Help with O2 & SVN script writing

[170417]

abc123

[PharmDstudent]

Originally Posted by incognito13169

What is the proper way to write scripts for O2 and SVNs? I've listed my best guesses below, but I think that they may need some adjusting...

Rx: Oxygen
Sig: 2-4 liters per minute, 8-24 hours per day
Disp # 1 tank + 0 refills

Rx: Albuterol 3 mg and Ipratropium 0.5 SVN
Sig: 3 ml via nebulizer q6hours
Disp #25 vials + 0 refills

One last question, when prescribing pediatric solutions, should I dispense exact mls? Dispense "one bottle"? Dispense "stock"?

Thanks in advance for the helpful replies.

-michelle , PA-S

I have no idea about the oxygen...

With the albuterol/ipratropium, you could write the sig in that form, but I would recommend that you write: disp quantity sufficient, with a day supply. #25 is an arbitrary number, in my opinion, unless you wanted the patient to only have enough for 6.25 days . Don't forget to write a script for the nebulizer itself!

The pediatric liquids can be written by mLs or package size. Cough syrups usually come in stock bottles of around 500mLs, so you would want to write for the number of ounces or mLs. Antibiotic suspensions usually come in one of the following sizes: 50mL, 75mL, 100mL, 150mL, or 200mL. There are a few exceptions, like azithromycin, but not very many. Most of the liquid vitamins come in only one size, ~118mL. Check with the patient's pharmacy if you have any doubts or specific questions.

[sdn1977]

Originally Posted by incognito13169

What is the proper way to write scripts for O2 and SVNs? I've listed my best guesses below, but I think that they may need some adjusting...

Rx: Oxygen
Sig: 2-4 liters per minute, 8-24 hours per day
Disp # 1 tank + 0 refills

Rx: Albuterol 3 mg and Ipratropium 0.5 SVN
Sig: 3 ml via nebulizer q6hours
Disp #25 vials + 0 refills

One last question, when prescribing pediatric solutions, should I dispense exact mls? Dispense "one bottle"? Dispense "stock"?

Thanks in advance for the helpful replies.

-michelle , PA-S

For oxygen, you write the order for a range of liters/min & give a time frame - 1 week, 1 month, prn. The respiratory therapy company will handle it from there.

For nebulized meds - write the mg you want to adminster separately with the frequency & the time frame - ie....albuterol 2.5mg q 6-8h prn & request a one month supply (same with ipatroprium). We'll figure out the best packaging & amount.

For peds antibiotics - order the mg you want to give - amoxicillin 185mg (about 3/4 tsp of 250mg/5ml) q 8h x 10 d. I'll figure out the bottle size & I may use a larger or two smaller ones depending on what I have at the time. Likewise, you can order it as azithromycin 100mg/5ml - 7.5ml day 1 then 3.75ml days 2-5. I may change it depending on what I have & how easily the family can manipulate the devices used to measure. I just need to know your intent & I'll provide the best product available to provide that with the education the dosing may be different from what the prescriber described due to packaging differences.

[npage148]

If you write trade size for cough syrups/IBU susp/ APAP syrup. I give 120ml. If its a cream/oint, I give the smallest trade size. I really prefer that you write a discrete qty and not a day's supply. For the neb solution, writing 3 boxes/50 units is good but days supply is acceptable. Don't write trade size/days supply for control substance solutions. I NEED a discrete qty

[sdn1977]

Originally Posted by npage148

If you write trade size for cough syrups/IBU susp/ APAP syrup. I give 120ml. If its a cream/oint, I give the smallest trade size. I really prefer that you write a discrete qty and not a day's supply. For the neb solution, writing 3 boxes/50 units is good but days supply is acceptable. Don't write trade size/days supply for control substance solutions. I NEED a discrete qty

Isn't funny how different we are? I prefer days supply & will always dispense the largest qty.

Agreed - controls need a specific qty.

Neither is better nor worse - we're just different. Your way is as good as mine.

But, I'd rather not be restricted by a qty which is unacceptable to an appropriate days supply. I just got 2 rxs which had 50ml azithromycin & the days supply only required 30 or 46 or whatever the qty which was needed. That just means I have to document more. Not an issue, just more time & trouble (oh & issues - audit rejects!).

[npage148]

Originally Posted by sdn1977

Isn't funny how different we are? I prefer days supply & will always dispense the largest qty.

Agreed - controls need a specific qty.

Neither is better nor worse - we're just different. Your way is as good as mine.

But, I'd rather not be restricted by a qty which is unacceptable to an appropriate days supply. I just got 2 rxs which had 50ml azithromycin & the days supply only required 30 or 46 or whatever the qty which was needed. That just means I have to document more. Not an issue, just more time & trouble (oh & issues - audit rejects!).

It's all about consistency! I also do a lot of ER scripts so I'd prefer not to give out 80g tubes of steroids/ 16oz of medicine from the ER. Small tubes and sizes means they need to follow up with their PCP. Often, it's always ER OTC packs like trade size IBU susp, trade size apap syrup, trade size diphen syrup.

[sdn1977]

Originally Posted by npage148

It's all about consistency! I also do a lot of ER scripts so I'd prefer not to give out 80g tubes of steroids/ 16oz of medicine from the ER. Small tubes and sizes means they need to follow up with their PCP. Often, it's always ER OTC packs like trade size IBU susp, trade size apap syrup, trade size diphen syrup.

True! If the rx for the TAC is coming from the ER v a derm, I'd choose different sizes.

But, for those that aren't ER rxs, I fill the largest size unless written otherwise.

[pharm765]

Originally Posted by sdn1977

True! If the rx for the TAC is coming from the ER v a derm, I'd choose different sizes.

But, for those that aren't ER rxs, I fill the largest size unless written otherwise.

Is this a problem if you get an insurance audit? I've always been told you had to give the smallest if it wasn't specified, but of course would prefer to be able to pick what I think is appropriate instead.

Speaking of topicals and insurance audit fears- I had an rx for a patient that was written for 60g of something that comes 15, 30, or 85g (I can't remember what it was now). We had no 30gs, but 2 of them would have cost the patient around $90. Four 15g tubes cost $120. One 85g would have only cost $60. The floater told me I couldn't give the 85 and because "it's illegal to give more" (although I suggested just taking away the refill) and "we might get audited." Maybe the prices would have been the same once we got updated insurance for them - but I just get so frustrated when we can't help a patient over stupid things like this! I suppose the right thing to do would be to bother the physician to approve a bigger package size...so dumb though.

[sdn1977]

I NEVER contact the prescriber on a topical unless its a huge quantity (>240 Gm over 30d).

I can document anything I want on the rx - whatever % of body surface being covered over a certain period of time.

But, as the previous poster mentioned, EMDs will write for the quantity sufficient to allow follow up with a derm. But if its a derm - I always give the largest quantity.

Who's to say its the trunk & legs rather than just the hands & feet? Just document on the rx.

[170417]

Thank you to all who replied - greatly appreciated!