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ways to say no?

Discussion in 'Pharmacy' started by Muse600, May 2, 2012.

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  1. Muse600

    Muse600

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    I bend over too far backwards to give good customer service, so I often find it difficult to tell people "no" for things I'm not supposed to do.

    So who has a good way of saying no to the following:

    1.) early fills on pain controls when MD has increased the dose

    2.) early fills on ADHD medications (by the same MD) when the patient "lost the previous fill"

    3.) turning people away (or telling them you'll fill tomorrow) 10-15 mins before closing when you have a lot of other Rx's to fill
  2. lactonerx

    lactonerx

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    The doctor is aware so why say "no"?

    refer them to 24h store
  3. All4MyDaughter

    All4MyDaughter SDN Mommystrator Staff Member Administrator SDN Senior Moderator Lifetime Donor Partner Organization

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    Why would you say no to #1. Change in dose? MD aware? I'm good with it.
  4. Wheresmyaricept

    Wheresmyaricept

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    1. If it is an increase in dose then it isn't early. Unless based on the updated directions, they're still early. Just say that there are laws prohibiting how often it can be filled.

    2. If they're always trying to get it filled early or "losing" it, make sure the md is aware. If you feel the doctor is just a pill mill tell him next time that you're not going to fill it until it's due. If they need to take the prescription elsewhere then fine. I know Walgreens often stands behind their pharmacists when it comes to dispensing controlleds early. If you're worried about a customer complaint to your boss, then let them complain. Don't break the law and put your job on the line because of customer service.

    3. Explain you have several other prescriptions that still need to be filled as well as closing procedures. If they can't wait until tomorrow, offer to transfer it to a 24 hour store so at least they don't have to physically bring the hard copy and wait.
  5. rxlea

    rxlea Unicorn in training Moderator Emeritus

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    For number 3, I think it would depend on the script... lovastatin? Come back tomorrow. Amoxicillin for a child? I would fill it.

    As for number one, I also don't see the problem there. I think some pharmacists want to play drug seeker police when they shouldn't. Many patients' pain is not adequately controlled or they are prescribed prn pain meds. Unless you know without a doubt that the doctor is a pill mill, just believe the patient. MD aware? Valid script? Seems OK.

    Now number two I don't really know much about how to deal with "I lost it".
  6. WVUPharm2007

    WVUPharm2007 "I hear the WMD is the bomb."

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    CVS's official controlled policy is pretty liberal for pharmacists. It allows us to refuse if we THINK it may not be for a legitimate medical purpose. In fact, the pharmacy ops manual actually says for all pain meds, you are required to have a diagnosis and confirmation from MD's office for all new scripts. And even if you get that, you can still refuse if you don't think its appropriate in any way.

    After the DEA has gone ape**** recently in Florida, I don't see them giving you any trouble with controlleds...even if it wound up being a legit script.

    For night shift, its pretty easy...unless its from an emergency room or a patient getting continuing therapy, you can't fill it. I have the local dope fiends trained. If I'm behind the counter, they don't even try me anymore.
  7. npage148

    npage148 Senior Member

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    I just got an email from my former law professor that clarifes dea law point. According to the clarification, a pharmacist can refuse any cs rx if they feel that it is not legitimate and that pharmacists will come under increased scrutinty for filling sketchy rxs
  8. Muse600

    Muse600

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    thanks for the responses everyone

    for #1, I should've clarified the situation: I was thinking back to a time a pt filled a pain control, MD changes dose (which is okay), but even at the higher dose, the pt shouldn't need a new fill for about more 5 days, finishing out that old script. When asked "do you have any at home?" they say "yes", but they still ask me "is there any way you can give me a few from that new Rx?".

    for #2, if I'm filling 2-3 weeks early, I call and document "okay to fill per MD". If I don't get that okay, I don't fill it...even if it's the same doctor. I've seen some doctors just writing scripts, when it seems like they don't even know what they're writing for. sometimes I'll call, and they'll say "oh yeah? that soon? yeah don't fill it".

    but stating the law limitations, or sending them to a 24 hour store seem like good options...I'll def. try them out
  9. abc1234567

    abc1234567

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    Whereismyscript :
    Well Walgreens does not stand behind their pharmacists when it comes to early fills on controlled substances it is the pharmacist who often chose between do they love their job more or do they care about their professional obligation+license more.I always go with the second one (professional obligation+license)
    They only care about customer service and profits nobody there cares about what is right
    May be your experience is different because of being from a different district.

    Well CVS also does not care atleast the district I know.CVS pharmacists I came across told me that their higher ups want them to fill everything .They themselves have to make sure that they dont do that and at the same time do not make the patient unhappy.
    Last edited: May 3, 2012
  10. Wheresmyaricept

    Wheresmyaricept

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    I've worked in three different districts in two states and different markets and it's always been the same. If your pharmacy supervisor or dm is forcing you to do it for customer service reasons contact your pharmacy operations director for the market, loss prevention, or even the market vice president. Or if you call the 1800 Walgreens number to put in an anonymous employee complaint it has to be investigated.

    Yeah the company is all about customer service these days, but I'm pretty sure they would rather worry about legal fees and fines for breaking laws instead of "jimmy overcharged my for my boxed prunes! This is ridiculous!" And remember that if you do something illegal it's your license and your job. They can fire you for it too. They can't fire you for one customer service complaint.
  11. rph3664

    rph3664

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    Some managers at Hy-Vee, which is a Midwestern grocery chain, are like that too. Sorry, the real world doesn't work that way.
  12. ancienbon

    ancienbon

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    An overnight pharmacist was fired because she reported the rx supervisor for forcing her to fill random oxy scripts. she was fired over something very minor.The fact is when you report your boss, they can fire easily. it is complicated .
  13. Wheresmyaricept

    Wheresmyaricept

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    Somehow I don't believe that's the reason why that person was fired. Retaliation is illegal. And if it was the reason, that person has a nice lawsuit on their hands.

    http://www.eeoc.gov/laws/types/retaliation.cfm
  14. ancienbon

    ancienbon

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    i should have clarified that she was not fired specifically for that . she was fired for somethig else, very minor. if she did not report the boss, perhaps she would not have been fired
  15. abc1234567

    abc1234567

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    As I said I care about my professional obligation more than my job. Another thing nobody will ask you to do it directly. I don't think that I ever said that I can jeopardize my professional obligation over their corporate ideology of making everyone happy and profits.

    Yes they only care about customer service and profits and I strongly disagree that they stand behind their Pharmacists .You did hear the news about what happened in Florida right ?

    I think most of the pharmacists in retail feel pressurized.It depends on their personality and judgement whether they get under that pressure or totally ignore it.
    Last edited: May 5, 2012
  16. ancienbon

    ancienbon

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    When i started as a floater pharmacist back in the fall of 2010, I used to float at very oxy store, a store where the pharmacy manager would fill anything.. It was ridiculous. At one time, i refused to fill those scripts. Patients went to pain clinic to complain. Doctors called rx supervisor to check on why the pharmacist (me)is refusing to fill those scripts. A few minutes later, rx supervisor called and was indirectly telling me i got to fill them. The next day, i called market scheduler and told her not to schedule me at that store. Now that store is on the dea short list,,, and i think it lost its dea license.Cant dispense controlled substances
  17. BidingMyTime

    BidingMyTime Lost Shaker Of Salt

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    Nobody can "force" you to fill a prescription. In a situation like that, the pharmacist should refuse to fill the prescription that (s)he feels there is a problem with (of course, (s)he should only be refusing to fill prescriptions that there are legitimate problems with....not for reason like she doesn't think the person looks like he needs oxy) If the pharmacist supervisor fires her for not filling problematic prescriptions, than she has reason to go to the board. But I really thinks such a situation is rare, I have never heard of pharmacy supervisors trying to force pharmacists to fill prescriptions that they have problems with them. But yes, reporting a supervisor is a quick way to get put on the "lets get rid of this person" list.

    As for the situations in the OP, most people with narcotic prescriptions have them for legitimate purposes. Every situation is different. With #1, I'd probably just sell them the RX--its safe to assume that the doctor had changed their dose shortly after they got the RX, and never bothered to let the pharmacy know (this happens all the time, even with maintenance meds.) Especially if the person does not have a history of seeking early refills. With #2, I would document very well. If the person is repeatedly losing their RX's, then at a certain point I would tell them I was concerned about their health (go into the adverse effects of the medication they are "losing") and tell them I do not feel comfortable filling it. You can also throw in that the law requires you to not fill prescriptions that could be detrimental to someones health. Then offer to give the RX back to them or transfer it (although when transferring the RX, I always make sure the pharmacist there knows the history--many times they will refuse to fill it also, sometimes they just don't care and want any RX....it's their judgement call at that point.) For #3, it depends, what is the RX and how complicated is it. An RX for a Z-pack, sure I'll do that. 10 RX's from the hospital they were discharged from yesterday....I'll send them to the nearest 24hr pharmacy. Even with the quick RX's, it's risky, because they can pull out some archaic insurance card that will take you 20 minutes to figure out how to work. But usually, I don't have a hot date right after work, so its not that big of a deal if I'm 20 minutes late getting out.

    Basically, just use your judgement. You can't really have strict rules about always doing this or always refusing to do that, because every situation is going to be different.
  18. ancienbon

    ancienbon

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    The instance where a pharmacy supervisor would force a pharmacist to fill questionnable prescriptions is not uncommon, at least in the state of florida. A friend of mine who was working for cvs was forced to fill a prescription for oxycodone from another county. When he refused to fill that prescription, the pharmacy supervisor who was in the store at the time said", the prescription looks legitimate to me". Feared for retaliation, the pharmacist had to fill the prescription. Now, thank god he no longer works for cvs.
  19. npage148

    npage148 Senior Member

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    Then you put your initials on it!

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