Filling a script without enough information

[Socrates25]

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Suppose you receive a script for the following medicine:

Amoxicillin 400/5, 3cc po bid x 10 days. No dispensing quantity given, no refill information stated.

 

[rxlea]

Well, is this a kid? Need Weight. I'd call.

Honestly, I need more info. I'm not going to just fill something without knowing who it's for, what it's for, etc.

 

[nnguyenc]

you'll last about a day in retail if you call for every little thing

 

[rxlea]

you'll last about a day in retail if you call for every little thing

I wouldn't call about every little thing. I've worked retail but this scenario doesn't give enough info and I'm not sure what the point is considering who posted it.

Need allergy info, weight, indication, etc.

 

[rxtech2012]

Agree somewhat with rxlea, so there's no DOB to determine age of pt? Dispensing qty is not necessary to be written since you have day supply an frequency. Just dispense a bottle that is at least 60 mls .Also, usually if there are no refills stated on hard copy I would assume no refills especially for antibiotics.

 

[All4MyDaughter]

Assuming dose doesn't seem crazy for patients age and size, I would fill with the 75 or 100 mL bottle (whatever is in stock) and instruct patient to discard remainder. No RF.

Edit: can ask pt/caregiver about DOB, wt, allergies.

 

[rxlea]

Assuming dose doesn't seem crazy for patients age and size, I would fill with the 75 or 100 mL bottle (whatever is in stock) and instruct patient to discard remainder. No RF.

This.

 

[All4MyDaughter]

Seriously, 90% of peds abx scripts look just like this. No dispense quantity calculated for liquids. Half of the time, when it is calculated, it is wrong.

 

[rxlea]

Seriously, 90% of peds abx scripts look just like this. No dispense quantity calculated for liquids. Half of the time, when it is calculated, it is wrong.

😛

 

[Rockinacoustic]

Suppose you receive a script for the following medicine:

Amoxicillin 400/5, 3cc po bid x 10 days. No dispensing quantity given, no refill information stated.

I'm assuming there's a name and date on this Rx and it's not just a drug and sig.

I would dispense QS since you state a length of treatment. Now if the directions were just "3cc po bid" with no days, I would verify before dispensing.

 

[Dr Wario]

Suppose you receive a script for the following medicine:

Amoxicillin 400/5, 3cc po bid x 10 days. No dispensing quantity given, no refill information stated.

If a pharmacist called you for clarification for qty or refills on this script, you should slap them.

 

[Sparda29]

Suppose you receive a script for the following medicine:

Amoxicillin 400/5, 3cc po bid x 10 days. No dispensing quantity given, no refill information stated.

60 ml needed, so fill with the closest quantity bottle available.

 

[owlegrad]

Dispense QS with no refills. Plenty of scripts don't have refills listed, so the assumption is no refills and a days supply was listed so QS is reasonable.

 

[FlavyFlav]

I love the ones that don't round the mg/kg. Hate so much seeing scripts that say 'give 7.3 ml bid'Who wants to measure out a fraction of a ml? But, yes, this script is pretty straight forward assuming the name and date of birth were on it. You can easily ask the caregiver for the rest of the info you need. We get those all the time.

 

[npage148]

If all the scripts I saw on a given day were this clear, I'd be very happy. Zero reason to call. Side point, isnt cc a banned abbreviation? I guess if you wanted to be a wiener you could call to clarify 3 ml or 300 if he cc was sloppy. But even then 300mg is pretty close to 3 ml in this example, close enough to not really matter

 

[pezdispenser]

Suppose you receive a script for the following medicine:

Amoxicillin 400/5, 3cc po bid x 10 days. No dispensing quantity given, no refill information stated.

No problem at all. For amoxicillin and all drugs that say "powder for suspension", or "reconstitution", an individual bottle is reconstituted for each patient, and it has to be to the volume of the available bottle sizes. I don't expect doctors to know what these bottle sizes are, so we just round up to the next available size, in this case a 75 mL bottle. We do not pour out from a large stock bottle the exact amount required by the script, in this case 60 mL. Well some drugs we do because they are not reconstituted, such as Septra suspension.

If no refill information is stated, we just assume zero refills.

 

[hereticmnk]

Zero reason to call even it is for a kid. Verify weight from the patient, look up dosing and dispense.

 

[Socrates25]

Thanks for the responses.

Our clinic system uses an EMR and the other day it was not sending out all the information (since then it has been fixed). It would send out the name of the drug, concentration, dose of medicine, and duration of treatment but it was not sending out the dispensing quantity or the number of refills.

We had many scripts that we got called back by the pharmacy on that day, which I understand because you needed that info to complete the script.

However, there were about 15 scripts with antibiotics (all of them were sent out like the one I listed above) that went out on that day, and we got no less than 4 calls from pharmacy stating that they couldnt fill it without a dispensing quantity or refills. Normally thats not that big of a deal because if they call during office hours our nurses can clarify quickly over the phone. But 2 of those calls came from midnight - 5 AM from 24 hour pharmacies (I have no idea why the patient would fill it that late, all of our patients were out the door before 7 PM). So I had to wake up in the middle of the night to deal with it.

I almost blurted out to them "so you're telling me you went thru 4 years of college and 4 years of pharmacy school. You have a doctorate level education and you cant read between the lines even a little?"

I understand that if you are dealing with narcotics you need all the i's dotted and all the t's crossed. But this was a series of simple antibiotic scripts, it shouldnt be that big of a deal.

 

[rxlea]

Thanks for the responses.

Our clinic system uses an EMR and the other day it was not sending out all the information (since then it has been fixed). It would send out the name of the drug, concentration, dose of medicine, and duration of treatment but it was not sending out the dispensing quantity or the number of refills.

We had many scripts that we got called back by the pharmacy on that day, which I understand because you needed that info to complete the script.

However, there were about 15 scripts with antibiotics (all of them were sent out like the one I listed above) that went out on that day, and we got no less than 4 calls from pharmacy stating that they couldnt fill it without a dispensing quantity or refills. Normally thats not that big of a deal because if they call during office hours our nurses can clarify quickly over the phone. But 2 of those calls came from midnight - 5 AM from 24 hour pharmacies (I have no idea why the patient would fill it that late, all of our patients were out the door before 7 PM). So I had to wake up in the middle of the night to deal with it.

I almost blurted out to them "so you're telling me you went thru 4 years of college and 4 years of pharmacy school. You have a doctorate level education and you cant read between the lines even a little?"

I understand that if you are dealing with narcotics you need all the i's dotted and all the t's crossed. But this was a series of simple antibiotic scripts, it shouldnt be that big of a deal.

Ugh that would suck...

I guess some pharmacists are paranoid. Maybe they were new grads or from a mill school

But yeah, with your situation, I would have just dispensed like the previous posters described.

 

[owlegrad]

Maybe something about overnight pharmacist make them more likely to call than day shifters?

 

[npage148]

Maybe something about overnight pharmacist make them more likely to call than day shifters?

Probably just wanted someone to talk to, overnighters get lonely

 

[rxlea]

Probably just wanted someone to talk to, overnighters get lonely

Lulz

 

[Wheresmyaricept]

Thanks for the responses.

Our clinic system uses an EMR and the other day it was not sending out all the information (since then it has been fixed). It would send out the name of the drug, concentration, dose of medicine, and duration of treatment but it was not sending out the dispensing quantity or the number of refills.

We had many scripts that we got called back by the pharmacy on that day, which I understand because you needed that info to complete the script.

However, there were about 15 scripts with antibiotics (all of them were sent out like the one I listed above) that went out on that day, and we got no less than 4 calls from pharmacy stating that they couldnt fill it without a dispensing quantity or refills. Normally thats not that big of a deal because if they call during office hours our nurses can clarify quickly over the phone. But 2 of those calls came from midnight - 5 AM from 24 hour pharmacies (I have no idea why the patient would fill it that late, all of our patients were out the door before 7 PM). So I had to wake up in the middle of the night to deal with it.

I almost blurted out to them "so you're telling me you went thru 4 years of college and 4 years of pharmacy school. You have a doctorate level education and you cant read between the lines even a little?"

I understand that if you are dealing with narcotics you need all the i's dotted and all the t's crossed. But this was a series of simple antibiotic scripts, it shouldnt be that big of a deal.

My experience with over night pharmacists is that they are super cautious about filling scripts because they don't have the experience of a day time pharmacist. The day time staff at that store might see it and go "lol fill it". The over night is more cautious and would want to ensure correct dosing. Which is why they are over night. They wouldn't last a whole shift during the day in the same store.

 

[npage148]

My experience with over night pharmacists is that they are super cautious about filling scripts because they don't have the experience of a day time pharmacist. The day time staff at that store might see it and go "lol fill it". The over night is more cautious and would want to ensure correct dosing. Which is why they are over night. They wouldn't last a whole shift during the day in the same store.

That is pretty much the opposite of everything I've seen. All the overnight pharmacists I've dealt with are just (if not more) competent than the day time people. They don;'t have the benefit of another pharmacist or techs to help. There's a difference between competent and too lazy/busy to do it the right way

 

[Wheresmyaricept]

That is pretty much the opposite of everything I've seen. All the overnight pharmacists I've dealt with are just (if not more) competent than the day time people. They don;'t have the benefit of another pharmacist or techs to help. There's a difference between competent and too lazy/busy to do it the right way

Can we trade then? Because every time I come in after an overnight (this is multiple stores too), there's almost a dozen scripts that are in the third party reject screen that could have been fixed and filled. The inventory smart counts usually don't get done or get done incorrectly (one time we got an extra 72 bottles of anastrozole because someone didn't know what they were doing). And they page doctors for silly things. Like a diagnosis code for adderall, when someone has been getting it for the last 2 years with the diagnosis code written on every rx. Oh and my favorite is when I found an overnight was filling some c-II's and instead of counting them, was weighing them. Like the one type of medication you want to be super accurate, you use the most inaccurate counting method? Really?

 

[Socrates25]

I have a follow-up question....

suppose you get the following script... amoxicillin 400/5, 2mL po bid x 10 days, dispense 50cc, no refills.


Here are your options:

1. Fill script as written
2. Call MD to clarify.... amount dispensed does not match the number of days

 

[All4MyDaughter]

I have a follow-up question....

suppose you get the following script... amoxicillin 400/5, 2mL po bid x 10 days, dispense 50cc, no refills.


Here are your options:

1. Fill script as written
2. Call MD to clarify.... amount dispensed does not match the number of days

Happens all the time. ALL the time.

I wouldn't call. I'd make sure we dispensed QS for the directions, as long as the directions make sense.

 

[owlegrad]

So the prescriber gave them a little wiggle room, no big deal. "Discard remainder" gets the job done easily.

What if the prescribed amount was less than QS? Then what? I am just curious to see what other people say. 🙂

 

[All4MyDaughter]

So the prescriber gave them a little wiggle room, no big deal. "Discard remainder" gets the job done easily.

What if the prescribed amount was less than QS? Then what? I am just curious to see what other people say. 🙂

I just fix it. The dispense amount is wrong more often than it's right. At least for some prescribers. LOL

 

[npage148]

If the qty is less than qs then I'm gonna call because is the dose correct? What if it's the correct qty and day supply?

 

[Socrates25]

Let me just say that there are some EMR systems that dont let you put "dispense quantity sufficient for 10 days", it forces you to pick a specific number.

 

[Socrates25]

How do you guys feel about the following script?

Amoxicillin 400/5, 3.7mL po bid x 7 days, dispense 51.8mL, no refills

 

[tkim]

How do you guys feel about the following script?

Amoxicillin 400/5, 3.7mL po bid x 7 days, dispense 51.8mL, no refills

That type of rx should've been corrected during residency.

 

[pezdispenser]

No problem at all. For amoxicillin and all drugs that say "powder for suspension", or "reconstitution", an individual bottle is reconstituted for each patient, and it has to be to the volume of the available bottle sizes. I don't expect doctors to know what these bottle sizes are, so we just round up to the next available size, in this case a 75 mL bottle. We do not pour out from a large stock bottle the exact amount required by the script, in this case 60 mL. Well some drugs we do because they are not reconstituted, such as Septra suspension.

Same thing. Round up to next available size. At the pharmacist's discretion. Do not call the doctor.

 

[pezdispenser]

How do you guys feel about the following script?

Amoxicillin 400/5, 3.7mL po bid x 7 days, dispense 51.8mL, no refills

Oh and also provide a dosing syringe. 3.7 mL can be marked on the syringe when counseling the patient. My pharmacy is moving towards standardizing dosing in milliliters, rather than, for example "3/4 teaspoonsful".

 

[Carboxide]

How do you guys feel about the following script?

Amoxicillin 400/5, 3.7mL po bid x 7 days, dispense 51.8mL, no refills

I don't see what's wrong with this...the quantity is sufficient as written...so I would pick the next size up and dispense. Anyone want to tell me what the issue is with this? I can't even figure it out.

 

[Daiphon]

I have a follow-up question....

suppose you get the following script... amoxicillin 400/5, 2mL po bid x 10 days, dispense 50cc, no refills.


Here are your options:

1. Fill script as written
2. Call MD to clarify.... amount dispensed does not match the number of days

Overall, follow the math... should be 40, and we docs do make mistakes. d=)

However, 2mL BID 400/5 implies a very young kiddo and they're known for spitting up; their doc may have just been anticipating this and wanted to give a bit extra just in case.

Cheers!
-d

Sent from my DROID BIONIC using Tapatalk

 

[atpsynthase]

I would fill it up QS with no refills, then calculate the weight range that this would be appropriate for and ask mom or dad when they come in to pick it up.

 

[ancienbon]

This prescription looks clear for me.I wish all rxs i deal in retail were that clear.

 

[BenJammin]

You need nothing more than how much the kid weighs. NOTHING MORE. You will be the laughing stock of the store if you call the doc for any reason on that script.

 

[BidingMyTime]

Dr's don't know the package size of stuff, why would they? I appreciate the doctors who write to dispense "stock" size. Makes it easy. But now, I would never call for a qty of a bulk item, I would just round to whatever size is appropriate/we have in stock. Obviously if no days supply at all for an antibiotic, I would call, but that seldom happens. Generally, if the qty disp is lower than the days supply needed, I go with the days supply & assume the doctor doesn't know math (or like me can't do it without a calculator ) The exception would be if the patient had just been discharged from the hospital, then I would call to question, since the lower amount could be indicative of the patient already having gotten some of the days in the hospital.

 

[DustinfromCA]

sorry to hijack but what about this one?

Flonase 60 grams. 30 day supply. 2 sprays daily.

Do you call and verify if it is 2 sprays in each nose daily? or just 2 sprays daily (1 spray in each nose).. and the quantity I wouldn't even think of verifying.. I'd just give em a box and call it a day, my main issue was the sig. I called and verified and it was ineed 2 sprays in each nostril once daily. (flonase can also be given 1 spray in each nostril daily if symptoms improve so there is no standard 1 sig). Was I being too vigilant?

About the OP though, I would definitely NOT call on that quantity. If no days supply were given though, I would call.

 

[Carboxide]

sorry to hijack but what about this one?

Flonase 60 grams. 30 day supply. 2 sprays daily.

Do you call and verify if it is 2 sprays in each nose daily? or just 2 sprays daily (1 spray in each nose).. and the quantity I wouldn't even think of verifying.. I'd just give em a box and call it a day, my main issue was the sig. I called and verified and it was ineed 2 sprays in each nostril once daily. (flonase can also be given 1 spray in each nostril daily if symptoms improve so there is no standard 1 sig). Was I being too vigilant?

About the OP though, I would definitely NOT call on that quantity. If no days supply were given though, I would call.

With that sig, I would fill it exactly as written... Use two sprays in the nose daily...and do 1 box = 120 actuations =60 days supply. If the doc wanted it as two sprays in each nostril daily, he should probably write that...instead of writing it incorrectly.

 

[Rockinacoustic]

With that sig, I would fill it exactly as written... Use two sprays in the nose daily...and do 1 box = 120 actuations =60 days supply. If the doc wanted it as two sprays in each nostril daily, he should probably write that...instead of writing it incorrectly.

I see this sig a lot. Problem is most insurances won't pay for a 60 day supply on 1 box of flonase. I end up just filling it as a 30 day supply with directions: "Instill 2 sprays daily as directed."


How about: albuterol MDI "2 puffs prn"
Call the prescriber or just add 'q4-6h prn' and dispense?

 

[Carboxide]

I see this sig a lot. Problem is most insurances won't pay for a 60 day supply on 1 box of flonase. I end up just filling it as a 30 day supply with directions: "Instill 2 sprays daily as directed."


How about: albuterol MDI "2 puffs prn"
Call the prescriber or just add 'q4-6h prn' and dispense?

If insurance won't pay, then I knock it down to 30ds. I try the 60 first, though. Package size can't be broken so such is life.

Albuterol...I'd have to call, I think because I've seen it QID PRN instead. It only matters for days supply. I don't think q 4-6h prn is unreasonable...but if you don't have a frequency you can get nailed by audit and lose the payment.

 

[farmadiazepine]

My experience with over night pharmacists is that they are super cautious about filling scripts because they don't have the experience of a day time pharmacist. The day time staff at that store might see it and go "lol fill it". The over night is more cautious and would want to ensure correct dosing. Which is why they are over night. They wouldn't last a whole shift during the day in the same store.

Just bc an rph is an overnighter doesn't mean they are more cautious, or don't have experience, or don't know what to do, or can't hack it during a day shift at the same store.

What you wrote is an insult to me. Don't insult your night rph's. You never know what it is until you do it. Your generalizations are plain ignorant.

 

[g40631]

How about EMR scripts for more expensive, uncommon dosage forms?

I.E. -

Hydrochlorothiazide 12.5 mg tablets (capsules of course are the always used and much less expensive option)

Omeprazole 20 mg tablets (these are OTC, as compared to DR capsules).

Do you call to change or just change yourself? Generally, your average person manipulating the drop down menu probably doesn't really get the difference, but in the world of misbranding, it could count I guess.



How about this one?

Hydrocortisone 2.5 % apply BID

Do you call to see if the doctor wants cream or ointment, or do you just pick one out yourself? This question is true for any topical of course.

I do find myself calling quite often on peds scripts in my area, but only because the pediatricians in my area have ATROCIOUS handwriting. You would think pediatricians would have more neat handwriting because of the patient population they're dealing with, but no. It infuriates me seeing absolute chicken scratch for pediapred, azithromycin, and some cough medicine for 1 year old. I'd rather be 100 % clear then only 90 % clear so I call on the unclear ones every single time.