DDI/therapy duplication with a med filled elsewhere

[MARX22]

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Hey guys!
I have two questions-

The manager at my pharmacy sometimes reactivates scripts, i noticed bc the tech does it. I told her not to do it on my shift but it got me thinking, if the other rph does it then il also be refilling things without knowing it was once deactivated and now reactivated. I can tell the manager not to do that but honestly, if he doesn’t listen, I can’t be expected to know what was dc’d then reactivated for me to avoid refilling...i think at chains once u close out an rx it can’t be reactivated? Or if the rph annotated on it as to why it’s discontinued, the other rph can’t delete their note so it should still show their note. My system lets any rph delete any note -_-

Also, when i process things, it will say paid then afterwards show an interaction with another medication they take that was filled at another pharmacy... or shows duplicate therapy. Are we responsible for not dispensing at our pharmacy merely because of what they got somewhere else? I mean, if the tech types I wont even see that message cuz when i verify it just does a DUR analysis for whatever is in our system, not whatever the insurance picks up. I would think its excessive to expect us not to dispense/consult md over the medication interacting or being duplicate therapy of whatever they got elsewhere... especially if I don’t see the message unless i’m the one typing! The insurance will easily reject if its refill too soon due to them getting it filled with us or elsewhere a few days ago, so if this polypharmacy issue is going to be our responsibility, insurance should completely reject an rx for ddi/duplication this way it will get the rph’s attention. I think I have seen it reject over an interaction/dup of something filled elsewhere before, but a lot of the time it will still pay for it then display a message. What do u think?

Thanks

 

[RxPreceptor]

I think you need to use/work on your professional judgment...
Do not take this the wrong way, but this is a good example showing how pharmacy schools are churning out RPhs left and right without proper training for real world scenarios (not going to cut it in a community/retail setting with so much indecisiveness & overanalyzing everything). Put in a forced counsel note if you can

 

[MARX22]

Well I never really cared for those transmission messages but started overthinking it. U cant even see them when verifying (my software only shows whatever has been dispensed at our pharmacy, pretty sure that’s how every pharmacy verification is like), so as rph I don’t think you’d be responsible. Insurance should reject it if they want the rph’s attention.

My software doesn’t even allow forced counsels like the chains do, so i could write it on the bag for rph to discuss at pick up and put a note in the profile, although any rph can delete the profile note, which is stupid. Anyhow, the concern was more due to the fact that its the transmission msg and i cant really see it unless i’m the one typing.

That’s my opinion but I posted on here to see what others thought, RxVampire.

I think you need to use/work on your professional judgment...
Do not take this the wrong way, but this is a good example showing how pharmacy schools are churning out RPhs left and right without proper training for real world scenarios (not going to cut it in a community/retail setting with so much indecisiveness & overanalyzing everything). Put in a forced counsel note if you can

 

[FinallyOnTrack]

Well I never really cared for those transmission messages but started overthinking it. U cant even see them when verifying (my software only shows whatever has been dispensed at our pharmacy, pretty sure that’s how every pharmacy verification is like), so as rph I don’t think you’d be responsible. Insurance should reject it if they want the rph’s attention.

My software doesn’t even allow forced counsels like the chains do, so i could write it on the bag for rph to discuss at pick up and put a note in the profile, although any rph can delete the profile note, which is stupid. Anyhow, the concern was more due to the fact that its the transmission msg and i cant really see it unless i’m the one typing.

That’s my opinion but I posted on here to see what others thought, RxVampire.

You realize that some insurances do reject this and they have simple DUR overrides that the techs can and will use without you ever seeing or noticing these rejects - I have seen it first hand..

Since you have referenced “the chains” a few times - I’m just going to assume you’re working at an independent - at which point I would say just roll with whatever the owner wants you to do - trust me - no matter how bad it may seem - it could always be much worse...


If you’re that worried about therapy duplication - subscribe to a service called Doctor’s First.. it allows you to see what patients are filling and where at (for controls and non controls).. we use it in the hospital for verifying Home Meds for patients..

Sent from my iPhone using Tapatalk

 

[MARX22]

Yeah the other software i used to work with showed me if a dur code was put in, but this one doesn’t. My concern was mainly for rxs that don’t even reject. Thanks for your comment 🙂

You realize that some insurances do reject this and they have simple DUR overrides that the techs can and will use without you ever seeing or noticing these rejects - I have seen it first hand..

Since you have referenced “the chains” a few times - I’m just going to assume you’re working at an independent - at which point I would say just roll with whatever the owner wants you to do - trust me - no matter how bad it may seem - it could always be much worse...


If you’re that worried about therapy duplication - subscribe to a service called Doctor’s First.. it allows you to see what patients are filling and where at (for controls and non controls).. we use it in the hospital for verifying Home Meds for patients..

Sent from my iPhone using Tapatalk

 

[BidingMyTime]

Rx's can be deactivated for any number of reasons, probably most common user error (ie pharmacist/tech clicks wrong and deactivate a different prescription then they intended) and/or patient error in telling the pharmacist/tech they no longer take the drug, then they realize they actually do. So I wouldn't be concerned about reactivating these, just check with the patient (and if you can't trust your techs to alert you to bag notes when selling, well that is a bigger problem then your manager reactivating prescriptions.)

 

[MARX22]

Good point. In my state counseling on new rxs is mandatory. I can put notes on bags so whichever rph is working will know what to tell the patient about, however if the other rph doesnt do that, all i can do is counsel on the med itself without having any knowledge of what interactions are there. Our system doesnt have a force counsel option like the chains do, but even with that, if an rph doesnt put a force counsel how would the rph on duty be expected to know what to tell the patient lol. Just getting scared of all these lawsuits im hearing about

Rx's can be deactivated for any number of reasons, probably most common user error (ie pharmacist/tech clicks wrong and deactivate a different prescription then they intended) and/or patient error in telling the pharmacist/tech they no longer take the drug, then they realize they actually do. So I wouldn't be concerned about reactivating these, just check with the patient (and if you can't trust your techs to alert you to bag notes when selling, well that is a bigger problem then your manager reactivating prescriptions.)

 

[CetiAlphaFive]

.
That’s my opinion but I posted on here to see what others thought, RxVampire.

If you were at my independent and asked me these questions I'd take you off the schedule.

It honestly sounds like you need more time as a grad intern.

 

[MARX22]

Hey, it’s a genuine question lol. If I can’t access the transmission msg unless I’m the one typing, there isn’t much I can do

If you were at my independent and asked me these questions I'd take you off the schedule.

It honestly sounds like you need more time as a grad intern.

 

[CetiAlphaFive]

Hey, it’s a genuine question lol. If I can’t access the transmission msg unless I’m the one typing, there isn’t much I can do

I'm not aware of any state where

"Don't bypass those transmission messages without telling me" isn't included in "the pharmacist must supervise technicians"

 

[MARX22]

Sometimes they don’t listen

I'm not aware of any state where

"Don't bypass those transmission messages without telling me" isn't included in "the pharmacist must supervise technicians"

 

[Rouelle]

Sometimes they don’t listen

BOP rarely accepts this argument. Sometimes you have to be more persuasive.

 

[BidingMyTime]

Seriously, if your techs are actually that bad, then you need to get another job (or fire the techs, but you don't have the authority to do that.) Because legally, you are responsible for anything your techs do, and the board or a malpractice court won't care about the realities of the job.