College of Veterinary Medicine

Veterinary Teaching Hospital

Ten Best Practices for Veterinary Clinic Pharmacies


  
  1. A clearly written order for legend drugs and controlled substances containing all legal requirements.
    • In WA, prescriptions must be printed by hand or machine--no cursive writing
    • Date written (must be dated on the date written)
    • Patient/Owner Address
    • Identification of the specific patient (including name, number and species)
    • Drug (name and strength), quantity, complete directions for use
    • Prescriber address (if sent with owner to be filled at outside pharmacy, veterinarian’s phone number)
    • Prescriber DEA number (if controlled substance)
    • Physician’s signature (if written to an outside pharmacy the signature on one of two signature lines on the form “DISPENSE AS WRITTEN” or “SUBSTITUTION PERMITTED”.
    • Prescriber’s specified withdrawal time for meat, milk, eggs or other by-products if food-producing animal.
  2. DO NOT use the abbreviation SID in the directions of any prescription destined for an outside pharmacy.  This abbreviation is not recognized outside the veterinary profession and veterinary patients have been harmed or killed when interpreted as Four Times Daily (QID).  Using the abbreviation q?h (q8h, q24h, q48h) will reduce the chance of misinterpretation. However, the abbreviations qd, bid, tid, qid, qod are recognized.  
  3. Best practice elements included on a prescription.
    • Weight of patient
    • Date of birth
    • Owner phone number
    • Indication for usage (especially important for PRN, as needed orders, along with an upper limit.  Ex:  Give 1 tablet by mouth as needed for travel.  Do not exceed 1 tablet every 8 hours or 2 tablets within 24 hours.)
    • Include typed or printed name.  
  4. Every box, bottle, jar, tube or other container of a prescription which is dispensed must have a label fixed with the following information.
    • Veterinary Clinic name and address
    • Prescription number
    • Prescriber name
    • Identification of the animal or other group of animals being treated (if the drug is a controlled substance, the name/number of the specific patient being treated is necessary)
    • The name of the medicine and the strength (if the prescription is compounded or a combination drug product, all ingredients must be listed or the trade name used)
    • Complete directions for use
    • Cautionary statements if any. Ex:  shake well, refrigerate. Meat and milk withdrawal times, if appropriate.
    • Date
    • Expiration date
    • Initials of the person who has prepared the prescription  
  5. The term “AS DIRECTED” is prohibited as the directions on a legend drug (prescription) label in WA. Only if the product is OTC can you say “Use according to package instructions” or “Use according to attached instructions.”  
  6. Assume that someday, you will be party to a lawsuit. Your best protection is to keep good records. Besides complete medical and prescription records, you might consider a phone log for important conversations.   
  7. Reduce work place distractions where prescriptions are being prepared. Ensuring an independent double check before dispensing medications is good practice.  Having one person perform order entry and a different person prepare the prescription can be helpful. Regardless, keep in mind that a veterinarian (not a licensed veterinary tech [LVT] and not a medication clerk [RVMC]) is responsible for checking the completeness and accuracy of any prescription prior to it reaching the hands of the client.  
  8. If checked by other than the original veterinarian who wrote the order, the prescription should be checked from the original order, not the computer-generated label, as order entry may have been incorrect.  
  9. Have LVT's or RVMC's keep the original order, the prepared product with label, and manufacturer’s product(s) together throughout the preparation process.  Verify the dispensing accuracy by comparing one to the other.  
  10. Triple check that the drug is correct. Check the drug when you pull it from the shelf, when you fill the prescription, and when you put the drug away. Make a rule that everyone must actually read the label and not rely on location/size/color of containers. Keep the area where drugs are prepared neat.  After an order has been checked for accuracy, put the drugs away.  Leaving drugs from previous orders in the preparation area increases the opportunity for the wrong product to be used.  
  11. Be conscious of math mistakes. Never use trailing zeros after a decimal. Always use leading zeros before a decimal. One of the most common medical errors is 10 fold over-and-under dosing. Always double check complicated calculations. Use both the calculator and mental estimates in order to check your math without automatically repeating the same error. Realize that most human oral solutions are based on milligrams per teaspoon (5ml), not mg/ml.


Last Edited: Nov 13, 2012 3:56 PM
Veterinary Teaching Hospital,  PO Box 647060 , Washington State University, Pullman WA 99164-7060, 509-335-0711, Contact Us   Safety Links