what's proper way to write for insulin/needs/machine/strips?

[bulldog]

is there a recommended way to write for the needles/syringe, lancets, strips, machine, and insulin?

i've written:

lantus 10 units daily. disp qs x 1 month.
needles/syringe for insulin. disp qs x1 month.
lancets. disp qs x1 month.
strips. dis qs x1 month.
glucometer. x1

and haven't had a problem.

---

Members don't see this ad.

 

[elwademd]

insulin, all forms as i understand, comes in vials. 1 vial is 1000 units. so, if you write that lantus order as you did, the patient will still get one vial which would last that particular patient about 3 months.

as far as the needles/lancets/test strips go, it would depend on how often the patient is monitoring his/her glucose at home- once a day, twice a day, three times a day, or more (really stringent diabetics test when waking up, before and after every meal, and at bedtime- a minimum of 8 times assuming 3 meals).

if i had the same patient, who tested 3 times per day:

lantus 10 units sc q daily disp # 1 vial
insulin syringes disp #90
lancets disp #90
test strips disp #90
glucometer x 1

i suppose if you aren't catching any flack about it from the pharmacy, you're good to go. as many things in medicine, there's more than one way to skin a cat.

 

[deleted87716]

insulin, all forms as i understand, comes in vials. 1 vial is 1000 units.

300 units, actually.

When prescribing insulin, I never write the number of units on the prescription, because it can change. I just write "as directed qhs" for Lantus, for example. If you later give a patient instructions that differ from what's written on their prescription bottle, confusion can result.

 

[VFTW]

No, usually a bottle is 10mL = 1000u. You should write for a vial/month even if they won't go through that much because the new synthetic insulins like glargine and lispro do not last 90 days, the synthetic compounds break down.

 

[deleted87716]

No, usually a bottle is 10mL = 1000u.

Sorry, he said "vial," so I thought "pen." That's what I mostly use nowadays. Of course, he also said "syringes," so...duh. Carry on. 😳

 

[theunc31]

insulin, all forms as i understand, comes in vials. 1 vial is 1000 units. so, if you write that lantus order as you did, the patient will still get one vial which would last that particular patient about 3 months.

as far as the needles/lancets/test strips go, it would depend on how often the patient is monitoring his/her glucose at home- once a day, twice a day, three times a day, or more (really stringent diabetics test when waking up, before and after every meal, and at bedtime- a minimum of 8 times assuming 3 meals).

if i had the same patient, who tested 3 times per day:

lantus 10 units sc q daily disp # 1 vial
insulin syringes disp #90
lancets disp #90
test strips disp #90
glucometer x 1

i suppose if you aren't catching any flack about it from the pharmacy, you're good to go. as many things in medicine, there's more than one way to skin a cat.

Just a quick background: I'm a 2nd year med student, but have worked, and currently work in a pharmacy. I realize I don't know nearly as much as residents on this forum, but I hope this will be somewhat helpful seeing it from a pharmacy's perspective and will save you time in the long run.

The big thing is to make sure you give a dosage on the insulin. Many physicians will write 'UTD' which is a problem because insurance plans won't cover medications without specific directions (exception would be something with a standard dose set like a Z-Pak or Medrol Dosepak). Pharmacies won't dispense meds if they aren't reimbursed, etc. etc. Lancets come in packages of 100 or 200 (pharmacies don't open these boxes, so the patient will always get a multiple of 100). Test strips generally come in boxes of 25, 50 or 100, depending upon the brand, again these packs are not split. Needles come in bags of 10, so always write for a multiple of 10 on those.

Basically, if you don't write a dosage for the insulin, the pharmacy will call you for one which will waste time that can be better allocated with other patients. This will save a huge hassle on both ends. Also, it will save time for the patient and will allow them to get their prescription in a timely manner (I've seen plenty of offices not return a pharmacy call for a few days, which leads us to bothering the office again for something that could have been nipped in the bud by writing a dosage on the prescription).

Good luck, I'll be in your position in a few short years!

 

[deleted87716]

The big thing is to make sure you give a dosage on the insulin.

Unfortunately, this is not possible when the dose is variable, as during titration or when patients count carbs.

 

[sdn1977]

Unfortunately, this is not possible when the dose is variable, as during titration or when patients count carbs.

True - but, as a pharmacist who actually has to submit audit reports, I have to document dosage. When you write "ud" - I ask the pt what the parameters are & I document it on the rx. Technically, I'm supposed to document with you, but that is time consuming for both of us.

Currently, there are very few insurance plans which will take "ud" directions on anything as a direction - so we're documenting on the rx what the pt is saying to document the days supply with the amount we dispense.

We know what is out of the norm - it can sometimes take 5-6 vials of Humalog to fill & prime a pump & allow for missteps at the beginning of a pump pt. But, after a pump pt is stabilized, it takes less.

Personally, I'd rather you write to use x-y units before meals & q2h prn BS > "qrs" up to 10 (or "n") times per day, with parameters high & low. That gives me the minimum required & the ability to titrate up to a higher amount per 30/90 days. I'll still use "inject as directed by doctor" on the label...but, for insurance - they'll see I've made the attempt to document the dose.

Strips are more controlled than insulin. Some plans allow for only 200 strips/month - no matter how many times they test. I have about 5 plans which will allow up to 300 strips/month. Beyond that...the pt buys the strips (or just doesn't test!). Rarely, I can get a prior auth for more strips & they, for the most part are pump pts.

For the OP - yes, give me an idea of the range the pt may use, which would influence the # of syringes, strips, insulin, etc... I'll document the amount so I can dispense the full box of 100 syringes rather than break it & dispense just 50-60.

Otherwise....when I'm audited, if I don't have a documented dose on the rx, the insurance company will charge back my company & rebill the pt. You don't want that - its cheaper to just buy the insulin & syringes OTC rather than have me dispense it in that case.

For the most part - the use of "take as directed" on anything does not fly for insurance. We may write it on the label, but we'll document what you told the pt & if the pt is confused or someone brings the rx in on their behalf, we'll have to bother your office staff. We don't like to do that.

 

[8744]

...is there a recommended way to write for the needles/syringe, lancets, strips, machine, and insulin?

Why, yes there is:

"Patient will follow up with his PCP tomorrow for long-term management of his diabetes."