What Happens Behind the Counter Stays Behind the Counter

Mrs. DK is one of my patients who is always on the run.

Every time she comes to the pharmacy, she drops off a prescription that contains at least 5 medications. The first question she always asks is, “How long will it take?”

No matter what time I give her, the expression on Mrs. DK’s face says, “Why would it take that long? Just print a label, slap it on the bottle, and give it to me! That’s it!”

Well, Mrs. DK, unfortunately, that’s not exactly it!

There’s actually a lot more going on in the pharmacy than most people realize. I decided to invite Mrs. DK to walk through what really happens behind the counter.

Upon dropping off her prescription, my pharmacy assistant asks Mrs. DK some questions to update her profile on the pharmacy electronic dispensing software (or create a new profile if it’s her first visit to the pharmacy). The profile includes allergies, current address, contact information, medical conditions, and any changes in health since the last visit to the pharmacy.

Then the filling process officially begins by checking the prescription’s validity as per the standards from the colleges of physicians and pharmacists. A key part of this step is decoding the physician’s handwriting to figure out what has been prescribed, including the dosage, method of delivery (for example, oral, injection, inhalation), and the instructions for taking it.

If the prescription is not clear, the pharmacy assistant, after consulting me, contacts the prescribing physician for clarifications. (As a side note, almost 50% of the prescriptions I receive in my pharmacy are still handwritten.) Even for the electronically written and signed prescriptions, my team may still need to contact the prescribing physician to clarify typo mistakes.

The next step is to verify that the medications prescribed do not interact with other currently used medications, supplements, herbal products and/or disease states.

If Mrs. DK is insured publicly (such as through the Ontario Drug Benefit Program) or privately, and her insurance covers the medications, the claim is processed through an online adjudication system. In this step, our pharmacy software communicates with the insurer software and receives immediate approval for the transaction.

The medication stock bottle is then scanned into the system, along with the lot and expiry. Next, the prescription is counted and packaged for the pharmacist to check.

As the pharmacist, I confirm that all the technical information was entered correctly in the system and revise as needed. I perform a clinical check that includes reviewing previous usage (if any) to rule-out any duplication of therapy and to confirm the appropriateness of therapy in treating the condition for which it was prescribed. I also print documents to provide my patients with more information about the medication.

Now it’s time for Mrs. DK was to pick up her medication. I counsel her on how the drug works in her body, the best time of day to take it, how to take it in relation to food and other medications, and potential side effects she should be aware of.

Now that Mrs. DK understands the prescription filling process, I am confident that the next time she comes to fill her prescription, she will appreciate the time it takes, as it assures her that safety is our prime concern.