Getting doctors to change the prescription.

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crimson1566

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This guy at our pharmacy has been getting percocet 10/650 3tab tid for the last 4-5 years. I got the rx to verify today and called the Md to try and change it since he's getting 5850mg of tylenol a day. The doctor wouldn't budge. He said the guy's been getting that forever and then asked why someone didn't complain about this 4 years ago. I asked the md if his liver profile is normal and he said it is fine. I asked the Md to switch to 10/325 and that he could still give 3 more tabs/day if it didn't work as well as the 10/650 and he'd still be ok for the tylenol dose. He didn't seem to care that he's giving almost 2gms over the 4gm/day limit. So i documented and wrote a note on the rx to the patient about how the tylenol dose is too high. Is there anything else i could do? If i didn't verify it one of the other pharmacists just would've like they had been before, we had 2 other pharmacists on that day.
 

Doctor M

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I guess if it aint broke dont fix it, right? You did the right thing, which was to document document document.
 

imperial frog

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I guess if it aint broke dont fix it, right? You did the right thing, which was to document document document.

You could slip the patient a bottle of NAC each time he comes in.
 

greatdeals225

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the MD probably doesn't care.. coz the patient might not be taking all of them himself..... he's probably selling them for higher price, and getting high on sthg else!
 

crimson1566

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that's basically what the other pharmacists said, that his liver would be fine because he's most likely selling them. I don't work in the best area. Just kinda pisses me off that the doctor wouldn't correct something so obvious.
 

SELDANE

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Short of refusing to fill the prescription, you did everything that you could do. You consulted with the MD, documented your conversation, and counseled the patient about your concerns. I don't think I would have done anything different.
 

Doctor M

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3 years into practice and i am starting to see the light at the end of the tunnel: Fill every script that comes through my hands. This is the message i get from some pts. "Well my doc wrote it that way, so you have to fill it that way"!:scared: Whatever, i fill what i feel is safe and call the doc when i feel it is not. "C.Y.A" is all i gotta say!
 

GravyRPH

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I hate to break it to you, but even if you document you can still be held liable. You know over 4grams can be fatal, so even if the doctor says "just do it!" doesn't make everything OK.

On the other hand, refusing to fill doesn't get you out of trouble. You have to be careful there too.

I would explain to the patient why I wasn't filling it, give him what I feel the doctor should prescribe and why, and have him take it up with the doctor or fill it elsewhere.

I would have a much easier time explaining to a jury why I didn't fill it then trying to explain why I filled a potentially fatal dose just because a doctor said to.
 

greatdeals225

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I hate to break it to you, but even if you document you can still be held liable. You know over 4grams can be fatal, so even if the doctor says "just do it!" doesn't make everything OK.

On the other hand, refusing to fill doesn't get you out of trouble. You have to be careful there too.

I would explain to the patient why I wasn't filling it, give him what I feel the doctor should prescribe and why, and have him take it up with the doctor or fill it elsewhere.

I would have a much easier time explaining to a jury why I didn't fill it then trying to explain why I filled a potentially fatal dose just because a doctor said to.

you definitely got a point. but I thought as long as we documented, the responsibility is of the malpractice of the MD......

the MD probably doesn't wanna change it coz he doesn't want another angry patient on his shoulders.... and he's cool charging regular copays to that guy every 2 weeks he needs a new rx... lol...

and I don't think you can give the pt what u think is right, especially when it comes to a C2
 

BMBiology

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It is not just on the MD but also the pharmacist who filled it especially if the pharmacist didn't inform the patient of the potential overdose on tylenol.

Tylenol overdose caused more than half of the acute liver failures in the U.S!
 

Farmercyst

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you definitely got a point. but I thought as long as we documented, the responsibility is of the malpractice of the MD......

the MD probably doesn't wanna change it coz he doesn't want another angry patient on his shoulders.... and he's cool charging regular copays to that guy every 2 weeks he needs a new rx... lol...

and I don't think you can give the pt what u think is right, especially when it comes to a C2

My understanding is that it could still come back to bite you. Let's say next week this guy goes in with acute liver failure and you've documented (as you should have) that he's being deliberately prescribed APAP OD. You gave him his meds anyway at a dose you knew would cause OD despite your better judgement. Sounds like legal problem to me. Then again I'm not even a P-1 yet. I'm guessing refuse to fill would have been the better way if you can't change the script.
 

pkpd

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I hate to break it to you, but even if you document you can still be held liable. You know over 4grams can be fatal, so even if the doctor says "just do it!" doesn't make everything OK.

On the other hand, refusing to fill doesn't get you out of trouble. You have to be careful there too.

I would explain to the patient why I wasn't filling it, give him what I feel the doctor should prescribe and why, and have him take it up with the doctor or fill it elsewhere.

I would have a much easier time explaining to a jury why I didn't fill it then trying to explain why I filled a potentially fatal dose just because a doctor said to.

I agree!!
 

Farmercyst

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Besides they doctor is bound to change if everyone either refuses to fill or calls each time he brings it in.
 

aphistis

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I hate to break it to you, but even if you document you can still be held liable. You know over 4grams can be fatal, so even if the doctor says "just do it!" doesn't make everything OK.

On the other hand, refusing to fill doesn't get you out of trouble. You have to be careful there too.

I would explain to the patient why I wasn't filling it, give him what I feel the doctor should prescribe and why, and have him take it up with the doctor or fill it elsewhere.

I would have a much easier time explaining to a jury why I didn't fill it then trying to explain why I filled a potentially fatal dose just because a doctor said to.

Definitely. You know that's way too much APAP. If you're afraid to exercise some professional judgment in a clear-cut case like this, you're pretty much reducing yourself to the role of highly-paid narcotic Pez dispenser.
 

greatdeals225

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i asked my pharmacist today, and she said that before fillng she would have the doctor mail in a written document to prove that he is aware of the tylenol dose and still wanted to dispense it....

what'd you guys think about that?
 

BMBiology

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Why put yourself in legal troubles? Just use your professional judgement and refuse to dispense the medication. Not only do you have the legal authority but you also have moral obligation to not dispense a medication that you know may cause great harm to the patient.
 

WSU2007

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Sounds pretty fishy. I would be interested in knowing why this PT needs such a strong pain med for 3-4 years. Is this MD a Pain Mgmt. Specialist or Oncologist? If not I would raise an eyebrow or 2! In addition to the APAP overdose what about narcotic addiction or possible diversion. You should investigate. Depending on your state regs you may be able to view the patients filling habits for controls at other pharmacies. I would never let a doctor tell me to shut up and fill it, especially for a C-2. You have a responsibility to the patients safety. There are crooked Dr.'s out there as well as jackasses too.
 

MountainPharmD

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You must always remember you have a shared responsibilty with the physician to ensure the prescription is correct and appropriate. The doctor can write all the prescritions in the world. There is nothing that states you have to filll them.

You better believe if this patient's liver fails you will get sued right along with the physician and likly lose. You can write a ten page note about your conversation with the doctor. What matters in the end is you knew it was inappropriate but filled it anyway.

This is actually a very good topic and lesson for all the students out there.
 

MountainPharmD

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Sounds pretty fishy. I would be interested in knowing why this PT needs such a strong pain med for 3-4 years. Is this MD a Pain Mgmt. Specialist or Oncologist? If not I would raise an eyebrow or 2! In addition to the APAP overdose what about narcotic addiction or possible diversion. You should investigate. Depending on your state regs you may be able to view the patients filling habits for controls at other pharmacies. I would never let a doctor tell me to shut up and fill it, especially for a C-2. You have a responsibility to the patients safety. There are crooked Dr.'s out there as well as jackasses too.

This is nothing. I could give you a list of 20 patients at my pharmacy that are getting pain meds that I feel is bordering on inappropriate. The question is what do you do about it? Do you refuse to fill the scripts knowing they will go some where else.
 

greatdeals225

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I heard that patients can complain about pharmacist so and so refusing to fill their scripts. My pharmacist said that there is always a fine line, that's what they taught her in pharm law class. Basically, no one knows whether a "yes-to fill" or "no-won't fill" will be to your advantage or not until you get to court....

lots of grey areas ....
 

WVUPharm2007

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Some day there will be a disgruntled pharmacist that will become a serial killer who goes around killing physicians who do not listen to their advice or respond to inquiries of pharmacists in a timely manner.


One can dream, anyway......ah, to have a crazy person to do your dirty work....
 
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