How many MD errors do you catch every day?

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MindOverMatter

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This thread is primarily for the retail people, but I'm sure this isn't confined to just the retail setting, so hospital pharmacists feel free to chime in too.

I was wondering how many others out there are amazed at the volume of errors that are sent to our pharmacies on a daily basis? My store does ~1500 rx's/week, and I would say that on any given week, I have to call the doctor for about 40-50 errors that would have led to patient harm if I just let it slide by. My partner does the same, so this makes about 80-100 of 1500 rx's that have blatant errors. Not the highest success rate by any means.

These mistakes can be anything from the wrong patient, wrong drug, duplicate therapies, allergies, interactions, or just quantities/strengths that don't make sense. In regards to e-rx, sometimes I feel that the doctors/nurses are just typing "asdklfa" in the program and hitting "send" without checking anything at all.

It is astonishing to me that they are allowed to operate with this level of ineptitude. If we filled prescriptions with this rate of success we would all be jobless. How are the doctors allowed a free pass?
 
This thread is primarily for the retail people, but I'm sure this isn't confined to just the retail setting, so hospital pharmacists feel free to chime in too.

I was wondering how many others out there are amazed at the volume of errors that are sent to our pharmacies on a daily basis? My store does ~1500 rx's/week, and I would say that on any given week, I have to call the doctor for about 40-50 errors that would have led to patient harm if I just let it slide by. My partner does the same, so this makes about 80-100 of 1500 rx's that have blatant errors. Not the highest success rate by any means.

These mistakes can be anything from the wrong patient, wrong drug, duplicate therapies, allergies, interactions, or just quantities/strengths that don't make sense. In regards to e-rx, sometimes I feel that the doctors/nurses are just typing "asdklfa" in the program and hitting "send" without checking anything at all.

It is astonishing to me that they are allowed to operate with this level of ineptitude. If we filled prescriptions with this rate of success we would all be jobless. How are the doctors allowed a free pass?

Cant speak for all doctors, but not once has a pharmacist ever called me on an error that would have led to patient harm.
 
I probably encounter an error that would potentially KILL someone about once every 1 to 2 weeks. As far as general patient harm, probably a similar amount - e.g. infant with serious issues getting sildenafil dose cut in half accidentally, etc.

Vistaril: you've already made it clear on many pharmacist threads that you're perfect. We get it, okay?
 
When I worked retail (and I may go back depending on my job search) I worked evenings and weekends. The pharmacist would catch a few errors in the evenings, usually less than 10. During the day when the receiving volume is higher I would imagine more errors being caught. I know of a few cases where life-endangering errors were caught, I know of one where the pediatrician actually refused to change what she had written (she chewed the pharmacist out too) and the child had a serious reaction as a result.
 
I guess it depends on what you consider an error. We do not have nearly that many calls on errors I think.

We do get several scripts probably almost every day written for controls by PAs, which is not valid in my state. So I guess that could be counted as an error and push up our number. We also get CII and other controls not written the way they need to be or otherwise not valid.

But actual errors in the sense of dose, interactions, general stupidness, not that many I think. :shrug:
 
I work inpatient/consult and often field the calls from outpatient pharmacies for our patients who recently discharged from the hospital. The majority of these calls are for minor things, I can not ever remember anything dangerous or life threatening. Most of the time they are not familiar with our patient population and the pharmacotherapy involved, I just assure them that, "yes, that is what we want the patient on but I appreciate you calling to double-check and looking out for the patient;'s wellbeing."

My partner can not remember the last time a pharmacist ever called her about one of her prescriptions.
 
I work inpatient/consult and often field the calls from outpatient pharmacies for our patients who recently discharged from the hospital. The majority of these calls are for minor things, I can not ever remember anything dangerous or life threatening. Most of the time they are not familiar with our patient population and the pharmacotherapy involved, I just assure them that, "yes, that is what we want the patient on but I appreciate you calling to double-check and looking out for the patient;'s wellbeing."

My partner can not remember the last time a pharmacist ever called her about one of her prescriptions.

oh I get a fair number of calls from pharmacists and pharmacies, but it's never a clinical issue. It's also something like pt needing a new prior authorization. In my entire life(both as a customer picking up medications and a physician) I don't think I have ever had a clinical conversation with a pharmacist.
 
oh I get a fair number of calls from pharmacists and pharmacies, but it's never a clinical issue. It's also something like pt needing a new prior authorization. In my entire life(both as a customer picking up medications and a physician) I don't think I have ever had a clinical conversation with a pharmacist.

I wonder if you meant to say "It's always something like..."?

No big deal, just stood out to me for some reason.

It is nice that you have never written a script that was dangerous or silly (or at least, that you don't remember being called about) but that is pretty rare. I have heard it said that there are two kinds of pharmacists: those who make mistakes and those who claim not to. I bet the same is true for all professions.
 
I wonder if you meant to say "It's always something like..."?

No big deal, just stood out to me for some reason.

It is nice that you have never written a script that was dangerous or silly (or at least, that you don't remember being called about) but that is pretty rare. I have heard it said that there are two kinds of pharmacists: those who make mistakes and those who claim not to. I bet the same is true for all professions.

oh Im sure I have written plenty of scripts that were potentially dangerous. But that's a much different thing than have I ever been called by the pharmacy to inform me of that. And that's not a knock on pharmacists- in most cases pharmacists just don't have the information needed to really determine a lot of the dangerous stuff.
 
In a retail setting, unless an RX is really screwed up, it's kind of hard to make a clinical intervention. We have no idea of the patient's labs or even their diagnoses, beyond what they tell us. Obviously we have the list of other meds we filled for them so we can spot interactions or duplicates, but that only gets you so far. Most interactions I call about are with abx, and the answer is either "we are aware and will be checking their INR on thursday anyway" or "okay they can skip their simvastatin for 3 days." We don't know renal function, so we can't recommend dose adjustments. We can't use an antibiogram either, so it's not like we can call and say Cipro was a poor choice.

The only time I can remember that I made an actual clinical intervention in retail was in an asthmatic who was refilling Ventolin way too often and I recommended a step up from flovent to Advair. Granted I haven't been in the game for long and I'm in a pretty slow store, but that's the only one I can think of right now. I wish we got more info to work with, so we could actually be more useful.
 
In a retail setting, unless an RX is really screwed up, it's kind of hard to make a clinical intervention. We have no idea of the patient's labs or even their diagnoses, beyond what they tell us. Obviously we have the list of other meds we filled for them so we can spot interactions or duplicates, but that only gets you so far. Most interactions I call about are with abx, and the answer is either "we are aware and will be checking their INR on thursday anyway" or "okay they can skip their simvastatin for 3 days." We don't know renal function, so we can't recommend dose adjustments. We can't use an antibiogram either, so it's not like we can call and say Cipro was a poor choice.

The only time I can remember that I made an actual clinical intervention in retail was in an asthmatic who was refilling Ventolin way too often and I recommended a step up from flovent to Advair. Granted I haven't been in the game for long and I'm in a pretty slow store, but that's the only one I can think of right now. I wish we got more info to work with, so we could actually be more useful.

yep....I do think retail pharms would catch more useful errors if they had useful data. Of course the downside to that(having more information and actually trying to serve some sort of clinical role/safeguard) would be that production would slow dramatically and profits would decrease(and theerefore salaries)....
 
the problem isn't necessarily with the doctors, its the nurses or the staff that writes or enters the escript.
 
Ballpark? Once an hour I have to page a doc for clarification - they vary in severity from ordering the wrong item from a pt's history (metoprolol vs. metoprolol XL) to ID issues like a doc ordering ceftriax/azithro for PNA when the pt actually came from an LTAC.

Order sets cut down on a lot of errors since things are essentially preprogrammed.

We have a lot of protocols so we just change doses ourselves for renal function or autosub things...I have working relationships with a lot of docs where I just change it myself and ping them a message in our CPOE system for them to co-sign it later.

Saves them a page, saves everyone time, pt gets treatment faster. Win-win-win.
 
the problem isn't necessarily with the doctors, its the nurses or the staff that writes or enters the escript.

I don't even count these, nurses are always messing up orders (mostly new ones) - not their fault, they've got a million other things going on and really physicians should be the ones putting in orders if they're on site (unless it's like a clear, emergent, one time thing). I catch maybe 6-7 of these a day that need some sort of fixing...usually minor though...and for some reason it's usually PRN orders of some sort.
 
Then add another 2-3 a day of a physician ordering stuff that's restricted at the hospital due to shortages - like we have injectable phos issues and we'll have to dig deeper if the pt has critical levels and symptomatic.

It's not a med error per se (right drug, dose, etc...) just a provisioning/rationing thing.

Oooh did I just say ration? The death panels are gonna get me.:meanie:
 
I wonder if you meant to say "It's always something like..."?

No big deal, just stood out to me for some reason.

It is nice that you have never written a script that was dangerous or silly (or at least, that you don't remember being called about) but that is pretty rare. I have heard it said that there are two kinds of pharmacists: those who make mistakes and those who claim not to. I bet the same is true for all professions.

I like that.
 
Back in the hospital days, several a day. I've seen several physicians make the type of common, sometimes potentially fatal mistake you see all the time. (i.e., order 20mg of enalaprilat IV STAT for very high HTN...because, you know, its what the patient takes PO)

In retail, its not as bad. Ambulatory patients are less likely to be given things that might be dangerous, so you see it less. I recall seeing a person prescribe 500mg of Tramadol to a 5 year old. I have a feeling (hope) that was a typographical error and not a real one. But its stuff like that. Stuff so stupid that I doubt they meant it.
 
I work at night (for now) so I usually deal with PGY-1 and PGY-2 med residents. Mostly their errors are renal dosing and errors of omission. Fortunately at our hospital we have automatic protocols to renally adjust most antibiotics. In addition we have authority to order labs (INRs for new warfarin start) and concomitant medications (such as hypoglycemia order set for patients on sulfonylureas, or insulin drip, etc).

I will say med residents are very nice and eager to learn. It's all about how you call them and ask them though. I hate to see rude pharmacists on the phones badgering them about an error or formulary choice. I'm always very cordial to them. And to this date I've never had one blow up at me. Then again I don't call about stupid things. And I don't press them if they want to keep the order as is for something minor---- obviously they aren't getting 500mg of tramadol for a child.
 
OP must have some sloppy doctors in the area. I question a prescription a few times a day, and usually that's something that wouldn't really be dangerous, like a switch from metformin er to metformin (ir) for no apparent reason. A few times a week I'll see something prescribed that the patient is allergic to, but other clinical problems are rare. The majority of the time I contact the doctor, the prescription wasn't clear or it had something to do with insurance.

Walmart is trying to address the issue that we don't have much information to work with - they want us to try to get a complete medical history (allergies, medical conditions, and medications taken from other pharmacies or otcs) from every patient every six months. They will probably encounter a lot of resistance from the pharmacies, who won't want to do the extra work.
 
This thread is primarily for the retail people, but I'm sure this isn't confined to just the retail setting, so hospital pharmacists feel free to chime in too.

I was wondering how many others out there are amazed at the volume of errors that are sent to our pharmacies on a daily basis? My store does ~1500 rx's/week, and I would say that on any given week, I have to call the doctor for about 40-50 errors that would have led to patient harm if I just let it slide by. My partner does the same, so this makes about 80-100 of 1500 rx's that have blatant errors. Not the highest success rate by any means.

These mistakes can be anything from the wrong patient, wrong drug, duplicate therapies, allergies, interactions, or just quantities/strengths that don't make sense. In regards to e-rx, sometimes I feel that the doctors/nurses are just typing "asdklfa" in the program and hitting "send" without checking anything at all.

It is astonishing to me that they are allowed to operate with this level of ineptitude. If we filled prescriptions with this rate of success we would all be jobless. How are the doctors allowed a free pass?

That's one reason why we have pharmacists... Right?
 
That's one reason why we have pharmacists... Right?

+ 1

Isn't that one of the main roles of pharmacists.. (Plus counseling.. which I have found most people prefer to read the drug information label every time I ask if they need counseling).. to double check & catch errors on medications & interactions?.. That's one of their main jobs.

I guess doc's aren't allowed to make any mistakes whatsoever?

I've worked as a tech for a few years & have seen many instances where the pharmacist gives the patient the completely wrong drug. For example, giving them someone else's medication.
 
errors that are going to kill a patient? few, if none at all.. i have yet to find anything like that.

errors though? a lot..

these are the most common ones i see and the few that i remember

levaquin bid
oxycontin's written q2-3 hrs prn
chloroquine written for hydroxychloroquine
quinine vs quinidine
bid meds written for qd but then qd meds written for bid

most of the errors are simply clerical.. missing strength or missing qty or mix up of drug names and strengths in the same class.. etc


in terms of making actual clinical interventions, its few. most of them are duplicate therapy like patients having more than 1 ace-inhibitor on board with an arb or two, or using multiple nsaids all at the same time, and some interactions, and some allergies, and some high doses.

most of the 'patient may die' errors actually come from the pharmacy itself in my opinion. reading coumadin 5 instead of clarinex 5. typing up oxcarbazepine 600 for oxaprosin 600, rph always overriding high dose alerts for pediatric pts like bromfed dm for a 1 year old etc..
 
oh I get a fair number of calls from pharmacists and pharmacies, but it's never a clinical issue. It's also something like pt needing a new prior authorization. In my entire life(both as a customer picking up medications and a physician) I don't think I have ever had a clinical conversation with a pharmacist.

Just another reason why I'm slowly being disillusioned with hospital pharmacy. It's no different from retail pharmacy except the rude customers are replaced with arrogant nurses and physicians. They don't want our help anyway.
 
Originally Posted by klaurent02 View Post
the problem isn't necessarily with the doctors, its the nurses or the staff that writes or enters the escript.

yep. that's about right.
 
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Just another reason why I'm slowly being disillusioned with hospital pharmacy. It's no different from retail pharmacy except the rude customers are replaced with arrogant nurses and physicians. They don't want our help anyway.

except you can fix that (i've seen culture changes in house)... you can't exactly fix the stupid public.
 
errors that are going to kill a patient? few, if none at all.. i have yet to find anything like that.

errors though? a lot..

these are the most common ones i see and the few that i remember

levaquin bid
oxycontin's written q2-3 hrs prn
chloroquine written for hydroxychloroquine
quinine vs quinidine
bid meds written for qd but then qd meds written for bid

most of the errors are simply clerical.. missing strength or missing qty or mix up of drug names and strengths in the same class.. etc


in terms of making actual clinical interventions, its few. most of them are duplicate therapy like patients having more than 1 ace-inhibitor on board with an arb or two, or using multiple nsaids all at the same time, and some interactions, and some allergies, and some high doses.

most of the 'patient may die' errors actually come from the pharmacy itself in my opinion. reading coumadin 5 instead of clarinex 5. typing up oxcarbazepine 600 for oxaprosin 600, rph always overriding high dose alerts for pediatric pts like bromfed dm for a 1 year old etc..

You don't think that Oxycontin q2-3 prn instead of BID would kill someone? Because I think it's a serious possibility.
 
You don't think that Oxycontin q2-3 prn instead of BID would kill someone? Because I think it's a serious possibility.

Not likely. The key there is the PRN. ATC, yes.
 
Not likely. The key there is the PRN. ATC, yes.

I'll disagree, nurse A hits a pt with some oxycontin for breakthrough pain and 2hrs later he's still in pain (gee, i wonder why), gets another dose...next thing you know he's desatting and not waking up.

You pair it with a shift change and/or an overloaded nurse, classic swiss cheese.
 
I'll disagree, nurse A hits a pt with some oxycontin for breakthrough pain and 2hrs later he's still in pain (gee, i wonder why), gets another dose...next thing you know he's desatting and not waking up.

You pair it with a shift change and/or an overloaded nurse, classic swiss cheese.

Seen this before for sure.
 
I actually catch alot. Most common is kcl mag sulfate kphos amiodarone and alot of iv without rate just a x1. In pediatric and Nicu is wrong baby or wrong frequency or something like 100mg/kg/day but 100mg/kg per dose. High in and vanco and still order high dose med. The more info I have at hospital the more I can use it to make a clinical judgements

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An error that would truely hospitalize a patient? Maybe 1 a month. Stupid stuff? Maybe 2-3 a day. The most common is dumping acute 3a inhibitors on old people on statins or 2c inhibitor on stable warfarin
 
I actually catch alot. Most common is kcl mag sulfate kphos amiodarone and alot of iv without rate just a x1. In pediatric and Nicu is wrong baby or wrong frequency or something like 100mg/kg/day but 100mg/kg per dose. High in and vanco and still order high dose med. The more info I have at hospital the more I can use it to make a clinical judgements

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ALOT.png




In honor of Owle.
 
Yesterday I got a script from the ER written by a PA that dosed Amoxicillin to 30kg 6 year old at 90 mg/kg/day. She "forgot to limit it to the adult max" Not really life threatening but eh
 
I probably encounter an error that would potentially KILL someone about once every 1 to 2 weeks. As far as general patient harm, probably a similar amount - e.g. infant with serious issues getting sildenafil dose cut in half accidentally, etc.

There are scenarios where it is perfectly appropriate to cut a sildenafil dose in half. Depends on the clinical context.
 
The only time I can remember that I made an actual clinical intervention in retail was in an asthmatic who was refilling Ventolin way too often and I recommended a step up from flovent to Advair. Granted I haven't been in the game for long and I'm in a pretty slow store, but that's the only one I can think of right now. I wish we got more info to work with, so we could actually be more useful.

I dont necessarily agree with this.

99% of the time the problem is non-compliance w/ flovent in this situation. They only use it when they are "sick" as opposed to daily controller therapy regardless of symptoms.

With the mortality issues of long acting beta agonists, I use them only as a last resort when I'm absolutely SURE that they are on a high dose of flovent and really using it every day, as well as using the proper inhalation technique (which most dont)
 
We have a lot of protocols so we just change doses ourselves for renal function or autosub things...I have working relationships with a lot of docs where I just change it myself and ping them a message in our CPOE system for them to co-sign it later.

Saves them a page, saves everyone time, pt gets treatment faster. Win-win-win.


IMHO this is a silly system.

If the changed med/dose actually gets cleared to get to the patient BEFORE the "co-sign" then I would argue it is a system based on fraud (yes, I know, you didnt design it you just follow the rules). Why have anybody "co-sign" it when it is YOUR decision and YOUR license that should be at stake?

If the med/dose change does not go to the patient before the "co-sign" then it doesnt save any time.
 
There are scenarios where it is perfectly appropriate to cut a sildenafil dose in half. Depends on the clinical context.

Sure, but when we page on them and the doc says, "Oh, yeah, that was an accident, switch that back to BID" you can be pretty sure they don't qualify...
 
Yesterday I got a script from the ER written by a PA that dosed Amoxicillin to 30kg 6 year old at 90 mg/kg/day. She "forgot to limit it to the adult max" Not really life threatening but eh

Sorry to ask but is it for acute OM? I am aware of the usual 1750 mg max adult dosing; however, I've seen 1.9g / day for acute OM in children. Besides, doses up to 3-4g QD (or 90mg/kg/ day) have been used in C.A.P. (although I have not seen this quite often) Sorry I have to ask but this post just get stuck in my mind the entire morning. Usually when I got Rx for amoxil susp. (and I got a lot of these due to us being next to a peds clinic and an ER), I ask the parent their kid's weight and I can, quite often, find out the dx (usually they tell me "it' strep" or "it's the ears") and I go from there to verify dosing. Anyone else have another quick protocol they use when verify Amoxil Rx for kids? Please educate me.... thanks...😍
 
Ultram ER 200 mg
#120
1-2 tablets every 6 hours as needed for pain.

So what would be the effect of 1600mg/day of Tramadol on a 65 y/o woman? Call the doctor's office and they say, yep that's what the doctor wants. I tell them to ask the doctor review it as it's way way way over the maximum recommended daily dose and by the way, I won't dispense that as written.

They e-scribe an Rx for Ultram 50 mg q6. DUH.....
 
I am currently having a lot of issues with the Combivent Respimat transition. Physicians don't seem to realize that it is dosed 1 puff qid. There have been times when I call for the new rx I tell them how to dose, and yet, they write the long thing. The upside is if they write incorrectly, I can bill for the intervention.
 
I hate how doctors don't know how to write for the new Combivent. Now, what I constantly see is them writing for the new Combivent, same directions, 2 puffs QID, and dispense #2 packs.

Also, I have seen someone getting tramadol ER 300mg QID. I thought this was a joke, but apparently it was the patient's 4th refill or something. Talk about starting to put yourself at risk for seizures.
 
Sorry to ask but is it for acute OM? I am aware of the usual 1750 mg max adult dosing; however, I've seen 1.9g / day for acute OM in children. Besides, doses up to 3-4g QD (or 90mg/kg/ day) have been used in C.A.P. (although I have not seen this quite often) Sorry I have to ask but this post just get stuck in my mind the entire morning. Usually when I got Rx for amoxil susp. (and I got a lot of these due to us being next to a peds clinic and an ER), I ask the parent their kid's weight and I can, quite often, find out the dx (usually they tell me "it' strep" or "it's the ears") and I go from there to verify dosing. Anyone else have another quick protocol they use when verify Amoxil Rx for kids? Please educate me.... thanks...😍

It was for an ear infection (dosed at 90mg/kg/day)but a tdd of 2.7g is way high. Just about double the adult dose and a far cry from 1.9 grams. It was obviously an error becaue then PA admitted to it when I talked to her.
 
I dont necessarily agree with this.

99% of the time the problem is non-compliance w/ flovent in this situation. They only use it when they are "sick" as opposed to daily controller therapy regardless of symptoms.

With the mortality issues of long acting beta agonists, I use them only as a last resort when I'm absolutely SURE that they are on a high dose of flovent and really using it every day, as well as using the proper inhalation technique (which most dont)

Socrates is spot on here, I saw this maybe 4x/day on my ambulatory peds rotation. Patient isn't taking the preventative flovent and thus has multiple flare ups and only takes flovent when a flare up occurs DESPITE telling them every damn time they're in the office how it's supposed to be done.

Don't recommend a step up in the asthma regimen unless you are 100% sure the patient is 100% compliant and still having issues, and even then you should be increasing the steroid before moving to a long acting beta 2

Prophylaxis >>> Acute Treatment
 
Also just for mentioning purposes. I saw a LOT of errors when I worked in pharmacy before going to med school but most of those were PA's or NP's doing something ******ed with their calculator-dosing. Amoxil 250mg/5mL Give 4.873mL PO BID x10. I would just shake my head as a queen latifah sized ghetto mamma with her kids screaming everywhere stood in front of me while I knew she had never heard of an mL in her life. There were only a handful of very serious mistakes within my 4yrs and only one (a PA) was not receptive to our call.

Since I joined med school, I have yet to see a single physician that wasn't absolutely grateful for any calls from a pharmacist when it came to dosing or interactions. Most physicians I've worked with respect pharmacists and definitely the residents & med students love it when a pharmacist is willing to calmly take the time to explain a dosing protocol or why something is done one way versus the other because it makes everyone's lives better. Honestly on this side of the perspective though, as far as my ambulatory training, most of the errors I've seen were simply due to interactions with drugs that the patient claimed to not be taking from a doc the patient claimed to not be seeing. All the time we get people who are seeing multiple physicians and still taking drugs from others while claiming to be exclusively there and taking only your meds. It's frustrating to say the least.
 
IMHO this is a silly system.

If the changed med/dose actually gets cleared to get to the patient BEFORE the "co-sign" then I would argue it is a system based on fraud (yes, I know, you didnt design it you just follow the rules). Why have anybody "co-sign" it when it is YOUR decision and YOUR license that should be at stake?

If the med/dose change does not go to the patient before the "co-sign" then it doesnt save any time.

I think my post implied I'm changing doses outside of protocol...not meant that way.

It's not a systems thing, it's a professional relationship I've forged with an individual provider wherein I act on their behalf within a limited subset of mutually agreed upon issues. This especially comes into play with our night float when there's just not enough time for things.

The changes I'm referring to involve dosage form changes, blatant duplications, timing, not using pre-determined order sets, etc... that technically-on-paper require prescriber's verbal/written order to change/discontinue.

I don't know anyone here that would actually page a physician to change Nexium from tablet to oral suspension, for example.

Some make the argument that I'm simply reading a prescriber's intent and filling orders appropriately.

The intent of the "co-sign" part of it signals to the physician that I did something on their behalf...we have the ability to do things and mark "no cosign" that does not ping the physician (i use this most often).

So it becomes a tiered system of:
1) "I'm just going to change this and mark 'no co-sign' because Dr. X told me 'feel free to fix this, this and this without calling me.'"
2) "I'll fix this order and mark it co-sign so Dr. Y knows what I modified it, don't really need it ahead of time."
**rarely used, it better be benign**
3) "This is weird - I'm going to page/call Dr. Z, either have him fix it or just take a verbal order."

So to address your post, absent renal protocols, I rarely change doses without consulting the physician. If I get a PNA dose for an abx when the chart says they're in for a UTI, I'm gonna talk to the person who actually listened to their lungs.
 
Socrates is spot on here, I saw this maybe 4x/day on my ambulatory peds rotation. Patient isn't taking the preventative flovent and thus has multiple flare ups and only takes flovent when a flare up occurs DESPITE telling them every damn time they're in the office how it's supposed to be done.

Don't recommend a step up in the asthma regimen unless you are 100% sure the patient is 100% compliant and still having issues, and even then you should be increasing the steroid before moving to a long acting beta 2

Prophylaxis >>> Acute Treatment
Patient was overusing both. Don't remember the details since it was a while ago, but she was filling both flovent and albuterol every 20ish days. She was on therapy for a long time and was gradually deteriorating. Also wasn't a peds patient, she was in her 40-50s.
 
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