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Type of changes a pharmacist can do without contacting prescibers

Discussion in 'Pharmacy' started by Tenchivu, Sep 19, 2014.

  1. Tenchivu


    Feb 24, 2013
    I was wondering what type of changes a pharmacist can do on non-controlled rx without the need to contact the prescribers first. For example, prescriber wrote 29g needles for insulin pens but it's not available. Can a pharmacist switch it to 30g or 31g without needing to confirm with them?
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  3. zelman

    zelman 7+ Year Member

    Nov 27, 2009
    Legally, no. You can't change anything.
  4. Wheresmyaricept

    Wheresmyaricept 2+ Year Member

    Jun 15, 2011
    Unless you have a medical protocol signed off by the doctor allowing you to substitute drugs or change things, then pretty much nothing. Unless you're one of those cool states that can convert it to a 90 day supply. My state isn't that cool.

    Then again if it's something stupid like changing the gauge for insulin pen needles, what's stopping you from just changing it because 99.9999% of doctors would be like "why are you calling just change it".
  5. msweph

    msweph 2+ Year Member

    Jun 27, 2013
    I can't imagine having to call a doctor to change a tablet size of a statin, etc
  6. FarmD711

    FarmD711 2+ Year Member

    Sep 19, 2013
    What do you mean by tablet size?
  7. BenJammin

    BenJammin No Apologies 5+ Year Member

    Jun 29, 2011
    Where my ex's live
    In Texas we're authorized to change dosage form as long as they're equivalent. Amoxicillin tablets to capsules to suspension to whatever. That sort of thing. Although I do wonder the legality of a doctor writing for albuterol HFA and just putting a brand name in its place.
  8. BidingMyTime

    BidingMyTime Lost Shaker Of Salt 10+ Year Member

    Oct 2, 2006
    Do you mean substituting 2-20mg tablets for 1-40mg tablet (or something like that?) It may depend on your state, that kind of substituting is exceptable in IL (unfortunately, we aren't as cool as TX and can't change dosage forms)
  9. msweph

    msweph 2+ Year Member

    Jun 27, 2013
    More like 1/2 of a 40 mg d/t insurance reasons
  10. stoichiometrist

    stoichiometrist 5+ Year Member

    Aug 2, 2011
    At the hospital where I did my IPPE, the pharmacists made renal dosing adjustments without contacting the prescriber, according to protocol.
  11. zelman

    zelman 7+ Year Member

    Nov 27, 2009
    Laws do not apply to hospitals' internal operations as far as I can tell.
  12. maria1oh

    maria1oh 7+ Year Member

    Jul 23, 2009
    Also heard hospital pharmacists can switch a patients PPI or statin to whatever their hospital formulary is. Pantoprazole was the only PPI available at the hospital I rotated at.
  13. gwarm01

    gwarm01 7+ Year Member

    Oct 7, 2009
    We do a lot of stuff like that too. We order levels and change dosing/intervals on vanco and aminoglycosides
    It probably depends on the hospital, but things like this are pretty common. Protocols are developed and the formulary decided on by the P&T committee. I'm not sure how it is presented from the physician's standpoint, but it seems like there is an understanding that if you practice at institution A, you must abide by the rules and regulations of the institution. I think it makes it easier on everyone to sort of streamline the process like that. Besides, anytime we need to bend the rules for a valid medical reason most of us are willing to make it work.
  14. bobisnew

    bobisnew 5+ Year Member

    Jul 5, 2011
    I do the best and most efficient thing for the patient......Annotate "MD OK" and write what you feel is correct and benefits patient. Done!
  15. marscole

    marscole Junior Member 10+ Year Member

    May 30, 2006
    For example, insulin pen needles:

    The script was written in 32G x 6 mm

    But, only 31G x 4 mm and 31G x 8 mm available in the store. Should you stick with either one of them?
    Or you tell the pt "Unfortunately, we don't have the written in stock. We will order for you, and will be available after xyz time. Is that okay for you?"
  16. zelman

    zelman 7+ Year Member

    Nov 27, 2009
    In reality, you give what you have. From a legal perspective, you cannot do so. You must turn away the prescription or order the product.

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