ERX errors drive me crazy, share yours!

[FLPHARMD2001]

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We must take the good with the bad. Here is the latest thing that drives me crazy about electronic prescriptions.

Lyrica 100 mg
1 c po qhs for 30 days
#90

The question is to type or not to type the 'for 30 days'? Does it mess up billing in any computer systems?

 

[ldiot]

I'd just leave off the 30 days, some people would actually call them since it's controlled

 

[BidingMyTime]

I would ignore the 30 days...it's often part of the directions that are prefilled in, and doctors forget to take it out.

 

[txpharmguy]

The Cynical Pharmacist has many excellent examples on his FB page

 

[Wickett]

Had these earlier this week.

Medrol Dosepack 4mg
Take 1mg po ud
#1

Zpack
Take 1 tablet po ud
#1

I knew what they meant in all probability, but I still called to clarify. Got treated like an idiot for verifying by the receptionist that probably typed them in the first place.

 

[Wickett]

New grads like this guy drives me nut. they call to verify everything!!!! use common sense.

Edit:
"Class of 2016-----About to graduate, thank god."

oh god....

I called due to the medrol dose pack and the directions being totally wonked. Having both the strength and directions that off Im personally calling to clarify before altering a script that much. Sorry if that drives you nut.

 

[trailerpark]

Don't call, just use sig code TUDP which in our system is "Take as Directed on Package" Easy... 2 seconds


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[npage148]

When I'm real pissy I'll call and say "just wanted to make sure you wanted medrol. you know, with those directions maybe you picked the wrong drug". They need to learn their system and shaming the office possibly might help

 

[BidingMyTime]

When I'm real pissy I'll call and say "just wanted to make sure you wanted medrol. you know, with those directions maybe you picked the wrong drug". They need to learn their system and shaming the office possibly might help

The sad thing is, sometimes they HAVE picked the wrong drug.

 

[RxPreceptor]

Epipen 0.3mg
Use 1 injection subcutaneously as needed for anaphylaxis...
Scary thing, this came from an ER

 

[a student]

These happen with various drugs on a daily basis. The annoying part is that when we call we can never reach the office. When we fax, we never get a response. When the patient comes, we get yelled at.

"Take 1 tablet by mouth once a day. Take one tablet by mouth twice daily."

"Take one tablet by mouth twice daily. Take one tablet by mouth three times daily."

 

[ChalupaBatman86]

The Cynical Pharmacist has many excellent examples on his FB page

I was doing a PowerPoint presentation for some offshore IT guys from India that were working on our computer application. These guys were not pharmacists obviously. I pulled down a bunch of those E-Rx images from Cynical Pharmacist and put them in the PowerPoint deck to demonstrate what can go wrong. These guys were literally rolling on the floor convulsing from laughter. I was afraid they might actually die.


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[goldenboy48]

What's wrong with it ?

it's IM

 

[CetiAlphaFive]

u will get treat like an idiot if u call to verify medrol dosepak dosing and zpak dosing.
tipa

u definitely need to work more before you're licensed!!!!!

Mocking someone for being extra careful while you're writing at the English level of an 8 year old seems overly harsh, no?

Furthermore, what's you're reasoning for despising pharmacists who are overly cautious?
Are you upset that they waste time?
Is speed the most important thing for a pharmacist in your mind?
Why?

If all you're there for is playing the matching game and checking as fast as humanly possible, you're not a pharmacist, you're a tech with a special certification on the wall.

 

[CetiAlphaFive]

When I'm real pissy I'll call and say "just wanted to make sure you wanted medrol. you know, with those directions maybe you picked the wrong drug". They need to learn their system and shaming the office possibly might help

+1.

Pharmacists like vtrx2013 are the reason most offices have a recording that says "call your pharmacy for refill requests"

 

[Wickett]

Don't call, just use sig code TUDP which in our system is "Take as Directed on Package" Easy... 2 seconds


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I know....this was also an office commonly known for calling in the wrong things/directions etc for patients, so it was a general check that they really wanted a dose pack and zpack for the patient.

 

[Wickett]

u will get treat like an idiot if u call to verify medrol dosepak dosing and zpak dosing.
tipa

u definitely need to work more before you're licensed!!!!!

I worked as a full time tech before pharm and overall had a decent amount of exp that landed me my pic position last summer out of school. I don't have any issue if someone else just put as directed/the standard dosing for the meds, but in my area I've caught multiple errors/totally wrong drugs prescribed by checking on "idiotic" stuff like that, including zpacks being put down and learning they meant azithromycin at a different dosing schedule. I'm not calling for stuff like changing out inhalers, asking for as directed sigs to be spelled out, etc. To each their own.

 

[RxPreceptor]

You can technically give it subq

Your pharmacokinetics professor would say that is less than optimal in an emergency but liberally ok based on the package insert

 

[npage148]

The sad thing is, sometimes they HAVE picked the wrong drug.

Oh yeah, I meant mavik. Oops, lol my bad

 

[npage148]

Sq vs Im for epipen shouldn't even be on the label. It's gonna autoinject as it feels like. Maybe sq. maybe im maybe through snowpants. Maybe though jeans. Who knows and the end user has no control over injection depth

 

[Sine Cura]

TBH, you should know your nearby prescribers and their habits. At least 50% the Rx I see come from community health centers or free clinics that are open once a week. They don't give a crap. You can tell they don't give a crap because the last time you "verified" something they didn't even update the patient record so they send off the same incorrect script next time.

I don't necessarily mind other pharmacists checking. Push back and tell them they're idiots for not even being able to do something as basic as writing a clear prescription.

 

[wucool33]

u will get treat like an idiot if u call to verify medrol dosepak dosing and zpak dosing.
tipa

u definitely need to work more before you're licensed!!!!!

There's nothing wrong with verifying if the direction is unclear. I never roll my eyes when another pharmacist wants to verify something, even if I feel like it's unnecessary. The only time I put a stop to it is when a RPH wanted to call the MD to change an OTC hydrocortisone from ointment to a cream. As for the Zpak, I have had the same situation and the prescriber really only wanted to give 3 or 4 tablets of azithromycin, bc the pt has already taken a couple of doses at the hospital. I don't get why you are this mad... when did YOU graduate and from where?

 

[PharmD17']

New grads like this guy drives me nut. they call to verify everything!!!! use common sense.

Edit:
"Class of 2016-----About to graduate, thank god."

oh god....

If your license is on the line why wouldn't you document checking this? Medrol dose pack and zpack aren't 1 as directed (zpack is after day one)...if it simply said as directed that would work...but the 1 simply throws it off. If the board of pharmacy came in and saw that, depending on the person auditing, that could mean trouble. Also no telling what the patient received prior too...so maybe they really want less than the actual pack....Why be annoyed when someone is trying to protect their license, and the safety of a patient?

 

[BenJammin]

If you don't want a pharmacist to call on "zpak 250 mg, take daily #1" then maybe you should learn how to use your eRx system.

 

[ldiot]

Had these earlier this week.

Medrol Dosepack 4mg
Take 1mg po ud
#1

Zpack
Take 1 tablet po ud
#1

I knew what they meant in all probability, but I still called to clarify. Got treated like an idiot for verifying by the receptionist that probably typed them in the first place.

I don't see why people are so bent out of shape over you calling, the directions are not only unclear, they are flat out wrong. Though I'd probably only call on the Medrol in this case since it specifically says take 1mg.

 

[gwarm01]

"ERX errors" is giving me nightmares about doing med build for Epic.

 

[sakigt]

I didn't say it was optimal. It's not technically wrong tho

SubQ for asthma, IM for Anaphylaxis

Having the indication on the script makes the route incorrect, imo

 

[Wickett]

I don't see why people are so bent out of shape over you calling, the directions are not only unclear, they are flat out wrong. Though I'd probably only call on the Medrol in this case since it specifically says take 1mg.

The medrol was the main reason for the call.....with both the strength and sig wrong I was like screw it, I'm verifying wth they want before filling. It is also a clinic that makes tons of prescribing errors in general....partly calling as a heads up to them to get their **** together.

 

[wucool33]

What? Cream and ointment, you need to call. OTC or not, if it's billed and filled through the pharmacy, it's need to be called and documented. This is a medication error.

If you call about something like this instead of using your own professional judgement then you are the one that needs to work more before being licensed. I find it funny you are so worked up over hydrocortisone cream and ointment, but rages over someone actually doing their job by making sure the pt is getting the right medication at the right dose. I'm literally laughing right now... I can't even... I'm done with you hahahhahaha

 

[Sine Cura]

Again knowing your prescriber tendencies and patient population tendencies helps if you choose to make these judgment calls. This is a reason floater pharmacists tend not to cope well at unfamiliar stores because there is a lot of stupid bull**** a knowledgeable staff pharmacist would just blow through to get from point A to point B efficiently. And I say this as someone who even floats from time to time because WTF in the age of saturation do I need to float to cover shortages as RXM.

Cash patient is not going to pay for Tirosint and the free clinic is open once a week. Insurance covers ondansetron ODT and not regular tabs called for by the original Rx. Insurance does not cover ondansetron oral solution but covers tablets. You have a script for amoxicillin tablets, but you don't carry any tablets but the patient has a "Muslim"-sounding name. Same goes for cephalexin tablets versus capsules. You have a script for HCTZ 12.5 mg tablets but tablets are not on the $4 dollar list. Insurance does not cover doxycycline hyclate tablets but covers only doxycycline monohydrate capsules. Insurance does not cover Tamiflu caps but covers Tamiflu suspension. Insurance does not cover omeprazole capsules but omeprazole tablets. Insurance does not cover generic Nexium but brand Nexium but only DAW 1 will get the claim to go through (srsly). ERx says "one spray" for Flonase and Flonase can come in 60 ct or 120 ct (60 ct OTC). Insurance does not cover Flonase but Veramyst. ERx says "1" for Symbicort but the quantity of actuations is not specified. Insuurance does not cover Lisinopril/HCTZ but will cover it separately. Insurance does not cover Lotrisone but will cover the constituents separately... Script is written for quetiapine 50 mg but 50 mg is never covered by insurance but other strengths are. Insurance covers no amoxicillin suspension except 400/5 but the Rx is for 250/5. Rx is written for morphine sulfate ER but the formulation is not specified and it's an ambiguous strength like 30 mg. No history. etc. etc. etc. etc. etc.

Which ones do you change with impunity and which ones would you actually call about and which ones do you not bother changing?

As I said before it is VERY common in my experience to call to get an error fixed or substitution authorized and the error is not actually fixed on the prescriber side upon subsequent re-prescribing. Such is the nature of the abject failure of non-delivery of assembly-line health care in the United States. I get plenty of patients who somehow get upset that we fill the Erx we get from the prescriber. Like what is the pharmacy for if not to dispense prescriptions? Patients and providers are grist for this broke-ass/broken-ass system. After all, health care is a business in the end.

 

[PharmD17']

LOL board of pharmacy have more important things to do than auditiong zpak and medrol dosing.
new grads without work experience drives me nuts. COMMON SENSE, it's not taught in school whether retail or hospital.

Before you laugh and make a statement like that think about where you work. The pharmacy I work for the board has been in once a week and picked at every little thing, prior to we had the same thoughts, "they don't have time". Well guess what lately they made time. So get off your high horse. This isn't a "new grad" issue.




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[npage148]

SubQ for asthma, IM for Anaphylaxis

Having the indication on the script makes the route incorrect, imo

Clinical pharmacology even says "eh, im is better but sq is fine". And how do you dictate inj dept with an autoinject device

 

[zelman]

Again knowing your prescriber tendencies and patient population tendencies helps if you choose to make these judgment calls. This is a reason floater pharmacists tend not to cope well at unfamiliar stores because there is a lot of stupid bull**** a knowledgeable staff pharmacist would just blow through to get from point A to point B efficiently. And I say this as someone who even floats from time to time because WTF in the age of saturation do I need to float to cover shortages as RXM.

Cash patient is not going to pay for Tirosint and the free clinic is open once a week. Insurance covers ondansetron ODT and not regular tabs called for by the original Rx. Insurance does not cover ondansetron oral solution but covers tablets. You have a script for amoxicillin tablets, but you don't carry any tablets but the patient has a "Muslim"-sounding name. Same goes for cephalexin tablets versus capsules. You have a script for HCTZ 12.5 mg tablets but tablets are not on the $4 dollar list. Insurance does not cover doxycycline hyclate tablets but covers only doxycycline monohydrate capsules. Insurance does not cover Tamiflu caps but covers Tamiflu suspension. Insurance does not cover omeprazole capsules but omeprazole tablets. Insurance does not cover generic Nexium but brand Nexium but only DAW 1 will get the claim to go through (srsly). ERx says "one spray" for Flonase and Flonase can come in 60 ct or 120 ct (60 ct OTC). Insurance does not cover Flonase but Veramyst. ERx says "1" for Symbicort but the quantity of actuations is not specified. Insuurance does not cover Lisinopril/HCTZ but will cover it separately. Insurance does not cover Lotrisone but will cover the constituents separately... Script is written for quetiapine 50 mg but 50 mg is never covered by insurance but other strengths are. Insurance covers no amoxicillin suspension except 400/5 but the Rx is for 250/5. Rx is written for morphine sulfate ER but the formulation is not specified and it's an ambiguous strength like 30 mg. No history. etc. etc. etc. etc. etc.

Which ones do you change with impunity and which ones would you actually call about and which ones do you not bother changing?

As I said before it is VERY common in my experience to call to get an error fixed or substitution authorized and the error is not actually fixed on the prescriber side upon subsequent re-prescribing. Such is the nature of the abject failure of non-delivery of assembly-line health care in the United States. I get plenty of patients who somehow get upset that we fill the Erx we get from the prescriber. Like what is the pharmacy for if not to dispense prescriptions? Patients and providers are grist for this broke-ass/broken-ass system. After all, health care is a business in the end.

Flonase and veramyst have different active ingredients. Fluticasone propionate and fluticasone furoate are not just different salts, and neither is metabolized into fluticasone. Your example may as well be that you would change Benicar to Cozaar without calling.

 

[a student]

Since we are on the topic, do you guys call to change between novolin and humulin?

 

[Wickett]

proair/proventil/ventolin are the only ones that are inter-changeable, anything else I'm calling.

You mean I can't interchange Symbicort with Ventolin? Man, I wish I had you around everyday to advise me, with your vast experience and all.

 

[zelman]

Since we are on the topic, do you guys call to change between novolin and humulin?

CYA. You need to call on that one or you will get blamed for hypoglycemic emergencies (regardless of actual fault).

 

[Sine Cura]

Flonase and veramyst have different active ingredients. Fluticasone propionate and fluticasone furoate are not just different salts, and neither is metabolized into fluticasone. Your example may as well be that you would change Benicar to Cozaar without calling.

The point I'm making is of all those examples, either there is no legal basis to substitute without prescriber authorization or the script is incomplete. (One exception being California where you can convert one strength to another of the same active moiety and dosage form as long as the total dosage is preserved.) Every pharmacist draws his own line.

As for fluticasone, I fax anyway. A better example would be if they left off the specification of which ester and just put in "fluticasone nasal spray." There is no free fluticasone formulation commercially available.

 

[CetiAlphaFive]

What? Cream and ointment, you need to call. OTC or not, if it's billed and filled through the pharmacy, it's need to be called and documented. This is a medication error.

Hahahahaha, oh man.

This has to be a troll account

 

[trailerpark]

I change everything. Tabs to caps, creams to ointments, Proair to Ventolin. Prelone to Orapred. I'm surprised anyone comes back to my pharmacy alive.


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