Anyone else nervous when dentists prescribe?

[BravoKilo]

Today I had my second 'incident' with a script written by a dentist that left me wondering WTF??

Lady brings a script for azithromycin suspension for her 2-year-old daughter, and after reading it I was almost speechless:

Azithromycin 500mg /2.5 ml
1 Tsp. QD x 1 day, then 1/2 Tsp. QD for 5 days
Disp. #12.5ml


#1 - Blatant overdose -- seriously, 10x what it should be?
#2 - Never realized they manufacturered suspensions in such a strength
#3 - 6-day therapy instead of the traditional 5? Interesting.
#4 - 5 + (5 * 2.5) = 12.5?? Guess I need to brush up on my math skills

Tell the lady it definitely needs to be called on, and she says the Dr. can be reached at the cell # written on the script (thought it weird that she'd have the Dr.'s personal cell # in the first place) and said she'd be back in a while to check on it. Pharmacist calls the cell # and it goes to straight to voicemail with some little kid's voice on it. WTF? Not to mention, it's over 2 weeks old AND was written in California, 2000+ miles away.

30 minutes later she's back with a new (and correct) script from the urgent care down the street. Turns out the dentist who wrote the script was her sister, and was given to her while visiting 2 weeks ago when her daughter became sick.


Am I the only one who sometimes questions dentist's ability to prescribe?

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[WVUPharm2007]

Eh, you could probably give all of it to her at once and she'd be fine. Hell, they give people 2g of the stuff at once with that new fangled "Zmax" thing they came out with. But, yeah, that's definitely more than is likely necessary. Plus, it was prescribing out of scope of practice from the way you described it. That leads me to believe that she was prescribing for something she didn't know how to treat to begin with.

Most dentists aren't ******s. Some are though. Oh well, what are you going to do?

 

[RxWildcat]

I have seen many, many scripts from MDs that are far more questionable than that. I don't think its a matter of the degree behind their name but of the actual practitioner themselves. Are you really going to make a blanket statement about dentist based off of one rx?

 

[b*rizzle]

I have seen many, many scripts from MDs that are far more questionable than that. I don't think its a matter of the degree behind their name but of the actual practitioner themselves. Are you really going to make a blanket statement about dentist based off of one rx?

Might I add that most of these folks are VERY glad when you catch their mistakes, regardless of their title.

To the OP: the point is that you caught the problem and took steps to get it fixed. Give yourself a pat on the back.

 

[loo]

In my state, DDS/DMD's cannot prescribe outside their scope of practice. The dental board encourages pharmacists to report dentists who do.

I've only reported one guy who BLATANTLY prescribed outside his scope of practice...called in viagra for himself multiple times. When asked for a dental diagnosis (in a nice way), he stated that my job was to fill, not question his rx's.

It's your call...just don't be ignorant about it. As stated before, most DDS/DMD's are cool.

 

[BravoKilo]

I realize I probably didn't word the first post the best way possible... didn't mean to put down the field or its professionals, it's just that I've seen quite a few scripts lately written by dentists that left me thinking WTF. That being said, I do come across just as many (if not more) errors by MD/DO's, it just seems much easier to spot and remember the ones written by a DDS/DMD.

In either case, you always have to wonder what said Dr. was thinking -- were they unsure of the correct therapy but wrote the script anyway when pressed by a patient (in this case, her sister)... or was it something that they thought was indeed the correct therapy and were unfortunately off base?

 

[VCU07]

Today I had my second 'incident' with a script written by a dentist that left me wondering WTF??

Lady brings a script for azithromycin suspension for her 2-year-old daughter, and after reading it I was almost speechless:

Azithromycin 500mg /2.5 ml
1 Tsp. QD x 1 day, then 1/2 Tsp. QD for 5 days
Disp. #12.5ml
#1 - Blatant overdose -- seriously, 10x what it should be?
#2 - Never realized they manufacturered suspensions in such a strength
#3 - 6-day therapy instead of the traditional 5? Interesting.
#4 - 5 + (5 * 2.5) = 12.5?? Guess I need to brush up on my math skills

Tell the lady it definitely needs to be called on, and she says the Dr. can be reached at the cell # written on the script (thought it weird that she'd have the Dr.'s personal cell # in the first place) and said she'd be back in a while to check on it. Pharmacist calls the cell # and it goes to straight to voicemail with some little kid's voice on it. WTF? Not to mention, it's over 2 weeks old AND was written in California, 2000+ miles away.

30 minutes later she's back with a new (and correct) script from the urgent care down the street. Turns out the dentist who wrote the script was her sister, and was given to her while visiting 2 weeks ago when her daughter became sick.


Am I the only one who sometimes questions dentist's ability to prescribe?

You need to report that to the board.

 

[StallionRx]

I had an optometrist writing benzos and a few other questionable meds for his secretary. A few were grey zone, but eventually I became fed up and began to question. I told her I wont fill them politely. A few hours later the opto marched into my pharmacy in the smallest sweater he could find all puffed up and began to make a scene. He embarassed himself and his entire practice. If he had come in civil I would have been more than willing to work with him and squash any problems between us right then and there.

My partner called the state and reported him.

Now, the state visits his practice constantly.

Dont feel intimidated, if you dont like it...dont fill it.

Guess who gets fined if theirs ever an investigation...

 

[MountainPharmD]

I had a podiatrist write for Levaquin 500 1 Bid for 10 days. I called and he said the patient had a really bad infection but was allergic to penicillin so he needed to use something else....

Dentists don't bother me to much except for the guy calling in Lunesta prescriptions for his wife. Why they have to prescribe flurbiprofen and write for amoxicillin 2 stat I will never know....

 

[FruitFly]

You need to report that to the board.

I would definitely call the doctor/dentist up and educate him on Azithromycin prescribing for minors. If you get any crap over the phone, or don't believe that the practitioner understands the mistake, you should report it to your board of dentistry. Reporting of medical errors is important because sometimes there are patterns which need to be aggregated for the sake of public safety.

Luckily that Rx was so preposterous, any average (or below avg) Rph would catch that.

If I were a board member, I'd probably vote for some sort of a probationary status with regards to prescribing to children/minors, if this were part of a pattern. And would recommend medical/Pharmacy error CEs.

Just don't make a blanket statement about all dentists, folks. Lots of good ones on top of their game...

 

[loo]

I would definitely call the doctor/dentist up and educate him on Azithromycin prescribing for minors. If you get any crap over the phone, or don't believe that the practitioner understands the mistake, you should report it to your board of dentistry. Reporting of medical errors is important because sometimes there are patterns which need to be aggregated for the sake of public safety.

Luckily that Rx was so preposterous, any average (or below avg) Rph would catch that.

If I were a board member, I'd probably vote for some sort of a probationary status with regards to prescribing to children/minors, if this were part of a pattern. And would recommend medical/Pharmacy error CEs.

Just don't make a blanket statement about all dentists, folks. Lots of good ones on top of their game...

If I were a board member, I'd recommend a reprimand. Unless that azithromycin rx was for a dentistry-related condition, the dentist is prescribing outside his scope of practice, period. I don't care if he was being a nice guy and helping someone out...you want to prescribe for non-dental reasons, go to medical school.

 

[FruitFly]

If I were a board member, I'd recommend a reprimand. Unless that azithromycin rx was for a dentistry-related condition, the dentist is prescribing outside his scope of practice, period. I don't care if he was being a nice guy and helping someone out...you want to prescribe for non-dental reasons, go to medical school.

There's a grey area with respect to dentistry related conditioned and antibiotics... They're allowed to prophylax before procedures, and prescribe abx after procedures (abscess issues, infection, etc). It's their job to keep the patient records and back it up. I don't see what's making us question that it's his scope of practice, except the primary factor -that the Rx is not dosed well. I was focusing more on the Rx itself, and giving the practitioner the benefit of the doubt wrt his practice. It's not an abused medication in the conventional sense, so I doubt it was written for any nefarious reasons. Still, it would be a fair question before a dental board (I just don't think we can make the assumption this med wasn't indicated from the information given)...

But one has to keep in mind that Dentistry is not always just the teeth. There's a lot (of human pathophysiology) connected to dental issues. That's why dentists, in most states/ and surely the Federal system, can prescribe systemic meds.

 

[loo]

Turns out the dentist who wrote the script was her sister, and was given to her while visiting 2 weeks ago when her daughter became sick.

Daughter's sick...with a toothache? Please. Need any more evidence? I would have asked the DDS on the phone what they were prescribing for.

I don't see this "grey area" of which you speak.

 

[loo]

But one has to keep in mind that Dentistry is not always just the teeth. There's a lot (of human pathophysiology) connected to dental issues. That's why dentists, in most states/ and surely the Federal system, can prescribe systemic meds.

State laws differ. I'm just saying that RPh's need to vigilant...for their patients and themselves.

 

[FruitFly]

State laws differ. I'm just saying that RPh's need to vigilant...for their patients and themselves.

Of course. But you also have to pick your battles... This one would only raise a flag with me because the Rx was written incorrectly. That opens it up to further question, because it seems as though this dentists does not usually write for that medication. There are other dentists who do, and could write an accurate children's dose Azithromycin in their sleep...

 

[loo]

There's no battle here. DDS is calling in antibiotic for a medical condition, not dental.

RPh should question dose and what medication is for. If not for a DENTAL condition, then RPh should offer to contact the child's physician. I have done this many times and most dentists are cool about it. A lot of dentists get pressured by family members/friends to call in stuff for them because they can't be bothered to see their physician.

Having the attitude, "well, at least you caught the incorrect dose" is only enabling prescribers to practice outside their scope, IMHO. A physician should be writing antibiotics for a kid with a medical condition, NOT a dentist trying to help out a family member/friend.

Gentle education goes a long way and prevents future problems.

 

[MountainPharmD]

Here is who makes me nervous......

1. Physician assistant
2. Podiatrist
3. Dentist
4. Nurse Practitioner
5. Any one who has a DEA number starting with F
6. Anyone who works in a Doc in a box

 

[FruitFly]

I'm most weary of secretaries 'prescribing'...

 

[MountainPharmD]

I'm most weary of secretaries 'prescribing'...

I swear if doctors actually paid attention to what goes on in their office they would be shocked.

 

[loo]

Here is who makes me nervous......

6. Anyone who works in a Doc in a box

Ring, Ring to DITB (Doc-In-The-Box)

Me: Hi! Need to speak to NP Dingbat re a TCN prescription for a pt. of hers?

NP Dingbat: What's the problem?

Me: You have prescribed TCN 500mg QID to this pt. Were you aware pt. was breastfeeding?

NP Dingbat: Yes, I am. She's being treated for a breast infection.

Me: I'm just calling because TCN can get into the breast milk, causing permanent tooth discoloration, bone issues etc. May I suggest a substitute....

NP Dingbat: (Irritated) First of all, I'M treating the patient. I looked it up in the PDR...it's PERFECTLY fine to give TCN to a breastfeeding patient...

Me: Thanks, just checking.

I speak to pt. and let her know the facts. She decides to call her OB/GYN because NP Dingbat wrote for cephalexin first---which she is allergic to. Then NP Dingbat writes for the TCN.

WTF?

 

[VCU07]

Here is who makes me nervous......

1. Physician assistant
2. Podiatrist
3. Dentist
4. Nurse Practitioner
5. Any one who has a DEA number starting with F
6. Anyone who works in a Doc in a box

No offense to PAs or NPs, but they def. make me nervous. When I worked for chain x, we had a np in the upfront clinic who would make dosing mistake after mistake. I had a PA write for Calcium carbonate 3000mg tid the other day???

 

[Farmercyst]

I swear if doctors actually paid attention to what goes on in their office they would be shocked.

Spoke to a Doc today because the patient wanted to know why the Doc prescribed Dyazide when the pt was already taking Tenoretic. Appears 2 docs in the same office. One originally wrote the script and the office authorized refills with the other's permission. She'd apparently been switching back and forth between the two meds for the two years and it finally caught up to the doc when pt ended up with a script for dyazide and was picking up her refills on Tenoretic.

 

[FNPkathy]

Ring, Ring to DITB (Doc-In-The-Box)

Me: Hi! Need to speak to NP Dingbat re a TCN prescription for a pt. of hers?

NP Dingbat: What's the problem?

Me: You have prescribed TCN 500mg QID to this pt. Were you aware pt. was breastfeeding?

NP Dingbat: Yes, I am. She's being treated for a breast infection.

Me: I'm just calling because TCN can get into the breast milk, causing permanent tooth discoloration, bone issues etc. May I suggest a substitute....

NP Dingbat: (Irritated) First of all, I'M treating the patient. I looked it up in the PDR...it's PERFECTLY fine to give TCN to a breastfeeding patient...

Me: Thanks, just checking.

I speak to pt. and let her know the facts. She decides to call her OB/GYN because NP Dingbat wrote for cephalexin first---which she is allergic to. Then NP Dingbat writes for the TCN.

WTF?

I take offense to this. Do you think that all NP's are dingbats? Let me see if I can remember a few MD mistakes I've caught this week...how about Keflex (monotherapy) prescribed for diverticulitis? How about Cipro prescribed for MRSA? I can provide a whole list of "dingbat" mistakes MD's have made.

 

[MountainPharmD]

I take offense to this. Do you think that all NP's are dingbats? Let me see if I can remember a few MD mistakes I've caught this week...how about Keflex (monotherapy) prescribed for diverticulitis? How about Cipro prescribed for MRSA? I can provide a whole list of "dingbat" mistakes MD's have made.

Did she say even one time in her post that ALL NP are dingbats? Read things a little more carefully. She was refering to ONE dingbat NP. Seems as if you have a complex. Or perhaps you are a dingbat and took offense to someone calling you out.

 

[WVUPharm2007]

I take offense to this. Do you think that all NP's are dingbats? Let me see if I can remember a few MD mistakes I've caught this week...how about Keflex (monotherapy) prescribed for diverticulitis? How about Cipro prescribed for MRSA? I can provide a whole list of "dingbat" mistakes MD's have made.

Well, to be fair, I see more dingbat mistakes by PAs/NPs than MDs/DOs. But it is what it is...years more education has to account for something, you'd figure.

 

[psurocks]

nope, the dentists in my area are cool: they write pain meds clearly, and they know what Abx to use also for their stuff, unlike 85% of PCPs who have no idea of anything when it comes to Abx

 

[meister]

Spoke to a Doc today because the patient wanted to know why the Doc prescribed Dyazide when the pt was already taking Tenoretic. Appears 2 docs in the same office. One originally wrote the script and the office authorized refills with the other's permission. She'd apparently been switching back and forth between the two meds for the two years and it finally caught up to the doc when pt ended up with a script for dyazide and was picking up her refills on Tenoretic.

This kind of stuff would be more likely to be eliminated with fully electronic medical records. Although I wonder how neither doc noticed both drugs in her chart. Surely she only has one chart...? Also, was all of this at your pharmacy? Seems like something the pharmacy should notice as well.

I take offense to this. Do you think that all NP's are dingbats? Let me see if I can remember a few MD mistakes I've caught this week...how about Keflex (monotherapy) prescribed for diverticulitis? How about Cipro prescribed for MRSA? I can provide a whole list of "dingbat" mistakes MD's have made.

Uh oh allnurses.com is leaking!

Eh, you could probably give all of it to her at once and she'd be fine.

With perilous consequences for the little chap's rectum.

 

[Quiksilver]

the absolute worst is stupid medical assistents who think they are the cats meow.

I once had one leave a voicemail message for ambien cr 12.5 i HS. No DEA given, no phone number, not even the name of the secretary. If you know NYS law there are about 2 or 3 things wrong with the situation. So being the good intern that I am, I call them back right away, no answer. So I leave a honestly, polite voicemail that says "I need a DEA number, and that it should really be called by the doctor herself, but a DEA and verification that this is legit would suffice, call me back." Now mind you, I called them 10 minutes after the Rx was called in at 11 in the morning.

They didn't call back until the next day. They told me that I am the one who is wrong here, that they do this all the time and that technically, Ambien is not a controlled substance.

So i faxed them a copy of the law that says it is, and i wrote "technically it is a controlled substance"

 

[meister]

So i faxed them a copy of the law that says it is, and i wrote "technically it is a controlled substance"

There's nothing technical about it!

 

[Praziquantel86]

So i faxed them a copy of the law that says it is, and i wrote "technically it is a controlled substance"

Fiebs would be so damn proud!

 

[MountainPharmD]

the absolute worst is stupid medical assistents who think they are the cats meow.

I once had one leave a voicemail message for ambien cr 12.5 i HS. No DEA given, no phone number, not even the name of the secretary. If you know NYS law there are about 2 or 3 things wrong with the situation. So being the good intern that I am, I call them back right away, no answer. So I leave a honestly, polite voicemail that says "I need a DEA number, and that it should really be called by the doctor herself, but a DEA and verification that this is legit would suffice, call me back." Now mind you, I called them 10 minutes after the Rx was called in at 11 in the morning.

They didn't call back until the next day. They told me that I am the one who is wrong here, that they do this all the time and that technically, Ambien is not a controlled substance.

So i faxed them a copy of the law that says it is, and i wrote "technically it is a controlled substance"

I had the same thing happen with a prescription for Lyrica. It was all I could do to not come through the phone and stangle the idiot MA.

 

[Doctor M]

Fiebs would be so damn proud!

How is the good professor doing? I use to dread his law exams!

 

[Quiksilver]

Fiebs would be so damn proud!

did I make you proud?

 

[meister]

Hey guys they went to night school for six months and took a course in pharmacology! Cut them some slack!