1. The SDN iPhone App is back and free through November! Get it today and please post a review on the App Store!
    Dismiss Notice
  2. Dismiss Notice

dispensing tube size in stock

Discussion in 'Pharmacy' started by SCCpharm, Aug 4, 2011.

  1. SCCpharm

    10+ Year Member

    Joined:
    Apr 15, 2006
    Messages:
    243
    Likes Received:
    15
    Status:
    Pharmacy Student
    Doc writes for Lidex #15 grams. You look on your shelf and you see only 30gram and 60 gram tubes. No 15 gram tubes. Do you call the doctor to change to #30 grams or are you okay with dispensing the 30gram tube?
     
  2. Note: SDN Members do not see this ad.

  3. kern07

    7+ Year Member

    Joined:
    May 2, 2008
    Messages:
    113
    Likes Received:
    4
    Status:
    Pharmacy Student
    I was taught to always verify with the provider or his/her assistant and document, document, document with name/date/time.

    Although calling the provider on that may seem trivial, but it's always good to communicate any changes you make. :)
     
  4. Farmercyst

    Farmercyst From the shadows
    Pharmacist Moderator Emeritus 10+ Year Member

    Joined:
    Sep 21, 2006
    Messages:
    7,860
    Likes Received:
    6
    Status:
    Pharmacist
    If caught on audit without documentation, it's a guaranteed charge-back. You might as well order it for the patient, or call the MD just to dot the i's and cross the t's.
     
  5. Sparda29

    Sparda29 En Taro Adun
    Pharmacist Classifieds Approved 10+ Year Member

    Joined:
    Mar 25, 2008
    Messages:
    8,879
    Likes Received:
    828
    Status:
    Pharmacist
    Call MD, leave message saying its OOS and you're gonna give 30g.

    Dispense 30g and write on back of Rx, MD okayed 30g. Case closed.
     
  6. Praziquantel86

    Pharmacist Moderator Emeritus 7+ Year Member

    Joined:
    Oct 28, 2008
    Messages:
    2,572
    Likes Received:
    40
    Status:
    Fellow [Any Field]
    Yeah, I would just call and tell the office staff. Not a big deal, but covers you for audits.
     
  7. owlegrad

    owlegrad Uncontrollable Sarcasm Machine
    Staff Member Administrator Pharmacist 7+ Year Member

    Joined:
    Mar 19, 2009
    Messages:
    20,910
    Likes Received:
    5,257
    Status:
    Pharmacist
    If the doc specified the size, we call. Thankfully we mostly get "Disp: 1 tube" or something similar. :thumbup:
     
  8. farmadiazepine

    7+ Year Member

    Joined:
    Jul 10, 2011
    Messages:
    1,038
    Likes Received:
    537
    Status:
    Pharmacist
    I give whatever I have.
     
    #7 farmadiazepine, Aug 4, 2011
    Last edited: Aug 5, 2011
  9. spacecowgirl

    10+ Year Member

    Joined:
    Feb 27, 2004
    Messages:
    2,373
    Likes Received:
    297
    Status:
    Pharmacist
    I keep thinking this title says "dispensing tube sock".
     
  10. Quiksilver

    Quiksilver Secundum Artem PharmD
    7+ Year Member

    Joined:
    Jan 25, 2007
    Messages:
    1,040
    Likes Received:
    3
    Status:
    Pharmacist
    Mee too, secretly I hoped it did because it would have been more entertaining
     
  11. museabuse

    museabuse Senior Member
    7+ Year Member

    Joined:
    Apr 27, 2005
    Messages:
    604
    Likes Received:
    6
    Status:
    Pharmacy Student
    I always wondered about this... Can you squeeze out 30 grams into a jar from a 60 gram tube and dispense that?
     
  12. MindOverMatter

    10+ Year Member

    Joined:
    Jun 12, 2007
    Messages:
    342
    Likes Received:
    22
    Status:
    Pharmacist
    If it's an expensive med, I call. If not, I'll usually give the smallest size available.
     
  13. Quiksilver

    Quiksilver Secundum Artem PharmD
    7+ Year Member

    Joined:
    Jan 25, 2007
    Messages:
    1,040
    Likes Received:
    3
    Status:
    Pharmacist
    Even though this would be compounding, I am under the impression you cannot compound a product that is available commercially.
     
  14. All4MyDaughter

    All4MyDaughter SDN Mommystrator
    Pharmacist Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    May 7, 2005
    Messages:
    22,792
    Likes Received:
    334
    Status:
    Pharmacist
    I don't think it's compounding. If anything, it's repackaging.
     
  15. Quiksilver

    Quiksilver Secundum Artem PharmD
    7+ Year Member

    Joined:
    Jan 25, 2007
    Messages:
    1,040
    Likes Received:
    3
    Status:
    Pharmacist
    I've sat for the last 10 minutes thinking bout this and I've changed my response and stance a couple times.

    You might be right. I mean after all we pour liquids and repackage them for dispensing if a full bottle isn't being dispensed.

    But practically, you'd have to weigh these things to the appropriate weight, and those $#$%@ stupid torsion balances suck so badly. Honestly, when is pharmacy going to join the 21st century?
     
  16. Farmercyst

    Farmercyst From the shadows
    Pharmacist Moderator Emeritus 10+ Year Member

    Joined:
    Sep 21, 2006
    Messages:
    7,860
    Likes Received:
    6
    Status:
    Pharmacist
    I'm not sure how the insurance company would see it. Technically it is repackaging, but which NDC do you bill? The 60gm you took it out of or the 30gm you're dispensing. I would think legally, the 60gm, but that would mess up the software, at least most of the ones I've dealt with would reject saying you can't split the tube.

    (Yes, I tend to overthink things)
     
  17. g40631

    2+ Year Member

    Joined:
    Feb 24, 2011
    Messages:
    54
    Likes Received:
    0
    This is one of those "gray areas" where technically, yes, you should be contacting the doctor. Legally speaking, there isn't any justification in changing a prescription without notifying/getting approval from the doctor. For instance, combining refills so a patient requests a larger supply, or using higher/lower strength tablets and changing the directions on a script because you're out of stock of the strength the doctor wrote for. In real life practice, we just make the changes ourselves because we're 99.9 % sure the prescriber will approve (and maybe roll their eyes). It's that 0.1 % where you MAY get into trouble (and even that may be a stretch).

    As for dispensing a larger quantity of a cream/ointment then the doctor wrote because you're out....that seems dangerous kind of. I would definitely call. The prescriber may have wanted the patient to be limited to the length of therapy of the steroid/antibiotic cream to a certain amount of time, and estimated the size of the tube based on that. Dispensing a greater quantity then prescribed (if the prescribed quantity exists) seems to be risky. Just my opinion.
     
  18. kvl1027

    kvl1027 Member
    10+ Year Member

    Joined:
    Jul 11, 2006
    Messages:
    620
    Likes Received:
    61
    Status:
    Pharmacist
    We will dispense the size in stock to the patient, fax the Doc saying we gave a larger tube size and then document on the back of the script. We that being said you usually don't get audited for inexpensive items. But, so long as you document it on the script then your ass is covered.
     
  19. kvl1027

    kvl1027 Member
    10+ Year Member

    Joined:
    Jul 11, 2006
    Messages:
    620
    Likes Received:
    61
    Status:
    Pharmacist
    Torsion Balance!! We have two of them and they sit on the shelves for decoration. We have an Ohaus Electronic Balance, you guys need to get with the times.
     
  20. Quiksilver

    Quiksilver Secundum Artem PharmD
    7+ Year Member

    Joined:
    Jan 25, 2007
    Messages:
    1,040
    Likes Received:
    3
    Status:
    Pharmacist
    You always have to tell the patient the duration of the therapy. You certainly can't give em a tube of some cream and say, take it until its finished. That far more dangerous and bad medical practice then dispensing a larger tube. That doesn't work because some people apply gobs of it while others place a thin layer, duration should be more of a priority.
     
  21. g40631

    2+ Year Member

    Joined:
    Feb 24, 2011
    Messages:
    54
    Likes Received:
    0
    I agree, but how many Rx's do you get for topicals that list the duration of therapy in the sig? Not many.....If the doc doesn't tell them, the patient may be inclined to use the whole product.
     
  22. owlegrad

    owlegrad Uncontrollable Sarcasm Machine
    Staff Member Administrator Pharmacist 7+ Year Member

    Joined:
    Mar 19, 2009
    Messages:
    20,910
    Likes Received:
    5,257
    Status:
    Pharmacist

    I wa thinking the same thing. Pretty rare for that to be specified. If it's not in the sig, I assume the patient should use it until it is gone or that the doctor told the patient how long to use it. If the doc had a specific length of time in mind he should have shared it with me. ;)
     
  23. Sparda29

    Sparda29 En Taro Adun
    Pharmacist Classifieds Approved 10+ Year Member

    Joined:
    Mar 25, 2008
    Messages:
    8,879
    Likes Received:
    828
    Status:
    Pharmacist
    Honestly, I've never seen my dermatologist write duration on any of the acne prescriptions he's prescribed for me. He told me how long he wants me to use it for, or to just continue using it until the next appointment when he'd decide whether to continue or not.
     
  24. owlegrad

    owlegrad Uncontrollable Sarcasm Machine
    Staff Member Administrator Pharmacist 7+ Year Member

    Joined:
    Mar 19, 2009
    Messages:
    20,910
    Likes Received:
    5,257
    Status:
    Pharmacist
    So how long do you tell them to use it for if the doctor didn't say?
     
  25. R2pharmD2

    Moderator Emeritus

    Joined:
    Dec 20, 2010
    Messages:
    1,285
    Likes Received:
    3
    Status:
    Pharmacy Student
    When in doubt, "as directed"? :shrug:
     
  26. owlegrad

    owlegrad Uncontrollable Sarcasm Machine
    Staff Member Administrator Pharmacist 7+ Year Member

    Joined:
    Mar 19, 2009
    Messages:
    20,910
    Likes Received:
    5,257
    Status:
    Pharmacist
    The comment was "you always have to tell them", which I don't see how you can do in practice. :shrug:
     
  27. PharmDstudent

    7+ Year Member

    Joined:
    Jan 8, 2007
    Messages:
    4,342
    Likes Received:
    69
    Status:
    Pre-Health (Field Undecided)
    I see the duration on topical steriods. But that's about it.
     
  28. SomeGuy

    SomeGuy Senior Member
    7+ Year Member

    Joined:
    May 11, 2005
    Messages:
    339
    Likes Received:
    0
    For those topical RXs that say M: x days, I love pulling out a bunch of containers and asking the patient what size they'd like (within reason) of course.
     
  29. bp2313

    bp2313 Yummy
    7+ Year Member

    Joined:
    Jan 21, 2011
    Messages:
    218
    Likes Received:
    18
    This reminds that at Wal-mart, triamcinolone cr is $4/tube regardless of the size (15 or 80). Many patients requested us to call their Dr to change from 60 to 80, what a pain!
     
  30. Farmercyst

    Farmercyst From the shadows
    Pharmacist Moderator Emeritus 10+ Year Member

    Joined:
    Sep 21, 2006
    Messages:
    7,860
    Likes Received:
    6
    Status:
    Pharmacist
    This reminds me. Do you see Triamcinolone abbreviated Tac? We get scripts for it frequently. Tac 0.1%. I'm thinking it could be a little iffy given that Protopic is Tac(rolimus)0.1%
     
  31. Quiksilver

    Quiksilver Secundum Artem PharmD
    7+ Year Member

    Joined:
    Jan 25, 2007
    Messages:
    1,040
    Likes Received:
    3
    Status:
    Pharmacist
    On some things you can assume its going to be indefinitely such as products for acne and psoriasis, obviously chronic conditions are just, well, chronic. The doctor is probably making sure products and refills last until the next time they are seen. Psoriasis is not curable and outside of very mild acne, people are usually on a topical retinoids which take forever to work effectively. So perhaps duration is not the issue in these cases. Its acute problems that this is far more important.

    Using "ut dict" is not all that appropriate either if the patient doesn't know duration. Any time this is in question, the best practice would be to call and ask. If the doctor writes good progress notes, you should be able to get a duration of therapy even from a MA or RN. Now how many people do that, well thats a better question
     
  32. kvl1027

    kvl1027 Member
    10+ Year Member

    Joined:
    Jul 11, 2006
    Messages:
    620
    Likes Received:
    61
    Status:
    Pharmacist
    Unfortunately, this is a good way to prompt an insurance claims audit and if you have as directed as the sig, those bastards will take their money back and you will be SOL.
     

Share This Page