What would you do?

[Pharmgrlnxdor]

Pt brings in Rx: Hydrocod/APAP 5/325 #300 - SIG: 2PO q4h up to 10 per day from Dr. Feelgood dated 04/04/2015. Patient asks you to fill.

When looking in the prescription monitoring program you see a script written on 3/23/2015 by same doctor for Hydrocod/Ibuprofen 7.5 - 200 filled on 03/27/2015 for #90 with days supply stated as 30.

In looking back patient has been getting this combo for a while however, not nearly as many of the Hydroco/APAP's as is being prescribed this time. Your response would be?

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[FarmD711]

Nope

 

[WVUPharm2007]

And he's practicing polypharmacy? Haha, no.

 

[Estrace]

Not a chance in this world.

 

[Pharmgrlnxdor]

Yeah that was my overall feeling too.

 

[Old Timer]

I would tell them the script is illegal. Scripts cannot be post dated. Go back to the doctor and get a new script. And, oh by the way, when you get the script, have the doctor call and explain why you need both items. Without that phone call, I won't be filling any narcotic analgesics for you, period. Have a nice day

 

[SpartanLaser]

nope.jpg

 

[SClENCE]

"I'm not comfortable filling this" repeated after every statement/question that comes out of his mouth until he leaves

 

[Pharmgrlnxdor]

So told patient that I was not comfortable filling the script and at the very least I needed to consult with Doctor re it on Monday after the holiday weekend. Pt was pissed off took script back and told me off. Pt had one script transferred out and then called to tell me he was reporting me and that my partner pharmacist never had a problem filling his scripts even for that qty, that I did not need to call the doctor to verify anything, and he was never filling anything at "specific" pharmacy again and was transferring out all his scripts (approx 20 other items) so Monday when he calls to tell on me we shall see how my partner (the PIC) handles it. I have constantly been told by all that the pharmacist makes the call on what to fill or not but at the last job I had the pressure to fill C2s no matter what was so great as to be unbelievable. I find it hard to believe there aren't more stories re feeling pressured, manipulated, or coerced to "just fill it" to avoid confrontations or corporate backlash.

 

[doublehh03]

So told patient that I was not comfortable filling the script and at the very least I needed to consult with Doctor re it on Monday after the holiday weekend. Pt was pissed off took script back and told me off. Pt had one script transferred out and then called to tell me he was reporting me and that my partner pharmacist never had a problem filling his scripts even for that qty, that I did not need to call the doctor to verify anything, and he was never filling anything at "specific" pharmacy again and was transferring out all his scripts (approx 20 other items) so Monday when he calls to tell on me we shall see how my partner (the PIC) handles it. I have constantly been told by all that the pharmacist makes the call on what to fill or not but at the last job I had the pressure to fill C2s no matter what was so great as to be unbelievable. I find it hard to believe there aren't more stories re feeling pressured, manipulated, or coerced to "just fill it" to avoid confrontations or corporate backlash.

You should not feel pressured to fill ANY medication, let alone controls. I've always told my staff RPHs it's their call on whether to fill or deny. I do post the red flags posted by the DEA and certain guidelines on what scripts to avoid/not fill for my staff to see so they know ahead of time. But even with a script that I would most likely fill and they don't feel comfortable, that's their call. I'm not going to force them because a customer complained.

I've had a ton of corporate complaints on refusal to fill narcotics. But corporate can't do anything because I have had legitimate reasons why I refused them. It's the corresponding responsibility of the pharmacists).

So do not feel pressured to do anything. If anyone does pressure you, pull out the corresponding responsibility card.

 

[lt23]

So told patient that I was not comfortable filling the script and at the very least I needed to consult with Doctor re it on Monday after the holiday weekend. Pt was pissed off took script back and told me off. Pt had one script transferred out and then called to tell me he was reporting me and that my partner pharmacist never had a problem filling his scripts even for that qty, that I did not need to call the doctor to verify anything, and he was never filling anything at "specific" pharmacy again and was transferring out all his scripts (approx 20 other items) so Monday when he calls to tell on me we shall see how my partner (the PIC) handles it. I have constantly been told by all that the pharmacist makes the call on what to fill or not but at the last job I had the pressure to fill C2s no matter what was so great as to be unbelievable. I find it hard to believe there aren't more stories re feeling pressured, manipulated, or coerced to "just fill it" to avoid confrontations or corporate backlash.

Assuming you have a good reason to deny a controlled substance script, if you get corporate backlash for controlled substances, you should not be working for that company. Corporate and your manager/supervisor should trust your professional judgment.

 

[Dr Wario]

This would be a very easy answer for me as due to the quantity it would be an automatic no. We are actually limited by our supplier on the amount of controls we can order per month (and we often hit this max for many different drugs) so the choice is really made for me.

 

[Ackj]

The only reason I'd fill it is if the patient had something like a GI bleed and couldn't use the ibuprofen anymore, but that still doesn't account for the dose jump up to 50mg hydrocodone.

 

[504poboy]

Defintely no. Let the patient complain to corporate. In the DEA pharmacist manual, it says pharmacists have a corresponding responsibility in addition to the physician. Let them complain all they want. Don't ever let the supervisor or corporate pressure you. Tell the patient straight up. No, you can go somewhere else and I am not doing it. I don't know what you guys do, but I used to write on the back of the RX last filled how many tablets and then put the pharmacy stamp on it. I put a check mark PMP (Prescription Monitoring Program) letting the other pharmacists know whats going on. You can write on the back of the RX not the front.

 

[Ackj]

Defintely no. Let the patient complain to corporate. In the DEA pharmacist manual, it says pharmacists have a corresponding responsibility in addition to the physician. Let them complain all they want. Don't ever let the supervisor or corporate pressure you. Tell the patient straight up. No, you can go somewhere else and I am not doing it. I don't know what you guys do, but I used to write on the back of the RX last filled how many tablets and then put the pharmacy stamp on it. I put a check mark PMP (Prescription Monitoring Program) letting the other pharmacists know whats going on. You can write on the back of the RX not the front.

What's wrong with the front? I usually write it in the top corner, like where the dropoff tech jots down their phone number or whatever. If you write it on the back, there's a pretty good chance the other pharmacy will miss it. If that is for some reason illegal, well oops.

 

[504poboy]

Writing on the front of the rx is considered defacing a prescription...there was a pharmacist in lousiana a couple of years ago that did some stupid stuff....he did 2 stupid offenses....

1. He ripped up a patient's valid rx thinking it was fraud.
2. He wrote a giant X on the front of a prescription for a different patient. They nailed him for defacing a prescription.


like we get quarterly board of pharmacy law letters. Our pharmacy law teacher that taught our class was like "Before you read the first page, go straight to the back and look at all the pharmacist violations that people did and look for your name. If you don't see your name, you are good for now"

 

[Lnsean]

Writing on the front of the rx is considered defacing a prescription...there was a pharmacist in lousiana a couple of years ago that did some stupid stuff....he did 2 stupid offenses....

1. He ripped up a patient's valid rx thinking it was fraud.
2. He wrote a giant X on the front of a prescription for a different patient. They nailed him for defacing a prescription.


like we get quarterly board of pharmacy law letters. Our pharmacy law teacher that taught our class was like "Before you read the first page, go straight to the back and look at all the pharmacist violations that people did and look for your name. If you don't see your name, you are good for now"

That's not true at all. You can write on the front; just don't put a X on it and tear it up. Common sense.

 

[504poboy]

That's not true at all. You can write on the front; just don't put a X on it and tear it up. Common sense.

You are correct about writing on the front...let's say pharmacist A writes a short message on the front of the rx....like patient too soon, check pmp, next fill date so and so.....patient gets pissed goes to pharmacist B working at CVS down the street.....tech shows the rx to pharmacist and is like can we fill this?!?!....pharmacist B is like screw it, I'm not the police and I don't have time to look up their info in the state monitoring program....just say we're out......pharmacist c at Walmart is asked by the tech...hey we got this in stock boss.....pharmacist c says nope....we can't get it in for 2 weeks.....I don't mind people writing on the front....but usually by the time it comes to an independent pharmacy.....they see a defaced rx with so much writing from pharmacists refusing to fill it and the rx and it's all crumpled up and moist because some lady was too lazy to put it in her purse that she had to keep it under the crease of her breast

 

[fauxden]

You are correct about writing on the front...let's say pharmacist A writes a short message on the front of the rx....like patient too soon, check pmp, next fill date so and so.....patient gets pissed goes to pharmacist B working at CVS down the street.....tech shows the rx to pharmacist and is like can we fill this?!?!....pharmacist B is like screw it, I'm not the police and I don't have time to look up their info in the state monitoring program....just say we're out......pharmacist c at Walmart is asked by the tech...hey we got this in stock boss.....pharmacist c says nope....we can't get it in for 2 weeks.....I don't mind people writing on the front....but usually by the time it comes to an independent pharmacy.....they see a defaced rx with so much writing from pharmacists refusing to fill it and the rx and it's all crumpled up and moist because some lady was too lazy to put it in her purse that she had to keep it under the crease of her breast

That was an eloquent post

 

[SClENCE]

If it's too soon I sometimes write it on the back if the patient pisses me off. Usually I get a phone call from another pharmacy 20 minutes later.

 

[BidingMyTime]

Why do people think "I'm not comfortable filling this" is a good thing to say? "comfortable" is feeling that can change, so it opens up to have the patient argue and try to convince you to fill the prescription. Let your yes be yes, and your no be no. I just say, "I will not fill this prescription for you because..." and then state the reasons why. My "comfort" level has nothing to do with it, either their scripts meets DEA requirements, or it does not (and if its unknown, then I tell them I can't legally fill their prescription until I talk to the doctor.)

In this case, I would tell the patient I will have to talk with their doctor about their combination use before I can fill the prescription. Facts, not feelings. Does the RX look-up show they are feeling each script every 30 days? That would be pretty hard for the doctor to explain. If they are getting each script filled every 60 or more days, then possibly they are alternating (maybe using the hydro/ibu RX when they are having more pain or the hydro/tyl when they are having less pain?) I have seen patients who have extremely similar RX's like this, who alternate them...not a problem as long as they aren't using both at the same time. So the length between refills is probably the deciding key. Either way, I would follow-up with the doctor and let her/him know about the health concerns in writing 2 hydro RX's (and also the illegality of post-dating an RX.)

 

[zelman]

Why do people think "I'm not comfortable filling this" is a good thing to say? "comfortable" is feeling that can change, so it opens up to have the patient argue and try to convince you to fill the prescription. Let your yes be yes, and your no be no. I just say, "I will not fill this prescription for you because..." and then state the reasons why. My "comfort" level has nothing to do with it, either their scripts meets DEA requirements, or it does not (and if its unknown, then I tell them I can't legally fill their prescription until I talk to the doctor.)

In this case, I would tell the patient I will have to talk with their doctor about their combination use before I can fill the prescription. Facts, not feelings. Does the RX look-up show they are feeling each script every 30 days? That would be pretty hard for the doctor to explain. If they are getting each script filled every 60 or more days, then possibly they are alternating (maybe using the hydro/ibu RX when they are having more pain or the hydro/tyl when they are having less pain?) I have seen patients who have extremely similar RX's like this, who alternate them...not a problem as long as they aren't using both at the same time. So the length between refills is probably the deciding key. Either way, I would follow-up with the doctor and let her/him know about the health concerns in writing 2 hydro RX's (and also the illegality of post-dating an RX.)

Because many of the DEA requirements are unknowable nonsense.