Prescriptions and dispensing labels Flashcards
(49 cards)
VCPR and prescriptions
A vet cannot prescribe drugs requiring a prescription unless a valid VCPR exists.
However, a prescription may be filled/dispensed without a VCPR to clients of another clinic in which case your clinic is acting as a veterinary pharmacy.
Clients also have the option of taking their prescription elsewhere e.g. a human pharmacy or another vet clinic to be filled.
SVMA Bylaw 13: VCPR Definition
i. the veterinarian has assumed responsibility for making medical judgments regarding the health of the animal and the need for medical treatment, and the client, owner or other caretaker has agreed to follow the instructions of the veterinarian;
ii. the veterinarian has sufficient knowledge of the health, environment and need for care of the animal (s), acquired by virtue of:
A. personally examining the animal(s); or
B. making medically appropriate examinations and timely visits to the premises where the anima is kept, thereby obtaining sufficient knowledge to initiate a general or preliminary diagnosis of the medical condition of the animal; or
C. where medically appropriate, through history taking, including details of any presenting complaint and a review of previous medical records obtained as soon as possible after the first encounter; and
iii. the veterinarian is readily available or has arranged for emergency coverage for follow-up care in case of adverse reactions or failure of the treatment regimen
grey areas with animals and VCPRs
In the case of herd animals/litters it is not always required to examine each animal in the herd/litter to prescribe medication. Visiting the premises sufficiently to have enough knowledge to be able to make a confident diagnosis is acceptable to prescribe to others in the herd/litter.
Refills may also be prescribed for a current condition without the need to see the patient again.
It is ultimately the veterinarian who must use their judgement in some of the more “grey” situations.
A VCPR is terminated when
a. the condition is reasonably resolved;
b. care is transferred to the client;
c. care is transferred to another veterinarian;
d. care is transferred to another competent person or body;
e. the requirements of Section 13.1.b have not been met; or
f. the client has been informed in writing, delivered either in person or by registered mail, that the veterinarian and/or veterinary practice will no longer provide service to the client
Options for the veterinarian for the filling of prescriptions:
Human Drug- Phone, Fax, or Write Prescription to a Human Pharmacy or fill at a clinic.
Veterinary Drug- Phone, Fax, or Write Prescription to a Veterinary Pharmacy or fill at your clinic if have a valid VCPR. (Veterinary drugs in Canada are not usually available to human pharmacies due to the marketing policies of veterinary drug manufacturers.)
Blanket prescription is
When a veterinarian authorizes a specific list of prescription medications, to be given at any time and any quantity for a period of ONE year to a specific list of clients with a valid VCPR. An example of this would be Herd Health. Once the list is made, it must be reviewed every year and signed by the veterinarian and acts as a prescription authorization. When the client requests a drug from the list, a prescription order is written and kept on file.
How do animals prescriptions get refilled
Prescriptions can only be refilled if the veterinarian has authorized refills.
It cannot be refilled more times than the number of refills the veterinarian has authorized.
The refill must be exactly as the original prescription. Any changes (dose, frequency, dose form, duration) requires a new prescription.
Refills & Rxs are only good for 1 year from the date the script was written. I.e. if the client hasn’t filled the Rx within 1 year of receiving it, it should not be filled.
Frequency of refills must be checked to ensure intervals are consistent with the prescription.
Part-fills are not the same as refills. A part-fill is where the client requests only a portion of the drug ordered to be dispensed at any one time.
Prescriptions are
A prescription is a legal order for a specific patient, with a specific condition, for a specific drug with specific instructions as to dosage and use.
It is prescribed by a veterinarian.
It can be provided in written or verbal form. If provided verbally, it must be transcribed into the written record.
It must be documented by the prescribing veterinarian and the veterinarian responsible for filling it.
Dispensing label is and what does the RVT do
The label and information placed on the package of medication to go home with the patient.
RVTs can perform the task of dispensing medication as per the Rx order which includes creating a dispensing label.
What are the legal requirement’s for prescription labels
Name of Client (Address if narcotic)
Name of Patient and Species (weight optional)
Drug (Brand or generic name or both acceptable, if Brand name given, cannot be substituted without DVM permission)
What may be on a prescription label
Strength/Concentration (100mg capsule or 25mg/ml)
Dosage Form (Suspension, tablet, ointment)
Quantity (If not conveyed through the directions e.g. 40 tabs)
Directions on prescription labels must include
Route (po, IM, od, au)
Dose (ml, ii, TWO, ¼ inch)
Frequency (tid, q8h)
Duration (for 10 days, until recheck, 1/12)
What is on the prescription label
Legal requirements
May have strength/concentration, quantity or dosage form
Directions
Refills if requested (None if narcotic; Interval if controlled drug or Pr)
Clinicians Signature (Printed name & phone number also)
Date
Must be legible!!
Verbal orders for Rx
Verbal orders are common in clinic between the DVM and RVT.
RVT then writes the Rx in the patient’s medical record
Then dispenses the drug.
Verbal orders may be called to a human pharmacy to be filled or another veterinary hospital
The DVM needs to make this call.
How to record verbal Rx
Verbal orders must be recorded into the permanent record. When making a record of a verbal order, the same information must be present as on a written prescription.
If from outside veterinarian, recommended to re-write it on a clinic prescription pad, under “signature” enter veterinarian’s name, time of call, (all clinic contact into) and indicate “by phone”. Scan into file.
How to take a verbal drug order when it is controlled drugs
For controlled drugs, it is recommended that prescription transfers are received directly from the prescribing clinic (fax or signed e-script or veterinarian phone call). ALWAYS verify validity with the prescribing clinic.
What to do if you are getting verbal drug orders from someone on the phone
If receiving a verbal prescription from another clinic, the verbal drug order must come directly from the prescribing veterinarian.
If from outside veterinarian, recommended to re-write it on a clinic prescription pad, under “signature” enter veterinarian’s name, time of call, (all clinic contact into) and indicate “by phone”. Scan into file.
CAN RVT TAKE VERBAL ORDER (VO) FROM YOUR OWN VETERINARIAN?
yes
CAN VT TAKE VO FROM AN OUTSIDE VETERINARIAN FOR A CLIENT?
YES (This is new)
CAN RVT TAKE VO FROM AN OUTSIDE RVT FOR A CLIENT?
NO
CAN RVT TAKE VO FROM AN OUTSIDE VETERINARIAN FOR EMERGENCY CLINIC USE?
YES
For example, if a neighboring clinic needs to purchase some emergency medication for in clinic use such as TRAMADOL than verbal Rx can be taken by the RVT
THE RVT & GIVING PHONE ORDERS
ONLY THE VETERINARIAN CAN GIVE THE VERBAL ORDER FOR A PRESCRIPTION FOR A CLIENT OVER THE PHONE. This is federal law.
THE VETERINARIAN CAN ONLY GIVE THE VERBAL ORDER FOR THE PRESCRIPTION FOR THE CLIENT TO A PHARMACIST (DVM) OR RVT (who is acting under the direct supervision of their veterinarian).
The RVT cannot phone in prescriptions on behalf of the veterinarian for their patients. (Scope of the veterinarian) unless ordering stock for clinic.
An easier away around this is FAX in the prescription for client to the pharmacy of client’s choice if vet does not have time to phone the order in.
How does a clinic act as a pharmacy
fill Rxs for clients from another clinic.
Your clinic does not have a VCPR with this client/patient.
Must still assess validity of the Rx written or verbal.
Does the Rx make sense i.e. drug for the condition, dose for the size of patient
Call to confirm with other clinic.
Make sure prescribing DVM’s name is on dispensing label.
Maintain records: Place physical Rx in a file with any additional pertinent information e.g how was validity verified? Record of your dispensing e.g. label etc.
When may Rxs be transfered
Veterinarians can transfer a prescription to another veterinarian or a pharmacist
Transfers involve prescriptions that were originally given to one clinic/pharmacy to fill. In other words, one prescription is dispensed by more than one clinic and/or pharmacy.
