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- Mar 2, 2014
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Dear Colleague,
Please give your thoughts on this discussion:
Patient was given warfarin 1 mg, 30 pills, 1 pill a day. That should last 30 days.
After 14 days, warfarin 1 mg is not enough, doctor gives new instruction (patient still has 16 pills of warfarin 1 mg.)
If doctor writes:
STOP WARFARIN 1 MG.
START WARFARIN 2 MG, TAKE 1 TABLET BY MOUTH DAILY. DISPENSE: 30 PILLS. REFILL: 3.
My official label has this information:
WARFARIN 2 MG
TAKE 1 TABLET BY MOUTH DAILY. STOP WARFARIN 1 MG.
What do you think about the sig:
TAKE 1 TABLET BY MOUTH DAILY. STOP WARFARIN 1 MG.
My reason to put “STOP WARFARIN 1 MG.” in the sig line is:
I want to counsel in writing. I heard of malpractice lawsuit where:
New dose was given with verbal counseling that patient should stop old pill.
But patient took both old pill and new pill and overdosed and sued pharmacist for overdosing.
In lawsuit, of course, patient claimed the pharmacist never counseled me to stop old pill so I took both old pill and new pill.
Because of that lawsuit, I always put extra warning directly in the sig line so no patient can go back and claim that I did not warn about stopping old pill.
However, my manager insisted that: we all should not add ANYTHING to sig line and for ANY WARNING for any medication, we should only write a piece of paper to put in the bag and counsel verbally and when patient signs, we make sure patient marks that “I have been counseled.”
I have a few worries with that method:
If patient died because of overdose, the family will claim pharmacist did not counsel.
The evidence that ‘’patient signed and marked “I have been counseled”’’ can be claimed by attorney that: pharmacist counseled about side effects but still did not counsel about “stopping old pill.”
I discussed with a few friends and we agree that: the solid proof of counseling to prevent overdosing is on the label which is on the vial. If patient claims pharmacist did not counsel about “stopping old pill”, my defense would be: “Show me the label. You took the pill from the bottle, you have duty to read the label. On the label, I did my duty and wrote “stop old pill.” That’s solid counseling to me.
If I hand write a piece of paper, somewhere along the line, the paper may fall off the basket, or paper may drop out of bag when tech pulls med out, or get lost and hidden inside all the printouts. In my heart, even if patient does not sue later, I do not want any patient to suffer overdosing on my watch.
Therefore, the only solid proof of warning is: on the sig line.
Is there any legal reason why we should not put warning in sig line as a defense in malpractice lawsuit?
Am I missing something in the law book that says we can not add extra warning to sig line? (My manager has 7 years of experience so he may know things I do not know yet)? I have respect for him at the same time worrying about patient’s life as well as my license if warning for prevention of overdosing is lost or not clear.
Would you put that warning in sig line? Please give your quick answer and vote (Vote is at the top of this post).
Thank you very much.
Please give your thoughts on this discussion:
Patient was given warfarin 1 mg, 30 pills, 1 pill a day. That should last 30 days.
After 14 days, warfarin 1 mg is not enough, doctor gives new instruction (patient still has 16 pills of warfarin 1 mg.)
If doctor writes:
STOP WARFARIN 1 MG.
START WARFARIN 2 MG, TAKE 1 TABLET BY MOUTH DAILY. DISPENSE: 30 PILLS. REFILL: 3.
My official label has this information:
WARFARIN 2 MG
TAKE 1 TABLET BY MOUTH DAILY. STOP WARFARIN 1 MG.
What do you think about the sig:
TAKE 1 TABLET BY MOUTH DAILY. STOP WARFARIN 1 MG.
My reason to put “STOP WARFARIN 1 MG.” in the sig line is:
I want to counsel in writing. I heard of malpractice lawsuit where:
New dose was given with verbal counseling that patient should stop old pill.
But patient took both old pill and new pill and overdosed and sued pharmacist for overdosing.
In lawsuit, of course, patient claimed the pharmacist never counseled me to stop old pill so I took both old pill and new pill.
Because of that lawsuit, I always put extra warning directly in the sig line so no patient can go back and claim that I did not warn about stopping old pill.
However, my manager insisted that: we all should not add ANYTHING to sig line and for ANY WARNING for any medication, we should only write a piece of paper to put in the bag and counsel verbally and when patient signs, we make sure patient marks that “I have been counseled.”
I have a few worries with that method:
If patient died because of overdose, the family will claim pharmacist did not counsel.
The evidence that ‘’patient signed and marked “I have been counseled”’’ can be claimed by attorney that: pharmacist counseled about side effects but still did not counsel about “stopping old pill.”
I discussed with a few friends and we agree that: the solid proof of counseling to prevent overdosing is on the label which is on the vial. If patient claims pharmacist did not counsel about “stopping old pill”, my defense would be: “Show me the label. You took the pill from the bottle, you have duty to read the label. On the label, I did my duty and wrote “stop old pill.” That’s solid counseling to me.
If I hand write a piece of paper, somewhere along the line, the paper may fall off the basket, or paper may drop out of bag when tech pulls med out, or get lost and hidden inside all the printouts. In my heart, even if patient does not sue later, I do not want any patient to suffer overdosing on my watch.
Therefore, the only solid proof of warning is: on the sig line.
Is there any legal reason why we should not put warning in sig line as a defense in malpractice lawsuit?
Am I missing something in the law book that says we can not add extra warning to sig line? (My manager has 7 years of experience so he may know things I do not know yet)? I have respect for him at the same time worrying about patient’s life as well as my license if warning for prevention of overdosing is lost or not clear.
Would you put that warning in sig line? Please give your quick answer and vote (Vote is at the top of this post).
Thank you very much.
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