Chapter 6: Inventory Management for the Pharmacy

Technician

4 Contact Hours

By Katie Ingersoll, RPh, PharmD, and Staff Pharmacist for a national chain
continuing pharmaceutical
Author Disclosure: Katie Ingersoll and Elite Professional Education, To Obtain Credit: A minimum education. This program is
test score of 70 percent is approved for 4 hours (0.4 CEUs)
needed to obtain a credit. Please of continuing pharmacy
LLC do not have any actual or potential conflicts of interest in education credit. Proof of
relation to this lesson. submit your answers either by
mail, fax, or online at
PharmacyTech.EliteCME.com.
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issues should be directed to 1-888- have successfully completed the
Initial Release Date: June 1, 2015 666-9053. This lesson is $17.00. post-test. Participants must
participate in the entire
Expiration Date: May 31, 2017 Educational Review Systems is presentation and complete the
accredited by the Accreditation course evaluation to receive
Council of Pharmacy Education continuing pharmacy education
Target Audience: Pharmacy Technicians in a community-based setting. (ACPE) as a provider of credit.
Learning objectives
application in considerations. new procedures for medications
After completing this continuing education managing products returning from bulk
program, the pharmacy technician should be inventory. as well medications that bottles into unit
Introductio as are outdated, dose packages
able to:
Š Discuss the n paying damaged, and the labeling
invoices recalled, or requirements for
Š Discuss the technology available to help process of and overstocked, repackaged
pharmacies manage inventory, including ordering Š Summarize
medication for a what to including medications.
computer systems, perpetual inventory the process of
do if an controlled
systems, and automatic dispensing systems. pharmacy, receiving
order is substances, and
including medication orders, Š Recall the
terminology incorrect when it is temperatures
including
Š Describe the automatic dispensing associated with or appropriate to required for
receiving regular
machines available to help pharmacies ordering, where damage destroy medication
orders,
manage their inventory, including how errors medications may d upon medications that storage at room
medications with
can occur with these machines. be obtained from, receipt. cannot be used. temperature as
special storage
automatic and conditions, well as
Š Recognize the concepts of availability, manual ordering controlled Š Š List five refrigeration and
expiration dates, and turnover rates, and their procedures, and substances, and Describe reasons for freezing.
special ordering the repackaging
of a on the restocking hospital. general will review
In the pharmacy environment, the needs of pharmacy. facilit in a retail Despite principles basic
inventory refers to all of the the patients a y, and pharmacy to the of inventory
medications and medical supplies pharmacy The level of can purchasing variety in pharmacy managemen
used in daily operation of a serves, and pharmacy range and responsibiinventory t
pharmacy. The management of careful technician from maintaining lity level managemen terminology
inventory comprises a large portion inventory involvement basic the and t remain the and
of the pharmacy technician’s managemen in inventory inventory of location- same. procedures
responsibilities. It is essential to t can also specific
management orderi all for the
ensure there is an adequate stock of increase the varies based medications considera This course pharmacy
ng and
medications and supplies to serve profitability for a tions, the technician.
Purpos e and goals of inven tory mana gement
carefully inventor ●● occurre stocks on Decreas maintainin cost icati
Ensuring there is manage y. Other Mini nce of to patient ing the g an s of ons
adequate stock of a reasons mizi unexpe decrea care. carryin inventory. orde fro
medications is only one pharmac include: ng cted se the g cost ●● ring m
of the many reasons to y’s the out-of- impact ●● of Lowering med who
lesalers. medicati asso age and ry. asing cy and organizatio prod est
ons and ●● ciate expirati total overall n by ucts cost
●● Ensuring minimal purchasi Preventi d on of ●● costs to health focusing with .
time is spent ordering ng tasks. ng costs with invento Decre the care on the
dam pharma purchasing low
Page 53 Pharm acyTech.Elit eCME.com

There are two main goals to keep in mind when managing an from or contract pricing with specific drug companies to
inventory for a pharmacy. The first is to ensure medications are decrease the cost of purchasing medications. The pharmacy
available when patients need them. The products that are regularly technician should make an effort to use preferred delivery systems to
kept in stock are based on the needs of the pharmacy and its try to keep acquisition costs as low as reasonably possible.
customers. While some rarely used, extremely expensive or
cumbersome products may be ordered in as needed, efforts should be Preventing profit loss is also a contributing factor to controlling
made to keep the medications used regularly in stock and available for medication costs. Properly managing stock by using medications
use – not outdated or damaged. before they expire and processing returns regularly can help keep
medication costs down.
The second goal of inventory management is to keep medication costs
at a minimum. Many pharmacies have preferred wholesalers to order
Inventory management computer systems
wholesaler’s computer passwords to use to access pharmacy technician should complete
system. This function can the system. This allows the computer regularly to ensure continued
Computer systems are used in
both hospital and retail allow the pharmacy staff to employer to prevent systems are operation of vital systems.
order medications directly unauthorized access to essential to
pharmacies to assist with the
through the wholesaler’s protected health the
maintenance of inventory as Checking reports for errors
well as processing website and check stock at the information and keep a continued after information is entered
prescription orders and wholesaler’s facility as well record of who performed function of into the computer system is
as look up specific each task in case an error the system.
maintaining patient files. an important step in making
information on the products occurs. Pharmacy staff Ensuring the sure information is recorded
the wholesaler carries. should protect their computers correctly. A simple data entry
usernames and passwords are clean and
error, such as missing a zero
Wholesalers often have and avoid giving them out free of dust
Users of pharmacy computer or a decimal point, could
computer programs that they systems are generally limited to
to unauthorized individuals. or moisture
result in severely incorrect
allow pharmacies to use to pharmacy staff members, who is a task the information.
access information in the are given usernames and Backup and maintenance of pharmacy
Perpetual inventory syste ms
for the the computer filled track turnover levels are When a entry also may be
Most pharmacies prescription is system. and rates, predict low. These medication stock used to help
use a removed from gener future drug needs, points can level in the maintain a
computerized the inventory to There are several ate notify pharmacy be set in theperpetual perpetual
perpetual ensure the tools used in the autom staff when computer inventory system inventory in a
inventory system quantity on hand management of a ated possible system for is reduced to the pharmacy. These
to maintain the in the computer perpetual and each pre-set minimum portable devices
stock of manua level, the
is always current. inventory system. errors are medication, allow the user to
medications in the l computer system
Deliveries and The inventory is detected, and which walk around the
pharmacy. A reports can
returns are also generally to
even order more allows the automatically pharmacy and
perpetual recorded, often managed through medication user to set a order enough scan the barcode
inventory system allow
automatically, as a computerized pharm based on set maximum medication to or enter the ID
is a method of they occur. inventory reorder points. amount of reach the number for a
management acy
recording the medication maximum level medication that
quantity of a system (although staff to
Federal law Schedule II analyz In a perpetual that the again. This needs to be
particular e and pharmacy allows for a ordered. These
requires the use of controlled inventory
medication this inventory substances are monito system, many would like simplified devices can also
continuously as r the
system for required to be pharmacies use to have at ordering be used for
prescriptions Schedule II managed on paper invent reorder points, orany point in system and updating on-hand
are filled. After controlled ory. In time and a decreased quantities as well
as well). The periodic
each substances, but computer system genera minimum workload for the as performing
automatic
prescription is using this system is designed to l, the level that pharmacy other functions,
compu replacement
filled and for all medications automatically
(PAR) levels, to should be technician. such as recalls or
dispensed to ensures an update on-hand ter automatically maintained outdates.
the patient, the accurate quantities as system
order more at all times.
amount of reflection of the prescriptions are can Handheld
current stock in often medication when
medication used devices for order
Automati c dis pensing syste ms
to help community tha ured that can them in automatic pharmacy that have machines
pharmacie and hospital t through for print prescriptio dispensing technicia these can be very
There are
s fill setting. pill counting to labels, n vials. systems is n’s elaborate
many
prescriptio They range s elaborate count an responsib machines. and require
different important ilities in Because a lot of
machines ns in both from simple are robotic pills, Maintenanc
the machines po machines and put part of the facilities the user input
available e of
to work many can occur. dep nt should safety the properly , and ensure are
correctly, different The art have a plan to machines filled and technicia these followed
there are ways errors pharmacy me written ensure are maintained ns should regulations closely.
2

Pharmacy Tech.EliteC M Page 54

E.com
Automatic dispensing in a community
pharmacy
Baker Cells® is pharmacies. They
In the community another type of have robotic
pharmacy setting, there machine that can be capabilities that
are several types of used in community include label
machines available to pharmacies to printing, pill
assist with the filling of count medications. counting, pouring
prescriptions. The This is a much pills into the bottle,
Kirby Lester® and even applying
larger machine
machine is a simple than the Kirby the label to the
machine that the user Lester® and has prescription bottle.
pours pills into from many different Like
the top, and it uses cells filled with
lasers to count pills as medications. When Baker Cells®, the
they pass into a tray at an order is sent to pharmacy
the bottom of the the machine, it technician must
machine. It is a small counts out the refill these
device that can sit on necessary number machines
a countertop and of pills of the regularly under the
allows for quicker ordered medication supervision of a
counting of and holds them in a pharmacist, and
medications by segregated area care must be used
pharmacy staff. Users from the rest of its when filling the
must be sure to pour stock for the cassettes to
medications into the technician to put prevent
machine at a into a bottle. potentially
reasonable speed, dangerous errors.
because pouring A log of the
medications too The pharmacy expiration dates
quickly can result in technician is and lot numbers of
responsible for
an error. medications added
refilling the
machine’s cells to each container
Newer versions of thiswith medication. must also be kept to
machine are coupled Errors are trace medications
with barcode common when in case of recall or
technology that allow refilling this type of expiration.
the pharmacy automatic dispensing
technician to scan the machine, so it is These elaborate
prescription label and very important to machines can
the pill bottle being ensure the correct contain cells for
used for counting to medication is poured hundreds of
into the correct cell,
make sure they match, different
and a pharmacist
and new machines can should check each medications, so
even estimate the pill medication before care must be
bottle size that should the technician applied when
be used for the refills the machine. refilling cells and
counted pills. Technicians must replacing them in
also keep a record of the machine to
Tech alert! Because lot numbers and prevent incorrect
the Kirby Lester® expiration dates for medications from
uses lasers to count medications used being dispensed to
pills, certain types of to fill Baker Cells®. patients. These
pills cannot be machines are much
counted accurately, ScriptPro® and more expensive
such as clear gel caps Parata® are two than the previous
like docusate sodium types of robotic systems, but their
and benzonatate. dispensing systems cost is often
available to high- justified in very
volume community busy pharmacies.
dispensi hospital y
Automatic ng in a pharmac
that are and n stock of nursing .
Hospital differen Omnice prescripti staff
pharmaciest from ll® on with The
also have retail machin medicati the machin
several pharma es are ons on medicat es are
options for cy commo the ion compri
automated machin nly hospital needs sed of
dispensing es. The used to floors to of their many
systems Pyxis® maintai assist the patients drawer
s and numbe removes machines dispens machin
cabinets r and the must enter ing e, a list
that have passw medicati their machin of all of
pockets or ord on, the fingerprint es in the
compute or ID the medica
trays that and
hold preset select r system number hospital tions
deducts and setting
levels of a the needed
are
this password to
variety of patient often
medicati , the restock
common for refilled
on from machine on a the
medication whom tracks machin
s. They they daily
the every basis, e is
may also are user of or less printed
be used to trying machin
the frequent and
hold to e’s used to
machine ly,
controlled obtain invento and what dependi pull
substances medica ry. This medication ng on its medicat
and tion. process s they location ions in
patient- Patient allows were in the the
specific files for a authorized hospital pharma
orders, have a more to add or and cy
generally list of streamli remove. usage departm
in locked medicat ned This data level. ent. The
These
boxes or ions medicat can then machine pharma
cubes that ion be used to cy
s
dispensiprint technici
within the have common
ng reports of ly utilize an is
machine. been respons
Because prescrib system who PAR
as well accessed levels to ible for
medication ed to the pulling
as automati
s used in them, machine, cally the
the and so increasi
what determi correct
hospital nurses ng the medication ne medicat
setting are can pharma s they when a ion and
often select cy’s accessed, particul quantity
packaged the ability and how ar off of
in unit medicat to track much was medicat the
doses so ion they users of removed ion pharma
each tablet wish to the from the needs cy
is labeled, take out system machine at to be shelves
refilled.
the of the and the a or out
When
dispensing machin items particular the of the
they point in stock pharma
machines e from
add or time. level for cy’s
have a
remove. These a carouse
accounted patient’ l and
for this in s file. It also reports specific
product arrangi
their prevent
goes ng the
design. s errors are
This below a list of
from particularl pre-set medica
will
picking y useful level, tions
Once an prompt the when the for
order for a the wrong trying to medicat
medication drawer verifica
medicat resolve ion is tion by
has been containi ion for discrepan added the
created by ng the a cies in to a list
selected pharm
a doctor patient stock of
medicati acist.
and medicat
on to and levels and ions After
reviewed open so allows research that the
by a the for how pharm
need to
pharmacist nurse more errors acist
be
, the order can accurat may have refilled, verifies
is sent to remove e occurred. along that
the the billing with the the
machine ordered of quantity medica
on the medicati Pharmacy needed tions
medicat technicians to reach
patient’s on from and
ions are often the
floor. the quantiti
used. responsible maximu es
Nurses machine for m level match
can then for maintenanc again.
sign into administ Because e and what
the ration to all users refilling of the
the of these When machin
machine
patient. Pyxis® computeri it is e
with their
Once and zed time to needs,
fingerprint the Omnicel machines. refill the
or ID nurse l® Automatic the technic
ian takes many lly affect the es to
the Pharmac steps in patient machin prevent
medicationy the care. e and errors.
s to the technici process give
floor ans that are the
For Some
where the should automat
example, incorre hospital
machine be ed or ct
is. After aware of verified if a pharma
medicatio medicat cies use
logging in potential by
n is put ion to a automat
with a errors barcod
fingerprint that can e into the patient ic
technol wrong . carouse
or ID occur
ogy or pocket of Pharm ls to
number when
a drawer acy store
and refilling a
technic bulk
password, automa pharma in an
medicat
the tic cist, automatic ians
ions
technician dispens there dispensin should
and
can refill it ing are still g exercis
track
using a machin times machine, e
their
refill es in when a nurse cautio
usage.
function patient- errors could pull n
These
on the care can slip the wrong when
comput
machine’s areas. through
medicatio refilling erized
computer While and
n out of these machin
system. there are potentia machin es can
Page Pharmac yTec h.Elit eCME.com
55
store hundreds of medications outside company, such as a
and use barcode technology to wholesaler. In this system, the
track the removal of wholesaler fills the list of
medications from the medications needed by a
machine’s stock. These particular machine and
machines increase the ability sends the completed list and
of the pharmacy to track medications to the pharmacy.
medication usage and Then the medications simply
increase efficiency. need to be checked by a
pharmacist before the
Some pharmacies for large pharmacy technician can
hospitals have their lists of refill a particular machine.
medications needed to refill This process streamlines
their automatic dispensing and simplifies the work of a
machines filled by an pharmacy technician in
large hospitals.
dispensing a hospital
Non- systems in pharmacy
automatic
the days, less
Some patient’s Carts are often depend expensi
hospitals entire used to hold ing on ve than
do not medicati cassettes or the automat
have on list. drawers filled instituti ic
automatic These with each on. dispens
dispensin hospitals patient’s Althou ing
g systems must use medications.
gh they systems
on their a These may be
are less and
floors or different filled by
means of pharmacy secure more
use and applica
automati storing technicians
and more ble to
c prone hospital
systems dispensin and are
g to s that
only for designed to
medicati hold unit dose errors, are not
certain
ons for they very
drugs medications for
and not
patient are busy.
one or several
use. much
ode technology
Barc
have g to allow sy bar ude C comp
Man barc for easy ste cod s numb uter
y odes identificati m. e the er, the
medi on on of the Th gen pro whic name
catio their product in e eral duc h and
ns pack a ly t’s tells pack
agin computer incl ND the age
size hine to to sca she a e.
of s for patients. fill nne lf patie
the stora Systems pre d ma nt’s Tech
prod ge are scr to tch presc alert!
uct. on available ipti cre es riptio Barc
Barc the that allow on ate the n. ode
ode nursi nurses to s. the pro Barc techn
tech ng
scan their lab duc odes ology
nolo unit.
ID badges Aft el t are is an
gy is Dep
er error-
usef endi followed for tha also
by the a a t avail preve
ul in ng
ntion
both on patient’s pre pat wa able
scr strate
the tech ID ien s on
gy
retail nolo bracelet, ipti t’s sel paper
that
and gy then the on pre ect work
shoul
hosp avail medicatio is scri ed that
d not
ital able ns they typ pti in acco be
setti at want to ed on typ mpan bypa
ngs. the give to the int via ing ies ssed
facili patient to o l. the the unles
In ty, ensure the the Thi pre presc s
the barc correct co s scr riptio absol
hosp odes medicatio mp all ipti n to utely
can ute
ital ns are ow on ensur neces
setti even
being r s to e sary.
ng, be
given at sys the en patie Regu
medi used
larly
catio to the right te co sur nts
m, mp e recei bypa
ns verif time.
sto ute the ve ssing
can y the
ck r to cor the barco
be pres The
de
scan cript outpatient bot che rec paper
chec
ned ion pharmacy tles ck t work
kpoin
out befo setting also ha tha me that ts is
of re has ve t dic corre assoc
the nurs barcode bar the ati spon iated
phar es technology co bot on ds to with
mac give available des tle is their incre
y medi to ensure tha pic us presc ased
and catio the t ked ed riptio error
ns correct can
into off to n s!
mac medicatio be the fill bottl
n is used
c s to w n d ng m ing
C e consi h o e an aninven
o pt der e r ri d agtory
n
ti externa h b ld d alternat ter
ol o eth be ph ive w
A E
n factors. s e ke ar options x hi
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s These p afa pt m and ch
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a issues t fit co y nicate ti ey
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y b manufal cs id ch inform n
no
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af , e er ati ci patients at ng
A fe recalls, t dm on an ,
v es er
ct decreast ul w s caregi be
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la d availab n yy. n ou nurses M ed
bi b ility of g or ld and ed ,
lit ic
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se materiac hru ri pr al staff on lle
of v ls, and a ag ng ep when s d
ce er higher n nav m ar specifi all an
rt al deman gail ed ed c ex
ha
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n ff usual. l sili ati co ations da rat
m er Availa s ns are io
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n
e bility o i sh s, id unavail s
di da
nt in the nou an er able. af
ca te.
A u on date c t te a is moving er u
ft ct has a . of hi us medica ra c
er . passed. n m gh ed tions te h
a M ed tur s
n Ticano up are hi
se e be always ca g
It is o utio ve
t di fo in stockn h
import t rns. r
a ca a re and al er
m ti ant for nTh rat so
the l ois e th that tu
o o ch
u ns pharma l vter to e slow- an rn
b m fill ex moving ge o
nt m cy eref pr
of us technic e rerses pi medica ba v
ti t ian to ra tions se er
to cri
m b consid u rth pti ti are not d ra
e, e er s ae on on oversto on te
th p expirat e tti s da cked. th in
e ul ion d em un te e D
ch le dates e til ap Some ti e
e d when b it th pr medica m c
m of orderin e W ta e oa tions e e
ic f g hke ne
f es xt ch have of m
al th es much ye b
medica o nto or
st e . faster ar. er
tions. r us de
ru sh e me r
F d
ct el For turnove or
exampl aup de
T r rates ex ur
ur f na liv
i in
es w e, apa er he than a
of h epinep t re others, m g
grti y
m e hrine e i cu da fo which pl fl
ed n has a x nlar y. re,can e, u
ic th relativep gpr it differ s
at is ly i od is based T e
io d short r i uc Dr i on the a a
ns at expirat e nt ug s
m locatio m
m e ion s vin s o
eth wi po n of the ifl
ay a date, , rt pharma u, n
ch p general i ne th
an cy. A a th
an pr ly no t t ph a
oar t pharma n a
ge o longer c lo n
rm to cy next a
to ac
than a a yac w be to a in
de h , y’stu
nt
cr es
year n a pain ivi J
i in rn u
ea , after t ve ov
w clinic ra
r n
se b its i nt er ar would l
th ec receipt e e be e,
s sor rat m w
e a at the i y. e of expecte e
p us pharmau mTe w d to di
h
sh
ot e cy. The l pch hi have a c e
en it pharmat oni ou ch much at n
cy is cy i r ciald m higher io fl
of u technic n t ns be u
ed turnove n
m ns ian ash ke s
nou pt ic r rate u
ed af should a ati of e
ic e ensure t ld at s a
t fo mi on methad e
at to that the p s
ocu s one d
io di pharmao ni o
n sp s ar than a to
cy t con m e pharma tr n
or e e oen u is
does us cy
ch ns n nsu m e e
an e not ed located at
ever t srin st ss
ge m i g oc m next to in
it e order i or a e
a dth k fl nt
in di more eer le e pediatri u
to ca epinep l re th c e
ial
ve
an ti hrine l t is an hospita n ly
en o than it o hen ls, ot l o
eou to
z
tir n could s he becaus a, v
el af reason s gh en rs e er
y te ably t stosu m .
uck re to methad a
di r use o en one is y P
ff th before f r of th
su not h
er e it nm e h
p oed re used in a ar
en e expires r m m
vica th childre v
t x
, o etio ed at n. a
pr pi r ns ic
e
becaus f fa cy
o ra i r wi ati a te
d ti e if it ath on
st- Turnov m
c n uld be p and is ge dering
h s aware h cap kn w medica
ni s of the a ypl o he tions.
ci h needs r y wl n
a o of their m ath ed or
hinvem a
mt r egie
O entor a g
es as
t ry n e
nt t
this t In o t lose m caile w t
T Rinvent h th r t mana e ad h i
h uory is e o geme d r rep i o
e l mana ru i f nt of i r orts c n
egeme le m o the c i can h s
8 :nt , p c invent a ebe m
strate it o u ory of t duse e
0 gy, it is r s the i . d to d
/ Iis th t o top 20 o Ddete i
2 nassum er a n perce n ermi c
0 ed ef n c nt of s t ne a
Pharmac
y
fall into the top 20 percent class consists of 20 percent of
of the pharmacy’s inventory. products that account for 80
Reports can also be used to percent of the pharmacy’s
review the purchasing annual drug costs. The B class
history of the top 20 percent consists of 15 percent of the
of medications to pharmacy’s medications that
appropriately manage future account for 15 percent of the
stock levels of these pharmacy’s annual drug costs.
products. The C class consists of 65
percent of products that
ABC analysis: account for 5 percent of the
pharmacy’s annual drug costs.
This system focuses on tight
This inventory management control of the medications that
strategy is a process of
have high costs to the
classifying medications into
pharmacy while focusing less
three classes, based on their
usage and cost. The A on low-cost products in order
to balance profitability with
inventory control.
g ons
Orderin medicati
Terminology
invoice se order of items are
also ordered, ordered
Invoic
e include A purchase order and the as
s the is a form used to total requeste
total price of d, which
order medications
An cost of from a the order. minimiz
invoice the wholesaler. It is es the
in the order as assigned a Just-in- number
pharma well as number, or time of
cy the purchase order orderin products
setting purchas number, to track g in the
is a list e order the order until it pharmac
of number is received by the This y and
goods and pharmacy. The ensures
term
that contact form also refers to that
has includes
informa ordering money is
been tion for not tied
deliver products
the the name and up in
ed to as they
organiz contact products
the are
ation information of needed. that
pharma orderin the facility could
In this
cy and g and ordering potential
the products, the date inventor
the ly sit on
cost of of the order, the y
wholesawholesaler’s manage the shelf
each of ler. for a
these name and ment
address, strategy, long
product period of
s. The Purcha description, products
quantity and price time.
 Ordering
d the need ntiall n h does
W sou individual ed on y s deliv not
rces drug an funct it eries carry
her
e to to manufactur emer ion u gene beca
obt ers. genc like s rally use
obt
ain ain Wholesaler y whol e occu of
ph me s simplify basis esale s r low
or
ar dica the ordering rs. a only dem
befor
ma tion process by e The ll once and,
ceu s ordering their ware a or high
tic for large next hous t twice cost,
al the quantities e oa or
pro pha of purc n week spec
du rma medicationsware hase c . ific
hous
cts cy. from the s e stor
e
Bec manufactur deliv medi a Drug age
aus ers to ery. catio n man cond
Th e supply to Smal ns d ufact ition
ere ther pharmacies, ler from i urers s.
are e and then indep man s can Drug
sev are pharmacies ende ufact l sell man
eral hun can nt urers e prod ufact
diff dre purchase phar to s ucts urers
ere ds various maci deliv s direc often
nt of products es er to e tly to take
sou ma from many may man x phar long
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s actu manufactur all of store e es. deliv
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me Many supp i whol catio
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atio whol
wo process evenesale mac h wide es
ns uld easier by r if y a ly than
for be using with n used, whol
they
use an electronic do most u medi esale
in a extr ordering not of its s catio rs,
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rm ly delivering a catio n that shoul
acy more ware ns. g are d
. frequently, hous This a order only
Wh tim and e.
e- maintaining syste wed be
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cess infrequently
of pani mac a are cann
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ord medications. es y to l gene ot
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st er Large chain own
me retail ware n r, those ya
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wholesalers whic the o whol prod
nly s to supply
fro medications h medi u esale uct.
use esse catio g r
m that are
o to m ic os
H w order ed ati n
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O d most tec co his its d m oc
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d att ici pl pnti ck pli y d
e i inventor an et hnu of es. is wi
ri oy is e, a ou meEn ad th
n n manage re be r sly dicsur eq m
g s ment qu ca mde ati ing ua ed
m is tasks a ire us a ple on the tel ic
o pharmac d e c tin s ph y ati
o n terized qu Or e d. as rde ce or
n s and an de s So ther an ou
s t automat tit rs e me y boxd t
t h ed, y for vfac go . ite of
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s c must be ail ed r ies ce nu oc
e o manuall ab ica a ha the
tio l Ot ite m k.
r uy le, ve herms be Th
ns
v l checked as a fac co r e
ca
e d and we m
n tec ilit me lis or
it e confirm ll e
be hn ies in, te de
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c p occasio gi ne han ve car on g
u ir nally vi rat owa an d is it. sh
s e edited ng ed dlk or put W ee
t b as ph m s ar derbac he t
o e needed. ar an f ou car k n is
m f m ua ond d wit th th
e o Ordering aci lly r the loc h e en
or mph ate the
r r generall es st us
au a ar d fres
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’ t place on e to nma
m ucy h sto k to
n h the ab ea ck is or
ati a
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e yr y th me me tti r
ly.
d a through to la dic dic ng m
Ph
s r an se y
ar po ati atiolo or
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u u ordering m ac dble an th m
s s system. or y e or d e ed
t e This e tec t de as La sti ic
b d system de hn e r filli stlyck ati
e . contains tai ici r ent ng , er on
b Aa list of le an mry is so is fo
a lt all d s i de ta me re r
ca nvic kinph
l h medicati de m th
n i e, g ar
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ed ph
c g ordered, io an gual
ua e, s fr ar
e h includin n ly if use o m
lly w
d a g the of ch an a m ac
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w l drug’s th rt ec ite stic th y.
it o name, e i
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or ng ne
me ed M
p o number, od de hthe ed an
r f and uc r if sto s tho ic ua
e t package t, th mck to d ati l
v h size. in ey e of be of on
or
e e Some cl se dea or ord an
de
n o wholesal ud e a i ch de eri d
re ng. ad rs
ti r ers offer in pa c ite
d, So de als
n d the use g rti a m
th me d o
g e of their pa cu t an
lar i d e wh m
o ri online ck to ay
pr osc ca ole
v n ordering ag an be
od nan rd sal
e g system e is ers or ne
uc s
r p in the siz ni tak ha de ce
t n
s r pharmac e th
ng en ve ri ss
t o y. This an e pr aw stic ng
at ar
o c allows d e
is od ay sh
ker ee y
c e the ev ne duct fro
s t un
k s pharmac en ed s m de
for of
o s y staff to pi ed t tha the r
f is see ct is ot me eac ite ce
m n exactly ur ou ne dic h m
rta
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in
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an ati at cir
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Th dde putwit e m
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er e re int h
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o u and the reo pri
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ar e
f laMedicati ne
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r p are used to
p r infreque be
a o ntly or sp
rt d only by eci
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c ctpatient or
u s. may de
Page 57 P ar a y
h mcT
The time of year also comes
into play when ordering
medications.
The fall and winter seasons
bring the cold and flu season,
increasing the use of antiviral
medications to treat the flu as
well as antibiotics used for
common infections associated
with colds. The summer season
may be associated with less
cold and flu medication, but
more allergy medication and
sunburn relief products. If PAR
levels have not been increased
for these items at the beginning
of the season, manual orders
may be required until the
automatic system is updated.
Tech alert! Don’t forget to
decrease PAR levels of seasonal
medications at the end of the
season to avoid overstock!
When compiling a manual order
in the computer system,
technicians can use an online
ordering system. This allows
them to search for the desired
medication in the database by
scanning the barcode with a
portable order entry device or
entering the national drug code
(NDC) or order number of the
desired product in the computer
system. They can then select the
product to add it to the order and
decide how many packages to
order. Manual ordering can be
used alone
or in combination with
automatic ordering systems to
replenish the pharmacy’s
stock.
Automatic orders can be
generated by the computer
system based on reorder
points, or PAR values, set up
by the pharmacy. When the
stock level goes below a set
minimum desired level, the
computer calculates how many
items need to be added to raise
the stock level to the
maximum desired level and
adds this quantity to the order.
Although the computer creates
re a edi ed sis as d.
d r cat on can th
ea e io an als ey
ch uns emo ar
ti s tha er be e
m et ge ord re
e dare nc ere qu
th . ne y d es
ey Med ba in te
ec Eli M .c m
h. teCE o
automatic orders, it is good
practice to verify what the
computer is trying to order
before the order is sent out to
ensure it is not ordering too little
or too much stock. The
pharmacy technician can view
the list of pre-ordered
medications and edit quantities
on automatic orders if the
medication quantity ordered is
not appropriate for the
pharmacy. This is commonly
used for routine warehouse
orders that are often delivered
once or twice a week.
Orders for Schedule II
controlled substances are
regulated and require special
ordering procedures. The Drug
Enforcement Administration
(DEA) is responsible for the
regulation of controlled
substances and the enforcement
of the Controlled Substance Act.
It governs the ordering and
return of controlled substances
and requires the use of DEA
form
222 to order Schedule II
controlled substances. The
pharmacist must fill out this
triplicate form carefully to
order Schedule II drugs.
Many wholesalers also require
the pharmacy to enter the drugs
ordered on the 222 form into the
computerized ordering system as
well. The 222 form must be sent
out with the wholesaler’s
delivery person, and the order
will generally arrive the next
business day. Therefore, it
generally takes an extra day to
order in Schedule II products,
and this should be taken into
account when giving estimated
pickup times to patients.
After the order has been medication or provide a
compiled, each order must be substitution, it will generally
issued a purchase order number notify the pharmacy by making a
to keep track of what was notation on the invoice. When a
ordered and when. The order can wholesaler cannot supply a
then can be sent to the medication, the pharmacy
wholesaler over the phone or technician may need to reorder
across an Internet the
connection. A confirmation
code should be sent to the medication or notify the patient
pharmacy once the wholesaler for whom the medication was
has received the order. After ordered. Sometimes medications
ordered cannot be supplied
confirmation of receipt, the because they are backordered,
wholesaler verifies the discontinued, or temporarily out-
medications ordered to of-stock products.
ensure there is enough stock to
complete the order. The order Orders for products that are
is then picked off the not normally carried by the
warehouse shelves by wholesaler or those that
machines or workers and require special storage
collected together for delivery conditions or ordering
to the pharmacy. Many procedures may need to be
wholesalers deliver ordered directly from the
medications to pharmacies on manufacturer. Each
the next business day, manufacturer has specific
depending on the contract the ordering procedures for its
wholesaler has with the products, such as specific
pharmacy. order forms that must be
faxed or mailed in, or
If a medication is not available requirements that orders
from a wholesaler, the must be placed over the phone.
wholesaler may substitute an The manufacturer of the
equivalent alternative desired drug product should
medication. The substitution be contacted to find out
must be bioequivalent and what special ordering
comparable to the product requirements they use.
ordered. For example, if the
pharmacy technician orders a
100-count bottle of When ordering from a drug
manufacturer, orders generally
levothyroxine from the generic
take longer to arrive than they do
company Mylan and the
if ordered from a wholesaler, so
wholesaler is out of the Mylan this must be taken into account
brand, it may substitute a 100- when obtaining specific
count bottle from Teva instead. products for patients. The
shipment of a medication from a
Tech alert! Some patients manufacturer to a pharmacy is
called a drop shipment. This type
require the use of specific
of shipment is often used for
manufacturers of their products that have specific
medications, so be sure to storage conditions, such as
keep this in mind if the frozen vaccines, or those with
wholesaler automatically specific dispensing regulations,
substitutes medications! such as the antiarrhythmic
medication
If the wholesaler cannot fill an
order for a particular Tikosyn.
Receiving
steps to bo cted opened, and
When properly xe quantity of inspected
products are receive the s packages. for damaged
shipped to shipment. or The or outdated
the The tot packaging products.
pharmacy technician es should then
from an receiving del be inspected If any
external the order ive before products
wholesaler from the redopening to are
or delivery ma see whether damaged,
manufacture driver tch it has been outdated,
r, the should first es tampered or
pharmacy verify that the with. Then otherwise
team must the ex the package unfit for
take several quantity of pe may be use, it
should be order. The the be matched discussed
brought to invoice lists wh up with the with the
the attention the name, ole invoice to wholesaler
of the strength, and sal verify that and entered
wholesaler dosage form er the quantity, into the
as soon as of an strength, pharmacy’s
possible. medications d package computer
shipped, as req
These size, and system to
well as the ues
products number of allow for
cost of each tin
should be product, the g units match accurate
separated ph what was accounting.
from the ar ordered. The After
pharmacy’s quantity prices verifying
stock to shipped, and ma printed on that the
notations if cy.
prevent the invoice products
items are
accidental unavailable Ea
from the received
use. or a lesser ch wholesaler match the
quantity was pr should products
The shipped. It od match up listed on the
packaging also includes uct with the invoice, the
should the total cost shi prices listed invoice
contain an of the order pp on the should be
invoice, and purchase signed and
ed
which should information order. Any dated, and
sh
be used to on the discrepancie set aside for
check in the location of ouls should be accounting.
d
P rmacyTe CME.co
m Page 58
ha ch.Elite
Receiving medications with special storage
conditions
accidental exposure to companies have
these potentially special precautions
Any shipped products that
dangerous medications. for hazardous
require special storage
Special precautions for materials.
conditions, such as hazardous substances
freezing or refrigeration, can be found on
should be checked in After medications
first and stored in their with special
proper place. These the Material Safety conditions are put
products should be Data Sheets (MSDS) away, the remainder
addressed first to avoid that are provided to of the order can be
damage or decreased the pharmacy from put away as well.
potency of the product. the manufacturer for When putting an
any hazardous agent. order away, it is
Chemotherapy medications important to put the
are considered hazardous Some of these newest stock behind
substances, and should be medications may older stock to ensure
shipped separately. Policies require special that products with
and procedures of the shipping procedures shorter expiration
facility should be followed because the U.S. dates are used before
carefully when handling Postal Service and those that will last
these products to prevent other shipping longer.
controlled substances
Receiving
checking has not controlle y; the es are
Controlled in been d pharmac given
substances controlled tampered substanc y immedia
should be substance with es technici tely to
shipped s, it is before an the
separately especially opening upon should pharmac
from other important it. A arrival atensure ist when
medications. to verify pharmaci the controlle they
When that the st must pharmac d arrive.
packaging check in substanc
ng tigat drug
Receivi inves ional s
regula be medic and ook igati the
Investigati r kept ation. shou stori of onal facili
onal medic in a Polici ld ng receiv drugs ty’s
medicatio ations separ es and be thes ing, may rules
ns may be , ate proce follo e dispe be and
received thoug area dures wed med nsing, requi state
in a h the for of the for icati and red, laws.
similar invoic this facilit recei ons. return depe
manner to es type y ving A ing ndin
must of logb invest g on
da ed td e e ve, or or s
Rece m , at x s or re d
iving ag ou ed, c si incct er
ne wh dict m v ofte wi th mentati rea tat
If any ed, ole atin u e n ll e on so io
product it sal g st cr requ se cr should n n
s are ma er wha b e ire nd ed include the m
receive y ge t e di cred do it the ite ust
d be nermed fo t it to cu re original m be
damageeli all icati ll fobe m qu purchas is se
d or gib y ons o r requ en es e order bei
nt
outdate le ha may w re este tat t number, ng
wi
d, or if for s be e tu d io is the item ret
th
the ret polretu d rnbefo n ap number ur
th
pharma urn ici rned to s. re to pr of the ne
e
cy to es for pr the th ov item to d.
pr
acciden the an cred o Wpro e ed be Th
od
tally wh d it, p h duct ph . returned is
uc
ordered ole pr and er ol is ar T , the
a sal oc thes ly essent m hi quantity t
do
product er. ed e re al bac ac s being w
cu
it does Th urerule c er k, y do returned he
not e s s ei s and if cu , and the m n
en
it is co ed a u. t pt ed that s ey
shippe If ve inco ct r Wh in re were th ca
d to a rs rrec th e ole th tu not at n
the ph th tly e o sal e rn ordered we be
wholes ar at upo w u ers ne of as well. re se
aler, m th n h t will xt an The no nt
and a ac e rece ol a ofte sh y wholesat ba
copy y or ipt, e r n ip pr ler may or ck
must te de the s e sen m o need to de .
be ch r tech al s d en d send re
retaine nic ha nici er olthe t uc return d
d at theia s an t u cor an ts paperw be
pharm n be sho o ti rect d re ork for for
acy as dis en uld fi o pro ac ce the e
well. fill cont g n duc ce iv product th
P a yi n g i n voic e s
nt a
t
After in
g c
the
e a
order n n
is s b
receivur e
ed es ti
and th m
put at e
away, al c
invoi l o
ces in n
must v s
be oi u
paid c m
accor es in
ding ar g
to the e t
p o
accou
ai fi
nting d
x.
proce as
dures th
of the e
facilit y
y. ar
They e
often re
need c
to be ei
enterev
d into e
the d,
comp a
uter n
d
syste
p
m on r
the e
same v
day e
they nt
s
are a
receiv b
ed or a
as c
soon kl
as o
possib g
le of
after in
receip v
t. oi
Keepi c
ng up e
with s
accou th
 R ec e ivi n g n ew
n wval
New a aan
medi m rd
catio e epai
ns v hd
and e oac
newl r uco
y s
s rdi
intro i eng
duce o , to
d n
athe
gene . nac
ric dco
prod T un
ucts h
s tin
are e
const s
hg
antly e opr
goin p uoc
g l ed
r dur
onto
o es
the
d i of
mark
et. u nthe
Man c cph
y t l ar
phar s uma
maci a dcy.
es r e
wait e
to o a
order f
n
new t
medi e
catio n i
ns n
until s v
a o
h i
patie
i c
nt
bring p e
sa p
presc e t
riptio d h
n for a
them f t
, but r s
some o h
, m o
espe
u
ciall t
y l
h d
large e
chain w
phar b
h e
maci
o
es,
are l c
set e h
up to s e
recei a c
ve l k
new e e
gene r d
ric o
prod r
u
ucts c
p
base o
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their p n
usag a
e of n a
the r
y r
bran
d i
 R t r

Ther
e are
seve
ral
diffe
rent
type
s of
retur
ns
that
need
to
be
com
plete
d
regu
larly
to
mai
ntai
n
the
phar
mac
y’s
inve
ntor
y.
Retu
rn
pape
rwor
k
and

othe
r
reco
rds
mus
t be
kept
for
at
least
two
year
s or
long
er,
dep
endi
ng
on
stat
e-
spe
cific
law
s.
 O t
r on r as
Eac e da e w
h s te el
pha p on l.
rma o a
cy n sti
M
has s ck
ed
its i er
ic
ownb ca
ati
poli l n
on
cies e he
s
and lp
sh
pro f te
ou
ced o ch
ld
ures r ni
be
for ci
pu
pro c an
lle
cess h s
d
ing e sp
of
out c ot
f
date k so
th
d i on
e
pro n -
sh
ductg to
el
s. In -
f
gen o tw
eral u ex o
, t pi to
out d re th
date a m re
s t ed e
sho e ic m
uld s at on
be th
io
pull o s
ns
ed n or
off to
m
of a he
or
the l lp
e
shel l us be
ves e fo
at p u re
reg r p th
ular o st ei
inte d oc r
rval u k ex
s to c be pi
min t fo ra
imi s re ti
ze it on
the i da
ex
pos n te,
pi
sibil de
ity t re
pe
of h s.
nd
expie B
in
red ec
g
medp au on
icatih se th
ons a pr e
gett r es po
ing m cr lic
to a a ip ie
pati c ti s
ent. y o of
The n th
pha o la e
rma n
be
cy c
ls
tech e
nici ar
an a e
is re
ofte m q
n o ui
 P
a
specific pharmacy. All on the processing of expired,
medication the patient receives recalled, or damaged medications.
must be used up before the They take these products back from
expiration date occurs, and because pharmacies and complete the
many patients get 90-day supplies necessary paperwork required by
of their medications, the expiration each manufacturer to receive credit
date must be at least three months for returned items. Then they
away for these patients. The
pharmacy technician should ensure
this task is done regularly to
maintain the safety and
effectiveness of products in the
pharmacy’s inventory.

Wholesalers and warehouses

generally only accept outdated
products for credit if they are
returned within a specific
window of time, generally two to
three months before and after the
manufacturer’s expiration date. The
pharmacy technician is responsible
for completing this task once
monthly to prevent profit loss.

Items that have expired should be

separated from the rest of the
pharmacy stock until the technician
is ready to prepare and package
these items for return to avoid
dispensing expired products to
patients. After outdated products
have been pulled off of the
pharmacy’s shelves, the technician
must take several steps to prepare
them to be sent back to the
wholesaler.

A list of all expired products,

including the name, strength, and
dosage form of the medication as
well as the quantity, must be
compiled. The list is then
transmitted to the wholesaler to
seek approval for the return. Once
approval has been given, the
outdated products may be packaged
and prepared for shipment to the
wholesaler.

The specific procedures for

processing outdated
medications depend on the
policies and procedures of the
pharmacy, and must be followed
carefully to ensure credit is
received for outdated products.
Pharmacy technicians are generally
responsible for the important
inventory management task of
checking for outdates at least
monthly and sending them back to
the wholesaler or drug
manufacturer.

If medications are outdated and are

ineligible for return to the wholesaler,
they may be eligible to be sent to a
reverse distributor for credit. Reverse
distributors are companies that focus
package and ship the unusable garbage; they should not be
medication to the manufacturer and poured down the sink or flushed
track the medication until credit is in the toilet to avoid
received. contamination of the water supply.

These companies also accept expired, However, there are some

damaged, or unusable Schedule II-V exceptions. Medications that are
controlled substances for return to the cytotoxic, such as chemotherapy
manufacturers. There is agents, must be discarded in a
a fee to use the service of a reverse hazardous waste container. Any
distributor, which is generally a medications that have needles in
percentage of the refund that is their packaging should be thrown
automatically deducted from the away in a sharps container.
final refund amount.
If the drug product that cannot be
Some outdated products are not returned is a controlled substance,
eligible for return to a wholesaler, the DEA must be notified before
reverse distributor, or the product may be destroyed by
manufacturer. Compounded or the pharmacy. DEA form 41 should
reconstituted drug products are be used to request permission to
generally not eligible for return, destroy controlled substances, and
and some companies will not must be completed at least two weeks
accept bottles of medication that before the destruction of controlled
have been partially used. These substances. Once permission is
medications must be either granted, the pharmacy may destroy
the drug products
disposed of by the pharmacy or
sent to an outside company for
destruction. for which permission has been given.
Destruction of medications must also
comply with local, state, and federal
If the pharmacy is destroying the environmental regulations, so care
medications, care must be used to must be exercised when throwing
ensure the medications are not away medications. The completed
endangering the environment or DEA form 41 must be maintained at
anyone who may come in contact the pharmacy for at least two years or
with the product in the garbage. longer, depending on state
Many medications may be recordkeeping laws, and copies must
discarded with the pharmacy be submitted to the DEA as well.
returns
Overstock
previously produ ation back. will depend
Pharmacies special ct for Once on the
can often ordered for a return. approval has wholesaler’s
return stock to patient who been granted, return policy.
the wholesaler discontinued Whole the
that has been treatment salers technician Tech alert!
ordered in with the should should Check for
excess or is specific be package the
product. In contac medication
overstock of
moving slowly seasonal
off of the general, if a ted to and send it to
package has reques the products and
shelves. return them
Pharmacy not been ta wholesaler
for credit
technicians opened or return using the
damaged and appro method after the
should monitor
the pharmacy’s does not val outlined on end of the
shelves for expire for at before the approval season to
products that least 12 sendin notice. prevent
are not being months, a g the Specific profit loss
used or were wholesaler can medic policies and from
accept the procedures outdates!
Damag ed produc ts
cy in a the to seek must retu code or back to
Occasio damage pha replac send rn return the
nally, a d rma ement an of a form wholes
product conditio cy of any approv dam has aler for
sent n. If it sho damag al code age been credit
from is uld ed or d issued, or
the noticed cont produc return prod the replace
wholesa before act ts. The form uct. pharma ment,
ler may dispensi the whole before Onc cy may as
arrive at ng to who saler they e an send determi
the the lesa genera will appr the ned by
pharma patient, ler lly accept oval product the
wholesa its pha m damag will replace not
ler. attempt rma from ed sen the request
ed use, cy its producd a item the
If a the can stock, t. repl the pharma
patient patient giv then After ace pharm cy to
receive may e contac compl men acy ship
sa general the t the eting t gave back
product ly bringpati drug the ite out to the
and it back ent manuf necess m the damag
discove to the a acture ary to patient ed
rs that pharma repl r to paper the . The item.
it is cy for ace seek work, pha manuf
damage replace me replac the rma acturer
d after ment. nt ement manuf cy may or
The ite of the acturerto may
Rec al ls
from be Ma and du issu duct nticul rem
Reca adve en nuf Dru cts es: ion a ar oval
lls rse ma act g tha or t batc from
even nufurer Ad t pac i h of the
are ●●
issue ts act s min are kagi omedi mar
Inco
d to from ure are istraaff ng ncatio ket
ensur the d req tion ect rrec erro on. due
e the use ina uire (FD ed t to
rs. f
publi of a pprd A) by labe safet
a ●●
c is prod oprby to the ling. y
prote uct iat the reca foll ●● pFDA reas
cted that ely Foo ll ow ●● Con a man ons.
has . d pro ing Pro tami r dated
Pha cy ch lit M Pa 6
om
rma Te .E eC E.c ge 0
●● Any error that occurs that drug products being recalled,
prevents the medication from including the drug name, expiration
meeting the guidelines of the FDA date, and lot number. It also
or manufacturer. contains information on why the
recall is being issued and how to
Manufacturers can also voluntarily return recalled medication to the
recall products if they are concerned manufacturer.
about minor issues, such as potential
tampering with products, or if their
quality control teams find an
inconsistency in the drug
manufacturing process. This is
known as market withdrawal.

Recalls are classified into three

classes:

●● Class I recall: Medications are

recalled because they may cause
serious harm to a patient’s health,
potentially including death.

●● Class II recall: Medications are

recalled because they can cause
temporary or reversible health
effects, and are at a low risk of
causing serious harm.

●● Class III recall: Medications

are recalled for reasons that are
unlikely to have adverse health
consequences, such as labeling
errors, defects in the containers, or
abnormal color or odor.

When a recall has been issued, the

manufacturer or wholesaler
informs the pharmacy by mail, fax,
or electronic message. The recall
notice contains information on the
Once a recall notice is received, the attempt to recover the
pharmacy should then check its
shelves for the affected lot numbers
affected medication to send back to
and expiration dates of the product. If
the manufacturer. Patients whose
the pharmacy has any recalled
products on its shelves, medication has been recalled
they should be removed should have their medication
immediately and segregated from replaced with unaffected
the regular stock. Recalled medication, free of charge.
products can be returned to the
manufacturer or reverse distributor, Even if the pharmacy does not have any
and the pharmacy should receive products that are listed on a recall
credit for returned products. Any notice, its completion should still be
confirmed in the computer system.
stock that has been lost to a recall Documentation of the completion of
should be reordered if necessary to recalls is important
maintain the pharmacy’s inventory. to maintain the safety of the
pharmacy’s medication inventory
Depending on the severity of the and therefore patient safety as well.
reason for recall, the recall can
extend to the stock that a patient has Tech alert! Recalls should be
received as well. If this is the case, completed the same day they are
patients who may have received received to prevent patients from
recalled medication should be receiving recalled medications!
contacted, and the pharmacy should
prescriptions
Unclaimed
have prevent funded company
In automatic insuranc program, such standards and
community reports that e fraud as Medicare the law as
pharmacies, print daily to as well. or Medicaid, well as
notify the When it can be allowing
prescriptions
that have not technician of an considered these
which insuranc a greater medications
been picked e violation of
up in a prescriptions to be added
compan the law.
timely have been y is back to the
fashion by waiting for billed Violations inventory to
pick up for for a can be be used for
the patient associated
must be too long. prescript with hefty other
returned to ion that purposes.
fines that
the pharmacy Many a patient
can affect
shelves to insurance has not Tech alert!
the
use for other companies are received Calling
, it can profitability
patients. billed for patients a few
products that be of the
Most days before
have been pharmacy. returning their
pharmacies
have policies sitting on the consider prescriptions
shelves for ed Restocking to stock will
that require
more than 14 insuranc these help to
prescriptions days, so it is e fraud, prescriptions minimize the
to be important to and if on a daily number of
restocked 7- not only unclaimed
the basis will
14 days after restock these prescriptions
insuranc ensure the
they are products for that need to
e pharmacy is
initially accurate compan compliant be returned to
filled. Many inventory y is a with the shelf!
pharmacies management, federallyinsurance
but also to
medic sho the acy in stock?
What ations uld pharm keep
will the hospit an and dosages will ns are
The vary custoal outpat forms are also com
medic greatl mer pharm ient commonly play monl
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each ding each carry a becaus setting. gover in a
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and A than formularie catio
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Pa ge Pharma cy Te c h.E lite CME.com
61
commonly covered medications and prevent overstock of non-covered
medications.

Counting medications in the pharmacy

inventory
a patient’s an accurate
prescription, theft, reflection of what is
Managing a
actually on hand are
pharmacy’s inventory or improperly
inputting an invoice essential to
often involves managing a
counting medications for an order pharmacy’s
in stock to verify or received. inventory properly.
update their quantities There are two
in the computer Knowing how much commonly used
system. Medication medication is on the means of counting
counts can be off shelves and ensuring items in the
because of many that the quantity on inventory, annual
different reasons, hand in the inventory counts and
including miscounting computer system is cycle counts.
inventory counts
Annual
inventor loss any help there are
Annual y. It through issues ensure no issues
inventory allows medicati with everythi with
counts are the ons emplong is complia
conducted pharmac expiring yee counted nce to
once a year y to see , theft correctly this law.
to verify the its total inaccura or ! A
quantity and profitabil te missi pharmac
dollar value ity for accounti ng ist must
The
of products the ng, and inventControll physicall
on the previous
imprope ory. ed y count
pharmacy’s year, as rly all
shelves. This well as Substanc
showing recorded Tech e Act controlle
event is returns alert! requires d
generally the
pharmac than a Organ biennial substanc
done at a
time when y how
pharmac izing inventor es in this
the well its y that medic y counts inventor
pharmacy is inventory has a ations for y, and
closed or is being well- on the controlle records
usually not managed. manage shelv d must be
busy to d es substanc kept for
ensure all Pharmac inventor befor es. Many at least
medications ies with y. e an pharmac two
are counted a poorly annua ies years or
at the same managed longer,
Annual l complete
time for an inventor dependin
inventor inventthis
accurate y may g on
reflection of ies may ory count
have also count annually state
the law.
more uncover will to ensure
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allow Whe re also tities prod th e mize
the n the a are ucts e coun error
pharmac com auto risk upda are c ts pote
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continua d c erro in ted m done .

a e m di at n ul packa
Storg of e c io sB k ging
ac st ttle uir an s a dr C) an e
The ies oc s ed d a nt u number, d nt
majoriar k inc by ge g it g lot st s.
ty of e bo lud th ne e y, c number, or
medic re ttl e e ric f n o expirati ag
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in iv . eli D ug r io e name of re
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ack e ah s e
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 P ar m ac y
●● Some medications are not
available in unit dose
packaging and must be
repackaged into unit doses for
use in the hospital setting.
●● Some unit dose
medications are much more
expensive than the bulk
version, so the hospital
pharmacy may repackage the
bulk version to save money.
●● Repackaging medication
increases the speed at which
the medication is ready to use
because the pharmacy does not
have to order in unit doses and
wait for them to be delivered.
●● Unit dosing allows all of
the drug information to be
printed on each package,
decreasing the risk of errors.
●● If the unit dose is not used
for a particular patient, it can
be added back to the
pharmacy’s stock and reused at
another time.
When repackaging
medications, personal
protective equipment should be
used and good manufacturing
practice (GMP) guidelines and
state law must be followed.
There are many GMP
guidelines that can be applied
to any step of the drug
manufacturing process. Several
of these guidelines apply when
repackaging medications,
including:
●● Ensuring the equipment is
clean and in good working
condition. ●● Prepackaging
medications that originated
from a bulk bottle that
had not been previously
opened.
●● Only one medication
should be prepackaged at a
time.
●● A registered pharmacist
must verify all medications for
accuracy and completeness.
●● The packaging must be
appropriate for the medications
being repackaged.
The
ech.E l
Repackaged medications must
include either a six-month
expiration date from the time of
repackaging or 25 percent of the
remaining time of the
manufacturer’s original
expiration date, whichever is
shorter.
5 Repackaged medication labels
must also include the generic
name and strength of the
medication, dosage form, and
the name of the manufacturer
and lot number. The packaging
used for repackaging
medications should comply with
the manufacturer’s
recommendations for drug
storage, including UV light-
resistant packaging if needed.
A log must be maintained to
keep track of all repackaged
medications so that repackaged
medications may be traced back
to the original manufacturer,
expiration date, and lot number
in case of a recall.
The log must contain these items
as well as the date of
repackaging, the name of the
medication, the pharmacy-
assigned lot number, the quantity
of medication that was
repackaged, and the initials of
the technician and pharmacist
involved in repackaging. The
pharmacist must verify all
repackaged medications for
quality assurance.
Repackaging of medications to
create unit dose packaging can
be done for both liquid and solid
dosage forms. The Joint
Commission on Accreditation of
Healthcare Organizations
(JCAHO) requires all
medications to be patient-
specific to decrease the risk
of errors and contamination.
This means all liquid
medications must be in unit dose
packaging; whole bottles may
not be sent to a patient’s room
for continuous use. Oral syringes
or dosing cups may be used.
General drug storage
manuf acturer’s recommen
dations be stored and cts. s in the
should be above or dust, manufactur
followed below this and Some er’s
when temperature be medication original
storing range prope s are container
prescription unless rly sensitive to or an
medications authorized ventil UV light amber-
. Many by the ated and can colored
medications manufactur to decompens vial to
are able to er. allow ate under decrease
be stored at for these the
room The storage adeq conditions. transmissio
temperature area should uate It is n of UV
, between be clean airflo recommen light
59-86 and free of w ded to through the
degrees F. clutter, aroun store bottle.
Drugs moisture, d the medication
should not produ
Stock org anizat ion
lithiu c be be sho in ced,
The m, for found used uld small the lot
medic instea m under for alsoquanti numb
ations d of of R, birth hav ties to er and
stocke next Pril becau contr e a avoid expira
d in to its ose se its ol sep manuf tion
the brand c. gener pills, arat acturi date
pharm name, e ng, of any
ic liquid
acy Zestril are becau produ
. Org name s, a se cts
can be
aniz is topic for pharm used
organi rosuv al
Other atio astati
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n treat bag may comp
many pharm n. ments s oundi
differe acies can , and ng,
also
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nt organi
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ze able dic ound the
Some medic don phar medi atio small initial
pharm ations e macie catio ns quanti s of
alpha alphs
acies
organi ns, that ties of the
betica a- have and hav medic pharm
ze
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the generi all n s
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even in large assur
ation to the ductof have anti quanti ance
name brand s medi sectio cip ties of verifi
on the name are catio ns for atio them catio
bottle, produ org ns the n of witho n.
so ct. In aniz that fastes rec ut an Thes
simila this ed are t eivi additi e
r situati in not movi ng onal medi
on, alphmixe
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and ng an licens catio
Prilos abet d in medi ord e. ns
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may azole by bottle them pre ok d,
not be would thei s of close
scri should stored
r pills. ber.
locate be to the The be in a
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to d next eric nding nsing pro
ained, nated
each to namon includ area,
count duc ing
other. each e; the er for ts the and
For other, in needs easier sho date check
examp becau this of the use. uld and ed for
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be quanti
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Hospi co ty of
ril
azole Cre separ mp medic produ
may tal
is the stor ate pharmoun ation
cts
be
next to generi wouareas acies ded produ regula
ld may
rly. orated sam s also in to the
as e from be An severa highe
Regar well. medpullin used exa l r
dless Separ icatig the for mpl dosag potent
of the ating on wron high- e of es. ial
type simila wit g alert this Placin risk
of r h medi medi is g of
divide
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fari rs
organi g ders n off ns or will
betwe
zation bottle will the those n, a en the help
s or helpshelf that blo preve
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error produ pre to fill are od es and nt
cts ventan prone thin potent
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ntion whi signa
are nici . more dange
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shoul ent and ers rous ava the errors
d be dosag pha or errors ilab techni from
incorp es of rma signs . le cian occur
the cist can ring.
Pag e Phar yTe liteCME.com
63
mac ch.E
Schedule II controlled
substances
separate continuously
monitored and
Schedule II from any recorded in a
medications non- perpetual
should be Schedule II inventory log
stored refrigerated by the
separately medications pharmacist
from other . as
medications prescriptions
Schedule II are filled.
and are
generally medications
kept in a may be Ordered
locked organized Schedule II
cabinet that alphabeticall controlled
only the y by brand, substances
pharmacist generic, or must also be
the name recorded in
can access
listed on the the perpetual
to prevent bottle, inventory log
theft or whichever is upon receipt,
diversion. preferred by and any
Refrigerate recalls,
d Schedule damaged
the pharmacy
II products, or
and
controlled pharmacist. outdated
substances The stock of products
must be Schedule II must be
stored in a controlled recorded as
locked substances they occur as
refrigerator, must be well.
al suppli es
Medic
the k of ass bedp phar
dura isti ans. mac
Disposrest y,
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pharm atio whe livi ume area
acy, n. elch ng, a or
and So airs, suc signi order
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often pha ches as t from
, sho amo the
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type s vat w e rc m rr
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Final Examination Questions

Choose the best answer for questions 1 through 5 and mark your answers online at
PharmacyTech.EliteCME.com.
a technician should
Which of the following is NOT a take when receiving a Class I recall.
purpose of inventory management? medication delivery?
Minimizing the occurrence of Verify that the quantity of
Class II recall.
unexpected out-of-stocks to decrease the boxes or totes delivered
impact on patient care. matches the expected
Preventing costs associated with damage quantity of packages. Class III recall.
and expiration of inventory. Each product shipped
Decreasing total costs to the pharmacy should be matched up Class IV recall.
and overall health care organization by with the invoice to verify
focusing on purchasing products with that the quantity, strength, Which of the following
the lowest cost. package size, and number
of units match what was are trays of medication
ordered. that are used when
Increasing costs and thus boosting
income by ordering medications from patient’s medical
wholesalers. The invoice should be
signed and dated. condition is rapidly
decompensating, such as
Which of the following forms does the when the patient’s heart
DEA require pharmacies to use to order Invoices must be paid stops or they stop
Schedule II controlled substances? according to the breathing?
Form 222. accounting procedures of
the facility.
Code or crash carts.
Form 41.
Which of the following
recall levels occurs when Automated dispensing
Form 72. medications are recalled systems.
because they may cause
Form 333. serious harm to a patient’s Baker Cells®.
health, potentially
Which of the following is the first stepincluding death? Kirby Lester®

RPTF
L04I
ME14

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