1. The Pharmacy
Technician 4E
Chapter 17
Other Environments

2. Course Outline
1. Mail Order Pharmacy
2. Long-Term Care
3. Home Infusion

3. Mail Order Pharmacy
 Chronic condition
 Continuing condition that requires ongoing
treatment for a prolonged period.
 Maintenance medication
 Medication that is required on a continuing basis
for the treatment of a chronic condition.
 Acute condition
 Sudden condition requiring immediate treatment.

4. Mail Order Pharmacy
 Type of pharmacy that mails or delivers
medications.
 Requires a delivery time of at least 24–48 hours.
 Used for maintenance medication.
 Serves broad geographic areas.
 Process a high volume prescription which allows
deep discounts.
 Dispense a 3 month supply at time..
 Most third party insurers force their clients to use
mail order pharmacy for maintenance medications.

5. Online Drugstores
 Online drugstores are a type of mail order pharmacy
that use the Internet to advertise and take orders
for drugs which are then mailed to the customer.
 Drugs cost less in Canada and U.S. Cross-border
regulations allow Canadian pharmacies to fill
individual prescriptions from U.S. consumers for
small amounts of drugs.
 Canadian online drugstore industry has grown
rapidly, and has been the subject of much consumer
and political debate.

6. Long-term Care Facility
 Long-term Care Facility
An institution that provides care for geriatric and
disabled patients.
 Includes adults who suffer from chronic (long-lasting)
or debilitating illnesses as stroke or Alzheimer’s
disease.
Nursing Homes
Most long-term care facilities are nursing homes that
provide daily nursing care.
Patients in this setting are generally referred to as
residents.

7. Institutional Pharmacy
 Skilled-care facilities (SCF)
 Limited to patients requiring more round-the-clock
nursing care (such as IV infusions) or recovery after
a recent hospitalization.
 Most patients are discharged from SCF to home
when they have adequately recovered.
 Other long-term care facilities
 Include patients with acute or chronic psychiatric
disorders or rehabilitation facilities for those with
serious traumatic brain or spinal cord injuries.

8. Long-Term Care Pharmacists
 Distributive pharmacist
 Ensures long-term care patients receive the
correct medications ordered.
 Consultant pharmacist
 Develops and maintains an individual
pharmaceutical plan for each long-term care
patient.

9. Licensed pharmacists’ Role
 Some long-term care facilities have an “in-house” pharmacy
while others contract with a community pharmacy or allow each
resident to choose his or her pharmacy.
 Licensed pharmacists’ Role
 Establish record-keeping systems related to controlled
substances.
 Review drug regimens.
 Monitor repackaging and storage of pharmaceuticals.
 Ensure that medications are uncontaminated and have not
expired.
 Note medication errors and adverse reactions or interactions.
 Educate residents on drug therapies and self-medication.
 Provide medications to outpatients or residents on weekend
leave.

10. A Pharmacy Technician’s Role
 Log prescriptions and refill orders via computer.
 Prepare billings.
 Maintain drug boxes or trays for emergencies.
 Package and label medications.
 Deliver medications to the nursing home.
 Maintain records, retrieve and organize patient charts.
 Conduct inspections of drugs in the inventory and in
the nursing stations.
 Repackage drugs in unit doses labeled for each
patient.

11. Long-Term Care Pharmacy
 In-house pharmacies may provide a 7-day supply of
medication in “blister packs.”
 Community pharmacies fill medication carts or trays
with a 30-day supply of medication.
 Medication orders rarely change in this
environment.

12. Home Infusion Pharmacy
 A pharmacy that dispenses, prepares, and delivers
drugs and medical supplies directly to the home of the
patient.
 Spiraling hospitalization costs, regulatory changes,
and advances in parenteral therapies have created an
explosion in this field.
 The home healthcare market continues to grow
because of our aging society and as an alternative to the
higher cost of hospitalizations.
 Many hospitalized patients are discharged as soon
as possible to continue their recovery at home with
IV solutions.

13. Home Infusion Pharmacy
 Pharmacists and pharmacy technicians working in
home healthcare.
 Provide educational materials.
 Carry out traditional compounding and delivery
functions.
 Prepare and provide infusions and infusion
equipment.
 Might be available for emergencies on a 24-
hour basis.

14. Primary Home Infusion
Cont.
The primary therapies provided by home infusion
service include:
 Antibiotic Therapy
 Common home infusion service used in treating AIDS
related and other infections.
 Parenteral Nutrition
 Required for patients with various intestinal disorders.
 Pain Management
 Applies to the infusion of narcotics for patients with painful
terminal illnesses or other types of severe chronic pain.
 Chemotherapy
 Provided in the home, generally in conjunction with an
oncology program at a hospital or clinic.

15. Home Care Team
The team that provides home health care includes the
following:
 Physician
 Orders the infusion therapy.
 Registered Nurse
 Responsible for coordinating and monitoring the care plan and the home
care team, and for educating the patient.
 Pharmacist
 Works with the supervising nurse to develop a pharmaceutical care plan
which includes selection of the infusion device, identification of potential
adverse reactions and interventions, and monitoring practices.
 Pharmacy Technician
 The technician works under the pharmacist's supervision and may be involved with
compounding, labeling, delivery, and other non-consulting activities.
 Home Care Aide
 Aides are non-professional staff employed by the home care agency who work under
the supervision of the registered nurse. They assist in various aspects of a patient's
care, but generally not in medication therapy.

16. Home Care Team
Cont.
 Pharmacy Technician
 Works under the pharmacist's supervision.
 May be involved with compounding, labeling, delivery, and
other non-consulting activities.
 Home Care Aide
 Non-professional staff employed by the home care
agency.
 Work under the supervision of the registered nurse.
 Assist in various aspects of a patient's care, but generally
not in medication therapy.

17. Managed Care
•A type of health insurance system that emphasizes
keeping the patient healthy of diseases controlled to
reduce healthcare costs.
•A relatively new form of healthcare that has grown
dramatically over the past 35 years.
• One of the first managed-care organizations
was Kaiser Permanente.

18. Managed Care
Cont.
• Health maintenance organization (HMO) is
another name for managed care.
 Most HMOs are centralized primary-care clinics.
 Serve patients with pharmacy, x-ray, and
laboratory departments.
 Similar to a hospital, HMO’s usually have an
approved drug list or formulary that has been
recommended by a drug information pharmacist
and approved by the medical staff.

19. Managed Care
Cont.
 After the patient sees the physician, the patient may
go to the HMO pharmacy to fill a prescription.
 Patients needing refills may call an automated
telephone number to expedite processing and reduce
waiting times.
 This “time savings” also allows the pharmacist to
spend more time reviewing the computerized
medication profile and counseling the patient.

20. Managed Care
Cont.
 The pharmacy technician in managed care performs
similar functions to those in the community pharmacy.
 Insurance billing and cashiering are minimal.
 Clinical pharmacists may work closely with the primary-
care physicians to better control chronic disease.
 Educating
 Monitoring
 Adjusting doses of medications per physician-
approved protocols.

21. Terms to Remember
1. Acute condition
2. Antibiotic therapy
3. Automated dispensing system
4. Chronic condition
5. Consultant pharmacist
6. Distributive pharmacist
7. Home care agencies
8. Maintenance medication