Ask Your Pharmacist
Why does it take so long to count out my pills?
I spent the last six days hiking New Brunswick's National Geographic acclaimed Nepisiguit Mi'gmaq Hiking Trail that runs 150 km along the beautiful Nepisiguit River. During the hike I was asked this question, and after I responded, my hiking buddy looked mind blown and encouraged me to share the answer in my column.
Although there are variations of this process from pharmacy to pharmacy, I will share the system that occurs at my place of practice, which focuses on the five "Rs of medication safety": right patient, right drug, right dose, right frequency or timing of dosing, and right route of administration". Everything that happens from your first interaction with a pharmacy team member at prescription drop off is done with the intent of safely providing you with the correct medication therapy.
When you drop off your prescription, a registered pharmacy technician (RPT) or assistant will accept your prescription. They will verify your name, date of birth, New Brunswick Medicare number, and other demographic information including an up-to-date address and phone number. It is vital that this information is correct because your medication profile at each pharmacy undergoes an electronic sync with your provincial electronic health record. In this way, every pharmacy, and prescriber in New Brunswick has access to your complete medication profile over the last 365 days when your electronic health record is accessed using the Drug Information System (DIS). The highest level of confidentiality, accuracy and precision is required each and every time your medication profile is accessed for the benefit of your medication safety.
At prescription drop off your allergy status will then be updated. The importance of your pharmacist knowing your allergy and medication intolerance history cannot be understated. Be specific with the details of your allergy history: What medication did you have the reaction to? Was the reaction life threatening, or a rash, or hives, or was it stomach upset or drowsiness? Who told you about the reaction? Did you require a trip to the hospital? When did it occur?
Your drug plan insurance information should then be presented to the pharmacy staff. This information must be accurate for an electronic claim submission.
Establish at drop-off when you need the prescription to be ready so that your expectations are met by your pharmacy team and we can let you know an approximate time that your prescription can be ready.
At this point, your prescription is scanned into the computer (not all pharmacies have this capability yet but most are working towards it). A RPT or assistant will then type the prescription for the pharmacist. The RPT or assistant takes care of billing your prescription electronically. An online adjudication occurs, and your drug plan informs us of the co-pay to charge. If a medication is not covered, this gets passed to the pharmacist and efforts are made to find the most cost-effective medication for you, in conjunction with your prescriber.
Once your prescription is entered and billed, it enters a prioritized que to be verified by a pharmacist. The pharmacist verifies the data entered, including the 5 R's is correct. This includes ensuring that the date of the prescription is valid; a prescription in Canada is valid for one year from the date it was written. The name of the prescriber is also verified to be certain it is correct and that the prescriber has a valid Canadian license.
It is at this point that a clinical verification occurs by the pharmacist. It will be determined based on a number of factors whether this prescription is safe to be dispensed. For example, the pharmacist will receive notification electronically from the DIS if the prescription has recently been filled at another pharmacy in New Brunswick. This will be investigated if necessary to make sure you are not accidentally getting double dosed.
The pharmacist will look at your prescription to make sure that the drug being filled is appropriate for your medical condition. They will ensure the dosage is correct based on your age, kidney health, liver function, weight for pediatrics, and other factors. When needed, the pharmacist will log into your provincial electronic health record to determine from recent blood work, relevant factors including a calculation of how well your kidneys are working. If necessary, the pharmacist will perform a therapeutic dosage adjustment from the original prescription. If there is a medication shortage, the pharmacist will perform a therapeutic change to a medication that works similarly and is available. This requires documentation to be sent to the prescriber and this takes time.
The pharmacist will examine your allergy history. They will also look at your complete medication record at the pharmacy, and again will access your provincial record if needed for a complete medication profile, to make sure there are no clinically relevant drug-to-drug interactions with your prescription. If all these checks are met, the pharmacist will then send the prescription to be filled by an RPT or pharmacy assistant.
The RPT or pharmacy assistant will receive a printed label that contains relevant information including a Drug Identification Number (DIN) and a bar code. These two pieces of information will help ensure the correct product is filled. Narcotics and targeted substances are generally doubled counted by two pharmacy team members.
The assembled product then goes to a pharmacist or RPT to do a final product check. After this step, your prescription is ready. When you pick up your prescription, a pharmacy team member will verify your identity by confirming your name and a second piece of personal information such as your date of birth. Your prescription will be paid for at this time.
All new prescriptions will be counselled on by your pharmacist unless you decline counselling. This is the last opportunity we have to confirm that the medication you are receiving is intended for you. It also allows us to discuss therapy with you and to go over what you should expect the medication to do, and how to minimize any side effects. A condensed version happens for refills.
Above and beyond this process, pharmacy teams are busy with phone calls from patients and prescribers. Pharmacists are now also prescribing for over 40 minor ailments, immunizing against COVID 19, providing other vaccinations, performing COVID rapid tests, assessing and prescribing birth control, along with many other clinical services.
We love doing our work making New Brunswickers healthier. We encourage you to be patient with us, and to allow sufficient time to give you the safest and highest level of health care.
Dr Kevin Duplisea (PharmD BSc. Pharm, BSc. ACPR) is a pharmacist at Shoppers Drug Mart in Quispamsis, New Brunswick. His opinions expressed in this newspaper are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.
Quispamsis pharmacist Kevin Duplisea dispenses information and advice on a wide range of pharmacy questions in a regular column published in several newspapers.
If you have a question you’d like to see answered in his column, you can send it to him at AskYourNBPharmacist@gmail.com.