prescribing out of scope of practice

[vardenafil]

just curious if you guys in your practice encounter people with prescribing authority who dont stay in their scope of practice. there is this dentist in town who im currently butting heads with. He routinely writes prescriptions for people in a manner that can be deemed out of his scope of practice. ie... i have seen prescriptions from him for:

1. z-pak along with a codiene cough syrup and guafenisin/psudophedrine tablets (for what the pt described as a 'chest and head infection'.
2. synthroid with refills.
3. ambien 30 day supplies with several refills.
4. coumadin

when he calls these scripts in he is always am ass about it. i ask him if hes going to assume responsibility for monitoring the patients thyroid levels ect... when i question him he gets rude and beligerent. on the few occassions that i have refused to fill a script from him he states that he will call the board of pharmacy on me if i dont comply. do you guys run into situations like this? what do you guys do or would do in this situation. my manager is an ass he wont back me up on this. according to him i should fill everything without question. i just dont think that its in the patients best interest to have a dentist prescribing potentialy dangerous drugs when hes not obivously trained in that area of expertise.

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[Old Timer]

just curious if you guys in your practice encounter people with prescribing authority who dont stay in their scope of practice. there is this dentist in town who im currently butting heads with. He routinely writes prescriptions for people in a manner that can be deemed out of his scope of practice. ie... i have seen prescriptions from him for:

1. z-pak along with a codiene cough syrup and guafenisin/psudophedrine tablets (for what the pt described as a 'chest and head infection'.
2. synthroid with refills.
3. ambien 30 day supplies with several refills.
4. coumadin

when he calls these scripts in he is always am ass about it. i ask him if hes going to assume responsibility for monitoring the patients thyroid levels ect... when i question him he gets rude and beligerent. on the few occassions that i have refused to fill a script from him he states that he will call the board of pharmacy on me if i dont comply. do you guys run into situations like this? what do you guys do or would do in this situation. my manager is an ass he wont back me up on this. according to him i should fill everything without question. i just dont think that its in the patients best interest to have a dentist prescribing potentialy dangerous drugs when hes not obivously trained in that area of expertise.

This depends on where you work. I would tell him it is outside of his scope of practice and I would refuse to fill them.

 

[Fenderplayer108]

You think thats bad, get this, just the other night I had a dentist call in birth control for his wife.

I refused to fill it.

 

[All4MyDaughter]

That would be out of scope for dentists in my state. According to my law class if the prescriber refused to cease trying to RX out of scope he/she should be reported to the Dental licensure board.

Standard in Kentucky for dentists is treatment of conditions related to the "oral cavity."

 

[npage148]

In NY, they cant prescribe anything out of their scope. I'd shut them right down and tell them to go a head and call the BOP. Its oral stuff only. If its not pushing their boundaries they better have a good reason.

 

[pharmdinfl]

I haven't come across that issue yet but I would definitely look into contacting a regulatory board regarding that since it sounds like it's the same prescriber repeatedly.

 

[StallionRx]

I wouldnt fill any of those.

I think of it this way-

The pharmacy is not a pizza place where you can call in and get whatever your want. When you fill those scipts your putting your name on it authorizing that the med being filled is correct, safe for the patient and in accordance with the law. I wouldnt put my name on something that I know isnt right.

You have a job to do. Dont let any doctor, nurse or patient push you around and not allow you to do what you were trained to do and spent all those years in school studying for.

Id give him the number to the BOP next time he calls.

 

[Aznfarmerboi]

agreed

 

[WVUPharm2007]

Synthroid...for toothaches....

 

[ClassOf78]

In Missouri it is unlawful and unethical for a prescriber to prescribe medications that aren't in the realm of their practice. I don't see it day in and day out, but I have dealt with this several times. I do try to tell the prescriber diplomatically that it's against the law, getting rude with me doesn't phase me or sway me to break the law. Honestly, most prescribers I've dealt with have been pretty nice about it. Just say what you mean and mean what you say. My reply is "Gee, I wish I could help you but if my inspector saw that, I'd be in big trouble, sorry." I guess what I'm saying is I try not to get them on the defensive, I try to let them back out gracefully. Hope this helps.

 

[pkpd]

I had a patient that drop off a prescription for mycolog crm written by her dentist few weeks ago. I called up the dentist (giving him the benefit of the doubt that he might have a MD degree because some dentists do) but he said no. Then I started questioning him...it was funny because the first question i asked was "Are u telling this patient to apply this cream inside her mouth or gum?" I couldn't stop laughing inside.
Apparently, he wrote an antibiotic a week ago and the patient developed rash from it so he was trying to give her mycolog for the rash. I denied his prescription and told him this is out of his scope of practice. He was nice enough to apologize. hahahaha

 

[letjin]

I don't know any state specific laws regarding legend Rx, but federal law states all controlled substances "must be issued... in the usual course of his professional practice" for it to be valid...so if you're filling it, it's actually illegal... I'd deny all controlled script from a dentist other than the ones for pain.
http://www.deadiversion.usdoj.gov/21cfr/cfr/1306/1306_04.htm

 

[Old Timer]

Just be careful with confronting prescribers. Especially MD's. It is always better to seek information than be confrontational. All specialist's are M.D.'s or D.O.'s first and dermatologists/cardiologists/gynecologists second. So hwile it is OK to question a gynecologist prescribing a cough syrup for a male, you can't just deny it up front. He is still a licensed M.D. or D.O.

The biggest problem is usually with dentists, podiatrists, optometrists, etc....

 

[Old Timer]

I don't know any state specific laws regarding legend Rx, but federal law states all controlled substances "must be issued... in the usual course of his professional practice" for it to be valid...so if you're filling it, it's actually illegal... I'd deny all controlled script from a dentist other than the ones for pain.
http://www.deadiversion.usdoj.gov/21cfr/cfr/1306/1306_04.htm

You were posting while I was so, I again remind you don't be confrontational. I have a local oral surgeon who prescribes muscle relaxants all of the time (Valium/Flexeril/Parafon) for TMJ patients where he believes there is a muscular component to the condition. It is always better to call and ask a question than be confrontational and eat your words later.

 

[njac]

Old Timer - exactly. I know someone who managed to injure their masseter muscle during a tooth extraction (don't know the whole story) but ended up with Somas and Percocet from the dentist rather legimately.

Now birth control from a dentist a completely different ball game.

 

[MacGyver]

The difference between MDs and dentists is that MDs have an unrestricted license to practice medicine. Dentists, on the other hand, do not.

If an MD is writing "out of scope" its still legal, although perhaps unethical. Its a lot different than a dentist writing for coumadin or synthroid.

 

[genesis09]

The most common prescriptions I've seen from Dentists are antibiotics and pain killers. Once in a great while you might see a benzo from them.

 

[Aznfarmerboi]

The difference between MDs and dentists is that MDs have an unrestricted license to practice medicine. Dentists, on the other hand, do not.

If an MD is writing "out of scope" its still legal, although perhaps unethical. Its a lot different than a dentist writing for coumadin or synthroid.

While this is true, sometimes MD do not know what they are prescribing. Then this falls "outside" of their scope. An example is a physcian (i believe it was a psychiatrist or some unrelated field) calling in insulin for his daughter. Although it is well within his scope, he does not know how to prescribe it, or dose it. He can look it up and re-learn it, but until he does, it is not per se, bad for a pharmacist to reject the script politely.

In a lot of cases while it is legal for a MD to prescribe outside of their scope, it does not mean that a pharmacist should fill it. During insurance audits, insurance companies loves to find MD prescribing outside of scope and refuse to pay for it.

 

[JerryPharmD]

just curious if you guys in your practice encounter people with prescribing authority who dont stay in their scope of practice. there is this dentist in town who im currently butting heads with. He routinely writes prescriptions for people in a manner that can be deemed out of his scope of practice. ie... i have seen prescriptions from him for:

1. z-pak along with a codiene cough syrup and guafenisin/psudophedrine tablets (for what the pt described as a 'chest and head infection'.
2. synthroid with refills.
3. ambien 30 day supplies with several refills.
4. coumadin

when he calls these scripts in he is always am ass about it. i ask him if hes going to assume responsibility for monitoring the patients thyroid levels ect... when i question him he gets rude and beligerent. on the few occassions that i have refused to fill a script from him he states that he will call the board of pharmacy on me if i dont comply. do you guys run into situations like this? what do you guys do or would do in this situation. my manager is an ass he wont back me up on this. according to him i should fill everything without question. i just dont think that its in the patients best interest to have a dentist prescribing potentialy dangerous drugs when hes not obivously trained in that area of expertise.

I'd threaten to call the dentistry board; he'd stop after that. I refused a podiatrist rx for eyedrops once.

 

[VCU07]

just curious if you guys in your practice encounter people with prescribing authority who dont stay in their scope of practice. there is this dentist in town who im currently butting heads with. He routinely writes prescriptions for people in a manner that can be deemed out of his scope of practice. ie... i have seen prescriptions from him for:

1. z-pak along with a codiene cough syrup and guafenisin/psudophedrine tablets (for what the pt described as a 'chest and head infection'.
2. synthroid with refills.
3. ambien 30 day supplies with several refills.
4. coumadin

when he calls these scripts in he is always am ass about it. i ask him if hes going to assume responsibility for monitoring the patients thyroid levels ect... when i question him he gets rude and beligerent. on the few occassions that i have refused to fill a script from him he states that he will call the board of pharmacy on me if i dont comply. do you guys run into situations like this? what do you guys do or would do in this situation. my manager is an ass he wont back me up on this. according to him i should fill everything without question. i just dont think that its in the patients best interest to have a dentist prescribing potentialy dangerous drugs when hes not obivously trained in that area of expertise.

Coumadin and synthroid? I don't see any reason for a dentist to prescribe coumadin. Are they going to take on the resonsibility of monitoring INR levels also? You don't want to be the one caught filling such a rx if something goes wrong. I would deny it and report him or her.

 

[Pharmguy07]

How about a dentist prescribing Chantix? I guess the reasoning could be smoking is harming the patient's teeth.

 

[bodiddely]

How about a dentist prescribing Chantix? I guess the reasoning could be smoking is harming the patient's teeth.

Not to mention increased risk for periodontitis and oral cancer (and probably a bunch of other oral conditions). Not really sure what kind of monitoring chantix needs. I went to the student clinic on campus and got an Rx for 3 months, didn't have to schedule a followup or anything. Don't know if that is normal though.