Why is “standard” such a dirty word: Part 2
Moving on to Part II- Hard copies..you know those sheets of paper that patients hand you and ask you to fill? At one time they used to be your basic 4×6 piece of paper. It had the Dr name on the top ( when each Dr had is own address and phone..which when called, someBODY actually answered), an address, and a phone number. The dr would scribble something on the prescription and the patient would drive that piece of paper to the local pharmacy where the pharmacist would squint at what was written and fill the rx….provided he/she could read it. If the RPh needed clarification, all he had to do was call the office and somebody would yell at the dr at his desk. Ah, the old days.
Things are a bit more complicated now. 1) we have WAY more regulation . 2) we have WAY more drugs and 3) we have way more prescribing entities.
When I first became licensed I was in a smaller community. There weren’t many prescribers . I now live in a huge metro area. Lots of pharmacies. Lots of Doctors..and since there is a TEACHING hospital nearby..lots of residents, PA’s and NP’s. The joke in Chickville is that everybody INCLUDING the janitor can write prescriptions and GTH ( Giant Teaching Hospital).
And therein, lies the problem….who are signing all these prescriptions? Cuz I surely don’t know.
Last Saturday: 2 pm. Customer brings in a GTH generic discharge blank. Written on it is a list of 4 prescriptions including a C-II drug. Not only is the DEA number missing but the signature is a scribble, 2 dashes and what appears to be either a g or s. NICE. When I ask the patient ” WHO wrote this?” I got the answer I often get in these cases….
” isn’t it written on there?”…well sir, if it WAS, would I be asking you?
How does this problem go away? STANDARDIZATION.
A standard prescription can be quite simple. Be a doctor, have a pad of blanks..Rule no. 1. If you write a prescription, it must meet certain criteria to be legally filled. This has already been established by the board of pharmacy. Sadly it seems its up to US to make rx’s legal by filling in the blanks ourselves. Time to stop that nonsense.
At the very minimum the following standard preprinted information should be on all prescriptions given to patients: 1) The doctor’s name,2) address, 3) phone ( fax), and 4) NPI and DEA number. If Dr’s are pissy about putting the DEA number, then pre print all but the last 3 numbers and have the rest filled in if the rx is controlled. With the advent of hand helds and computer rx programs, nearly every rx can and should be computer generated. With that in mind, even more valuable information can be pre printed…such as the Patient name, address, phone, dob and allergies. then we can finally get to the Drug, dose, sig, and refills. It should be easy to read and in a format easy to read. It should be 1 drug, one prescription.
PRINT..sign and give to patient. DONE.
About a year ago I tossed a bucket of water the wrong way and sent my neck and shoulder into a spasm I will not soon forget. After about 12 hours of agony I went to a local immediate care center ( note NOT a hospital emergency room). I had been unsuccessful trying to stretch, massage or heat the spasms out. The dr saw me, and went to issue the prescriptions. He did NOT whip out a pad and scribble Vicodin and Flexeril. He went into another room and came back with 2 rx’s, neatly produced on a computer, signed and dated. It was made on security paper, one page per rx ( yea, thats a bit of paper waste, but with printers, what can you really do?.. they print in 8×11).
I filled the cyclobenzaprine, had no use for the vicodin, so that went on hold. But the point is this: this script was COMPLETE. Nothing was missing. It was easy to read, everything was there, nothing was left to guess about.
Of course, it wont prevent human input error: Like the one I got today: Doxycycline 150mg monohydrate caps # 20: sig: take 100mg twice daily for 10 days. OOOOKKAAY…
We still have a way to go to hurdle over that problem, but Standardizing hardcopies is a good start.