or biological safety cabinets, is included and uses for each type of hood are given. SyringesThe components of a syringe are illustrated and reviewed. Various types of syringes are graphically illustrated. The components of a needle assembly and how the size or gauge of a needle is determined are graphically illustrated.Parenteral

This sub-section contains drugs which affect the Renal System. A review of basic definitions referencing the renal system is discussed. Drug interactions, meclianism of action and manufacturer named drugs are reviewed. Components of the Renal System are briefly reviewed.Anti-Bifectant DrugsDrugs classified as Anti-Infectant Drugs are included in this sub-section. Drugs interactions, mechanism of action and manufacturer named drugs are reviewed. Anti-lnfectant drug classes and typical treatment regimes are discussed. Therapeutic classes used in the treatment of infections are reviewed.Cancer Chemotherapy Drugs

Aseptic TechniquesAseptic Techniques gives the student a ‘bird’s eye* view of preparation procedures for parenteral products. Pictures taken during actual preparation of various sterile products are used to illustrate a particular topic. Laminar airflow and Horizontal airflow hoods are covered with pictures and diagrams. Devices used in the preparation of sterile products are illustrated. The study topic provides the basics of Aseptic Techniques with emphasis toward possible testing topics. USP 797 & 800 sterile preparation and procedures are covered in this section.Xuh-Seetions

receivedJUL 0 7 mn

doh/hsqa/ocs

A high level review of various injection types is reviewed. The uses of parenteral routes and the four most widely used parenteral routes are discussed. Intravenous injection types and widely used parenteral fluids are illustrated. The module prepares the student for review of sterile compounding.

of Sterile CompoundingA review of sterile compounding procedures provides a broad ‘overview’ of skills needed to perform sterile compounding. Tips in avoiding contamination while using a laminar airflow hood and various procedures that assure successful sterile product mixing, are provided. Examples of filling a syringe, breaking an ampule, reconstituting a sterile powder, injecting liquids into a plastic IV bag, introducing liquids into a glass intravenous bottle, and many more needed aseptic techniques are reviewed. SolutionsThe Solution sub-section reviews the uses of various solutions used in Pharmacy. Irrigation solutions, parenteral solutions, and TPNs are highlighted.Parenteral Antineoplastic Agents

CalculationsPharmacy calculations are an essential function of the Pharmacy Technician. The PTTP’s calculation section provides a refresher path through the aspects of Pharmacy mathematics. Many example calculations are done using diflerent methods, thus, providing the student a choice for calculating Pharmacy math problems that best suits the individual’s needs. The Calculation section provides an excellent tool for learning Pharmacy mathand the calculations are performed ‘in motion’, with a timed audio presentation.

Metric System

A general overview of preparation, and the safe handling of Antineoplastic agents used in the treatment of cancer is provided. Emphasis on personal safety and safety procedures for handling these dangerous agents are discussed.Stability Considerations for Parenteral ProductsParenteral Products have special stability concerns. Stability considerations, as well as information on various types of reference material are given. The steps of a Parenteral Admixture Order are illustrated. Details from receiving the order to delivering to the patient are discussed. USP797The United States Pharmacopeia is a non-govemment, non-profit organization designed to create standards on patient safety, healthcare information, and verification of products. The purpose of the U.S.P. 797 is to set the standard for the compounding of sterile products as well as to prevent harm and deadi to patients. Standard operating procedures, compounded sterile preparation, microbial contamination risk levels, storage and b^ond use dating, hazardous drug {reparation, environmental quality control, and quality assurance are some of the topics discussed in this section. USP800Like USP 795, 797 the provisions of USP 800 address the product transport, product storage, compounding, pre{)aration and the administration of parenteral products. USP 800 focuses on hazardous drugs and occu{)ational safety in health care settings and all types of pharmacies. USP 800 also explains how to limit and minimize ex|x>sure to hazardous drugs.

RECEIVEDPharmacy Operations JUL 01 ?n?n

DOH7HSQA/OCS

Audio, charts, graphic illustrations and text help files are used to provide the student with knowledge and reference tables for use in performing various conversions. The units of measurement for the Metric, Avoirdupois, and Apothecary systems are discussed. Abbreviations

The Pharmacy Industry exists in a world of ^breviations. Abbreviations uses in prescriptions are covered in detail. Emphases on abbreviations that have historically been misinterpreted are discussed. Reference listing of Pharmacy abbreviations is included.

Roman NumeralsThe eight primary Roman Numerals are illustrated, with emphasis on ‘rules' for adding and subtracting. Roman Numerals are widely used in Pharmacy.

Fractions, Decimals, A Percent

This review provides the basics of fractions, decimals and percent. The intensive use of ‘motion graphics' support the audio driven lesson. A good understanding of this section will provide the student a basis for the remaining calculations topics.

Temperature ConversionsTvto widely used methods for Fahrenheit - Centigrade temperature conversions are illustrated. The audio driven lesson uses ‘graphics in motion ‘ to provide clearly explained examples of typical pharmacy temperature conversions.

Ratio ProportionsRatio proportion relationships are used to provide a means for reducing or enlarging chemical mixtures used in pharmacy. Determining the proper amount of solution to mix with drug active ingredients is covered.

Quantities, Dilutions, A ConcentrationsQuantities, dilutions, & concentrations provide a review of unit of measurement for drug and expressions of quantity and concentration for drugs in drug products. Illustrations are discussed for the different methods for determining quantities of ingredients and concentration of drugs when preparing or dispensing drug products.

Doses and Dose RegimenA review of methods of expressing doses and dosage regimens is given. The student will learn to calculate the amount of drug product to dispense and the number of days' supply from a dosage regimen. In addition, methods to calculate doses for pediatric patients are provided.

Calculation of IV Flow RatesThe student will learn to determine the flow rate of an IV solution when given die total volume, total timeof administration, and the drops delivered per ml by the administration set.

Powder Volume

Discussions of powder volume concept are given. Learn how to calculate powder volume and how to use this infonnation in reconstituting dry powders for suspension or solution.

Pricing

Pricing methods support the needs of the pharmacy as a business enterprise. Our study guide will provide a review of various pricing methods used in retail pharmacy.

JUL 07 2(17(1DOH/HSQA/OCS

Pharmacy Operations is the core of the Pharmacy Technicians responsibilities. Day to day operations, interfacing with customers, maintaining patient records, and assuring the Pharmacy meets all State, Federal and local requirements are covert. Managing proper inventory control is vital in assuring continuing success of the Pharmacy business. An overview of insurance claims and ""Third Party” reimbursement is provided. Medication safety is a priority in dispensing medication to patients. Learning how to give appropriate change in covered in the Cash Register sub-section. Sub-SectiansBask Facts in PharmatyThe Pharmacy Technician will need to be familiar with drug nomenclature. The three names given to each drug is reviewed. NDC codes, mnemonic codes, and the importance of understanding different expiration date formats are discussed and illustrated. The various drug containers are illustrated. The different types of container closures and uses for each are reviewed. Auxiliary labels affixed to prescription bottles are reviewed.Assisting the PharmacistAcceptable medication prescribers are reviewed. Mailing prescription requirements, patient confidentiality, assisting the pharmacist, immunizations, The Combat Me^amphetamine Epidemic Act of2005, and how prescriptions can be transmitted to a Pharmacy and requirements for certain classes of drugs is discussed. The required information on a prescription and the process for patient refills is given.General Prescription Duties

Maintaining an accurate patient profile is crucial in providing medication to a patient. A well-maintained patient profile can prevent improper dispensing of medication and adverse effects for medication. Details of what should be collected for a proper patient profile are illustrated. Brand versus generic, formularies, inventory control, measuring and counting techniques, compounding and the different classes of balances, medication errors, and the step tty step process of filling a prescription in a pharmacy are discussed. USP79SLIPS 795 defines general information to support extemporaneous compound preparations that are of acceptable strength, quality and purity. Important USP 795 terms and definitions are presented and explained. How-to Preparations are performed for suppositories, ointment, suspension and an enema. Medication Distribution and Inventory ControlDefinitions of key terms used in inventoiy management are provided. Ordering techniques and the proper receiving process of ordered items is reviewed. Expired or discontinued stock processes and drug recall issues are illustrated. Point of Sale Management Systems, electronic prescribing, electronic medication administration record, and theft and drug diversion are discussed also.Third Party ReimbursementKnowledge of ""Third Party” reimbursement is an "ever changing’ environment A general overview of processes used for reimbursement and different payment plans currently offered is illustrated. Formularies, generics, DAW codes. Affordable Care Act Medicare, and Medicaid are reviewed. Medication SafetyMedication errors are covered in depth. Prevention strategies, causes of medication errors and where and why they occur, sound-alike and look-alike medications. Tall Man lettering,

S!ub~seetinnx


DOH/HSQA/OCS

errors to Medwatch and MERP» 5 rights of medication administration, e-prescribing, HITECH Act, iPLEtXjE and other medication safety programs,Cash RegisterThe use of the cash register is vital to Customer Service in the pharmacy. The student will learn the accurate way of calculating how to give change.

Memory Matchusing the old school "Concentration Game’ students will need to turn over two matching cards with brand/generic drugs printed on them or match the appropriate pictures of brand named drugs to the name of the drug.

Roman Numerals

Study AidsThe Study Aids are an excellent way of teaching while having fun! The Study Aids were designed as an enhancement to the Medication Review Section. This part of the program will enable the student to become familiar with over 200 drugs widely used in the market place. The Study Aids consist of flash cards and are created to allow the student to recognize and pronounce the medications reviewed alt while having ftin "playing’ games. The games include Flashcards -""Top 200 Drugs”, ""Memory Match”, “Roman Numerals”, “Sigs”, ""Abbreviations”, and the additional Study Aids: “Study Table”, ""Virtual Rx” and ""Virtual Cash Register”. Drug name pronunciations as well as visual recognition of all medications reviewed are included.

Flash CardsFlash cards appear with a Cardinal (English) number or a Roman Numeral that are matched to the correct translation of the number or numeral. A short quiz follows.

Study TableWithin the “Study Table” all pertinent information regarding the Top 200 Drugs will be formatted that any part can be "covered’ in order to study the brand vs generic as well as the drug classes, therapeutic classifications and drug uses. Pictures of brand drugs are shown as well as brand and generic pronunciations are available. The user controls whether the information is viewable or hidden.

Top 200 DrugsFlash CardsStudents will discover more than 200 drugs used in the marketplace and review the brand verses generic, drug classes, therapeutic classifications and drug uses within this portion of flash cards. Tests are also available for this module.

SIGSFlash CardsFlash cards appear with a SIG or abbreviated directions that should be matched to the correct translation inEnglish. (Or vice versa) Abbreviations Flash Cards

JUL 07 2020DOH/HSQA7OCS

Each state board of pharmacy has specific rules and regulations that pertain to the pharmacy industry. You will be directed to your state’s laws via a link to per the address used when you fill out the profile information when first accessing this course.

Pre-FinalThe “Pre-Final” is available using the Student Learning Center’s web interface. The “ Pre-Final” has a separate ffata base of question sets from the six sections. The “Pre-Final” is a timed indicated test, with feedback to enhance the learning exercise. The test timers are halted when a feedback screen is displayed. When thetwo-hour time limit has expired, a warning will appear, indicating that the two-hour time limit has been reached. However, the “Pre-Final” will allow the student to complete the test, even if the two- hour time limit has expired.If an answer to a question is correctly selected, feedback is given supporting the correct answer. If an incorrect answer is selected, feedback is given offering the student additional information to understand the correct answer.

Flash cards appear with pharmaceutical abbreviations that are matched to the correct translation in English. (Or vice versa) A short quiz follows.

Virtual Rx

Effective CommunicationStudents realize the effectiveness on proper communications between customer/patient and the Pharmacy Technician. W ith appropriate communication, correct questions are asked and issues as well as orders are efficiently processed as well as misunderstandings and errors are avoided. A short quiz follows.

HIPAA RegulationsUnderstanding the confidentiality for all patients and customers should be one of the highest priorities in the medical field! Privacy Rules and laws that are standards in the pharmacy industry are discussed. A short quiz follows.

State Law

Flash CardsFlash cards with prescriptions enable the student to “dissect” all parts of the script and answer questions thatcorrelate with information that appears on the prescription. A short quiz follows.

InterviewStudents will understand the important preparations, considerations and attributes to a successful interview. A short quiz follows.

FinalThe “Final” is available using the Student Learning Center *s web interface, iFhen the educator has granted the student access to a **Finar, the student will gain web access to the testing system. The “Final” is designed to mimic the national certification exams. The “Final” offers the student no feedback. Directly after an answer is

The successful completion of the “Final” completes the didactic portion of the course.

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551 - (was SS21 Certification, I.iccns»re. and RcgislralRw 2:53552 - (was SS3) The Exams and Recertification 7:58______ '

(2) FEDERAL LAW_______________________________. SSI - Pharmacy l.»v and Tiriie 5:18

SS2-Fedcrattaw and DnigsrS:.!? •'• SS3 - Rilles of Controlled Substances 4:54

• SS4^> DEA Number Vwification 1:30 'SS5^ Schedule II Drugs 0:52

• .S$6-^ltiivestigatiortal Utu^0:54(3) MEDICAL REVIEW______________________

• SSi-Poses and Terhiindlbg'.22:50_____________552 - (moved from ’videos*) Basie Anatomy 5:27

-••• SS3-(was'SS2)-CNS9:55. - ::■••••• - •. '■ ■ ■• SS4 - (was SS3) PNS 10:50 < ___________SS5- (was SS4) Hbnnbrtes 6:27556 - (was SS5) Cardiovascular 6:27 _________SS7-(was SS6) Renal 3:13 :

. SS8 -(yas SS7) Aiiti-lnfcctant 4:58 ________SS9-(was SS8)CaiieerChcih6 3:53_____________

. ,.SS10-.twas SS9)Blootland Blood Formation3:04~SSI I (wail SSIO) Viiamins 6:06 ___________ •

(3.5)STUDY AIDS (done in conjunction wZMed.Review) Top 200 Drugs (Hash cards)_________ •

' .Memory Match (activity), -. . . 'Roman Numerals (flash.eordsj' _____ ._________'

• StiidS' Table (activity)Sigs (flash cards) _____________________________Abbreviations .(tlasfa cards), /•: .Viniial Rx (activity/iesi) ________ "•

(4) ASEPTIC TECHIQUES______________________SSI -Definitions 3 J7 •

• SSa'-Syringes 1:40 . " ’ : ■ ’ • : ' .553 - Pawnteral 5:0.5554- Ti^cliniques for sterile Compounding 11:13 :555- Solutions 2:14 ________ •

' VSSK^ Parehforal ' Ailtirieoplastie 7\gents'5:23557 - Sufoiliiy Ctmsideiations in Parenteral Products 2:26558 - (currently) IJSP 797 23:24SS9-.U$P 800 13:52

(5) CALCULATIONS___________SSI Metric System 5:29SS2-Abbreviations 4:18SS3 t7 Roman Numerals 2:08 . ______________

' SS4 - Fraction, Decimals, and Peritent 18:38_______. SS5.-Temiteratme Cotiyersibns 7:55, . .SS6-Ratio’Proportioris5:34 ■SS7 - Qmmtities. Dilutions, and Copcengations.28:28.,

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Pharmacy Technician Training Program Student Instructions

RECEIVEDJUL 0 7 7n7n

DOH/HSQA/OCS

Note: Never move forward to the next sub-section until you have mastered the subsection previously worked. Study/Complete all sub-sections tutorials & Learn Files/Quizzes in one section. Quizzes will not be accessible until the appropriate SubSection Tutorial video has been viewed. Section Tests are also not available until all Quizzes in that Section have been completed.

1. Log in (using the student credentials) via httDs://traininu.passassured.com/login and savethe address to your favorites. Log in may also be accessed via www.Dassassured.com.

2. Fill out the Student Profile (address is necessary) and agree to the Terms of Use.3. Click on the first Section, Orientation and watch tutorials (videos)4. Click the Learn File icon and read/study. a. All ~46 Learn Files are printable

b. You may choose to place the Learn Files in a 2” three ring binder w/dividers5. Take quiz found under the Quizzes & Tests tab.6. After each Section Tutorials are watched & Quizzes passed in the Section, take the

Section Test.a. Section Tests should be taken as often as needed. More complex sections i.e.

“Medical Review” should be taken more often than “Federal Law.” The “Study Aids” should be studied in conjunction with the “Medical Review” Section

7. Repeat any or all of the above steps until all content are learned.

8. Move to next Sub-Section and repeat above steps.9. As a preparatory or review for the last two tests in PTTP, take the Section Tests at least once more.10. After the completion of all of the above, take the Pre-Final.

a. The Pre-Final is a review of the entire course and has its own data base of question sets.b. Take Pre-Final several times; if there is a weakness in any of the course content then go back and re-do that subsection or section

1 l.Take the Final

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(6) PHARMACY OPERATIONS_______________SSI-^'Basicracte in Phamiacy 8:55 • •

,.,SS2Assisting tfiePhnrniacist..l5:l8 . ________,SS3-Generar Prescriptions 15:20 ___________ .

• SS4 - (added) USP 7^5 9;05 ‘SS5-(wuiSS4) Medication Distfibtttion Inventory 12:38

' SS6 - (Was SS5) Third Party Reimbursement 13:56 ■SS7 - (was SS6) Medication Safety 27: L*i

•. SS8 - (cunently named Cash Register) activity_______IfrteMew 10:19 ______ •Effective Communication 22:40 _____________ •

''HIPAA Regulations (Read then tost) . ____Pre-Final_________________________________final

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Module 1DOH/HSQA/OCSFor reference for all modules see the following websites:

Successful completion is 80% or greater on all tests and exams. For complete preparation for the ExCPT or PTCE, it is recommended that all tests taken pass with 85% or greater.

The following modules will cover critical knowledge from the Pharmacy Act, Pharmacy Ancillary Personnel Act, Legend Drug Act, Controlled Substances Act and other statutes applicable to pharmacy practice, federal and state regulations and guidelines/interpretive statements. After completion the trainee should be able to fluently discuss legal considerations in pharmacy practice and how they are applicable to the practice of their profession. Each module will be discussed with the instructor following review. Discussions should total no fewer than 8 hours and must be verified through documentation by the designated instructor(s).

Know that knowledge of current law is critical to the practice of pharmacy. Ignorance of the law is not a valid excuse in pharmacy. Always refer to the state board of pharmacy and the DEA website for the most up-to-date information.

Principles of Applicable Pharmacy Law Tri-Area Pharmacy

Appendix B:Principles of Applicable Pharmacy law

a. The Final is only accessible if all prior Quizzes, Section Tests and PreFinal have been passed with an 80% or above.

b. The Final has a completely separate database of test question sets.i. The Final should not be accessed if there is not time to complete in2 hoursii. If the Final is started and not finished in two hours, all unanswered

questions will be marked as wrong and the Final will be locked for 10 days.

iii. If the Final is locked & you absolutely need access, please have your educator reset it or call our office for directions.

iv. The Final may only be taken a maximum of three times.1. If the Final is failed all three attempts the program should be restarted.

a. Call PassAssured fordetails

PharmacistsPrescription record requirements RCW. 18.64.245

Prescription labeling/containers RCW. 18.64.246

Prescription paper and tamper resistance RCW. 18.64.500

Dispensing of non-controlled drugs - limits RCW. 18.64.520

Pharmacy AssistantsDefinitions RCW.18.64A.010Qualifications and Training RCW.18.64A.020

Technician/Assistant Duties RCW.18.64A.030

Practice Limitations RCW.18.64A.040

Grounds for Disciplinary Action RCW.18.64A.050

Uniform Disciplinary Act RCW.18.64A.055

Application for Ancillary Personnel RCW.18.64A.060

Acting Technicians RCW.18.64A.070

Liability and Responsibility RCW.l8.64A.080

Uniform Disciplinary ActUnprofessional Conduct Findings RCW. 18.130.160

Unprofessional Conduct RCW. 18.130.180Fraudulent/Misrepresented Licensing RCW. 18.130.200

JUL 0 7 ?n7n

DOH/HSQA/OCS

httns://www.doh.wa.gov/licensespermitsandcertiFicales/faciHtiesncwTcncwonipdatc/pharmacy/laws http://search.leg.wa.gov

Legend Drugs and Prescription Drugs- Prohibited Acts- Prescription Requirements/Penalties- Record Requirements- Confidentiality- Labeling Requirements/Penalties- RX Drug Equivalents/Substitution- Substitution Signage Requirements

RCW.69.41.020RCW.69.41.040RCW.69.41.042RCW.69.41.044RCW.69.41.050RCW.69.41.120RCW.69.41.160

RECEIVED

RCW.51A,005

RCW.70.02

RCW.70.225.020

receivedJUL 07 ?o?o

doh/hsqa/ocs

Prescription Monitoring Program- Duties of Dispensers

Medical Records- Health Care Information Access

Drug Injection Devices- Sales of Syringes and Needles- Not Required to Sell Syringes

Medical Marijuana- Purpose and Intent

RCW.70.115.050RCW.70.115.060

RCW.69.75.010RCW.69.75.020

RCW.69.50.1RCW.69.50.2RCW.69.50.3RCW.69.50.4

Uniform Controlled Substances Act- Definitions* Standards and Schedules- Controlled Substance Regulations- Offenses/Penalties

Dextromethorphan- Definitions * Retail

Module 2

WAC.246.12.260

WAC.246.12.270Accepted AIDS Education

WAC.246.860Standards of Professional Conduct

WAC.246.861Professional Pharmaceutical Education

WAC.246.869Pharmacy Licensing

WAC.246.870Electronic Prescriptions Transmission

Parenteral Products Outside the Hospital

WAC.246.871.020Policies

Physical Requirements WAC.246.871.030

WAC.246.871.040Personnel

WAC.246.871.070Clinical Services

WAC.246.871.080Quality Assurance

Patient Medication Record System

WAC.246.875.010Definitions

WAC.246.875,020Minimum Info in Automated Record System

Minimum Info in Manual Record System WAC.246.875.030

WAC.246.875.040Minimum Procedures for use of Record System

WAC.246.875.050Auxiliary Record Keeping Procedures

WAC.246.875.060Retrieval of Info from Automated System

WAC.246.875.070Confidentiality and Security of Data

WAC.246.877.020Pharmaceutical Drug Sample Restrictions

Good Compounding Practices

WAC.246.878.030Organization and Personnel

RECEIVED

JUL 0 7 2020DOH/HSQA7OCS

Administrative Requirements for Care Providers - AIDS Education

WAC.246.878.040Facilities

Equipment WAC.246.878.080

WAC.246.878.090Components/Containers/CIosures

WAC.246.878.100Drug Compounding Controls

WAC.246.878.120Records/Reports

Prescription Drug Price Advertising

WAC.246.887.010Price Advertising Definitions

WAC.246.881.020Drug Price Advertising Conditions

WAC.246.881.030Prohibition on Controlled Substances

WAC.246.881.040Drug Price Disclosure

WAC.246.883Sales Requiring Prescriptions

WAC.246.885Legend Drug Identification/Marking/Labeling

WAC.246.887Implementing the Uniform Controlled Substances Act

Precursor Substance

WAC.246.889.070Sales of OTC Pseudoephedrine/Precursors

WAC.246.889.085Sales Requirements

WAC.246.889.090Acceptable Forms of Identification

WAC.246.889.095Recording of Sales

WAC.246.889.110Maintenance of Sales Records

WAC.246.889.115Exemptions from Electronic Reporting

WAC.246.889.120Denial of Sale and Overriding

RECEIVEDJUL 07 7071)

DOH/HSQA/OCS

WAC.246.891WAC.246.895WAC.246.899WAC.246.901WAC.246.907

ProphylacticsGood Manufacturing PracticesDrug Substitution Ancillary PersonnelLicensing Periods and Fees

Module 3

Module 4

DEA Controlled Substances Act

Labeling and Packaging Requirements for Controlled Substances

General Information Regarding Prescriptions

Schedule II Controlled Prescriptions

JUL 07 ?n?oDOH7HSQA/OCS

Reference:https://www.doh, wa.uovZLiccnscsPcmiitsandCertificates/ProfcssionsNcwRcncworUpdate/PharmacyCommlssion/WhoCanPrescribeandAdininlsterPrescriptions

Washington State Department of Health: Who can Prescribe, Administer, Possess Legend Drugs and/or Controlled Substances in Washington State

Required SymbolSymbol Location and Size in LabelingSealing Controlled Substances

Prescription PurposeIssuance of PrescriptionsPersons Allowed to Fill Prescriptions Dispensing/Administering Narcotic DrugsElectronic Prescriptions

Prescription Requirements Refilling PrescriptionsPartial Filling of PrescriptionsLabeling and Filling Prescriptions

Section 1302.03Section 1302.04Section 1302.06

Section 1302.04 Section 1302.05Section 1302.06Section 1302.07Section 1302.08

Section 1306.11 Section 1306.12 Section 1306.13

RECEIVEBection 1306.14

Reference:https;//www.deadiversion.usdoj.gov/21cfr/cfr/inde.x«html

Section 1306.15Retail and Central Fill Provisions

Prescriptions - Schedule III, IV, and V

Module 5

RECEIVED

JUL 01 7070doh/hsqa/ocs

Chapter 11: Law and Ethics tor Pharmacy Technicians Chapter 11: Review Questions

Section 1306.21 Section 1306.22

Section

Section 1306.24Section 1306.25Section 1306.26Section 1306.27

Prescription RequirementRefilling PrescriptionsPartial Filling of Prescriptions1306.23Labeling and FilingTransfer of Prescriptions - Schedule III, IV, and V Dispensing Without a PrescriptionRetail and Central Fill Provisions

Reference:Pharmacy Certified Technician Training Manual

Please check off or fill in “n/a*’ (not applicable) after completed;

After all aspects are complete: Pharmacist Tech Date


receivedJUL 0 7 7n?f)

doh/hsqa/ocs

Appendix C:Pharmacy Tech Experiential Skills Checklist

2. Understanding patient confidentialitya. Employee must fill out confidentiality statementb. HIPAA

3. Ability to perform pharmaceutical calculationsa. Fractions, Decimals & Percentsb. Temperature Conversionsc. Ratio Proportionsd. Quantities, Dilutions & Concentrations_e. Calculations of IV flow rates if applicablef. Powder volume

1. Orientationa. Pharmacy layout

i. Knowledgeable of various departmentsii. Knowledgeable of merchandise sold

b. Pharmacy laws and rulesI. State and Federal dispensing guidelinesii. Ephedrine, pseudoephedrine, phenylpropanolamine - Sales

restrictionsiii. Record keeping requirementsiv. Required RecordsV. Prescription Recordsvi. Transfer or disposal of controlled substancesvii. DEA number verification

c. Security and safetyd. Hygiene

I. Washing handsii. Cleaning counting trays, counters, and other equipment

Tech After all aspects are complete: Pharmacist Date

4* Refill supplies and stock for dispensing.




Date

receivedJUL 07 2020

DOH/HSQA/OCS

8. Refilling a prescription (Electronically or phoned In or in person) a. Requests from Doctors

i. Name of patient

5, Knowledge of store pricing strategya. Being aware of price increasesb. Update selling prices of stock_c. Stock rotation

6. Receiying prescription from customera. Greet the customer promptly and courteouslyb. Assist with selection of productc. Ask if new patient or existingd. Collect/follow up necessary data from customer and enter

informationi. date of birthii. nameiii. addressiv. brand name or generic preferenceV. telephone number

Vi. drug allergiesvil. weight (important to know for infants)viii. insurance information

e. Guidelines for referring customers to the pharmacist for questions

7. inputting new prescriptiona. Ensure all information is accurate (from 6. d.)

After all aspects are complete: Pharmacist Tech



RECEIVED

JUL 07 20?0D0H/H3QA/0CS

9. Understanding components of a patient medication profilea. Medication historyb. Disease statesc. Allergiesd. Special requests (i.e. easy open tops)

ii. Patient's DOBHi. Patient's medication name/strength/qty/# refills

b. Customer phoned in or deliveredi. Patient nameii. Phone number

Hi. Prescription numberiv. Drug name, strengthV- Qtvvi. Prescriber's name and info.vii. Insurance info.

c. Information given to prescriber when calling for a refill authorization.,i. Pharmacy name & numberii. Patient's name & DOB

Hi. Drug name, strength and qty.iv. Original prescription date and last refill dateV. Prescription sig

10. Interpreting prescriptionsa. Patient informationb. Drug brands and genericsc. Strengths and systems of measurementd. Number of dosage unitse. Routes of administrationf. Frequency of administrationg. Directions for useh. Commonly used abbreviations, symbols, and terminology.i. DAW codes


c.



a.


DOH/H3QA/OCS

12. Patient Profile warningsa. Drug-to-Drug Interactionsb. Drug interactionsc. Allergiesd. Cross sensitivity

11. Drug Utilization Reviews and Third Party Reimbursement Considerationsa. Not on formularyb. Quantity Restriction

Prior Authorizationd. Over-utilization

13. Drug preparationCreating new patient profile or updating existing patient profile

b. Entering prescription information and type labeli. If not legible, ask pharmacist to clarifyii. Call doctor for clarification if needediii. If any alerts, promptly bring to the attention of pharmacist

c. Selecting the correct stock bottle containing medicationI. Check the NDCii. Scan the stock bottle & prescription labeliii. Watch for Look-alike Drug namesiv. Use of Tall Man Lettering

d. Accurately counting or pouring appropriate amount of drug to fulfill prescription order

e. Selecting proper containerf. Attaching prescription labelg. Attaching auxiliary labels if neededh. Preparing the finished product for inspection and final check by

pharmacistsi. Bag the script




DOH/HSQA/OCS

i. Place in proper placementii. Check out customer

1. Verify name and DOB2. Verify number of scripts picking up3. Check scripts are correct4. Check if pharmacist counseling is needed or if questions for

pharmacist5. Does Customer need instructions on taking meds6. Customer need to sign log?7. Receive payment

a. 3^*^ party copayb. Cash transactionsc. Proper use of cash register/making change

8. Thank them

14. Using proper Telephone etiquettea. Taking refill requests from patientsb. Calling doctors for refill requests or questions on new or refilled

prescriptionsc. Referring questions to the pharmacistd. Referring new prescriptions called in by doctors to the pharmacist

15. Drug inventorya. Ordering medication

i. Know timetables for orderingii. Borrowing from other pharmacies

b. Restocking medicationc. Returning medication per pharmacy return policies

i. Controlled Drugs1. Full2. Partial

ii. Out-of-date medicationsiii. Overstocked medsiv. Damaged meds



RECEIVEDJUL 07 7070

DOH/HSQA/OCS


18. Aseptic Techniques and USP797 Guidelines



V. Re-called medsd. Understanding turnover ratee. Keeping stock clean and straight and proper orderf. Replace borrowed stock from other pharmacies

16. Ordersa. Placing orders

i. Ordering drugs needed to fulfill patients' prescriptionsii. Ordering drugs to maintain current stockHi. Ordering any merchandise sold in pharmacy

b. Receiving ordersI. Verifying receipt of drug by invoice or purchase orderii. Placing stickers on drugsiii. Placing new drugs on the shelves, in refrigerator, etc.iv. Complete the proper documentation of receipt of goods.v. File invoice

17. Compoundinga. Calculationsb. Formulasc. Proper garbingd. Measuring ingredients.e. Proper labelsf. Pharmacist approvalg. USP795

Tech Date After all aspects are complete: Pharmacist

RECESVEDJUL 0 7 7n?n

DOH/HSQA/OCS


a.


a. 22. Quality Assurance and Improvement

Notify pharmacist of adverse drug reactions b. Five Rights of Medication Administration

21. Printing daily drug logsControlled Drugs,

b. Legend Drugs

b. Denialsi. Expired Duration of coverageii. Misspelled name or incorrect date of birth

m. Patient no longer employed with company providing insurance iv. Not listed on Insurance Companies Formulary.V. Exceeds allowed limit/time frame

c. Overridesd. Understanding Medicare / Medicaid Coveragese. Paper claims

20. Insurance processinga. Submitting prescriptions

i. Customer payment forms1. Copayments2. Deductibles3. Coinsurance

ii. Prescription Card1. Card Holder name_2. ID number3. Group number4. Coverage date5. Rx BIN number6. Rx Group Number.


receivedJUL 07 7n9n

DOH/HSQA/OCS


23. Solving Problemsa. Defuse complaints from patients, doctors or employeesb. Identify potential problems and notify pharmacist

25. Maintain Environmenta. Keep fill area neat and prepared_b. Noise levels down to a minimumc. No personal cell phonesd. Keep bottles and lids fillede. Keep printers readyf. Shred old labels promptly

i. Right Patientii. Right Medicationiii. Right Doseiv. Right RouteV. Right Time

c. Avoiding "Do Not Use" abbreviationsd. Reporting medication errors

i. Institute for Safe Medication Practicesii. Med Watch

e. Help in gathering information for auditsf. Keep up with CE credits for technician skill enhancementg. Assist in maintaining compliances with laws

24. Professionalisma. Adhere to personal appearance guidelinesb. Be a team player by:

i. Rarely missing workii. Being punctual

iii. Filling in for others as needed Iv. Being polite and helpfulV. Promoting good customer service_vi. Have a positive attitude



27. Gimplete any duty as directed by the pharmacist


(technician) has

Technician Training Director;

Printed Name: Date:

RECEIVED

JUL 07 7070DOH/H3QA/OCS

I hereby proclaim that completed the required practicum requirements.

26. Filing prescriptionsa. Controlledb. Legend

TECHNICIAN

ON THE JOB TRAINING

PROGRAM

JUL b! zu/U

OQh/HSQA/QC§

MANUAL

TRI-AREA PHARMACY

RECEIVEDJUL 07 ?n7n

A. OrientationDOH/HSQA/OCS

B. E-learning with Instructor Discussions and Activity work

Pharmacy Technician Training Program Student Instructions

Pass Assured Access:

8. Move to next Sub-Section and repeat above steps.

Note: Never move forward to the next sub-section until you have mastered the subsection previously worked. Study/Complete all sub-sections tutorials & Learn Flles/Quizzes in one section. Quizzes will not be accessible until the appropriate SubSection Tutorial video has been viewed. Section Tests are also not available until all Quizzes in that Section have been completed.

Online learning will be derived from Pass Assured and Good Neighbor University. Summary of the topics is listed for both online programs. There will be Instructor discussion for new topics and review of the online materials for better understanding of the subject matter. Trainee activities will also be done after Instructor discussions as part of the course requirement.

IntroductionsTrainee will be given copy of the Pharmacy Technician Training Manual.Discuss training program objectives and expectations from both instructor and student. Discuss course outline and On The Job training functions of the trainee. Discuss course requirements and time documentation (see appendix A) Review of Tri-area Pharmacy Company Rules and Regulations (copy is enclosed) Review of Tri-area Pharmacy Ancillary Utilization Plan (copy is enclosed)

1. Log in (using the student credentials) via https://training.passa.ssured.com/loQin and savethe address to your favorites. Log in may also be accessed via www.passassured.com,

2. Fill out the Student Profile (address is necessary) and agree to the Terms of Use.3. Click on the first Section, Orientation and watch tutorials (videos)4. Click the Learn File icon and read/study. a. All ~46 Learn Files are printable

b. You may choose to place the Learn Files in a 2” three ring binder w/dividers5. Take quiz found under the Quizzes & Tests tab.6. After each Section Tutorials are watched & Quizzes passed in the Section, take the

Section Test.a. Section Tests should be taken as often as needed. More complex sections i.c.

“Medical Review” should be taken more often than “Federal Law.” The “Study Aids” should be studied in conjunction with the “Medical Review” Section

7. Repeat any or all of the above steps until all content are learned.

RECEIVED.11 IL 0 7 2020

T

5

0.5

2.5

1,5

TestTTT

Successful completion is 80% or greater on all tests and exams. For complete preparation for the ExCPT or PTCE, it is recommended that all tests taken pass with 85% or greater.

0.51

2.52.5

47

££4

Learn r

0.25 0.75

__ __ 1__

0^0.25 Q;2S 0.25

34 5

___3

___432

__ __ 2__ __ 3

4

Pass Assured Petalled Timeline(1) ORIENTATION

551 - (was SS2| Certification, Licensure, and Registration 2:53552 - (was SS3| The E><am$ and Recertification 7:58.

(2) FEDERAL LAW _____________________551 - Pharmacy Law and Time 5:18552 - Federal Law and Drugs 5:32 :553 - Rules of Contrgjied Substances 4:54

'•' SS4 - DEA Number Verification 1:30 •SS5— Schedule H Drugs 0:52 • SS6r Investigational Drug5.0;54.

(3) MEDICAL REVIEW^____________________

551 - Doses and Terminology 22:50552 " (moved from Mdeos’) Basic Anatomy 5:27SS3.-(was SS2ICNS 9:55 _______554 - (was SS3IPNS 10;50____________’

. SS5 - (was SS4) Hormbnes 6:27‘ SS6-!-(was SSS) Cardiovascular.6:27

557 - (was SS6) Renal 3;13 :_______ •' ’558 ~ (was SS7| Anti-lnfectant4:58____________559 - (was SS8) Cancer Chemo 3:53___________5510 - (v^s SS9) Blood and Blood Formation 3:045511 (was SSIO) Vitamins 6:06

0.50.25 0.25 0.25

0.5 1.5

Quia0.75 0.25 0.5

2.25 0.5 0.5 0;5

0-25 0.25- Q:2S. ■

10.5 0.5 0.5

1 0.5

0.25 0.250.250.5

Total3

0.75 1.75

8 1.75 1.75 1.25-- 01750.75

4 • 4

Tutorials/ videos0.75

0.25 . 0.5

_________ 0.250.25 0.25

_________ 0.25 _________ 0.25 _________ 0.25

6.75 1

0.5

9. As a preparatory or review for the last two tests in PTTP, take the Section Tests at least once more.10. After the completion of all of the above, take the Pre-Final.

a. The Pre-Final is a review of the entire course and has its own data base of question sets.b. Take Pre-Final several times; if there is a weakness in any of the coursecontent then go back and re-do that subsection or section '^OH/HSQA/OCG

11. Take the Finala. The Final is only accessible if all prior Quizzes, Section Tests and Pre

Final have been passed with an 80% or above.b. The Final has a completely separate database of test question sets.

i. The Final should not be accessed if there is not time to complete in2 hoursii. If the Final is started and not finished in two hours, all unanswered

questions will be marked as wrong and the Final will be locked for 10days.

iii. If the Final is locked & you absolutely need access, please have youreducator reset it or call our office for directions.

zv. The Final may only be taken a maximum of three times./. If the Final is failed all three attempts the program should be restarted.

a. Call PassAssured fordetails


2

1:

4.75 30.25

1.5

6

1.5

.r •

3

0.5 0.5

MV

Good Neighbor Pharmacy University access: Email will be sent by the instructor to the trainee to access the program.

11.5

1.5 __ 3_ __ 2_ __ 2_

,.2 __ 8_

4 ^415

4 . 4

19.56.5

1-2 2 3 3 2

153"1.5

Blood Borne Pathogen In the PharmacyMedicare Parts C and D FWA Compliance training 2020 HIPAA training for PharmacyMethGuardOSHA - HazCom and SDS Standards

0.250.25 0.5 O.S0.50,5..

__1_ 18

0.5 O.S

0.25 __1_ __V0.5 1.5

1.25 0.5

.=0.5 0.5

"53" 0.25 0.75 0.75 0.5

0.75 0.75 1.5

0.25 0.25 0.5

151

___ __£

2 1 1

__ .5

2

__3

__ __ 1^ _ £ __£ __ -J_ __£ _ £ ._ £

2 ""33

4.5 _ £ _ £

4 _ £

6 _ £

0.5

4.511___2___2___

1.52___5.750.25 0.25 0.25

0.5 0.5 0,50,52___1

“535’ 0.5__O.S

0;2S1___1___

0.5__2 ■

1.25 0.50.5__0.25

"835'0.5__

0.750.75

0.5__1___1___2___

0.5__O.S__0.75

964

10.58.5

44

2.7353.255.256.57.5

5 7.757.757.51.25 0.75 1.25

• 1 s 2

67

(3.5)STUDY AIDS {done in conjunction w/Mcd.Review) Top 200 Drugs, (flash cards)

' Memory, Match (activity) ' Roman Numerals (flash cards)• ‘ :Study.Table(actlvitv) ....

Sijgs (flash cards) _________Abbreviations (flash cards)virtual Rx (actiytty/test)

(4) ASEPTIC TECHIQUES551 - Definitions 3:17_______552 - Syringes 1:40553 ~ Parenteral 5:05_______________________=SS4 -r Techniques for Sterile Cornpoundihg 11:13 . SS5‘Solutions 2:14__________ _________________

, SS6Parenterar Antineoplastic Agents 3:23557 “• Stability Considerations In Parenteral Products 2:26558 - (currently) USP 797 23:24 ___________________559 - USP 80013:52

(5) CALCULATIONSSSI - Metric System 5:29

, .iSS2-Abbreviations 4:18 ,5S3 - Roman Numerals 2:08SS4-Fractions, Decimals, and Percent 18:38

. SS5->-Temperature Conversions 7:55• SS6-Ratio Proportions 5:34 •:_____ .■SS7 ~ Quantities, Dilutions, and Concentrations 28:28558 - Doses and Dose Reglriiehs 17:21 • ______559 - Calculation of tV Flow Rates 7:16 '_____ •5510-Powder Volume 5:09 . !:..SjSll-.Pricing 3:20______________________________

(6) PHARMACY OPERATIONS_____________________551 - Basic Pacts In Pha.rtnacy 8:55 . : .552 - Assisting the Pharmacist 15d8_________553 -General Prescriptions 15:20554 - (added) USP 795 9:05 ______________555 - (was SS4) Medication Distribution inventory 12:38556 - (was SS5) Third Party Reimbursement 13:56SS7-(was SS6) Medication Safety 27:15____________SS8 - (currently named Cash Re^ster).activity Interview 10:19____________ •••’••Effective Communication 22:40

. HIPAA Regulations (Read then test) Pre-Final_____________________________________RnSI

rOTTCCNbiWBER oFWC^RaM hours:


doh/hsqa/ocsC. On the Job Training

Trainee must satisfy following before allowed to start on the job training:

Information covered during on the job training:

Workbook and activities with Pharmacist:

a. Tech Experential Checklist (see appendix B)- provides structure and activities based on information that trainee learned during online

training.- to be completed by the pharmacist the trainee works with during On the Job Training.

• Trainee has appropriate license/registration (must hold a Pharmacy Assistant License)• Trainee must have completed HIPAA, FSA, MethGuard and Blood Borne Pathogen training.• Trainee must have passed Final Exam from Pass Assured.

Pharmacy Computer System (data entry)Technician responsibilities - ancillary utilization planLabeling requirements£>rug product orderingDrug product recallsDrug product receiving proceduresOTCInventory guidelinesPharmacy SecurityCustomer Service StandardsProfessional standard of conductDrug product pricingPrescription returns and refundsGeneric substitutionPatient consultation and offer to counselPrescription accuracy standardsPrescription filling - selecting NDC numbersPrescription refillsPrescription safety containersAudits and InspectionsHIPAAPatient records releaseRecord retentionThird party billingExpired medicationsDrug product storage

D. Final evaluationTrainee must have completed following before Certificate of Completion is given;

E. Certificate of Completion

RECEIVED

JUL 07 207(1DOH/HSQA7OCS

Certificate of Completion issued after fulfilling all requirements for Final Evaluation.

At least 80% in Final Test of PassAssuredCompletion of all activities in handbookMust have spent no less than 520 hours in the program (completed timesheet) Must have spent no less than 12 hours with the instructor (completed timesheet) Must have spent no less than 8 hours instruction in the subject of Federal and State law (completed timesheet)Completed Experential Technician Checklist.

Director of the Tri-area Pharmacy Technician training program will check if trainee has completed following requirements.

- completed checklist to be placed in associate training file.b. Prescription reading and calculations practice- Workbook activitiesc. OTC product location- Workbook activitiesd. Communication- how to handle patient complaints* how to handle phone conversations

how to properly explain certain issues with prescriptionse. Inventory and proper storage of medications

proper storage of certain medications- inventory management

1. ordering2. checking for invoices and updating on hand quantities3. procedures in disposing expired medications as well as management of inventory in

keeping track of expiration datesf. Third Party Billing- proper entry of patient’s third party/insurance information- day’s supply (dosing charts for different dosage forms)- audits

Hours

3

3

2Week!

Weeks

Week 4

RECEIVEDIlli 07 2020 ■

8OOH/HSQAZOCS

21.51.5 1.5

Orientation in the Pharmacy (lecture) Orientation (Pass Assured - online) Federal Law (Pass Assured - online) Federal and State Law (Instructor discussion Module 1 and 2) Federal and State Law(Instructor discussion Module 3 and 4) Federal and State Law (Instructor discussion Module 5)

238

7444 642.52.52.5 42

16,5 12 23 3 22

Vitamins (Pass Assured - online)Top 200 drugs (Pass Assured - online) Memory match (Pass Assured - online) Roman numerals (Pass Assured - online)Study Table (Pass Assured - online)Sigs (Pass Assured - online)Abbreviations (Pass Assured - online)Virtual RX Activity/Test (Pass Assured - online) Instructor Review and DiscussionActivity 2

Doses and Terminology (Pass Assured - online) Basic Anatomy (Pass Assured - online) Central Nervous System (Pass Assured - online) Peripheral Nervous System (Pass Assured - online) Hormones (Pass Assured - online)Cardiovascular (Pass Assured - online) Renal (Pass Assured - online)Anti-infectant (Pass Assured - online)Cancer Chemo (Pass Assured - online) Blood and blood formationInstructor Review and Discussion Activity 1

Tri-area Pharmacy Technician Training Schedule Weekl

Virtual RX - activity/test (Pass Assured - online)Aseptic Technique (Pass Assured - online)Syringes (Pass Assured - online)Parenterals (Pass Assured - online)Techniques for Sterile Compounding (Pass Assured - online) 3 Solutions (Pass Assured - online) 2Parenteral Antineoplastic agents (Pass Assured - online) 2 Stability Considerations in Parenteral products 2(Pass Assured - online)USP 797 (Pass Assured - online)

Weeks

Week 6

Week?

Weeks

1

RECEIVED1

Illi 07 ?020’1

DOH/HSQA/OCS1

441.5964

10.58.5

5.256.5

5

7.757.757.51.250.751.251

42

Metric System (Pass Assured - online)Abbreviations (Pass Assured - online)Roman Numerals (Pass Assured - online)Fraction, Decimals and Percent (Pass Assured - online) Temperature Conversions (Pass Assured - online)Ratio and Proportions (Pass Assured - online)Quantities, Dilutions and Concentrations (Pass Assured - online)Doses and Dose regimens (Pass Assured - online)

44 2.758

Calculation of IV Flow Rates (Pass Assured - online) Powder Volumes (Pass Assured - online) Pricing (Pass Assured * online)Instructor Review and Discussion Activity 4Basic Facts in Pharmacy (Pass Assured - online) Assisting the Pharmacist (Pass Assured - online) General Prescriptions (Pass Assured - online) USP 795 (Pass Assured - online)

USP 800 (Pass Assured - online)Instructor Review and Discussion Activity 3

462

Blood Borne Pathogen In the Pharmacy(httD://gnpu.learnercommunity.com/)Medicare Parts C and D FWA Compliance training 2020 (hltp://gnpu.learnercommunity.com/)HIPAA training for Pharmacyhttp://gnnu.learnercoiTiinunity.com/)MethGuard(http://gnpu.learnercommunity.com/)OSHA - HazCom and SDS Standards

Medication Distribution Inventory(Pass Assured - online)Third Party Reimbursement (Pass Assured - online) Medication Safety (Pass Assured - online)Cash Register Activity (Pass Assured - online) Interview (Pass Assured - online)Effective Communication (Pass Assured - online) HIPAA Regulations (Pass Assured - online)Instructor Review and DiscussionActivity 5Pre-final (Pass Assured - online)Final (Pass Assured - online)

(http://gnpuJearnercomnnuuty.com/) 1

RECEIVED

JUL 0 7 2020 doh/hsqa/ocs

INSTRUCTOR DISCUSSION 1

Module 1For reference for all modules see the following websites:

PharmacistsRCW. 18.64.245RCW. 18.64.246

RCW. 18.64.500

RCW. 18.64.520

RCW.18.64A.010RCW.18.64A.020RCW.18.64A.030

Practice Limitations RCW.18.64A.040

Grounds for Disciplinary Action RCW.18.64A.050


DOH/HSQA/OCS

The following modules will cover critic^ knowledge from the Pharmacy Act, Pharmacy Ancillary Personnel Act, Legend Drug Act, Controlled Substances Act and other statutes applicable to pharmacy practice, federal and state regulations and guidelines/interpretive statements. After completion the trainee should be able to fluently discuss legal considerations in pharmacy practice and how they are applicable to the practice of their profession. Each module will be discussed with the instructor following review. Discussions should total no fewer than 8 hours and must be verified through documentation by the designated instructor(s).

Qualifications and Training Technician/Assistant Duties

Principles of Applicable Pharmacy Law Tri-Area Pharmacy

Pharmacy Assistants• Definitions

Know that knowledge of current law is critical to the practice of pharmacy. Ignorance of the law is not a valid excuse in pharmacy. Always refer to the state board of pharmacy and the DEA website for the most up-to-date information.

https://www.doh.wa.gov/lictfnsespcrmitsandcertificates/faciliticsnewreneworupdate/phannacy/laws http://scarch.leg.wa.gov

Prescription record requirements

Prescription labeling/containers

Prescription paper and tamper resistance Dispensing of non-controlled drugs - limits

- Uniform Disciplinary Act RCW.18.64A.055

Application for Ancillary Personnel RCW.18.64A.060Acting Technicians RCW.18.64A.070

Liability and Responsibility RCW.18.64A.080

Uniform Disciplinary ActUnprofessional Conduct Findings RCW.18.130.160

Unprofessional Conduct RCW.18.130.180

Fraudulent/Misrepresented Licensing RCW. 18.130.200

RCW.51A.OO5

RCW.70.02

JUL 0 7 ?07nDOH/HSQA/OCS

Medical Records- Health Care Information Access

Drug Injection DevicesSales of Syringes and Needles

RCW.69.75.010RCW.69.75.020

RCW.69.50.1RCW.69.50.2RCW.69.50.3RCW.69.50.4

Medical Marijuana- Purpose and Intent

Legend Drugs and Prescription Drugs- Prohibited Acts* Prescription Requirements/Penalties- Record Requirements- Confidentiality- Labeling Requirements/Penalties- RX Drug Equivalents/Substitution- Substitution Signage Requirements

Uniform Controlled Substances Act- Definitions- Standards and Schedules- Controlled Substance Regulations- Offenses/Penalties

DextromethorphanDefinitions

- Retail

RCW.69.41.020RCW.69.4I.040RCW.69.41.042RCW.69.41.044RCW.69.41.050RCW.69.41.120RCW.69.41.160

Not Required to Sell Syringes RCW.70.115.060

RCW.70.225.020


DOH/HSQA/OCS

Prescription Monitoring Program Duties of Dispensers

Module 2

WAC.246.12.260

Accepted AIDS Education WAC.246.12.270

Standards of Professional Conduct WAC.246.860

WAC.246.861Professional Pharmaceutical Education

Pharmacy Licensing WAC.246.869

Electronic Prescriptions Transmission WAC.246.870

Parenteral Products Outside the Hospital

Policies WAC.246.871.020

Physical Requirements WAC.246.871.030

Personnel WAC.246.871.040

Clinical Services WAC.246.871.070

Quality Assurance WAC.246.871.080

Patient Medication Record System

Definitions WAC.246.875.010

Minimum Info in Automated Record System WAC.246.875.020

Minimum Info in Manual Record System WAC.246.875.030

Minimum Procedures for use of Record System WAC.246.875.040

Auxiliary Record Keeping Procedures WAC.246.875.050

Retrieval of Info from Automated System WAC.246.875.060

WAC.246.875.070Confidentiality and Security of Data

WAC.246.877.020Pharmaceutical Drug Sample Restrictions

Good Compounding Practices

Organization and Personnel

DOH/HSQA/OCS

Administrative Requirements for Care Providers - AIDS Education

received,,,, WAC.246.878.030JUL 07 7070

Facilities WAC.246.878.040

Equipment WAC.246.878.080

Components/Containers/Closures WAC.246.878.090

Drug Compounding Controls WAC.246.878.100

Records/Reports WAC.246.878.120

Prescription Drug Price Advertising

Price Advertising Definitions WAC.246.887.010

Drug Price Advertising Conditions WAC.246.88l.020

Prohibition on Controlled Substances WAC.246.88I.030

Drug Price Disclosure WAC.246.881.040

Sales Requiring Prescriptions WAC.246.883

Legend Drug Identification/Marking/Labeling WAC.246.885

Implementing the Uniform Controlled Substances Act WAC.246.887

Precursor Substance

Sales of OTC Pseudoephedrine/Precursors WAC.246.889.070

Sales Requirements WAC.246.889.085

Acceptable Forms of Identification WAC.246.889.090

Recording of Sales WAC.246.889.095

Maintenance of Sales Records WAC.246.889.110

Exemptions from Electronic Reporting WAC.246.889.115

Denial of Sale and Overriding WAC.246.889.120

RECEIVEDJul 07 7070

DOH/HSQA/OCS

WAC.246.891WAC.246.895WAC.246.899WAC.246.901WAC.246.907

ProphylacticsGood Manufacturing PracticesDrug SubstitutionAncillary PersonnelLicensing Periods and Fees

Module 3

Module 4

DEA Controlled Substances Act

Labeling and Packaging Requirements for Controlled Substances

General Information Regarding Prescriptions

Schedule II Controlled Prescriptions


Reference:https://www.deadiversion.usdoj.gov/21cfr/cfr/index.html

Washington State E>epartment of Health: Who can Prescribe, Administer, Possess Legend Drugs and/or Controlled Substances in Washington State

Prescription Requirements Refilling PrescriptionsPartial Filling of PrescriptionsLabeling and Filling Prescriptions

Reference:https://www.doh.vva.uov/LicensesPcrniitsandCertificatcs/ProfcssionsNcwRcneworUpdatc/PharmacyCommission/WhoCanPrescribeandAdministerPrescriptions

Prescription PurposeIssuance of PrescriptionsPersons Allowed to Fill Prescriptions Dispensing/Administering Narcotic Drugs Electronic Prescriptions

Required SymbolSymbol Location and Size in Labeling Sealing Controlled Substances

Section 1302.03Section 1302.04Section 1302.06

Section 1302.04Section 1302.05Section 1302.06Section 1302.07Section 1302.08

Section 1306.11 Section 1306.12 Section 1306.13Section 1306.14

RECEIVED

Retail and Central Fill Provisions Section 1306.15

Prescriptions - Schedule III, IV, and V

Module 5

receivedJUL 0 7 ?n7(l

doh/hsqa/ocs

Chapter 11: Law and Ethics for Pharmacy Technicians Chapter 11: Review Questions

Section 1306.24Section 1306.25Section 1306.26Section 1306.27

Section 1306.21 Section 1306.22

Section

Prescription RequirementRefilling PrescriptionsPartial Filling of Prescriptions1306.23Labeling and FilingTransfer of Prescriptions - Schedule III, IV, and VDispensing Without a PrescriptionRetail and Central Fill Provisions

Reference:Pharmacy Certified Technician Training Manual


Pain Relievers and Anti-inflammatory Drugs

‘^vECEfVEDIlli 07 9090'

OOHzHSQA/OCS

Nociceptive pain• Due to cellular damage leading to a release of various substances that travel from the site of

injury to the brain causing a feeling of pain• Pain may range from dull and achy (visceral) to deep and pressure-like (somatic)• May be further classified as:

- Visceral - due to damage to the internal organs- Somatic - due to damage of skin, bone, joint or muscle

Neuropathic pain• Due to nerve damage• Pain is described as a burning, tingling or stabbing sensation• Example - diabetic neuropathyFunctional pain• Due to nervous system dysfunction• Description of pain is the same as neuropathic pain - burning, tingling or stabbing sensation• Example - fibromyalgiaAcute Pain• Pain with sudden onset and known origin, such as specific injury or surgery• Typically nociceptive in natureChronic pain• Pain that is ongoing• Does not always have a clear cause• May be accompanied by other problems including sleep disturbances, depression and/or

impaired mobility due to prolonged symptoms of pain• May be nociceptive, neuropathic or functional in natureTerminology• Anti-pyretic• Analgesic• Anti-inflammatoryMedications• Non-Steroidal Anti-Inflammatory Drugs - NSAIDs

- Non-narcotic- Have analgesic, anti-pyretic and anti-inflammatory properties- Does not contain steroidal ingredients

Inhibit prostaglandin productionSide effects - Gl upset, abdominal pain, ulcers, intestinal bleeding

- Caution♦ This class of drugs have antiplatelet effects and can interfere with blood clot formation; avoid in patients on blood thinning medications or at risk of stroke or heart attackA Due to GI side effects; avoid in patients with GI issues

- Toxicity: kidney failure• Aspirin

receivedJUL 0 7 WO

doh/hsqa/ocs

Has similar properties as an anti-inflammatory drugHas analgesic, anti-pyretic and anti-inflammatory properties similar to NSAIDs Strong antiplatelet effectOften used to prevent clot based heart attacks and strokesSide effects - GI upset, abdominal pain, ulcers, intestinal bleeding

Caution - avoid in patients under 18 due to potential for causing Reyes Syndrome if taken during a viral infection with high fever

What NSAIDs are available OTC?• Acetaminophen - APAP

- Non-narcotic- Has analgesic and anti-pyretic properties- No anti-inflammatory or antiplatelet properties

Caution: May cause liver damage with prolonged useAvailable as prescription or over-the-counter

• Opioid Analgesics- Narcotic

Act by stimulating pain receptors to alter the perception of pain and therefore increase pain toleranceUsed for moderate to severe painOften combine with non-narcotic pain relieversSide effects: nausea, vomiting, constipation, sedation

Morphine and derivatives* First line opioid analgesic for severe painA Use with caution in renal impairment

Codeine and derivativesA Used for moderate to severe painA Available combined with APAP

MeperidineA Not widely used due to seizure possibility

FentanylA Used for severe chronic pain

MethadoneA Very long duration of actionA Used for acute and chronic pain

• Migraine HeadachesCaused by neuron dysfunction and dilation of blood vessels in the brainCertain foods, activities, and environments can trigger migrainesHeadaches include pain, nausea, and sensitivity to light and soundOveruse of migraine medications can cause rebound migraines

- Medications for migraine constrict blood vesselsTwo step therapy approach

A Preventative management - decrease the number of the migraine occurrencesO Antihypertensives0 Antidepressants

Respiratory Disorder


DOH/HSQA/OCS

0 AnticonvulsantsA Acute treatment to relieve pain

Non-narcotic medications 0 Opioid analgesics 0 Triptans

Upper respiratory• Common cold

- Infection caused by a virusSymptoms include sore throat, tiredness, low grade fever

• Rhinitis- Inflammation of the mucous membranes of the nose

Categorized as allergic or non-allergic based upon cause- Sore throat- May be secondary to either a bacterial or viral infection

Characterized by difficulty swallowing• Sinusitis

- Inflammation of the mucous membranes of the nasal cavity sinuses• Treatment therapy

~ Antihistamines♦ When the body is introduced to an allergen it reacts by releasing histamine

which leads to an allergic response4b Antihistamines block histamine release and therefore, prevents a responseA Side effects - drowsiness, nausea, vomiting and weight loss

Decongestants4b Causes vasoconstriction of blood vessels4b Available orally or as a nasal spray♦ Rebound congestion may occur if used for more than 3 days consecutively 4b Side effects - increased heart rate, difficulty sleeping, dizzinessA Caution - avoid in patients with uncontrolled hypertension and diabetes

Expectorants♦ Taken with water, increases respiratory secretions, thins phlegm and mucous

leading to more productive coughA Most commonly recommended is guaifenesinA Side effects - G1 effects, headache, dizziness

* AntitussivesA Suppresses cough reflex by increasing cough thresholdA Most common antitussives are dextromethorphan and codeineA Side effects - drowsiness, dizzinessA Toxicity - CNS and respiratory depression

RECEIVEDJUL 0 7 707(1

DOH/HSQA/OCS

- Intranasal corticosteroids* Decreases nasal inflammation and swelling4b Used to treat acute conditions or as prevention therapy4b Treatment should begin 2-3 weeks before anticipated onset of symptoms

Lower respiratory• Asthma

- Long term airway obstruction* Chronic airway inflammation- Symptoms include wheezing, trouble breathing, chest tightness, coughing- There is no cure for asthma but, it can be controlled- Treatment choices are based on severity of symptoms

• Chronic obstructive pulmonary disease - COPD- Fourth leading cause of death in the United States- Progressive airflow limitation- Symptoms include shortness of breath, chest tightness, fatigue, wheezing- Treatment therapy

4b Slow down progression of the disease4b Symptom control

• Pneumonia- Viral or bacterial infection of the lungs

Symptoms include sudden onset of shortness of breath, productive cough, fever, chills, chest pain or tightness, fatigue, contusion (especially in elderly population)

- Treatment therapy is dependent on type of pneumonia• Treatment therapy

- Beta-agonists4b Relax smooth muscle around airways allowing airways to dilate4b Short acting beta agonists - SABA

0 Quick onset of action - about 10 minutes0 Often used as rescue medications0 May also be used in patients with exercise-induced bronchospasms

4b Long acting beta agonists - LABA0 Lasts about 12 hours and is dosed every 12 hours o Anticholinergics

Anticholinergics4b Prevent constriction of airways4b Used as maintenance for COPD4b Side effects - metallic taste, dry mouth, nausea

Corticosteroids4b Decreases inflammation and airway hyperactivity4b Used as maintenance4b Side effects - thrush (rinse mouth to prevent), weight gain, poor blood sugar

control

DIGESTIVE DISORDERS

receivedJUL 0 7 7n?n

DOH/HSQA/OCS

Leukotriene modifiers* Prevents bronchoconstriction* Used as maintenanceA Only available as oral therapyA Primarily used in patients with asthmaA Less effective than corticosteroids

Mast cell stabilizersA Prevents histamine releaseA Used prior to trigger exposureA Used as maintenanceA Side effects - sore throat, cough, wheezing

Flatulence• Gas in GI tract causing discomfort and pain• Treatment therapy

- Alpha-galactosidaseA Enzyme that breaks down sugars found in food high in fiberA Makes food more digestibleA Must be taken before meals

SimethiconeA Helps break down gas bubblesA Defoaming action produces a film on the intestines which collapses gas bubbles

Diarrhea• Increased GI motility• Treatment therapy

- AntimotilityA Decreases contractions of the intestinal muscle A OTC available medication - Imodium® A-D

AdsorbentA Acts locally on the intestinal mucosaA Binds with toxins or irritants that cause diarrhea

AntisecretoryA Inhibits intestinal secretionsA Stimulates intestinal absorption

Constipation• Difficult or infrequent passing of stool• Non-pharmacologic therapy

- High fiber dietIncrease fluid intake

• Treatment therapy

received

- Bulk forming laxatives4b May be used in place of natural fiber* May take up to 3 days to see effects

Stool softenersWorks slowly over several days4b Water is absorbed into the stool and softens it to make it easier to pass

- Stimulant laxatives4b Increases bowel movements4b Products available in combination with stool softeners4b Dependence with habitual use can occur4* Often used for preparation in GI surgery or tests

Nausea and vomiting• Emesis• Vomiting is triggered by an area of the brain called the chemoreceptor trigger zone (CTZ)• Various causes

- Medications- Chemotherapy- NSAID therapy- Pregnancy* Motion sickness

Infection• Treatment

- Based on cause- Anti-emetics- Antihistamines

BenzodiazepinesSerotonin receptor inhibitors

Gastroesophageal Reflux Disease• GERD• Back up of stomach acid in to esophagus• If left untreated can lead to esophageal erosion• Symptoms include heartbum, difficulty swallowing, asthma, non-cardiac chest pain• Symptoms may worsen when laying down flat

Acid-Peptic Disease• Peptic ulcers• Open sores (ulcers) occur most frequently in the lowest region of the stomach or in the first

section of the small intestine• Factors that worsen ulcers include increases in stomach acid, smoking, stress, alcohol,

caffeine, drugs such as NSAIDs, steroids, or aspirin, presence of H. Pylori• Treatment therapy

Antacids4b Eating a meal will stimulate production of gastric acid4b Neutralize acid in the stomach4b Duration of action is about 2 hours

- Histamine-2 receptor antagonistsJUL 0 7 2020

DOH/HSQA/OCS

* H-2 receptor antagonist* Promotes the healing of ulcers by blocking the H2 receptors in the GI tract and

reduces acid productionProton pump inhibitors

*PPIs4b Block acid secretion by inhibiting the hydrogen-ion pump which is the last step

in the production of gastric acidMiscellaneous

* Protect the lining of the GI tract - Cytotec®* Protective barrier that binds to the ulcer - Carafate®* Eradicating H. Pylori with combination antibiotics and PPI

RECHVed

M 07DOH/HSQA/OC3

ACTIVITY 1

2. What is the difference between Dyazide and Maxzide?

3. What is the difference between Macrodantin and Macrobid?

4. List 5 drugs with at least 3 different strengths and their uses.

RECEiVEDOuL fl ? aagp

5. List 5 commonly used inhalers in the pharmacy and their active ingi£UEttft!HSQA/OC3

I. List 10 drugs Irom the top 200 drugs with generic and brand names and their uses (use online reference)

Brand name Lopressor

Generic Name Metoprolol

Use_______Hypertension


HERBALS

Some examples of Minerals and Herbals and their uses.

RECEIVED


• Herbals are described as flowering plants which may be used for medicinal purposes• Herbal medications come in many different varieties and the same plant may be used for

various ailments• These drugs are not regulated by the FDA and some are potentially dangerous• Specific labeling requirements are regulated and the label cannot claim to “diagnose, treat,

cure, or prevent any disease”• Note: Always check with a physician before taking any herbal medication

5-HTP - DepressionACTIVATED CHARCOAL - Standard treatment for some acute poisonings ALOE VERA GEL * Bums and wound healing topicallyALPHA HYDROXY ACIDS - Sun damaged skin or facial wrinkles topicallyBEE POLLEN - Improve stamina and athletic abilityBELLADONNA - A prescription medication used for intestinal spasmsBLACK COHOSH - PMS symptoms and menopauseBLACK PSYLLIUM - ConstipationBLOND PSYLLIUM - ConstipationBUCKTHORN BARK - LaxativeBUCKTHORN BERRY - ConstipationCAFFEINE - StimulantCAMPHOR - Cold sores and topical analgesicCAPSICUM - Topical AnalgesicCASCARA - ConstipationCAT’S CLAW - ArthritisCHAMOMILE - Insomnia or indigestionCHITOSAN - Enhance athletic abilityCHONDROITIN - Arthritis and increased joint mobilityCHROMIUM - Weight loss and cholesterol reductionCLOVE OIL - Dental analgesicCOENZYME Q-IO - Heart failure and increased blood flow to the heartCRANBERRY - Urinary tract infectionsCREATINE - Enhance athletic abilityDHEA - Used for a variety of ailments - erectile dysfunction, enhance immune system function, cancer prevention, and to decrease blood pressureDONG QUAI - PMS and menopauseECHINACEA - Immune system functionEPHEDRA - Commonly used in weight loss supplements as a stimulantEVENING PRIMROSE OIL - PMS symptomsFEVERFEW - Headaches


VITAMINS AND MINERALSdoh/hsqa/ocs

Nutrients• Chemical that humans need for the body to grow and survive• Build and repair tissues, give energy and provide sustenance. Proteins• Produced from amino acids that are needed for tissue growth and repair.• Examples of proteins are meat, eggs, dry beans, nuts or seeds and poultry. Carbohydrates• The main source of energy in the body and include starch and sugar.• Examples are rice, wheat, com and fiber rich fruit.

Fats and oils• Concentrated form of energy; they provide nine calories/gram.

FISH OILS - Cholesterol and blood pressureFLAXSEED OIL - Cholesterol and blood pressureGINGER - Arthritis and cholesterolGINGKO - Memory enhancementGINSENG - Available in many forms and commonly used for energy and endurance GLUCOSAMINE - Arthritis and to improve joint mobilityGOLDENSEAL - Immune system functionGRAPE SEED - AntioxidantGREEN TEA - CholesterolGUARNA - Weight lossHAWTHORN BERRY - Cholesterol IPECAC - Used to induce vomiting of non-corrosive substancesJIMSONWEED - Used to produce a sense of well beingKAVA KAVA - Anxiety and depressionLACTOBACILLUS - Used to restore normal intestinal flora (bacteria)LICORICE - GI upsetLUTEIN - A common supplement to multi vitamins for eye health/improved vision MA HUANG - Stimulant for weight lossMELATONIN - Sleep and restlessnessMILK THISTLE - Used to improve liver functionPAPAYA • Food enzyme to aid in digestionPINE BARK - AntioxidantPODOPHYLLUM - WartsSAMe - DepressionSAW PALMETTO - BPH (benign prostatic hypertrophy)SHARK CARTILAGE - Cancer preventionST. JOHN’S WORT - DepressionTEA TREE OIL - Improve immune system function VALERIAN ROOT - InsomniaWINTERGREEN OIL - Topical analgesicYOHIMBINE - Erectile dysfunction

• Examples are fatty meat, dairy products, cakes and cookies.

Vitamins are group of organic nutrients that are required in small amounts for a body’s survival. The body cannot make them and is thus supplied from food.

VITAMINS:The following are key to understanding the labeling and explaining labels to patients.• Recommended Dietary Allowance (RDA) is the average dietary intake of the nutrient that

prevents deficiency in approximately 98% of the population.• Adequate Intake (Al) is the goal for each person for those nutrients that do not have a RDA.• Tolerable Upper Intake Level (UL) is the highest level of the nutrient that is likely to pose

no risk of adverse effects in 98% of the population.• Dietary Reference Intakes (DRl) are quantitative estimates of nutrient intakes to be used for

planning and assessing diets for healthy people.

Fat-soluble vitamins• Can be stored in the body for long periods of time and have the potential to cause toxicity

when they build up in the body.• Vitamin A (Retinol or Beta Carotene) is essential for development of bones, skin and

eyesight.• Vitamin D (Calciferol) is produced when ultraviolet (UV) rays from the sun are absorbed

through the skin and trigger vitamin D synthesis from vitamin D precursors already present in the cells. It is needed for calcium absorption and proper bone growth.

• Vitamin E (Alpha-Tocopherol) is an antioxidant that intercepts free radicals.• Vitamin K (Phytonadione) plays a vital role in blood clotting and also in binding calcium to

bones.Water-soluble vitamins• B vitamins

®O«/HSQ/vocs

07 20711

ACTIVITY 2

Reduce the following fractions to lowest terms.

1. 6/18

2. 8/48

3. 9/24

4. 21/294

5. 42/144

Convert fractions to decimal numbers.

6. 2/5

7. 7/18

8. 42/75

9. 7/4

10. 65/260

Convert the decimal numbers to fractions or mixed numbers in lowest terms

11.0.45

12. 155.2

13.0.475

received14.29.002

JUL 0 7 2020Convert these Roman numerals

doh/hsqa/ocs15. MIX

16. CMXCIX

17. XXXVIII

18. XLIV

19. DLVII

20. MCM

Convert these numbers to Roman Numerals.

21.72522.149223.2524. 539925. 10What are the other names for these vitamins and its uses.

Name Use

1. QAM =

2. QID =

3. Twice weekly =

Convert between the abbreviation and the English meaning by filling in the missing side of the equation.

Vitamin Vitamin A Vitamin Bl Vitamin B2 Vitamin B3 Vitamin B5 Vitamin B6Vitamin B9 Vitamin B12 Vitamin C Vitamin D2 Vitamin D3 Vitamin E Vitamin KI

07 2020 *’OH/HSQA/OCS

4. After a meal =

5. ODT =

6. At bedtime =

7. As needed for pain =

8. BID =

9. TID =

10. iii =

received'JUL 0 7 2020

DOH/HSQA/OCS


Non-sterile Pharmaceutical Compounding

IMMUNIZATIONS IN PHARMACY SETTING

/deceived

Vaccines• made from the viruses or bacteria they are designed to protect against.• comes as a live vaccine or inactivated or dead vaccines• comes in single dose syringe, multi-dose vial, reconstituted vial or oral capsules.• side effects include fainting, slight fever, soreness in the injection site and rarely an

anaphylaxis type of a reaction.• can be given as two-dose series, single dose or 3-dose series

What is compoundingLaws, regulations and standardsNon-sterile compounding environment Product inventoryBeyond-use datingRegulations for pharmacy personnel Documentation on non-sterile compounding Calculations in the compounding pharmacy Measuring devices for liquidsSupplies for making and molding ingredients Containers for packagingCompounding a specific formulation Labeling and cleanup

Vaccine-preventable diseases: Viral- Influenza

1. Viral illness that is easily spread by cough or sneeze2. Symptoms include fever, chills, body aches, tiredness and occasional cough

and sore throat3. There is a new vaccine developed every year4. Different type available for different age groups

4.1 Live Attenuated Influenza Vaccine (LAIV) given intranasally4.2 High dose (65 years old and older)4.3 Inactivated vaccine given IM4.4 Inactivated vaccine given intradermally

M 07 ?o?n ^OH/HSQa/Ocs


Rotavirus1. Severe or prolonged diarrhea and can often cause severe dehydration and possible

hospitalization.2. Two-dose or three-dose series, RotaTeq and Rotarix.

Poliomyelitis1. Paralytic polio can cause lasting paralysis of the limb muscles.2. Four-dose series with the inactivated vaccine, IPOL.

Hepatitis A and B1. Generally refers to inflammation of the liver.2. Most cases of Hepatitis A are due to contaminated food or water.3. Symptoms of Hepa A are jaundice, fever, upset stomach and/or vomiting.4. Hepa B is most often a sexually transmitted infection in the Unites States but can

also be transmitted from sharing of infected needles.5. Symptoms of Hepa B are jaundice, fever and influenza-like symptoms.6. Hepa B vaccine is given as a 3-dose series.

Varicella1. Virus that first presents as chicken pox which consists of widespread, itchy

lesions on a person’s body and highly contagious.2. Commonly spread through the respiratory droplets or by direct contact with

lesions of an infected person.3. There are currently two kinds of varicella vaccines available

3.1 Zostavax3.2 Shingrix

HPV - Human papillomavirus1. Common sexually transmitted infection.2. Can cause genital warts and cervical cancer3. Available as Gardasil and Cervarix

Measles, Mumps and Rubella1. Measles often presents as body rash (with or without fever), common cold-like

symptoms and blue-white spots on the mucus membranes.2. Mumps include rash, swollen salivary glands, headache, fever and possibly

testicular inflammation in males.3. Rubella appears as a full body rash, with or without fever, and is usually mild

compared to measles.4. Two-dose series is recommended for all children and certain at-risk adults like

health care workers, international travelers and non-pregnant women of child-bearing age. RECEIVED

3. Comes in an oral dose.

Vaccine-preventable diseases: Bacterial

1.

1.

received'JUL 0 7 ?D7n

doh/hsqa/ccs

Haemophilus Influenza Type B1. It is cause by Haemophilus influenzae type B (Hib) and was the leading cause of

bacterial meningitis in children under the age of five.

Meningococcal diseaseIt is caused by Neisseria meningitidis bacterium and is transmitted through contact with infected respiratory droplets and can cause symptoms such as headache, neck stiffness and sensitivity to light which can be fatal sometimes.

2. Vaccines available on the market are polysaccharide vaccine (Menomune) and two conjugated vaccines (Menactra and Menveo).

Other vaccines1. Rabies vaccine2. Travel vaccines

Pneumococcal disease1. Caused by Streptococcus pneumoniae2. Infection of the lungs that causes inflammation and possible fluid accumulation of

the lungs.3. Meningitis is an infection of the protective covering of the brain and or spinal

cord.4. Vaccines available are PCV 13 or Prevnar 13 protects against 13 different strains

of the pneumococcal bacteria and PPSV (pneumococcal polysaccharide vaccine) or Penumovax 23 which protects against 23 strains of the bacteria.

Tetanus, Diphtheria and PertussisTetanus is caused by the spores of the bacterium Clostridium tetani found in soil, dust and elsewhere when it enters a skin lesion or a wound.

2. Tetanus can cause severe muscle spasms, lockjaw, muscle rigidity amd sometimes death.

3. Diphtheria is caused by Corynehacterium diphtheriae and can infect many body sites but most commonly appears as a thick, bluish-white membrane on the back of the throat that can lead to obstruction of breathing which can be fatal sometimes.

4. Pertussis or whooping cough is caused by Bordatella pertussis bacterium and is characterized by severe and frequent coughing fits that can be severe enough to make it difficult for the person to breathe.

5. Vaccines available are DTaP, Tdap and TD.

ACTIVITY 3

A. Fill in the blanks.

Weight/Measure

gram

millilitertsp

tablespoon

microgramoz

centimeterGr

B. Draw and label basic parts of a syringe.


DOH/KSQA/OCS

Weights and Measures Abbreviations:Abbreviationcc

gtt. mEq mm

LKg

C. What gauze size is appropriate for drawing out Testosterone products to be injected IM?Why?

unit millimole

D. Fill in the blanks.

? ?

? ? ?

Zoster ? 1 1

PPSV23 ? 1

PCVI3 ?1

9 9 ?

receivedJUL 07 2020E. What is the difference between a trivalent and a quadrivalent vaccine?

DOH/HSQA/OCS

F. Describe the Pharmacy Technician’s role in the Immunization workflow?

Influenza Inactivated

MeningococcalConjugate (MCV)

Vaccines. Vaccine Hepatitis B (HepB)

Doses/Frequency2 to 3 dose primary series.

Pharmacy StorageRefngerated.

Influenza, Live Attenuated (LAIV)

Brand Name Engerix-B, Recombivax HB______?

INSTRUCTOR DISCUSSION 5Review of the following:

RECEIVFn

'JUL 01doh;ho

Pharmaceutical Measurements and Calculations> Systems of Pharmaceutical Measurement- Metric System- Other systems of pharmaceutical measurement- Conversion equivalents> Numeric systems> Basic calculations used in Pharmacy practice' Ratio and Proportion' Converting quantities between the Metric and Common measure system- Percents' Converting ratios and percents

ACTIVITY 4The following are practice exercises for you to finish.

Convert the following decimals to percents.

1. 0.47

2. 1.69

3. 3.8

4. 0.0025

Convert the following percents to decimals.

5. 135%

6. 33%

7. 0.4%

8. 19%

Convert the following tractions to percents.

9. 11/22

10. 1 7/8received

11. ■/.JUL 07 7070

12,6/10doh/hsqa/ocs

Convert the following percents to fractions.

13. 98%

14. 55%

15. 15 1/5%

16.20%

Convert the following ratios to fractions.

17. 6:15

18.4:20

19.15:45

20.21:49

Convert the following ratios to percents.

21.6:8

22.4:10

23.2:5

24. 5:20

RECEIVEDSolve for the unknown in the following proportions.

JUL 0 7 202025.4.5:9:: X:50

DOH/HSQA/OCS26. X:12::3:4

n. 1:X:: 5:12

28. 5:8::22:X

Solve the following practical problems involving proportions. Show your solution.

29. A pediatric patient is ordered a dose of 2.5 mL of Amoxicillin. If Amoxicillin is available as a 125mg/5 mL suspension, how many mg is the patient receiving?

30. If Clindamycin injection is available as a 900 mg/6 mt vial, how many mL are needed to fill a Clindamycin 300 mg order?

35. If a patient weighs 88 kg, how much does the patient weigh in lbs?doh/hsqa/ocs

38. Using the information in the previous problem, what percentage of the compound is zinc?

34. If a patient weighs 264 lbs, how much does the patient weigh in kg? (Note: 2.2 lbs = 1 kg)

37. A patient presents with a compound of 20 g of hydrocortisone combined with 10 g of zinc oxide. What is the ratio of hydrocortisone to the total amount of the compound?

31. Vancomycin is compounded as a lOOOmg/40 mL oral suspension. If a patient’s dose is 250 mg, how many mL will be administered?

32. IF an IV solution is labeled as 0.45% sodium chloride, how many grams of sodium chloride will a 1L bag contain?

36. Tylenol extra strength tablets are available as 500 mg tablets. If a patient was prescribed a dose of 1,000 mg of extra strength Tylenol, how many tablets will he need to take?

33. If a 50 mL syringe contains 12.5 g of dextrose, what percent of dextrose does the syringe contain? (Note: % = x g/100 mL)

2020

Convert the following units of measure:

39. 56g = mg

40.4670 mg « g

41.1.2 mg = mcg

42.0.3L = mL

43. 5,800 cm - m

44.2.3 lb = kg

45. 82 pt = gal

46.7.77 Ib = oz

47. 562 gr = oz

48. 6.2 L = mL

49. 372 mL = L

50. 8.91 mm = cm

51.45 mL = L

RECEJVED52. 6 oz = gr

53.18qt = pt

54. 7000 gr = oz

55. 14 tsp = mL

56. 734 mg = gr

57.6qt = L

58.9gr = mg

59. 540 mL - oz

60.14 cups - mL


INSTRUCTOR DISCUSSION 5REVIEW OF THE FOLLOWING:

received

• Medication safety- What is a medical error- Scope and impact of medical errors- What is a medication error- Scope and impact of medication errors- Prescription-Filling Process tn Community and Hospital pharmacies

1. Receive and review prescription1.1 basic review of prescription1.2 verbal order prescription1.3 validity of prescription1.4 detailed review of prescription (prescriber information, patient information

and medication information?2. Enter prescription into computer

2.1 accurate data entry2.2 potential dangers

3. Perform Drug Utilization review (DUR) - performed by the pharmacist4. Generating prescription label5. Retrieve medication

5.1 safety practices for accurate drug selection (NDC numbers, look-alike and sound-alike)

6. Compound or fill a prescription6.1 auxiliary labels6.2 safety practices for accurate compounding and filling

7. Obtain a Pharmacist Review and approval7.1 Responsibilities of the Pharmacist7.2 Role of technician in verification process

8. Store Completed prescription8.1 proper storage conditions8.2 organizational systems

9. Deliver medication to patient9.1 verification of patient identity9.2 “show-and-tell” technique with patient9.3 Nursing unit deliveiy of medication

- The Responsibilities of the Healthcare Professionals1. Potential source of errors2. Patient education

- Innovations to promote safety1. Package, medication and label design2. Use of automation

- Medication error reporting system1. Error reporting2. Institute for safe medication process

M 0 7 2020 doh/hsqa/ocs

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2.232.242.252.262.27

• Your future in Pharmacy Practice- Pharmacy Practice Preparation* Professional requirements of a Pharmacy Technician

1. Credential2. Licensure3. Certification

- Pharmacy Technician Education Programs1. Pharmacy Technician Certification Examination

2.1 Medication Errors Reporting Program2.2 Medication errors include:

2.221ncorrect drug, strength or doseConfusion over look-alike and sound-alike drugsIncorrect route of drug administration Calculation or preparation errors Misuse of medical equipment Errors in prescribing, transcribing, dispensing or monitoring

medication

Human Relations and Communications- Personal service in the Contemporary Pharmacy- Knowledge, skills and qualities of a Pharmacy Technician

1. Multitasking2. Positive attitude

2.1 professional appearance2.2 attentiveness2.3 empathy2.4 helpfulness2.5 patience2.6 insurance issues

3. Good communication skills4. Courteous manner5. Sensitivity to Diverse Patient population6. Accommodating for mental and physical disabilities7. Good problem-solving ability8. Emergency preparedness

- Security in the workplace- Other aspects of professionalism- Appropriate workplace behavior- Professional boundaries

1. Professional Ethics2. Codes of Behavior

- Awareness of substance abuse issues- Patient confidentiality

1. Security2. Privacy - Notice of Privacy Practices

received

2. Recertification- Career goals- Performance reviews Industry awareness

• The Patient Profile- Components of a patient profile

1. Patient’s name2. Patient’s DOB3. Patient’s address and phone number4. Allergy5. Adverse drug reaction6. Medical conditions7. Insurance information8. Other patient information (preferences, etc)

- Medication selection and preparation- Drug inventory

Filling a prescription1. Accuracy checks

• Dispensing Medications in the Community Pharmacy- Basic components of a prescription

1. Doctor’s name2. Doctor’s DEA number3. Doctor’s NPI number4. Patient’s name5. Patient’s address and telephone6. Patient’s date of birth7. Inscription8. Subscription9. Refill10. Dispense as written (DAW)11. Brand name medical necessary12. Signa-sig

- Types of a prescription1. New prescription that can be written as hard copy, verbal order, an e-prescription,

telephone or faxed order, prescription not due yet, or a transfer from another pharmacy.

2. Partial fills3. Emergency fills4. Transfer prescription to another pharmacy5. Refills

- Controlled Substances1. Schedule II Prescription requirements2. Limitations on Schedules 111, IV and V prescriptions

- Processingaprescriptions

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2. Preparing oral dosage forms (tablets, capsules, liquids)3. Unit dose packaging4. Flavoring drugs5. Reconstituting oral powders6. Medication container label

6.1 auxiliary labels6.2 medication information sheet6.3 choosing medication label and container

7. Final check of the prescription8. Dispensing to patient

• The Business of Community Pharmacy- Nonprescription sales

1. OTCdnigs2. Dietary supplements3. Medical supplies4. Supplies to manage diabetes

- Cash register management- Inventory management- Handling out-of-stock and partially filled medications- Drug returns and credits

1. Drug returns process2. Patient decline of medication3. Expired medications4. Drug recalls

- Estimating drug inventory- Business Math used in Pharmacy practice

1. Profit2. Gross profit3. Average wholesale price (AWP)

- Prescription Insurance Plans1. Pharmacy benefits manager (PBM)2. Deductible3. Co-pay4. Co-insurance5. Third party6. Medicaid7. Tricare8. Medicare9. Private Insurance

••

ACTIVITY 5

1.

RECEJVED4. What is the difference between Medicaid and Medicare?

It!! 07 2020£G.i/HSQA/OCS

5. How would you explain a doughnut hole?

What is missing from this prescription (Pharmacist will provide trainee with the prescription)?

2. What is wrong with this prescription (Pharmacist will provide trainee with a prescription)?

3. Write all information you need for a new patient that has never filled at the pharmacy.

6. What is a prior authorization?

received

7. List 3 examples of medications from Schedule II-V.

Schedule II: Schedule III:Schedule IV:Schedule V: __________

JUL 0 7 ^OHZHSQ^Oqq

ON THE JOB

TRAINING

receivedJUL 0 7

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RPh initial1. Measure 100 mL

2. Measure 0.8 mL

3. Measure 1.5 L

4. Measure 2 oz.

5. Measure 275 mL

receivedJUL 01 ?n7n

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C. Give definition of meniscus and how is it related to measuring liquids. Draw down below an illustration of a meniscus.

B. List and draw examples of measuring device and equipment used in pharmacy. Identify in the pharmacy these examples if present and have pharmacist check if they are correct.

ACTIVITY 6ON THE JOB TRAINING

A. Measuring Liquids (practice with water for liquid measurements) - Pharmacist will initial after trainee shows Pharmacist correct measurement.

D. Write the following from 5 prescriptions the Pharmacist will provide you.

Rxl

Rx2

Rx3

Rx4

RECEiVuD

Rx5

1. Translation of the Sig.2. Name of the Drug3. Number of Refills4. DAW?5. Strength of Drug6. Dosage form of the Drug7. Date written

M 07 ^oh/hsqa/ocs


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£. Calculate following: Use separate paper to show solution and answer.1. If prednisone is needed at 1 mg/kg/day in three divided doses for a child weighing

44 pounds, what would his daily dose be? What would each dose be? If the child needs to take prednisone for 7 days, how many doses will the patient need? How much Prednisone 5 mg/mL solution do you need to dispense in order to give the child enough for 7 days?

2. A physician orders 35 mcg/kg/day of digoxin for a patient in your pharmacy. The pharmacist is instructed to adjust the dose monthly based on the child/s weight. The mother reports to you that the child’s weight is at 13 pounds and 6 ounces. Determine the baby’s daily dose.

3. A physician prescribes phenytoin 6 mg/kg/day divided into three daily doses for a 163-pound female patient to control convulsions. The physician wants to use 150 mg phenytoin capsules compounded by the pharmacy instead to lessen the number of capsules patient must take each day.3.1 How many Phenytoin must be administered for each dose?3.2 If the doctor prescribed the phenytoin for a total of 5 days, how many

milligrams of medication should be dispensed?3.3 The pharmacy is unable to compound the 150 mg capsules and must order the

commercially available 50 mg chewable tablets. How many tablets would be dispensed for 10 days of therapy?

3.4 The patient continues to experience, convulsions, so the physician increases the daily dose to 8 mg/kg/day. The pharmacy is able to once again compound the 150 mg capsules. How many 150 mg capsules will the patient take each day?

4. A geriatric patient who has difficulty swallowing large tablets presents a prescription for Erythromycin 400 mg/5mL with directions to take 500 mg every12 hours for 10 days.4.1 Determine the amount of suspension needed to make one 500 mg dose.4.2 Determine the volume of medication to be dispensed for the full course of

therapy.5. Theophylline 100 mg tablets are prescribed for the treatment of asthma and have a

recommended dose of 3 mg/kg of body weight every 8 hours. The patient weighs 219 pounds and the doctor would like the patient to take the medication for 14 days before returning to the office for further evaluation.5.1 What dose is required for this patient?5.2 How many 100 mg tablets should be dispensed to this patient to complete the

regimen?6. A prescription for Chad calls for Triamcinolone injectable suspension 10 mg/mL

to be diluted down to 0.125 mg/mL by adding distilled water. How much triamcinolone suspension and how much water must be added to make 480mL of the final product?

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19.119.2

7. A prescription arrives at the pharmacy and calls for 0.089% betamethasone dipropionate lotion to be applied to patient Dana’s arms three times daily for 30 days. The specified quantity is two pounds (908g). Betamethasone dipropionate lotion only comes as 0.1% and 0.05% commercial product. Write a recipe for this compound.

8. A prescription calls for 100 mL of 30% ethanol to be compounded from 25% ethanol and 50% ethanol. Write a recipe for his compound.

9. A prescription to treat “strep throat” is written: Give Kristi 3.5 mL of a 250 mg/5mL pf Cefdinir suspension twice daily for 10 days. Upon reaching the shelf, you find that you are out of 250 mg/5mL suspension but you have plenty of the 125 mg/5mL suspension. Write out how this prescription would look using the125 mg/5mL suspension.

10. What is the weight (in milligrams) of active ingredient present in 30g of a 7% ointment?

11. You receive a prescription to compound 5% coal tar and 2% salicylic acid added to commercially available 0.005% calcipotriene cream (120g) tube to treat psoriasis. If coal tar comes as a 200 mg/mL solution, how much coal tar solution (in mt) must be added to the 120 g tube of calcipotriene to make final compound be 5% coal tar?

12. You receive a prescription for Sally for an itch relieving topical cream with this recipe: combine 8 g 1% hydrocortisone, 14 g 1% diphenhydramine and acid mantle up to 30 g. How much diphenhydramine is in the final compound (expressed in grams)?

13. Determine the infusion time of 1 L of D5W if a control flow set is at 18mL/hour.14. The pharmacy stocks a premixed lidocaine IV containing 2 g of lidocaine in 500

mL of D5W. The physician orders a lidocaine drip at an infusion rate of 4mg/min. what is the IV fiow rate in mL/hr?

15. The doctor orders a nitroprusside drip 50 mg in 250 mL D5 W to run 5 mcg/kg/min. For a 60 kg patient, what is the IV fiow rate in ml/hr?

16. If the contents of a vial of cefazolin in its dry powder form occupies 1.2 mL and the total volume of its reconstituted solution is 20 mL, what amount of sterile water is needed to prepare the solution?

17. Determine the infusion time of 1 L of lactated ringers solution if an infusion set delivering 30 gtts/mL is set at 20 gtt/min.

18. If an IV fluid is ordered at 85 mL/hr, how many liters of fluid will the patient receive in a 24-hour period?

19. A 112 pound nursing home patient is prescribed a medication at 0.1 mg/kg/min. The technician prepares an IV with a concentration of 1 g of medication in 1,000 mL of 0.9% NS.

How long will the 1,000 mL IV bag last for this patient?If the dose for this patient was 1.5 mg/min, what would the IV flow rate be

in mL/hr?

20.1

RECEIVED

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20. The doctor orders 2 mg/kg/hr of phenobarbital IV for a 156-pound patient who is seizing. The pharmacist instructs the technician to put 500 mg of phenobarbital in 250 mL ofD5W.

What would the IV flow rate be in mL/hr for this preparation?20.2 How many hours would one IV bag last?

List at least 5 products from the following OTC category and find its location from the front end.


DOH/HSQA/OCS


A. AnalgesicsB. Feminine hygieneC. EyecareD. Ear care£. AllergiesF. First aidG. DigestiveH. Foot careI. Oral careJ. Sleeping aidK. VitaminsL. Herbal supplementsM. Cough and ColdN. Baby careO. Psoriasis/Eczema/AcneP. Anti-fungalsQ. SuncareR. Medical Suppoit/equipment

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COMMUNICATION EXERCISES. Pharmacist need to initial and date after each situation is acted out.

A. Pretend that pharmacist is patient Jane Doe and you have to explain to her why her prescription is not ready yet. Her monthly refill of Enbrel needed a Prior Authorization with her insurance and Jane has never had any problems with her insurance covering it before.

B. Pretend that pharmacist is Doctor Rayban's medical assistant. Jane Doe asked you to call the doctor's office directly to follow up her refill request because it has been more than one week since you have faxed the doctor’s office.

C. Pretend that pharmacist is one of the representatives from an insurance company and you need to talk to them to get Jane Doe’s new insurance information because Jane lost her card in the mail.

D. Pretend that pharmacist is one of the representatives from an insurance company and you need to find out why Jane's refill on her Lantus is not covered when they have covered it for many years. The rejection error when you process the claim is very vague and you want to get more information.

E. Pretend that pharmacist is a new patient that has never filled at your pharmacy and you need to get all the information you need to fill his prescription.

F. Jack is upset because his Oxycodone prescription that he dropped off 30 mins ago is not ready yet. Jack just filled another Oxycodone prescription from the same doctor with the same directions just a week ago. He is almost 3 weeks early! Pretend that pharmacist is Jack and explain to him what is going on.

G. Jack is calling to fill his Lisinopril early because he is leaving for a 3-month vacation. His insurance rejects the claim with a refill too soon rejection. What do you do? Pretend that pharmacist is Jack and you have to call him and explain the situation.

H. Pretend that pharmacist is Dr. Rayban. Dr. Rayban is calling to find out why Jack's oxycodone prescription was not filled. How do you explain the situation to the doctor?


5. How do you handle expired and recalled medications?

RECEIVED

JUL 0 7 2020DOH/KSQA/OCS

2. What are the 4 main information you need to get from an insurance card to be able to successfully input it in the computer system?

1. Why is it important to put the patient's drug allergies and medical condition on their medical profile?


4. What are the common rejections from a third party billing when processing a prescription? How do you handle each of them?

6. Determine Days Supply for following: (use separate paper for answer and solution)a. You have a 10 mL vial of insulin that has 100 units per mL. Your patient injects

35 units bid. How many days will three vial last?b. Patient uses Toujeo Solostar 450units/mL. A box has 3 pens and each pen has 1.5

mL of Toujeo Solostar on it. If the patient uses 50 units twice a day, how many days will 4 boxes last? If the insurance will only pay for 30 days supply and you can dispense the medication in pens, how many pen(s) can you dispense to the patient?

c. A child has a prescription for Amoxicillin 250 mg/5 mL. The bottle comes in 100 mL size. How many bottles will you dispense for a prescription that calls for 500 mg tid for 10 days?

3. Why is it important to put the correct days supply when processing a prescription? What are the future problems when the incorrect days supply is put in?

Appendix A: Timesheet

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Student is expected to record actual time spent on the job training, online learning, lectures, quizzes and exams, practicum tests and director/instructor-student discussions where trainer is not responsible for prescription area, instructor or Pharmacists name and signature must be obtained as well.

Time spent3

Activity_____Ex. E-learning

Pharmacist Cielo Tan

Time in 9:00 am

Time out 12:00 pm

Date6/7/20

Appendix B; Pharmacy Tech Experiential Skills Checklist

Please check off or fill in "n/a" (not applicable) after completed;



REcjzjveo

1. Orientationa. Pharmacy layout

i. Knowledgeable of various departmentsii. Knowledgeable of merchandise sold

b. Pharmacy laws and rules1. State and Federal dispensing guidelines

ii. Ephedrine, pseudoephedrine, phenylpropanolamine - Sales restrictions

iii. Record keeping requirementsiv. Required RecordsV. Prescription Records

vi. Transfer or disposal of controlled substancesvii. DEA number verification

c. Security and safetyd. Hygiene

i. Washing handsii. Cleaning counting trays, counters, and other equipment

2. Understanding patient confidentialitya. Employee must fill out confidentiality statementb. HIPAA

3. Ability to perform pharmaceutical calculationsa. Fractions, Decimals & Percentsb. Temperature Conversionsc. Ratio Proportionsd. Quantities, Dilutions & Concentrations^e. Calculations of IV flow rates if applicable,f. Powder volume

JUL 07 yn-ifi


4. Refill supplies and stock for dispensing.




Date

RECEIVEDa.

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8. Refilling a prescription (Electronically or phoned In or in person! Requests from Doctors

i. Name of patient

6. Receiving prescription from customera. Greet the customer promptly and courteouslyb. Assist with selection of productc. Ask if new patient or existingd. Collect/follow up necessary data from customer and enter

informationi. date of birth

ii. nameiii. addressiv. brand name or generic preferenceV. telephone number

Vi. drug allergiesvil. weight (important to know for infants)viii. insurance information

e. Guidelines for referring customers to the pharmacist for questions.

5. Knowledge of store pricing strategya. Being aware of price increasesb. Update selling prices of stock_c. Stock rotation

7. Inputting new prescriptiona. Ensure all information is accurate (from 6. d.)

After all aspects are complete: Pharmacist Tech

c.



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10. Interpreting prescriptionsa. Patient informationb. Drug brands and genericsc. Strengths and systems of measurementd. Number of dosage unitse. Routes of administrationf. Frequency of administrationg. Directions for useh. Commonly used abbreviations, symbols, and terminology.i. DAW codes

9, Understanding components of a patient medication profilea. Medication historyb. Disease statesc. Allergiesd. Special requests (i.e. easy open tops)

ii. Patient's DOBiii. Patient's medication name/strength/qty/# refills

b. Customer phoned in or deliveredi. Patient nameii. Phone numberiii. Prescription numberiv. Drug name, strengthV- Qtyvi. Prescriber's name and info.vii. Insurance info.

Information given to prescriber when calling for a refill authorization.,i. Pharmacy name & numberii. Patient's name & DOBiii. Drug name, strength and qty.iv. Original prescription date and last refill dateV. Prescription sig


c.



RECElVaj'”1 07 7n?o

12. Patient Profile warningsa. Drug-to-Drug Interactionsb. Drug interactionsc. Allergiesd. Cross sensitivity

11. Drug Utilization Reviews and Third Party Reimbursement Considerationsa. Not on formularyb. Quantity Restriction

Prior Authorizationd. Over-utilization _

13. Drug preparationa. Creating new patient profile or updating existing patient profileb. Entering prescription information and type label

i. If not legible, ask pharmacist to clarifyii. Call doctor for clarification If needediii. If any alerts, promptly bring to the attention of pharmacist

c. Selecting the correct stock bottle containing medicationi. Check the NDCii. Scan the stock bottle & prescription labeliii. Watch for Look-alike Drug namesiv. Use of Tall Man Lettering

d. Accurately counting or pouring appropriate amount of drug to fulfill prescription order

e. Selecting proper containerf. Attaching prescription labelg. Attaching auxiliary labels if needed h. Preparing the finished product for inspection and final check bfv* >/h».;v’A/OCS

pharmacists



receivednil 0 7 2020'

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14. Uslna proper Telephone etiquettea. Taking refill requests from patientsb. Calling doctors for refill requests or questions on new or refilled

prescriptionsc. Referring questions to the pharmacistd. Referring new prescriptions called in by doctors to the pharmacist

i. Bag the scripti. Place in proper placement

ii. Check out customer1. Verify name and DOB2. Verify number of scripts picking up3. Check scripts are correct4. Check if pharmacist counseling is needed or if questions for

pharmacist5. Does Customer need instructions on taking meds6. Customer need to sign log?7. Receive payment

a. 3'”'^ party copayb. Cash transactionsc. Proper use of cash register/making change

8. Thank them

15. Drug Inventorya. Ordering medication

i. Know timetables for orderingii. Borrowing from other pharmacies

b. Restocking medicationc. Returning medication per pharmacy return policies

i. Controlled Drugs1. Full2. Partial

ii. Out-of-date medications




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iii. Overstocked medsiv. Damaged medsV. Re-caHed meds

d. Understanding turnover ratee. Keeping stock clean and straight and proper orderf. Replace borrowed stock from other pharmacies

17. Compoundinga. Calculationsb. Formulasc. Proper garbingd. Measuring ingredients.c. Proper labelsf. Pharmacist approvalg. USP795

16. Ordersa. Placing orders

i. Ordering drugs needed to fulfill patients' prescriptions^li. Ordering drugs to maintain current stockiii. Ordering any merchandise sold in pharmacy

b. Receiving ordersi. Verifying receipt of drug by invoice or purchase orderii. Placing stickers on drugsiii. Placing new drugs on the shelves, in refrigerator, etc.iv. Complete the proper documentation of receipt of goods V. File invoice





DOH/HSQ/VOCS



21. Printing dally drug logsa. Controlled Drugsb. Legend Drugs

20. Insurance processinga. Submitting prescriptions

i. Customer payment forms.1. Copayments2. Deductibles3. Coinsurance

ii. Prescription Card1. Card Holder name_2. ID number3. Group number4. Coverage date5. Rx BIN number6. Rx Group Number.

b. Denialsi. Expired Duration of coverageii. Misspelled name or incorrect date of birthiii. Patient no longer employed with company providing insuranceiv. Not listed on Insurance Companies Formulary.V. Exceeds allowed limit/time frame

c. Overridesd. Understanding Medicare / Medicaid Coverages e. Paper claims


a.

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25. Maintain Environmenta. Keep fill area neat and prepared_b. Noise levels down to a minimumc. No personal cell phones

22. Quality Assurance and Improvementa. Notify pharmacist of adverse drug reactionsb. Five Rights of Medication Administration

i. Right Patientii. Right Medication

Hi. Right Doseiv. Right Routev. Right Time

c. Avoiding "Do Not Use" abbreviationsd. Reporting medication errors

i. institute for Safe Medication Practicesii. Med Watch

e. Help in gathering information for auditsf. Keep up with CE credits for technician skill enhancement g. Assist in maintaining compliances with laws

24. ProfessionalismAdhere to personal appearance guidelines

b. Be a team player by:i. Rarely missing work

ii. Being punctualHi. Filling in for others as needed iv. Being polite and helpfulV. Promoting good customer service_

vi. Have a positive attitude

23. Solving Problemsa. Defuse complaints from patients, doctors or employeesb. Identify potential problems and notify pharmacist



27. Complete any duty as directed by the pharmacist


.(technician) has

Technician Training Director:

Printed Name: Date:

RECEIVEDIlli. 07 ?(i?n

DO.’-WHSQA/OCS

I hereby proclaim that completed the required practicum requirements.

d. Keep bottles and lids fillede. Keep printers readyf. Shred old labels promptly_

26. Filing prescriptionsa. Controlledb. Legend

RE: Ancillary Personnel Utilization Plans

TECHNICIANS tZ



5. Cails to wholesalers with the ordering of prescription medications and OTC's.


JUL 0 7 202(1DO'H/H3OA/OCS

f

3. Calls from physician's or other authorized medical health profession's office, authorizing refills providing no changes to the prescription involved.

4. Calis'from patients relating to prescriptions last filled, refills left, if refillable, and price information on last copay, cash price, if delivery arrived, how long will it take to fill pFescription(s) and if medication is in stock.

D. Performs nonprofessional phone calls to/from:1. Calls to physician's, ARNP's, dentist's, naturopathic physician's or podiatrist's office

for refill authorization shall be allowed stating the patient's name and date of birth, medication and strength, directions, medication and strength, quantity and date of prior refills or last fill at another pharmacy. Additional inquiries from medical office concerning prescription must be the responsibility of the pharmacist on duty.


Tri-Area RX. LLC65 Oak Bay Rd Port Hadlock, WA 98339 (360) 379-9800


E. Counts and pours from medication stock bottles for specific and individual prescriptions. This is under direct supervision of licensed pharmacist on duty, who will review and triple check for accuracy of the specific prescription content involve. Licensed pharmacist must initial all prescriptions filled.

F. Reconstitution of liquid antibiotics, must be reviewed by licensed pharmacist on duty todetermine specific quantity of distilled water or proper diluent for amount measured is 100% accurate prior to mixing. Licensed pharmacist on duty must check and initial accuracy of the technician. _RECEIVED

H. Under direct pharmacist's supervision, technician responsibilities will be:

1. Transcribe orders must be checked and initialed by licensed pharmacist for accuracy.

K. Maintain assigned work areas and equipment in a sterile, clean and orderly condition.

•9

RECEIVED

JUL 07DOH/H3Q;V3C3

J. Receives, unpacks, labels with proper pricing stickers on each individual OTC's and prescription stock bottle involved.

2. Reviews patient profile for IRS tax reports, medication history and prints reports when requested with patient's individual ID (HIPPA) and pharmacist's signature.

3. Monitors label printing, obtaining prepackaged, labeled medication for prescriptions, obtains stock bottles for prescription filling (counting capsules or tablets or pouring liquids).

G. Inputs accurate prescription data for each individual patient: Proper name, street address, date of birth, allergies, drug plan or cash, easy open viat if requested and signs the proper record, caregiver information or power of attorney if patient authorizes another person to pick up their medications.

1. Piles completed prescriptions properly in three different prescription folders: legends prescription medications, Schedule II, and Schedule lll-V. Files and retrieves ail other pharmacy records as required.

ASSISTANTS /

A. Operates credit cards transactions and cash register tor customers.

D. Performs nonprofessional phone calls to/from:


F. Maintain assigned work areas and equipment in a sterile, dean and orderly condition.

received

JULO7?ij?oDOH/KSQa/OCS

4. Cails from patients relating to prescriptions last filled, refills left, if refillable, and price information on last copay, cash price, if delivery arrived, how long will it take to fill prescription(s) and if medication is in stock.

E. Receives, unpacks, labels with proper pricing stickers on each individual OTC's and prescription stock bottle involved.

3. Calls from physician's or other authorized medical health profession's office, authorizing refills providing no changes to the prescription involved.

1. Calls to physician's, ARNP's, dentist's, naturopathic physician's or podiatrist's office for refill authorization shall be allowed stating the patient's name and date of birth, medication and strength, directions, medication and strength, quantity and date of prior refills or last fill at another pharmacy. Additional inquiries from medical office concerning prescription must be the responsibility of the pharmacist on duty.




6. Calls’^regarding pharmacy business hours or delivery services.

Objective

Specific requirements

Reasonable accommodation of religious belief

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Any staff member who does not meet the attire or grooming standards set will be subject to corrective action and may be asked to leave the premises to change clothing. Hourly paid staff members will not be compensated for any work time missed because of failure to comply with designated workplace attire and grooming standards.

All staff members must wear the pharmacy n^me tag provided at ail times while at work.

All staff members are expected to present a professional image to customers and the public. Acceptable personal appearance, like proper maintenance of work areas, is an ongoing requirement of employment.

At the discretion of the pharmacist in charge, in special circumstances, such as during unusually hot or cold weather or during special occasions, staff members may be permitted to dress in a more casual fashion than is normally required. On these occasions, staff rhembers are still expected to present a neat appearance and are not permitted to wear ripped, frayed or disheveled clothing or athletic wear. Likewise, tight, revealing or otherwise workplace-inappropriate dress is not permitted

Tri-Area Pharmacy strives to maintain a workplace environment that is well functioning and free from unnecessary distractions and annoyances. As part of that effort, the company requires employees to maintain a neat and clean appearance that is appropriate for the pharmacy setting and for the work being performed. To that end, the pharmacist in charge may determine and enforce guidelines for workplace-appropriate attire and grooming; guidelines may limit natural or artificial scents that could be distracting or annoying to others.

Procedures

The pharmacy recognizes the importance of individually held religious beliefs to persons within its workforce. The pharmacy will reasonably accommodate a staff member's religious beliefs in terms of workplace attire unless the accommodation creates an undue hardship. Accommodation of religious beliefs

RECBVED

t

*»

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2

in terms of attire may be difficult in light of safety issues for staff members.

Addressing workplace attire and hygiene problems

Violations of the policy can range from inappropriate clothing items to offensive perfumes and body odor. If a staff member comes to work in inappropriate dress the staff member will be required to go home, change into conforming attire or properly groom, and return to work.

JUL 07 pggfBreaks and Meals DOH/Hsc^/Q^g

Breaks

When must a worker get rest periods?

Can workers take several “mini" breaks instead of a 10 minute rest period?

What is a worker allowed to do during a rest period?

Can a worker smoke while on their rest period?

3

Rest periods can be used as a worker chooses, except they are subject to whatever policies the business has established.

Yes, if the business allows smoking around the workplace, workers can smoke during a rest period if their employer permits them to go outside to smoke; state law prohibits smoking within 25 feet of a building's entrance, pursuant to RCW 70.160.

Examples of mini rest periods are personal phone calls, eating a snack, personal conversations, smoke breaks, and whenever there is no work to do for a few minutes during a work shift.

Yes. Businesses may allow workers to take several "mini" breaks in each 4 hours of working time. If these mini breaks total 10 minutes this substitutes for a scheduled rest period.

Workers must be allowed a paid rest period of at least 10 minutes for each 4 hours worked.

The rest period must be allowed no later than the end of the third hour of the shift.

X

The business may require workers to stay on the work site during:

Their paid rest periods.

No.

RECEIVEDMeal Periods

JUL 07 mnWhen must a worker get a meal period?

DOH/K3CA/OCSIf more than 5 hours are worked in a shift:

Workers must be allowed at least a 30-minute meal period.

Must workers be paid during their meal period?

Workers must be paid during their meal period when:

They are required or allowed to remain on duty.

They are required to be on-call at the business premises or

4

Must a business or organization provide a room where workers can eat meals or take rest periods?

A business is not required to pay for meal periods if workers are free from any duties for their entire meal period.

However, the business has the right to prohibit smoking on the work premises or job site.

Their meal period if the business pays the worker during that meal period. Their meal period without paying them if the workers are completely relieved from duty for the entire meal period and will never be called back to work during the meal period.

Can a business or organization require workers to stay at the workplace building or site during rest periods and meal times?

Workers must be at least 2 hours into the shift before the meal time can start.

The meal time cannot start more than 5-hours after the beginning of the shift.

Can a worker choose to give up his or her meal period?

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5

*

Workers may give up their meal period if they prefer to work through it and if the employer agrees.

They are called back to duty during their meal period even though they normally are not on call during the meal period.

designated worksite to be available to return to duty even if they are not in fact called back to duty.

Business owners please note: The Department of Labor & Industries recommends that you get a written statement from workers who want to give up their meal periods

receivedJUL 0 7 707(1

doh/hsqa/ocs

Pharmacy Policy and Procedures Manual

Section 1" General Information

Pharmacy operations:

1

Tri-area Pharmacy hours:Monday through Friday: 8:30 am to 6:00 pm Saturday: 8:30 am to 2:00 pm

Tri-area pharmacy staff is dedicated to providing exemplary medication services to the community. We offer delivery, immunizations, med box and bubble packing services, personalized consultations and record-breaking wait times. This is not a chain but a small town pharmacy where we take the time to get to know our patients on a personal level to serve them better.

Tri-Area Pharmacy65 Oak Bay .Road Port Hadlock, WA 98339360-3799800 (phone] 360-3798200 (fax)

Procedure:• A copy of Tri-Area Pharmacy's Policy and Procedures manual and Ancillary

Utilization Plan shall be available to all appropriate personnel and a copy will be kept on the location at all times.

• The facility administrator will prompt staff members to read, sign and date the included documentation. The administrator will verify that all appropriate staff members have done so.

• The facility must maintain all drug permits and licensures as required by the state in which it is operating. It is the responsibility of the administrator to acquire and renew such licensure when necessary.

• The facility must display all licenses, permits, registrations and inspection reports in view of the public as directed by applicable state law.

• It is the responsibility of the staff administrator to ensure that all state licenses of all appropriate personnel are current and displayed in plain view of the public. Renewal of said licenses are however the responsibility of the respective individuals. Failure to renew their license will prevent them from working in the pharmacy until resolved.

• It is the responsibility of the facility to keep a list of names and license types of medication handlers, drug administrators and other associated individuals if any.

Section 2 - Filling Prescriptions/Ordering/Receiving Medications

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JUL 0 7 2(J?nDOH/HSQA/OC3

• Medications will be provided on a defined basis. Ordering and deliveiy procedures will be available upon request

• Medications will be dispensed upon the clear, complete order of a person lawfully authorized to prescribe or those designated as agent for a legally qualified prescribing entity.

Procedure:• Any order or dosage that appears inappropriate in respect to the diagnosis,

allergies or current medication regimen will be verified with the prescriber and the dispensing pharmacist

• Medication allergies, medical conditions and any special dispensing requirements (e.g. use of easy open lids, special brands on generic medications, etc.) will be noted on the patients profile.

• All orders received such as from the patient directly (hard copies given to patient from the providerjor refill requests in person, electronic transmissions from the provider, faxed prescriptions, phone in refills and phone in prescriptions from a provider will be filled on the same day received expect:

• If the medication is not in stock, the patient will be informed and the medicationfs] will be ordered with the patient's consent as to when it will be available (generally within the next business day}.

• If the prescription has no available refills left, the pharmacy will contact the provider to request for a new prescription and an offer for an emergency supply will be given to the patient (except for

• controlled drugs] for maintenance medications upon approval of the dispensing pharmacist.

• The patient's third party plan denies payment for medication in cases like a prior authorization from theprovider is required or a refill too soon rejection occurs. If a prior authorization is required, pharmacy will notify the provider of the rejection and the requirements from the insurance of all necessary information needed to submit the claim. The patient will be notified and will be offered options while waiting for said authorization to be approved. If the rejection is refill too soon, the patient will be notified and options will be offered and discussed.

• The staff must consult pharmacist on duty and any other reference materials before filling any unfamiliar medications. Likewise, pharmacist must consult any reference materials for any unfamiliar medications.

• Special instructions for administering and monitoring specific medications (patient counseling will be delivered with the first fill of any medications (all new prescriptions as defined by state law] by the pharmacist on duty. Any

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Ordering Prescribed Medications

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JUL 0 7 ?a?nDOH/HSQ/VOCS

refusal for patient counseling can only be directed to the pharmacist. Extra copies are available upon request.

• Delivery options are available upon request Payments for medications with delivery and mail services are required prior or upon delivery. Payment options can be discussed with pharmacist in charge.

• Medications will be ordered, dispensed and delivered in compliance with state law, including proper transmission of such orders to Tri-Area Pharmacy.

• Controlled substances, such as classifled by the Drug Enforcement Agency (DEA) and/or state regulatory agencies, are subject to special ordering and storage requirements.

Filling controlled medications• By Federal law, a new prescription order must be written each time a

Schedule 2 medication is needed. These orders must be requested by the patient from their respective providers.

• Schedule 2 controlled substances (C2 medications) may only be filled once the original signed prescription fi^m the prescriber has been received by the pharmacy.

Procedure:• Medication orders must supply all of the following information:

• Date of prescription• Name of the facility/clinic• Patients name• Medication name• Strength of medication• Dosage form (tablets, capsules, etc.)• Frequency of administration or time of administration• Route of administration• Quantity to be dispensed or duration of drug therapy• Authorization to dispense either generic or brand name formulation• Prescriber's name and signature• Refill authorization or non>refillable indication• PRN (if needed) medications or instructions should include the exact

amount to be used in 24 hours, the symptoms that indicate the use of the medication and the exact dosage to be'used at each administration.

• Orders for new medications, other than controlled substances, may be transmitted to the pharmacy by phone, fax or e-scribe from the prescriber or his/her authorized agent

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• By law, orders for C2 medications may not be transferred from one pharmacy to another. If a patient decides to get his/her prescription filled somewhereelse, the patient must take the hard copy back from Tri-Area pharmacy.

• Federal law prohibits the return of any controlled substance to any pharmacy.

• Before filling any controlled medication, the technician/pharmacist will check first the date of previous fill of said controlled medication. All controlled medications will only be filled if patient has 3 days left of medication from the previous fill. If the prescription needs to be filled earlier than 3 days (patient going on vacation, lost medication, etc.], the provider will be notified and approval for early fill will be obtained and if approved, will be documented on the hard copy (reason for early fill, etc.).

• All controlled medications will be counted twice and indicated on the label.• Any suspicious looking prescription for controlled medication (unusually

high quantity or dosage, patient not from the area or provider not from thearea) will not be filled without any inquiries and research for proof of validity. The pharmacist will professionally handle the conversation to patient or representative informing them that added information is needed to fill the prescription. If proven to be a falsified prescription, the provider will be given a copy of the forged prescription and the local authorities will be notified.

• Patients that get multiple controlled substances from different providers will be evaluated for validity of any controlled prescription presented to pharmacy by inquiry to the involved providers (As defined by state law, a valid prescription is; To be valid, a prescription for a controlled substance must be issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice ). Pharmacist(s) With Tri-Area Pharmacy is/are registered with Prescription Monitoring Program to allow the pharmacist to have access to patient's controlled medication history fill with other pharmacies as reference for decision to fill or not to fill. The conversation between patient and pharmacist will be handled in a professional manner if indeed the prescription will be considered invalid.

• Schedule 3 thru 4 controlled substances are valid six (6) months from the date of issuance or for one (1) initial fill and five (5) refills. Schedule 5 controlled substances are valid for one (1) year from the date of issuance.

• Transfer orders or medications previously obtained at other pharmacies may be ordered by phone or fax except for Schedule 3 thru 4 controlled substances where transfer can only be done thru phone. Tri-Area pharmacy will comply with all sate and federal regulations regarding medication transfers.

Ordering Non-Prescribed Medications/Floor Stock SuppliesPolicy:

• Non-prescription products will be supplied to patients and facilities upon request, as negotiated, and in accordance with state laws and federal


D0H/KS0AZ0C3

regulations.Procedure:

• Over the counter medications [OTC] are non-prescription products and supplies maybe ordered in person from the pharmacy or phone, fax or email.

• OTC medications are not innocuous. Overuse or using for a longer span of time than the recommended on the product label or by the manufacturer's insert may cause serious harm. Additionally, OTC medications can interact with prescription medications. It is the patient's responsibility to oversee the use of any non-prescription medications. Tri-Area Pharmacists are always available for any OTC medication use consult

Procedure:• Tri-Area Pharmacy can provide legend (standard prescription] medications

and C2, C3, C4 and C5 drugs in any of the'following packaging: Vials:• By law, all medications received from Tri-Area Pharmacy must be

verified during check in procedure for correct labeling. Any that are incorrectly labeled should be returned to Tri-Area Pharmacy immediately and the pharmacy notified of the perceived deficiency.

• Each label will include:• Patient's name• Prescription number• Prescriber's name• Dispensing date• Expiration date of medication and prescription• Medication name• Medication manufacturer• Medication dosage• Medication type• Quantity contained in packaged• Directions for use including frequency of administration, route

of administration and quantity to be administered.5

Medication Packaging/LabelingPolicy:

• Medications are packaged in accordance with federal regulations and state laws and in containers appropriate for the accurate administration of the medication.

• Medications are to be labeled in accordance with federal regulations and state laws. All prescription medications must have a current pharmacy- produced label.

JUL 0 7 ?,(}?/)D0;-i/H3C.V0C3

• Tri-Area Pharmacy will permanently attach all labels to the exterior of the medication container.

• Only a pharmacist or a technician will place the label on any prescribed medication.

• Prescription medications received by the patient with damaged or illegible labels will be returned to the pharmacy.

• If the prescriber changes usage directions, such changes will be recorded on the patient’s profile and the patient notified for such changes.

• Any auxiliary information, such as special storage requirements, procedures or precautions (ex. Refrigerate, shake well, etc.)

• Initials of the dispensing pharmacist• Name, address and phone number of the dispensing pharmacy• Description of the medication dispensed (ex. Round yellow

tabs H25)• Additional information (ex. Warning for change in

manufacturer, increase in dose, etc.)

Medication Check-inPolicy:

• In accordance with federal regulations and state laws, a complete and accurate record of all medications ordered, received and administered must be maintained by the pharmacy staff.

• All check-in reports must be stored by the pharmacy for at lest three (3) years or tn accordance with state laws.Procedure:

*' " • Deliveries for Tri-Area Pharmacy from drug distributors arrive with a checklist of the enclosed medications. After verifying receipt of delivered medications, the lot number, expiration date and quantities for each medication received will be entered in RX30 (Tri-Area Pharmacy’s computer dispensing system).

• Medications received are then stored in the designated and secure area immediately after check in.

Patient/Representative Provided MedicationsPolicy:

• Patient(s) or their representative(s) may obtain prescription and nonprescription medications, medical supplies, testing equipment or related items from any licensed pharmacy.

Procedure:• Patients may only have access to those medications prescribed for him/her

by his/her physician or other licensed practitioner.6 RtCEJV-o

7 RECEIVEDJUL 0 7 ?n?n

D0:-3/HSCJA/0CS

• If a patient or his/her representative(s) obtain medications outside the services of Tri-Area Pharmacy, the patient(s] and his/her representative(s) is responsible for reporting any change in medications, dispensing instructions, new prescriptions or discontinued medications to the pharmacy staff.

Discontinuing MedicationsPolicy:

• Medications discontinued by the prescriber are discontinued on the patient's file.

• By law, record of any alteration or discontinuation of a medication must be maintained for each patient file.

Procedure:• If a prescribed medication is discontinued by the patient’s physician or

licensed practitioner, it is the responsibility of the patient or his/her representative(s] to notify the pharmacy immediately.

• If a prescribed medication has been discontinued, Tri-Area Pharmacy return policy allows medications to be returned to the pharmacy if the following conditions are met:

• The medication is in its original stock bottle or package and is still sealed. By law, medications filled with the pharmacy’s vial(s] or bottle(s] cannot be returned.

• The packaging is unopened, intact and complete. Drugs in damaged, opened or tampered packaging cannot be accepted.

• The full quantity of medication is returned. Partial returns cannot be accepted and partial credits cannot be given.

• When the pharmacy is notified of a discontinued medication, it is the responsibility of the pharmacy staff to update the patient’s profile of said changes in the notes section of RX30.

Section 3 - Medication Storage/DestnictionPolicy:• Prescription drugs will be stored in a secure area within the pharmacy

premises with access only by the pharmacist and appropriate personnel, following all federal regulations and state laws applicable to the facility.

• Prescription and OTC medications will be stored in optimal conditions to preserve the stability and efficacy of the drug when administered.

• Consistent with state laws and federal regulations, all C2 medications must be inventoried so that a perpetual count is maintained.

• Discontinued, unused, expired, ready to expire or recalled medications will be removed and disposed of properly or returned to the vendor.

Procedure:• The facility is responsible for knowing and enforcing the applicable laws and

regulations regarding medication storage for the state in which they are licensed.

Section 4 - Medication Problems/Recalls/Errors

• •

R^CEiVEDJUL 07 mn

•^OH/HSOA/OCS

• If medications are stored in a central location, the storage cabinet/area will be locked at all times. Access to the cabinet is only granted to the pharmacist and a code is needed to open it each time.

• Refrigerated drugs will be kept in the refrigeration unit and remain so except when in use.

• By law, no food maybe stored in the refrigeration unit used for storing medications. A separate refrigerator for use is provided for food storage.

• Medication will be stored according to the drug manufacturer's recommendations. A thermometer is to be placed in any refrigerated storage areas to ensure that temperatures are optimal for drug stability and longevity [temperatures are checked and recorded twice a day for all refrigerators and freezers used to store medications]. Note the following guidelines: (Fahrenheit Temperature]

• Room temperature: 59 degrees to 86 degrees• Controlled room temperature: 68 degrees to 77 degrees• Refrigerated; 36 degrees to 46 degrees• Store in cool place: 37 degrees to 76 degrees• Frozen: -5 degrees or colder to 5 degrees.

• Drug storage requirements are in effect 24 hours a day for as long as any medications remain in the facility. Specific staff members are to be assigned to routinely verily proper storage of medications.

• C2 medications can be inventoried online using RX3O's inventory form.

Policy:• A medication error is defined as any preventable event that may cause or

lead to inappropriate medication use or patient harm while the medication is in control of the health care professional, patient or consumer. Such events maybe related to professional practice, health care products or procedures and systems, including prescribing, order communication, product labeling, packaging and nomenclature, compounding, dispensing, distribution, administration, education, monitoring and use.

• Problems of any type with medication formulations or with drug administration are noted and reported according to applicable state and federal statutes. Corrections are based on the action most efficacious for the resident. Errors of a serious nature and involving specific entities are required by law to be reported to the FDA.

Procedure:• Problems with dispensed medications will be reported immediately to Tri

Area Pharmacy and appropriate medical personnel. Tri-Area Pharmacy will evaluate the problem and will resolve the issue, contact the manufacturer and Instruct the patient as to the appropriate response for the situation.

• Medication problems may consist of any of the following or other issues:• Damaged or crushed tablets, melted or broken tablets, or contaminated

8

9R£’Gp;u~^

or congealed liquid.• Damaged, leaking or incomplete packaging.• Mislabeling or missing labels.• Incorrect medication, dosage or drug type.• Discrepancy between the prescription, and/or label and/or medication.• Error in prescribing.• Error in ordering.• Incorrect dispensing or administration.• Incorrect recording of a medication administration.

• If the drug manufacturer is determined to be the source of the problem, TriArea Pharmacy will assist the patient in contacting the manufacturer and the Food and Drug Administration.

Medication Administration ErrorsPolicy:

• Errors in drug administration or in recording drug administration will be documented, evaluated and reported to the medical provider or his/her assigned agent such as medical provider, facility administrator, consulting pharmacist or head nurse.

• Medication errors can be any or caused by the following:• Circumstances or events that have the capacity to cause error; no error

exists.• Error occurred, but did not reach the patient; error exists, no harm.• Error occurred and reached the patient, but did not cause harm (not

ingested or used); error exists, no harm.• Error occurred, reached the patient and required monitoring to verify

that if resulted in no harm nor required intervention to preclude harm; error exists, no harm.

• Error occurred that may have contributed or resulted in temporary harm to the patient and required intervention; error exists, no harm.

• Error occurred that may have contributed to or resulted in temporary harm and required brief or extended hospitalization; error exist, harm.

• Error occurred that may have contributed to or resulted in permanent harm to the patient; error exist, harm.

• Error occurred that may have contributed to or resulted in the patients death, error exist, death.

• If an error in the administration of a medication, supplement or other ingested/applied medicinal product results in harm to a patient, the patient should notify the pharmacy of the event after proper help/advice is given.

Adverse ReactionsPolicy:

• Adverse reactions to any prescribed, non-prescribed, OTC medications or

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Medication RecallsPolicy;

• Tri-Area Pharmacy maintains a record of all drugs dispensed to patients. In the event of a drug recall by the Food and Drug Administration or by the manufacturer, Tri-Area Pharmacy will notify the affected patients.

Procedure:• Tri-Area Pharmacy will notify the patient by phone when a medication has

herbal/vitamin supplement will be documented after the patient, patient's representative, or prescriber notifies the pharmacy,

• Adverse reactions are defined as an unintended deleterious effect on a patient as a result of ingesting or contact with medications, pharmaceuticals, medicinal or topical products, sometimes in combination with other drugs or products. Such harmful effects may be but are not limited to:• Allergic reaction, particularly in those without a known allergy to the

substance, including but not limited to swelling, runny eyes and/or nose, itching, hives and/or blisters, flushing, wheezing, anaphylaxis, shock and other reactions based on individual history and side effects of medication.

• Nausea, diarrhea, vomiting, severe cramping, gastrointestinal irritation, constipation.

• Agitation, nervousness or sudden stress behaviors.• Blurred or double vision.• Headache, dizziness and/or ringing in the ears.• Psychotic behavior in those without psychotic condition or worsening of

diagnosed behavior.• Unexpected or severe drowsiness response to a non-sedative or mild

sedative.• Hyperactivity in those not previously known to be hyperactive.• Precipitous drop in blood pressure.• Sudden, severe dry mouth.• Confusion, forgetfulness, disorientation.• Depression, irritability, sleeplessness.• Severe coughing, wheezing or swelling.• Nasal congestion, runny eyes and/or nose.• Unusual bleeding.• Other reactions based on individual history and side effects of

niedication.Procedure:

• If administration of a medication, supplement or other ingested/applied medicinal products results in an adverse reaction, the patient should take immediate action to sustain or regain well being before any other actions. The patient/caretaker contacts the appropriate emergency personnel if needed, including calling 911 when necessary.

f

DOH/HSCA/OCS

RECESVuDHJV 07 7070

been recalled.• Recalls notifications received from either the manufacturer or drug

distributor will be checked on the day the notification is received if said product or medication is available in the pharmacy and/or dispensed within the last 3 months and filed together with all other pharmacy records.

• Any recalled drugs will be packaged securely and returned to Tri-Area Pharmacy for proper disposal.

• Tri-Area Pharmacy will provide a new supply of the affected product, if such is available. If not available, the pharmacy will contact the prescriber to discuss medication options.

WASHINGTON STATE BOARD OF PHARMACY

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