Does annotating actually CYA?

[Curiousone1111]

Hey,

lots of pharmacists I see just fill whatever and claim that as long as you document that you spoke to the doctor and tried to intervene, you’re good to go—even if there were a lawsuit, the blame’s on the doc. Does anyone who has been in the field for long know whether this is true?

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[M0df]

You can document whatever you want. Lawsuits are a tricky business. Plus if you work for big retail chain, you may not even get the details of your own case. I hope some lawyer can elaborate here because I really hope pharmacists don't have enough experience on these to discuss multiple lawsuits.

 

[Curiousone1111]

You can document whatever you want. Lawsuits are a tricky business. Plus if you work for big retail chain, you may not even get the details of your own case. I hope some lawyer can elaborate here because I really hope pharmacists don't have enough experience on these to discuss multiple lawsuits.

I always see things about chains getting sued in the MILLIONS for errors and what not. Always wondered, how did individual rphs not get involved? My school always scared us so I was always worried every time I filled a script. I wish we had some more insight from a lawyer as well

 

[M0df]

That is why your (secondary) liability coverage is under $200. They take the hit and all the information that goes with the lawsuit. If you are independent and pay for your own coverage, you can get that info first hand.

 

[johnpharm01]

I always see things about chains getting sued in the MILLIONS for errors and what not. Always wondered, how did individual rphs not get involved? My school always scared us so I was always worried every time I filled a script. I wish we had some more insight from a lawyer as well

I don't know about lawsuits but board complaints it may help. Don't be afraid, be intelligent. Know what your responsibilities are and how best to fulfill them at your employer. Minimize error. Put the customer's health and the law first.

 

[mentos]

Yes, when you fill something that causes patient harm and annotate that it's fine, you say "CYA" to your job.

 

[Curiousone1111]

Yes, when you fill something that causes patient harm and annotate that it's fine, you say "CYA" to your job.

LMAO, “see ya.” Well, the issue is not every interaction occurs in every patient. I err on the side of caution and notify the MD and pt, but if both wish to proceed what else am I supposed to do, especially when my coworkers are dispensing practically everything even contraindicated combos. Those I never do.

 

[Rockinacoustic]

Can you give some examples of "contraindicated combos"

 

[Sine Cura]

Hey,

lots of pharmacists I see just fill whatever and claim that as long as you document that you spoke to the doctor and tried to intervene, you’re good to go—even if there were a lawsuit, the blame’s on the doc. Does anyone who has been in the field for long know whether this is true?

"Doctor or dentist OKed it" => not really but the pt is gonna go after the doctor first.

I got out of a problem when someone at UCD claimed a guy went into anaphylaxis because a dentist prescribed amoxicillin to a pt but we actually documented the agent of the pt denied allergies specifically in the consult notes (someone else picked up for the pt)

 

[Dred Pirate]

Can you give some examples of "contraindicated combos"

PDE5 + nitrates

 

[ValeRx]

PDE5 + nitrates

Something like that is easily remedied with a counseling note. I wouldn't call on a nitrate unless they were on isosorbide.

 

[Rockinacoustic]

PDE5 + nitrates

Sure, if OP's co-workers are dispensing this and not documenting any intervention then shame on them. I'm just genuinely curious what contraindicated combos their co-workers are dispensing that gives them pause.

 

[Curiousone1111]

Something like that is easily remedied with a counseling note. I wouldn't call on a nitrate unless they were on isosorbide.

What counseling note? I thought they were absolutely contraindicated since it takes a certain amount of time for the pde5 to leave the body... and if you’re a heart patient you might need nitrostat at any point (while the pde5 is still in your system) so you shouldn’t be on both.

 

[Curiousone1111]

Sure, if OP's co-workers are dispensing this and not documenting any intervention then shame on them. I'm just genuinely curious what contraindicated combos their co-workers are dispensing that gives them pause.

Regardless of whether or not the individual rph finds a contraindication to be significant or not based on past experience of pts being on it for years and surviving... why would any rph want to expose themselves to extra liability by dispensing drugs that are clearly stated not to be taken together?

 

[Curiousone1111]

"Doctor or dentist OKed it" => not really but the pt is gonna go after the doctor first.

I got out of a problem when someone at UCD claimed a guy went into anaphylaxis because a dentist prescribed amoxicillin to a pt but we actually documented the agent of the pt denied allergies specifically in the consult notes (someone else picked up for the pt)

Shouldn’t the doc or dentist be aware of pt allergies, or be liable, as they’re the clinician who actually takes a thorough history?

 

[confettiflyer]

Can you give some examples of "contraindicated combos"

Entresto to/from ACEI < 36 hrs

 

[JustFillIt]

The truth is that documenting some sort of acknowledgement and intervention will CYA much better than doing nothing. If you council the patient and inform them of the incident (putting the ball in their court) will go an awful long way in CYA also. Just don’t be completely incompetent and you should be okay.

 

[Curiousone1111]

The truth is that documenting some sort of acknowledgement and intervention will CYA much better than doing nothing. If you council the patient and inform them of the incident (putting the ball in their court) will go an awful long way in CYA also. Just don’t be completely incompetent and you should be okay.

I was thinking that too... inform the pt of the DDI, that the md wants to move forward. inform them of the risk and annotate that they’re aware. At that point I don’t think there’s much else you can do, there’s no way you can still be held liable. Otherwise there’s no point in dispensing anything since everything has a risk lol

 

[Sine Cura]

Shouldn’t the doc or dentist be aware of pt allergies, or be liable, as they’re the clinician who actually takes a thorough history?

Making outlandish assumptions about prescribers

 

[grumpyRph]

I was thinking that too... inform the pt of the DDI, that the md wants to move forward. inform them of the risk and annotate that they’re aware. At that point I don’t think there’s much else you can do, there’s no way you can still be held liable. Otherwise there’s no point in dispensing anything since everything has a risk lol

i think i bombed a residency interview question because i answered like this. i think i had a "not much else you can do" answer and i think they were digging for me to stand my ground more. this was prob more for a hospital setting though too.

i suppose if you feel super strongly about a CI but the doc insists you might just have to tell them to find a pharmacy or pharmacist willing to dispense. just don't end up on social media or a phone recording haha, depending on the situation.

 

[Curiousone1111]

Making outlandish assumptions about prescribers

Well, when you visit the doctor you have to list out any allergies and current meds you’re on. Doctors/offices spend more time with patients than pharmacists do.

 

[Curiousone1111]

i think i bombed a residency interview question because i answered like this. i think i had a "not much else you can do" answer and i think they were digging for me to stand my ground more. this was prob more for a hospital setting though too.

i suppose if you feel super strongly about a CI but the doc insists you might just have to tell them to find a pharmacy or pharmacist willing to dispense. just don't end up on social media or a phone recording haha, depending on the situation.

Yeah you should stand your ground but it seems many pharmacists even on this board are saying “what’s an important contraindication?” I mean, why were we ever taught about contraindications if in practice we can just dispense anything and everything? That’s what I’m struggling to come to terms with. Me saying there’s not much else to do was about any other category besides contraindication, like a category D interaction. Get the md ok, inform the pt during counseling, annotate that they’re aware, and move on. I don’t see how else to practice

 

[JustFillIt]

Yeah you should stand your ground but it seems many pharmacists even on this board are saying “what’s an important contraindication?” I mean, why were we ever taught about contraindications if in practice we can just dispense anything and everything? That’s what I’m struggling to come to terms with. Me saying there’s not much else to do was about any other category besides contraindication, like a category D interaction. Get the md ok, inform the pt during counseling, annotate that they’re aware, and move on. I don’t see how else to practice

This is essentially why the medical community has largely decided that we are irrelevant. Unless of coarse harm does happen in which case it would be viewed by the physicians lawyer as a highly clinically relevant event where
The pharmacist failed to take action and save the patient.

 

[johnpharm01]

Yeah you should stand your ground but it seems many pharmacists even on this board are saying “what’s an important contraindication?” I mean, why were we ever taught about contraindications if in practice we can just dispense anything and everything? That’s what I’m struggling to come to terms with. Me saying there’s not much else to do was about any other category besides contraindication, like a category D interaction. Get the md ok, inform the pt during counseling, annotate that they’re aware, and move on. I don’t see how else to practice

Your a pharmacist? Our first duty is to do no harm. If filling a prescription and a drug interaction or drug age contraindication or drug disease contraindication. It is your job to resolve the issue before dispensing it. The first step is to gather information. The next is to assess risk and benefit. The third is to make a plan on how to manage the risk. If the risk is life threatening and unmitagated, then you don't fill. This happens rarely. Just because a combination of drugs i.e. atorvastatin and fluconazole interact, does not mean they can't be dispensed. The risk has to be identified, evalualated, and managed i.e. hold atorvastatin while on fluconazole. I have run into these issues routinely.

Fyi if all you are interested in is your liability, then you will get bit in the ass. You should care too and people can tell. If you want no.liability quit now.

And by the way, who cares what everyone else is doing? That's why licenses are issued individually. You lose yours and another job opening comes up for me.

 

[PharFromNormal]

Your a pharmacist? Our first duty is to do no harm. If filling a prescription and a drug interaction or drug age contraindication or drug disease contraindication. It is your job to resolve the issue before dispensing it. The first step is to gather information. The next is to assess risk and benefit. The third is to make a plan on how to manage the risk. If the risk is life threatening and unmitagated, then you don't fill. This happens rarely. Just because a combination of drugs i.e. atorvastatin and fluconazole interact, does not mean they can't be dispensed. The risk has to be identified, evalualated, and managed i.e. hold atorvastatin while on fluconazole. I have run into these issues routinely.

Fyi if all you are interested in is your liability, then you will get bit in the ass. You should care too and people can tell. If you want no.liability quit now.

And by the way, who cares what everyone else is doing? That's why licenses are issued individually. You lose yours and another job opening comes up for me.

I think they were asking because they are curious of the specific drug pair in the scenario. Good Pharmacists should know that “level 1 - contraindicated” drug interaction has no universal definition. There is no master list. There are differences in opinion even amongst the big drug references.

New Pharmacists forget that they are actually pharmacists that may have to do more or do less than what a computer tells them. You’re supposed to have a brain.

So again what was the specific drug pair?

 

[owlegrad]

Yeah I once worked with a pharmacist who would not dispense flomax and finasteride together because it is a therapeutic duplication. No joke.

How about linezolid with SSRIs? Personally I don’t usually object unless there are 3+ agents but I know some pharmacists who are significantly more conservative than that.

But I think most interactions are overrated. I mean how many DURs do you blow through in a day? Most of them are fake news.

 

[Sine Cura]

Medi-Cal always kicks back an additive toxicity DUR reject for lithium + 2 other serotonergic agents.

ESI typically generates multiple DUR rejects for **** like furosemide + lisinopril + amlodipine or whatever

Prob the most common "dumb" DURs that don't need to happen are gemfibrozil + statin (do a fibrate if it's covered instead if you really need an add-on). A DUR that should occur all the time is GLP+1 + DPP-IV but PCPs are dumb

 

[rxkrafted]

One thing I would like to mention is that if you're going to call the doctor about a contraindication or interaction, have an alternative recommendation on hand so the conversation can go smoothly and patient care isn't harmed. There's a lot of times I hear a pharmacist call and say, "there is an interaction with drug A and B" and then the conversation would just go stale or the doctor asks pharmacist for a recommendation and then the pharmacist just freezes.

 

[rxkrafted]

I think they were asking because they are curious of the specific drug pair in the scenario. Good Pharmacists should know that “level 1 - contraindicated” drug interaction has no universal definition. There is no master list. There are differences in opinion even amongst the big drug references.

New Pharmacists forget that they are actually pharmacists that may have to do more or do less than what a computer tells them. You’re supposed to have a brain.

So again what was the specific drug pair?

There was this one pharmacist I worked with who literally called doctors and said "the computer is telling me there is an interaction with drug A and drug B" then couldn't explain what kind of interaction

 

[Sine Cura]

I do notice tone-deaf pharmacists have "robotic" encounters and have a really difficult time "code-switching" based on the audience (or if you prefer, dumbing it down). Some people learn the hard way when they waste 10-15 minutes backtracking or re-explaining, but some never do

What rando MA or pt is gonna know what MME stands for or "therapeutic duplication." Spitting jargon or alphabet soup at regular pts isn't going to help, much less illiterates. Even the word "verify" is jargonese when it's not explained well what you are trying to do when "verifying"

 

[Charcoales]

Dont just put 'md said it's ok'... md needs relevant and specific clinical reasoning too that you as a pharmacist agree is reasonable... 'md said inx with warfarin is ok' vs 'md aware of inx and told pt to make inr appointment for this week to monitor'... or something

 

[grumpyRph]

i get some e-rx's where the pbr comments say : "contra indiciation ok. override"

but it's like....um did you really put that there? or is this a default comment cause you don't wanna be harassed? and actually you know it's a default comment on all rx's cause it's not even a relevant comment most the time. like it could be on polytrim eye drops or something dumb. haha

 

[Charcoales]

i get some e-rx's where the pbr comments say : "contra indiciation ok. override"

but it's like....um did you really put that there? or is this a default comment cause you don't wanna be harassed? and actually you know it's a default comment on all rx's cause it's not even a relevant comment most the time. like it could be on polytrim eye drops or something dumb. haha

Yeah imho that cmt is not specific enough, needs to mention the inx or issue specifically and how it is being managed specifically. No general comments.

 

[KidPharmD]

i think i bombed a residency interview question because i answered like this. i think i had a "not much else you can do" answer and i think they were digging for me to stand my ground more. this was prob more for a hospital setting though too.

i suppose if you feel super strongly about a CI but the doc insists you might just have to tell them to find a pharmacy or pharmacist willing to dispense. just don't end up on social media or a phone recording haha, depending on the situation.

In the hospital then there is always something else you can do. Either we decide that we are okay with the MD's reasoning/plan or it doesn't get dispensed. If they are insistent then the problem gets elevated. I have had to talk to the chief of a department before because of docs that didn't have good logic and didn't want to write for an alternative.

I was thinking that too... inform the pt of the DDI, that the md wants to move forward. inform them of the risk and annotate that they’re aware. At that point I don’t think there’s much else you can do, there’s no way you can still be held liable. Otherwise there’s no point in dispensing anything since everything has a risk lol

You will absolutely still be held liable. Even in the community either you are okay with the risk or you don't dispense. It is your job to weigh risks and benefits.

 

[Curiousone1111]

There was this one pharmacist I worked with who literally called doctors and said "the computer is telling me there is an interaction with drug A and drug B" then couldn't explain what kind of interaction

Omg lmao what happened to that rph

 

[Curiousone1111]

In the hospital then there is always something else you can do. Either we decide that we are okay with the MD's reasoning/plan or it doesn't get dispensed. If they are insistent then the problem gets elevated. I have had to talk to the chief of a department before because of docs that didn't have good logic and didn't want to write for an alternative.




You will absolutely still be held liable. Even in the community either you are okay with the risk or you don't dispense. It is your job to weigh risks and benefits.

If that were the case pharmacists would be getting sued or incarcerated left and right. There are plenty of careless rphs that are doing just fine.

 

[KidPharmD]

If that were the case pharmacists would be getting sued or incarcerated left and right. There are plenty of careless rphs that are doing just fine.

Let me rephrase then, you could still be held legally liable. By dispensing the drug you are signaling that you agree that either the warning isn't warranted or that the risk-mitigation strategy is sufficient.

 

[Curiousone1111]

Let me rephrase then, you could still be held legally liable. By dispensing the drug you are signaling that you agree that either the warning isn't warranted or that the risk-mitigation strategy is sufficient.

Fair enough, but if the patient is warned and they’re aware of the risks and they agree to proceed, that’s at their own risk. They weren’t unaware of the possible harm.

 

[rxkrafted]

Omg lmao what happened to that rph

in the market with the rest of the hungry unemployed grads

 

[PharFromNormal]

Fair enough, but if the patient is warned and they’re aware of the risks and they agree to proceed, that’s at their own risk. They weren’t unaware of the possible harm.

Informing... or rather I should say... claiming or documenting that you warned of a risk on something that’s completely inappropriate does not eliminate the possibility of a patient or estate/family of patient seeking damages. Additionally it’s also possible to lose a lawsuit even with your claim that the potential risk was informed to the patient. People say yes or I agree or provide “consent” often without the capacity of truly understanding what they are accepting. I can easily see an arguement that any verbal acknowledgment or pressing of ok on a pin pad was done without the capacity to understand the risks at the same level of the healthcare professional. There’s also the arguement that the risks may not have been appropriately communicated at an appropriate health literacy. Informing a patient of potential risk can significantly reduce the likelihood one may attempt to seek damages if harm is done, and may help in defense in the event those claims weren’t settled and ended up in ligation but in no means does it provide immunity.

 

[Curiousone1111]

Informing... or rather I should say... claiming or documenting that you warned of a risk on something that’s completely inappropriate does not eliminate the possibility of a patient or estate/family of patient seeking damages. Additionally it’s also possible to lose a lawsuit even with your claim that the potential risk was informed to the patient. People say yes or I agree or provide “consent” often without the capacity of truly understanding what they are accepting. I can easily see an arguement that any verbal acknowledgment or pressing of ok on a pin pad was done without the capacity to understand the risks at the same level of the healthcare professional. There’s also the arguement that the risks may not have been appropriately communicated at an appropriate health literacy. Informing a patient of potential risk can significantly reduce the likelihood one may attempt to seek damages if harm is done, and may help in defense in the event those claims weren’t settled and ended up in ligation but in no means does it provide immunity.

How do you practice with peace of mind then? we’re not psychic to know what will end up affecting someone or not, that’s my biggest issue. I care about patients but also my own liability.

 

[johnpharm01]

How do you practice with peace of mind then? we’re not psychic to know what will end up affecting someone or not, that’s my biggest issue. I care about patients but also my own liability.

See my post

 

[PharFromNormal]

How do you practice with peace of mind then? we’re not psychic to know what will end up affecting someone or not, that’s my biggest issue. I care about patients but also my own liability.

I think the easy high level answer is called insurance. In my example above if you work for a large company it’s very likely they are just going to try and pay out a settlement on the claim and make it go away and you’ll never know the details. If they refuse the settlement and you are following their policies and procedures and you documented like they want you to they will defend the **** out of the case. They’ll bury the other side in procedural bs and paperwork. You’ll have a lot of company resources behind you (provided you were following procedure and they like you). Additionally get your own insurance in the event they don’t or as a supplemental.

You are a practicing healthcare professional. You will have exposure to liability claims. Regardless of what you do to attempt to minimize risk exposure, this is the US and anyone can make a claim and try to sue anyone for nearly anything.

Stay up to date on the practice, do what you think is in the best interest of the patient first, and then what’s in best interest of your liability. Patients can often not know what’s truly in their best interest. Engage prescribers if needed.

Lastly, medicine is very often referred to as an art not a science. You’re right we don’t know for certain what outcome will result in every scenario. The more you think about things you’ll see risk/benefit micro decisions made in every aspect of your work. You have to just do your best to minimize risk to the extent you believe is practical and necessary knowing on many things it will never be completely 0. Mistakes happen, people get sloppy, careless etc. try not to but you’ll be paralyzed if you think you can prevent anyone from having any possibility of making a claim. People make claims on things that might not even be as a result of the pharmacist but depending on the angle and your legal counsels determination on defensibility (not internal perception of liability) it can be very often be just best to settle. Litigation is expensive, even if you win. Maybe moreso than the cost of the settlement.

Also try to get your patients to like you. They are less likely to sue you if they like you. But again, they still can sue you.

 

[Curiousone1111]

I think the easy high level answer is called insurance. In my example above if you work for a large company it’s very likely they are just going to try and pay out a settlement on the claim and make it go away and you’ll never know the details. If they refuse the settlement and you are following their policies and procedures and you documented like they want you to they will defend the **** out of the case. They’ll bury the other side in procedural bs and paperwork. You’ll have a lot of company resources behind you (provided you were following procedure and they like you). Additionally get your own insurance in the event they don’t or as a supplemental.

You are a practicing healthcare professional. You will have exposure to liability claims. Regardless of what you do to attempt to minimize risk exposure, this is the US and anyone can make a claim and try to sue anyone for nearly anything.

Stay up to date on the practice, do what you think is in the best interest of the patient first, and then what’s in best interest of your liability. Patients can often not know what’s truly in their best interest. Engage prescribers if needed.

Lastly, medicine is very often referred to as an art not a science. You’re right we don’t know for certain what outcome will result in every scenario. The more you think about things you’ll see risk/benefit micro decisions made in every aspect of your work. You have to just do your best to minimize risk to the extent you believe is practical and necessary knowing on many things it will never be completely 0. Mistakes happen, people get sloppy, careless etc. try not to but you’ll be paralyzed if you think you can prevent anyone from having any possibility of making a claim. People make claims on things that might not even be as a result of the pharmacist but depending on the angle and your legal counsels determination on defensibility (not internal perception of liability) it can be very often be just best to settle. Litigation is expensive, even if you win. Maybe moreso than the cost of the settlement.

Also try to get your patients to like you. They are less likely to sue you if they like you. But again, they still can sue you.

That’s true, but sometimes it’s hard to get them to like you when they just want their meds instead of understanding that you’re not dispensing for their own safety. I agree everyone should carry malpractice insurance on their own. I supposed my anxiety is blowing everything out of proportion and assuming the worst can happen despite the insurance and doing your best.

 

[Curiousone1111]

Your a pharmacist? Our first duty is to do no harm. If filling a prescription and a drug interaction or drug age contraindication or drug disease contraindication. It is your job to resolve the issue before dispensing it. The first step is to gather information. The next is to assess risk and benefit. The third is to make a plan on how to manage the risk. If the risk is life threatening and unmitagated, then you don't fill. This happens rarely. Just because a combination of drugs i.e. atorvastatin and fluconazole interact, does not mean they can't be dispensed. The risk has to be identified, evalualated, and managed i.e. hold atorvastatin while on fluconazole. I have run into these issues routinely.

Fyi if all you are interested in is your liability, then you will get bit in the ass. You should care too and people can tell. If you want no.liability quit now.

And by the way, who cares what everyone else is doing? That's why licenses are issued individually. You lose yours and another job opening comes up for me.

does the system automatically pop up for drug disease interactions? Unless the disease is entered will the system still generate a warning by running a check on their profile and determining which medications are used in which disease states?

Sometimes the drug disease pop up comes up thru an insurance transmission message and it makes no sense at all so I haven’t done much (usually with birth control for some reason).

i guess I get paranoid. My state requires AB rated generics to be used when substituting.... but the pharmacy software I was using lists non AB products as equivalents... so rphs are choosing from that list without knowing it isn’t AB rated. Can we be held responsible for this, we can’t be checking orange book for everything like inhalers, bc, etc.One time I had an rx for Auvi Q and the system gave me regular epinephrine injection as an option.. same with proair, proventil, ventolin. That’s one example I definitely remember from school as not being AB rated. I get bogged down by these little things, or the wrong insulin quantity on an rx and rphs changing it to 30 ds on their own when the state requires md auth. The whole job seems like a hassle when the state won’t give the rphs some leeway in doing things themselves.

 

[Sine Cura]

does the system automatically pop up for drug disease interactions? Unless the disease is entered will the system still generate a warning by running a check on their profile and determining which medications are used in which disease states?

Sometimes the drug disease pop up comes up thru an insurance transmission message and it makes no sense at all so I haven’t done much (usually with birth control for some reason).

i guess I get paranoid. My state requires AB rated generics to be used when substituting.... but the pharmacy software I was using lists non AB products as equivalents... so rphs are choosing from that list without knowing it isn’t AB rated. Can we be held responsible for this, we can’t be checking orange book for everything like inhalers, bc, etc.One time I had an rx for Auvi Q and the system gave me regular epinephrine injection as an option.. same with proair, proventil, ventolin. That’s one example I definitely remember from school as not being AB rated. I get bogged down by these little things, or the wrong insulin quantity on an rx and rphs changing it to 30 ds on their own when the state requires md auth. The whole job seems like a hassle when the state won’t give the rphs some leeway in doing things themselves.

You need to abandon that thinking. No one cares. You go by what the insurance covers anyway, which is not Auvi Q. When in chain pharmacy, aside from following policies and procedures so you don't get hammered for gross negligence and focus on whatever bull**** metrics are the flavor of the day just enough to stay in the mediocre zone, care as much as your patients do, which 95% of the time is very little. Don't be that rph that drags **** out so other people have to clean up your mess

Also if you gonna call on "1 spray" fluticasone or "5 each" insulin lispro it's over for you

 

[Curiousone1111]

You need to abandon that thinking. No one cares. You go by what the insurance covers anyway, which is not Auvi Q. When in chain pharmacy, aside from following policies and procedures so you don't get hammered for gross negligence and focus on whatever bull**** metrics are the flavor of the day just enough to stay in the mediocre zone, care as much as your patients do, which 95% of the time is very little. Don't be that rph that drags **** out so other people have to clean up your mess

Also if you gonna call on "1 spray" fluticasone or "5 each" insulin lispro it's over for you

I’m not experienced enough to even understand the reference to fluticasone and insulin lol.
What I was referring to about the insulin qty was when it comes in as 3 and the unit is left as unspecified as to whether it’s ml, pen, box, etc. Now I can understand to do the math and see what makes the most sense with the sig, will 3 ml (one pen), 3 pens (9 ml), or 3 boxes be the right choice. A friend of mine assumed before and dispensed whatever is closest to amount covered (30 ds), but had an office call to complain that they wrote 3 as in 3 ml just to try that insulin out. I believe it came out to 10 days supply or something short, so it was dispensed for 3 pens to make it a month. Luckily the office was nice about it, but I’ve heard you can get in trouble with the board for “deviating from the script” as the law states. Thought they had bigger fish to fry?

 

[Sine Cura]

That office is a bunch of dip****s that don't know **** about product presentations. If we "can't" break a box go to the nearest pack size and inform office. No one at a prescriber's office going to waste time filing a regulatory complaint other than some Karens with too much free time.

JFL you can get in trouble for ANYTHING, even not sending a refill auth to a clinic for some lazy POS customer so WFC. You really think a pharmacy board is going to care that much about anything that does NOT adversely affect a pt, i.e., pack sizes that "deviate" from what some ignoramo prescriber thinks exists or is possible

 

[rxkrafted]

I’m not experienced enough to even understand the reference to fluticasone and insulin lol.
What I was referring to about the insulin qty was when it comes in as 3 and the unit is left as unspecified as to whether it’s ml, pen, box, etc. Now I can understand to do the math and see what makes the most sense with the sig, will 3 ml (one pen), 3 pens (9 ml), or 3 boxes be the right choice. A friend of mine assumed before and dispensed whatever is closest to amount covered (30 ds), but had an office call to complain that they wrote 3 as in 3 ml just to try that insulin out. I believe it came out to 10 days supply or something short, so it was dispensed for 3 pens to make it a month. Luckily the office was nice about it, but I’ve heard you can get in trouble with the board for “deviating from the script” as the law states. Thought they had bigger fish to fry?

I would have asked the patient if they knew but otherwise I would have done the same as you. Do whatever makes the most sense. If that office called to complain, you can straight up let them know that they have to specify wtf they meant by just putting "3". Ask them how you are suppose to guess if its 3mL, 3pens, 3boxes ? Got to turn the blame on them until they apologize

 

[Sine Cura]

OP, you need to have the mindset that prescribers don't know **** about what's stocked in the pharmacy or how dispensing works so turn it around on them in the rare event they try to stir **** up.

"I'm not a ****ing mind-reader"
"Don't put a DAW 1 if you didn't mean it"
etc etc.