Scope of practice determinations

[aphistis]

There was another thread that touched on this topic a few months ago, but I'm still interested in the issue.

http://forums.studentdoctor.net/showpost.php?p=2313471&postcount=46

The thread linked above includes posts on pharmacists refusing to fill scripts from oral & maxillofacial surgeons after substantial trauma surgery based on the individual pharmacist's decision that the surgeon had no place writing them. I asked this rhetorically in the thread, but here I'm earnestly seeking an answer: 1) when was pharmacy as a profession given regulatory over other doctors' scopes of practice, and 2) if y'all folks are going to refuse to fill people's prescriptions on the basis of that authority (assuming you even lawfully have it), it seems to me there should be some fairly comprehensive training in your curriculum to help make this determination. What is it?

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[kwakster928]

There was another thread that touched on this topic a few months ago, but I'm still interested in the issue.

http://forums.studentdoctor.net/showpost.php?p=2313471&postcount=46

The thread linked above includes posts on pharmacists refusing to fill scripts from oral & maxillofacial surgeons after substantial trauma surgery based on the individual pharmacist's decision that the surgeon had no place writing them. I asked this rhetorically in the thread, but here I'm earnestly seeking an answer: 1) when was pharmacy as a profession given regulatory over other doctors' scopes of practice, and 2) if y'all folks are going to refuse to fill people's prescriptions on the basis of that authority (assuming you even lawfully have it), it seems to me there should be some fairly comprehensive training in your curriculum to help make this determination. What is it?

NJ Board of Pharmacy Rule states.

13:39-<<-6.1->><<+7.13 +>>Professional judgment in dispensing drugs

<<-(a)->> The pharmacist shall have the right to refuse to fill a prescription if, in his or her professional judgment, the prescription is outside the scope of practice of the prescriber; or if the pharmacist has sufficient reason to question the validity of the prescription; or to protect the health and welfare of the patient.

<<-(b) A pharmacist may dispense an supply (no more than a 72-hour quantity) of a chronic maintenance drug (except controlled dangerous substances) or device in the absence of a current valid prescription, if, in his or her professional judgment, refusal would endanger the health or welfare of the patient.->>

<<-1. The pharmacist must first ascertain to the best of his or her ability, by direct communication with the patient, that such a medication or device was prescribed for that patient by order of a licensed practitioner.->>

<<-2. The pharmacist shall document the communication and require the patient to provide suitable identification and sign a statement attesting to the need before dispensing.->>

<<-3. A patient's signature is not required for refilling of a previously valid prescription.->>

 

[aphistis]

Fair enough, that answers the first half of my question. Now how about the second?

 

[jdpharmd?]

It's not that we're determining the scope of others' practice, it's that we're chosing the scope of ours.

If I don't feel comfortable filling a script in my pharmacy, nothing prevents the patient from talking it to someone else's pharmacy. If some crazy patient wanted birth control from his/her dentist (you), you might deny them, but nothing prevents that patient from trying to go to another dentist (and/or pharmacy). You're not limiting the scope of others' practice, you're limiting the scope of your own, just as we are when we make decisions in our pharmacy.

As for "fairly comprehensive training" in our curriculum; for every year that you're in dental school, we're in pharmacy school.

 

[28657]

2) if y'all folks are going to refuse to fill people's prescriptions on the basis of that authority (assuming you even lawfully have it), it seems to me there should be some fairly comprehensive training in your curriculum to help make this determination.

I replied to your post in the dental forum...but I'll add some more here.

Pharmacist's do have comprehensive training to make the determination of whether a drug is usually in a specialist's scope of practice. We are the "drug experts" and we will usually know more about the drug than any doc or dentist. Because of our in depth curriculum, we learn about the dangers of dispensing certain medications. The bottom line is patient health and safety. The way you're coming across is kind of egotistical. I really wish we could get away from the debate of who has authority over who. We all are an integral part of health care team, meaning we each have our own knowledge and skills to offer for the better health of the patient.

 

[kwakster928]

http://www.temple.edu/pharmacy/dr-curri.htm

above is the link to the curriculum of PharmD program at temple. starting 2nd semester 2nd year, we are trained extensively what drugs are used for what purpose in what part of the body etc... as you can see there isn't too good of section in dental. for that i am regretful. as i said before two cases that you have presented in that thread, i concluded that 1. the pharmacist went little too far. 2. the pharmacist was required to refuse due to hospital policy. i dont know whether such a policy exist in chain pharmacies but if it does, pharmacist who works in that chain must follow its company's protocols.

refusing such a prescription in happens rarely during my time in pharmacy. but i belive in general we as pharmacist have decent idea what drugs should be used for what, and in extreme cases we should ask these question to the prescriber before we fill it.

i dont think it is question of authority. i dont think i will be feeling so good that i refused a prescription of a MD or DMD. rather it is patient safty. case above doesn't really present any danger however, that is not only drug out there. i would not be too comfortable dispensing and counseling the pt about a medication that i am not quite sure what it is prescribed for by what use especially a drug that is not so much used in particular part of medicine.

 

[aphistis]

It's not that we're determining the scope of others' practice, it's that we're chosing the scope of ours.

That's a way of framing the issue that I hadn't considered.

As for the rest, I'll just let it lie.

 

[burton117]

There was another thread that touched on this topic a few months ago, but I'm still interested in the issue.

http://forums.studentdoctor.net/showpost.php?p=2313471&postcount=46

The thread linked above includes posts on pharmacists refusing to fill scripts from oral & maxillofacial surgeons after substantial trauma surgery based on the individual pharmacist's decision that the surgeon had no place writing them. I asked this rhetorically in the thread, but here I'm earnestly seeking an answer: 1) when was pharmacy as a profession given regulatory over other doctors' scopes of practice, and 2) if y'all folks are going to refuse to fill people's prescriptions on the basis of that authority (assuming you even lawfully have it), it seems to me there should be some fairly comprehensive training in your curriculum to help make this determination. What is it?

Good thinking, aphistis.. I was about to do the same thing.

 

[burton117]

http://www.temple.edu/pharmacy/dr-curri.htm

above is the link to the curriculum of PharmD program at temple. starting 2nd semester 2nd year, we are trained extensively what drugs are used for what purpose in what part of the body etc... as you can see there isn't too good of section in dental. for that i am regretful. as i said before two cases that you have presented in that thread, i concluded that 1. the pharmacist went little too far. 2. the pharmacist was required to refuse due to hospital policy. i dont know whether such a policy exist in chain pharmacies but if it does, pharmacist who works in that chain must follow its company's protocols.

refusing such a prescription in happens rarely during my time in pharmacy. but i belive in general we as pharmacist have decent idea what drugs should be used for what, and in extreme cases we should ask these question to the prescriber before we fill it.

This raises a good point. As a future dentist (hopefully), how much dental pharmacology do pharmacists get training in? Of course I am not implying that dentists use other drugs that pharmacists are not experts in or anything like that. I guess my question is more like this: How much of the scope of the practice of dentists (or physicians for that matter) do pharmacists receive training in?

I am sure that pharmacists get some exposure, I am just curious about how this is addressed in pharmacy school. I am sure that dentists out there are and will be counting on a pharmacist to come through with the answers if they have questions regarding drug interactions, drug information, strange drug reactions and the like...

 

[dgroulx]

At my school we have 6 semesters of therapeutics. In this class, we are given a patient and a chart. The only thing we are not taught to do is diagnose. We have to choose the correct drug, dosage, length of therapy for most every common disease from hypertension to cancer, along with non-pharmacological treatment options. We don't focus a lot on dental, although we spend a substantial amount of time on infectious disease. From what I've seen at work, most dentists prescribe prophylactic antibiotics and a mild analgetic drug. Those drugs are covered extensively in other disease states.

Pharmacy students spend 4 years of post-graduate study just learning about medication. I don't know anything about dental school, because the field didn't interest me and I didn't look into it. I assume it is also 4 years of study which would make you qualified to become a dentist. I'm not sure how much of the curriculum focuses on medication, but it has to be less than 4 years.

 

[ultracet]

in my curriculum... (unfortunately) we are taught to diagnose (recognize signs/symptoms/test results and other things we are never really going to do) along with all of the drug stuff that has already been mentioned. As far as dental pharmacology... no
i do not have a single session regarding dentistry. most of that is covered in sections like "pain" or our ID classes with prophylactic antibiotics
we cover weird uses of medications and off lable uses throughout school
i honestly don't remember all that much about my pathophys classes in the first year

My take on the situation with the OMFS would be to actually talk to the patient first as with any weird (in my mind) rx. a simple question of "what did your doctor tell you this was for?" and when they say oh well i cracked my face open with my husbands fist.. then i can say alright just a few more minutes!

There are also a lot of resources in the pharmacy that can be used and look up off lable uses rather quickly.

i realize that not all pharmacists are interested in learning and being responsible practicioners but we can only take care of ourselves.

and that's why you can say....
"take this Rx over to her pharmacy and she'll fill it for you right away!"

 

[dgroulx]

in my curriculum... (unfortunately) we are taught to diagnose (recognize signs/symptoms/test results and other things we are never really going to do) along with all of the drug stuff that has already been mentioned.

I probably wasn't really clear. We have to recognize and evaluate signs/symptoms and test results, too. However, we are not taught to do a physical exam, what tests to order, etc. We only have to interpret the results. That's what I meant by diagnosis.

 

[ultracet]

I probably wasn't really clear. We have to recognize and evaluate signs/symptoms and test results, too. However, we are not taught to do a physical exam, what tests to order, etc. We only have to interpret the results. That's what I meant by diagnosis.

yeah..... i honestly don't know where the line is drawn here... its different for different instructors... some say... so with these symptoms what would you do? which to me is completely inappropriate except for the answer "refer"