The Pharmacy Chick

Comment by rxkerber

June 14, 2009 @ 11:43 pm

I had an erx come over for verapamil SR 120mg 1 tab qd #90……easy enough……but in the comment field was written….verapamil regular release (not SR) 120mg 2 tabs qam and 1 tab qpm. WHAT?????? I barely saw that. Now, I had to call the office and clarify. And I sent the fax back with a big not-so-nice note explaining how this is a giant mistake begging to happen. If their computer system does not have the correct drug then call the rx in or fax a written copy. Do not pick the wrong drug and fix it in the comment field!!!!!!!!!!!

Comment by Mike

June 15, 2009 @ 3:33 am

I don’t have any real data to back my opinion, but I’d be willing to bet that providers only see a small percentage of their faxed refill requests beforehand, and that the provider’s staff is making guesses on their own end.

I can almost count on one hand how many times I’ve actually spoken to the provider directly about a clarification.

Comment by chris

June 15, 2009 @ 5:20 am

I hate it when doctors/nurses just say, oops, sorry about that, change it and send it back for us to sign.

As far as they were aware, that prescription has left them CORRECT and they have signed it to say so.
If I gave a patient a script that I had initialled as dispensed correctly, but it wasnt. I would have to
1. deal with angry/upset/scared/agressive patient
2. apologise to the patient and hope they don’t sue me
3. contact the patient’s doctor if they have taken any, and try to resolve the situation with the doctor
4. report error fully and completely to head office
5. investigate why the error happened
6. put in place systems to stop the error happening again
7. document that all of the above has been carried out, even if there was no systematic fault, just a one off slip

I understand why i do all of this (most of the time) and am happy to do it, it’s my job after all. but wouldnt it save time if i could just say, oops! and get someone else to fix my mistake for me.
thats because its technically not an error until the patient gets it. Its too bad, because I’d rather not be a their filter. Judges hold us accountable for filling a prescription correctly “as written” even if the dr wrote it wrong. Sad, but true.

Comment by Phat

June 15, 2009 @ 8:45 am

I have become a real asshole about this the last few months. A couple of the offices are aware of what I’m doing, so they seem to be working on it.

That sorta thing happens, at our pharmacy, about a dozen times a day. Once I check to make sure we filled it correctly, I call the office back to clarify. Of course they are always stupefied, so they have to call me back. Meanwhile I circle the problems on the hard copy, make a note on what and why it’s wrong and fax it back to the office.

Sure I’ll get a phone call in ten minutes saying, never mind we really meant to sent what you asked for, but that’s not the point. When they give you that clarification, they can just brush you off in a way and not consider the problem.

If you fax it to them, and send it to them again, you get too benefits.

A) You waste their time just like they wasted your time

B) It either catches their attention or another’s attention and someone goes “Gee, maybe we should look into this problem”

Suffice it to say, it does appear to be working. With certain offices we’re having minimal problems now. Perhaps that’s a route you should try.

Comment by Frantic Pharmacist

June 15, 2009 @ 2:02 pm

This kind of thing makes me totally crazy. What would happen if we just filled whatever the doc’s office sent over (ie., acted like the pour-lick-and-stick automatons that some people think we are?) There would be some mighty wrong prescriptions out there.
and we would be liable because we didnt’ check…and we “should have” noticed.

Comment by Jen

June 15, 2009 @ 3:01 pm

I have some offices that send back the fax I sent them with NOTHING written on it. Our faxes have these nice little boxes to check and numbers to circle but they send it back blank. Some of my co-workers take that to mean one refill but I always call back and tell them that I don’t know what that means. They never seem to understand my confusion!
This happens to us all the time. A blank sheet is exactly that, BLANK. we do not fill it blank we send it back and ask them to complete it. sharpies come in really handy here to BOLD our notes.

Comment by Filet

June 16, 2009 @ 12:55 am

funny stuff! check out our blog as well at fastfoodpharmacy.blogspot.com

Comment by Pharmer Jane

July 5, 2009 @ 12:27 pm

This is a daily battle in my long-term care pharmacy. When I worked retail, I could at least ask the patient if they were expecting a change of dose, drug, or directions. My current population of patients are cared for my others, and they often have NO idea if anything was supposed to change. The rule for my technician staff is that if an order comes over that does not specifically indicate a change using words like increase, decrease, stop, etc, then it lands in the “clarify” bin next to my desk so that I can assess if the change was intentional, or if we faxed for refills and got crap as a response.

Most of our issues come for Acme brand CPOE. I don’t know if they’re used nationally, but the big three health systems in the area use them, and there are SO many opportunities for error. The part that I dislike the most is that an order can be entered by a medical assistant and sent to the pharmacy WITHOUT being explicitly authorized by a physician, PA, or NP. They do batch authorization at the end of the day. I am forever calling about confusion on IR vs ER formulations, because “extended release” in this system shows up as TB24 or TB12 at the very end of the drug name.

I know that my state’s medicaid plan pays for interventions like this, if I would take the time to document. Most of my patients are dual Medicare D and Medicaid, and the D plans do NOT reimburse for pharmaceutical care. I spend at least 2 hours each day playing phone tag to clarify orders, and for all my interventions I am reimbursed ZERO.