When you review a Rx, either a new, copy or refill, there are so many "fake" warnings need to be override. Do we need choose a reason on each override? It takes too much time to do so, I understand that are necessary steps to make sure your patients are safe. How do you guys handle this in general? How do you handle those "major or moderate" DDIs or drug-allergy warnings for a refill? I am a new RPh and need advise! Thanks!
Walgreens Rx review tips needed
- Thread starter rx201605
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Well this is where your professional judgment comes into play, and is what separates you from the techs. However if you ask 10 pharmacists what they'd do, you'll probably get 11 different answers 😛. Nevertheless, here are some of my tips on what to focus on:
- Major drug interactions. I think IC+ requires you to put a comment for these but there are standard options like "reviewed profile", "pt consulted", "prescriber consulted" right?
Even some major drug interactions I will just override such as those that have to do with drug metabolism, especially for refills. My reasoning is that the prescriber is meant to individualize the dosage for their patient and monitor the effects, so even if a drug interaction affects the levels of one of the drugs, they should be able to account for this by adjusting the dose.
Things like NSAIDs and antibiotics with warfarin, QT interval prolonging drugs and pt is on anti-arrhythmics you should consult the prescriber and the pt to make sure they are aware and give them the option to change, or at least monitor the pt very closely.
Drugs that affect potassium levels I tend to just override because this is a basic lab that the prescriber should be monitoring.
Interactions between drugs given through different routes I usually just override like Voltaren gel/warfarin, Timoptic/diltiazem.
- Allergies. If the pt has taken it before, just override it.
Codeine allergy is usually itchiness caused by histamine release. But it causes alerts on all opioids and tramadol. You may have to consult the pt or the prescriber.
- Therapeutic duplication. Look for signs of a therapy change like same Dr, more recent prescribed date. Or it was intentional for synergy. Sometimes there are false positives like nasal steroids and inhaled steroids.
Be more careful with controlled substances. Quick way of guessing if something is more than 3 days too soon when it shows you the previous fill date is to subtract 4 from the date if that month has 30 days, -5 for 31 days, -2 for Feb, or add 26 if it's in the first few days at the beginning of the month. This gives you the date in the current month when it's ok to fill, assuming a 30 day supply. So if the last fill date was 12/8/16, subtract 5 because Dec has 31 days, and it's ok to fill on 1/3/17.
- High dose. There are a lot of false positives here because the computer just divides the qty by the days supply to get the daily dose, but sometimes we deliberately manipulate the days supply such as with antibiotic suspensions, etc to give whole bottles.
For peds weight based dosing I use these tables to estimate the wt from just the age:
Boys: https://www.cdc.gov/growthcharts/data/set1clinical/cj41c021.pdf
Girls: https://www.cdc.gov/growthcharts/data/set1clinical/cj41c022.pdf
Main website: https://www.cdc.gov/growthcharts/
- Other alerts like age, late refill, disease contraindications (tend to be inferred and not necessarily accurate), excessive duration I don't worry about too much.
- Major drug interactions. I think IC+ requires you to put a comment for these but there are standard options like "reviewed profile", "pt consulted", "prescriber consulted" right?
Even some major drug interactions I will just override such as those that have to do with drug metabolism, especially for refills. My reasoning is that the prescriber is meant to individualize the dosage for their patient and monitor the effects, so even if a drug interaction affects the levels of one of the drugs, they should be able to account for this by adjusting the dose.
Things like NSAIDs and antibiotics with warfarin, QT interval prolonging drugs and pt is on anti-arrhythmics you should consult the prescriber and the pt to make sure they are aware and give them the option to change, or at least monitor the pt very closely.
Drugs that affect potassium levels I tend to just override because this is a basic lab that the prescriber should be monitoring.
Interactions between drugs given through different routes I usually just override like Voltaren gel/warfarin, Timoptic/diltiazem.
- Allergies. If the pt has taken it before, just override it.
Codeine allergy is usually itchiness caused by histamine release. But it causes alerts on all opioids and tramadol. You may have to consult the pt or the prescriber.
- Therapeutic duplication. Look for signs of a therapy change like same Dr, more recent prescribed date. Or it was intentional for synergy. Sometimes there are false positives like nasal steroids and inhaled steroids.
Be more careful with controlled substances. Quick way of guessing if something is more than 3 days too soon when it shows you the previous fill date is to subtract 4 from the date if that month has 30 days, -5 for 31 days, -2 for Feb, or add 26 if it's in the first few days at the beginning of the month. This gives you the date in the current month when it's ok to fill, assuming a 30 day supply. So if the last fill date was 12/8/16, subtract 5 because Dec has 31 days, and it's ok to fill on 1/3/17.
- High dose. There are a lot of false positives here because the computer just divides the qty by the days supply to get the daily dose, but sometimes we deliberately manipulate the days supply such as with antibiotic suspensions, etc to give whole bottles.
For peds weight based dosing I use these tables to estimate the wt from just the age:
Boys: https://www.cdc.gov/growthcharts/data/set1clinical/cj41c021.pdf
Girls: https://www.cdc.gov/growthcharts/data/set1clinical/cj41c022.pdf
Main website: https://www.cdc.gov/growthcharts/
- Other alerts like age, late refill, disease contraindications (tend to be inferred and not necessarily accurate), excessive duration I don't worry about too much.
Thank you for you response! I just do not want to slow down the work flow and doing things that are unnecessary.
Thank you so much! this will definitely help me a lot. I have a few Rx for Peds last week, each one came with a Max daily dose warning, I checked each single one of them to make sure not overdosed, of course they are fine, but IC+ just doing "silly" thing sometimes.
I have done the computer training for DUR when I was an pharmacist intern, it was too basic and does not help me in real life🙂
