Issue That Came Up Working @ the Pharmacy...

[justyliz]

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Hey all,

I was working at my pharmacy a couple nights ago and there was an issue that came up with a controlled substance, percocet. The script was written for percocet (surprise, surprise), however the doctor was not in our database and did not have a DEA #. I basically told the patient that I couldn't fill her script because we had no information about the doctor in our databases. The patient then proceeded with a series of expletives that I won't repeat for everyone's sake that ended with "I'm never going back to this pharmacy again!" However, after further investigating the issue (and after the patient left), I learned that the doctor was a new resident who had not been registered with the system. I'm wondering if you guys would have done the same thing if you were in my shoes... Thanks for any input!

 

[sdn1977]

Hey all,

I was working at my pharmacy a couple nights ago and there was an issue that came up with a controlled substance, percocet. The script was written for percocet (surprise, surprise), however the doctor was not in our database and did not have a DEA #. I basically told the patient that I couldn't fill her script because we had no information about the doctor in our databases. The patient then proceeded with a series of expletives that I won't repeat for everyone's sake that ended with "I'm never going back to this pharmacy again!" However, after further investigating the issue (and after the patient left), I learned that the doctor was a new resident who had not been registered with the system. I'm wondering if you guys would have done the same thing if you were in my shoes... Thanks for any input!

Don't take this the wrong way, but given that you are pre-pharmacy & not the pharmacist....it was not your call to make.

It was up to the pharmacist to decide if he/she wanted to fill it, fill a partial, contact the hospital page operator to verify status of the resident..whatever.

But - it is not your choice to deny or accept an rx alone. You should have let the pharmacist make that decison.

I've gone both ways & it depends on the situation.

 

[Hels2007]

I agree with sdn1977 that this is something that requires "professional judgement" and therefore you need to be a credentialed person (an intern or a pharmacist, depending on the state) to make that call. It is illegal for a clerk or a technician to make decisions requiring "professional judgement" - not even tell someone to take Tylenol when they come and ask for something for a headache.

What I personally do, I call the hospital, and if the resident doesn't have a DEA yet the attending will put it under his (though I never had that happen with a CII, only with CIII). With a CII I would call, explain that I cannot fill it and suggest they call in a hydrocodone combo instead. Or get the correct script to the patient in some way.

Rereading, I see it's just the doctor wasn't in the system. That's easily fixed... call the hospital and ask for the DEA number of that doctor. And if the doctor him/herself comes up, explain gently but firmly that a DEA number of CIIs is NOT optional.

 

[BMBiology]

I agree with sdn1977. The pharmacist should have made the final decision. Just because a prescriber is not in system, doesn't mean the prescription is not valid. I would just call and add the prescriber in the computer system. I know pharmacists are cautious but when someone is in pain, you need to take that into great consideration before you deny someone of their pain meds.

 

[justyliz]

Don't take this the wrong way, but given that you are pre-pharmacy & not the pharmacist....it was not your call to make.

It was up to the pharmacist to decide if he/she wanted to fill it, fill a partial, contact the hospital page operator to verify status of the resident..whatever.

But - it is not your choice to deny or accept an rx alone. You should have let the pharmacist make that decison.

I've gone both ways & it depends on the situation.

Right, I completely agree with you. The pharmacist DID make the decision that he didn't want to fulfill the script and I let the patient know this. But it just makes me wonder if its right for an honest person who just wanted their meds not get them just because their prescribing doctor was a new resident. Perhaps this thread is useless, since the pharmacist already told me his opinion about the script. However, the altruistic side of me makes me sad that this honest person had to go through the trouble of going to another pharmacy because our pharmacist said NO.

 

[sdn1977]

Right, I completely agree with you. The pharmacist DID make the decision that he didn't want to fulfill the script and I let the patient know this. But it just makes me wonder if its right for an honest person who just wanted their meds not get them just because their prescribing doctor was a new resident. Perhaps this thread is useless, since the pharmacist already told me his opinion about the script. However, the altruistic side of me makes me sad that this honest person had to go through the trouble of going to another pharmacy because our pharmacist said NO.

This is the truth of being a tech. The decisons are alwasy those of the pharmacist who is supervising at the time.

Some of us have the ability to be there the next day, or who have knowledge of the particularly hospital & who works there, or who have "inside abilities" to get the information we need.....or who just feel comfortable filling enough for the night.

For whatever reason, your pharmacist didn't feel comfortable. I had concerns about a phenergan w/codeine a few nights ago & I dispensed 30ml for the night rather than the 240ml. The pt then left the area for home & never came back - I verified the rx the next day, but 30ml was gone & not paid for.

Oh well - the pt got enough for relief for the night - not enough to get really dopey, but I didn't get paid.

New pharmacists & relief pharmacists need to have lots of resources available - you can help with that by developing those resources (call your local teaching hospital dept of med & get a list of the new residents July 1) or they just get tired & don't have it in themselves to pursue all the resources they might have if it were at 10AM.

sorry for your situation, but its not your fault - no ones fault actually - it just is what it is!

 

[no-see-um]

I am usually able to sniff out who's a resident and would call the hospital directly and gain permission to add the attending's DEA# to the Rx. Follow your state laws when dealing with controlled substance Rxs as there may be some variance in what is allowable regarding what a pharmacist can add to an Rx, if omitted.

A technician has every right to take a glance at what they are taking from a patient- and it's good to have vigilant technicians, but with that said, any issues that arise must be immediately brought to the attention of the pharmacist on duty and action should not be taken unilaterally without the approval of that licensed pharmacist.

 

[Doctor M]

This happens everyday; a new resident writes for a narcotic and the new resident is nowhere to be found in the system. Personally, I never deny an rx from an ER for narcs (assuming the rx was from the ER). I just pick up the phone and get it done right. Denying an RX because the doctor is not found in the system doesn't seem right. Do everything you can to verify the rx and denying the RX is a last resort for a legitimate prescription. Now if the RX is from an office that is closed, then that is a different story. You cant really partial the Narc and you cant verify it. Thats where our professional judgement takes place! Anyway, every pharmacist practices differently; I've just learned to pick my battles wisely. Good luck!

 

[Epic]

I would think this is a typical issue around July...when the new residents roll in.

 

[Aznfarmerboi]

There is also something crucial missing here. For one thing, there is no DEA number. It is good practice (not sure if it is a national thing for it to be on the prescription by law), and something a resident should know, that the DEA number should be on the prescription. That way even if he isnt in the system, we can verify if by the number. If the check is real, just add the doctor. I know some residents dont have their DEA numbers yet still, use your attendings, or the hospital plus your designated suffix.

IMO, even though the next best thing to do is to call, if the rx doesnt have a DEA number, it is written for a CII, and the doctor isnt in the database, I can understand why the pharmacist handed it back. New resident or not, it is kind of obvious. It is like writting a RX without your name or signature on it.

 

[MountainPharmD]

This sort of ties in with that guys post on how to write scripts in the ER. A DEA number on a controlled substances should be a no brainer taught from day number 1. It goes right along with clearly printing everything and making sure what you write for actually exists.

From a legal stand point a prescriber cannot write for any controlled substances unless they have a valid DEA number. A pharmacist has a legal obligation to insure all controlled subtance prescriptions are legitimate and are written for a valid medical purpose. If I get a controlled substance rx on one of those generic hospital rx blanks and the prescriber did not write their DEA number on it I do what I can to verifiy it. If I cannot verifiy it and I do not know the patient or they have never filled at our pharmacy I tell them sorry no can do and move on to the next problem.