When you request a change of Rx

[RaginCajun]

---

Members don't see this ad.

Hypothetical Scenario:

24hr Store pushing 3500+scripts/wk calling the ED

So your an intern with just an old school night pharmacist who is known for being shady, requesting a different drug for the same treatment due to coverage. They approve it and hang up. "Yeah, sure this is ____ that sounds fine click"

What do you do?
Look the sig up in the pharmacopoeia or guidelines, swallow ur pride and call back, or jump over the counter and run to ur car?

5 people in drop off line, 3 in pick up, 1 in consultation (trying to return Plan B bought at 7am that am)

 

[Jabberwocky12]

Hypothetical Scenario:

24hr Store pushing 3500+scripts/wk calling the ED

So your an intern with just an old school night pharmacist who is known for being shady, requesting a different drug for the same treatment due to coverage. They approve it and hang up. "Yeah, sure this is ____ that sounds fine click"

What do you do?
Look the sig up in the pharmacopoeia or guidelines, swallow ur pride and call back, or jump over the counter and run to ur car?

5 people in drop off line, 3 in pick up, 1 in consultation (trying to return Plan B bought at 7am that am)

I'd call back personally unless it is something extremely basic like going from DAW1 toprol XL when there was no generic available to metoprolol succinate. Otherwise if there isn't an extremely obvious dosage (ZPak?) I'd call back since I want to make sure I got it right.

The other people in line can suck it, they'd agree to wait an extra 20 mins too if their loved one wasn't killed by an rx error.

 

[PharmD RPh]

I'd call back personally unless it is something extremely basic like going from DAW1 toprol XL when there was no generic available to metoprolol succinate. Otherwise if there isn't an extremely obvious dosage (ZPak?) I'd call back since I want to make sure I got it right.

The other people in line can suck it, they'd agree to wait an extra 20 mins too if their loved one wasn't killed by an rx error.

Would have to have exact drug and situation to answer this.

 

[crazybob]

I usually try to write down the name of the person who spoke with me so I can call back to speak to the same person.

If they're in a hurry to hang up, try to interrupt them to get clear instructions about what to do.

 

[awval999]

Hypothetical Scenario:

24hr Store pushing 3500+scripts/wk calling the ED

So your an intern with just an old school night pharmacist who is known for being shady, requesting a different drug for the same treatment due to coverage. They approve it and hang up. "Yeah, sure this is ____ that sounds fine click"

What do you do?
Look the sig up in the pharmacopoeia or guidelines, swallow ur pride and call back, or jump over the counter and run to ur car?

5 people in drop off line, 3 in pick up, 1 in consultation (trying to return Plan B bought at 7am that am)

Are we changing Protonix to omeprazole here? Then yes.

 

[PANCFLRPH]

Yeah, depends on the drug. Protonix --> omeprazole, would prob just go for the 20mg QD. This is where pharmacists need to learn to "think" on their feet. No offense, but the younger folks and new grads tend to go strictly "by the book". More seasoned rph's tend to learn where the "safe" grey areas are and spend most of their career in the grey areas. I have made many a call to MDs in my early days, only to be dressed down and asked why I had to call them to verify this or that. I kinda chuckle when new grads call MDs for approval to use amoxicillin suspension when rx was written for 30 capsules. In the end, we are all responsible for our own licenses and must practice how we see fit, to best serve the patient.

 

[RaginCajun]

It was Ciprodex to Ofloxacin for a 2 day old ear ache nothing too urgent. Just wish indications were on scripts it would cancel out a lot of the guess work.

This isn't the first time they approve something and hang up without a sig or anything. I enjoy the trust and we aren't just robots if I felt really uncomfortable then it would be a call back for sure.

 

[ronkoshy]

...

 

[GreyFox2002]

LexiComp .. thats what its for.. sigs

there are many times you can figure out the right directions like protonix --> omeprazole .. sure u can figure it out.. even if they don't tell you the strength or sig .. use your best judgement .. if they didn't care at the office to tell you, it's kinda like them giving you permission to use your best judgement, after all, the patient has to have a trial of the med to see how it works for them .. just document on the rx to cover your ass

I too can't stand new graduates calling the md about every little freakin thing when I see older pharmacists doing things on their own.

I see new grads calling MD's offices bc they don't have the right strength of an antibiotic and are afraid to calculate a new sig on their own .. or for example, amoxicillin chewable 400 mg which they don't make anymore, I saw a younger pharmacist call the md office to ask permission to switch it to the suspension..

its a joke to me .. bc i know when i call the md's office, they will say yes .. when i'm in that situation, i use my best judgement

for example .. today someone's astepro cost $83 copay .. i see what astelin generic is .. $10 .. i tell them i'll call the md on monday to change it .. i put it in the md call box .. 2 seconds later i'm thinking wtf, i'm gonna approve the change myself .. so i do

why would the md say no to that .. of course they will approve, otherwise they will lose the patient

but of course you can't take advantage of it, just do it in the appropriate situations to make workflow better

I'm sorry but I completely believe this is a slippery slope practice. It doesn't matter how smart you are, and what your ability is at substitution/sig conversions. Automatically deciding to switch Astelin to astepro because Astelin is too expensive and there is a generic available for Astelin: that's a dispensing error if you ask me. No matter how "insignificant" it may seem to you. Just because some doctors don't care if you convert doesn't mean all doctor's don't care. All it takes is the wrong patient or the wrong doctor who will report you to the Board and your license is in serious jeopardy.

The pharmacist I've trained under for the past 2.5 years as an intern has been practicing for over 40 years. Despite him being up in the years he is sharper then most pharmacists I've ever met or worked with. He gave me one line of advice the very first day I started and he continues to repeat it to me on an occasional basis: "No matter what you do, there is no patient in the world whose interests should ever supercede your license. Your license is the most important thing you possess, more then your house or car. Never deviate from the law for the patient's convenience."

So yes, I'm probably going to be the uptight pharmacist who will be calling back to get the appropriate sig/strength, or to get authorization to switch astepro to astelin. I'm sorry it it annoys you.

 

[meister]

I really wish pharmacists would just use their brains more and switch drugs and directions at their professional discretion rather than calling for every little minor change, but I realize it is pounded into everyone's mind in retail pharmacy not to do this. I suppose if pharmacists did this their malpractice rates would increase and they'd have more responsibility, but it'd be really nice.

Oh well.

 

[GreyFox2002]

I really wish pharmacists would just use their brains more and switch drugs and directions at their professional discretion rather than calling for every little minor change, but I realize it is pounded into everyone's mind in retail pharmacy not to do this. I suppose if pharmacists did this their malpractice rates would increase and they'd have more responsibility, but it'd be really nice.

Oh well.

I wish we COULD use our professional discretion to switch drugs/directions. It doesn't take much to switch Aciphex to omeprazole, for example. The problem is the law doesn't permit this action currently. The law does not favor pharmacists, and it certainly hasn't adapted to the changes in the profession over the past 15-20 years.

Remember, for every MD who wishes pharmacists could do this and thus not be a pest, there is an MD (or maybe it's 2:1 or 3:1, who knows) who believes that pharmacists have no right to make any therapeutic interchanges. So as long as the law is in place, it's just the way it's going to be.

 

[ronkoshy]

...

 

[meister]

The problem is the law doesn't permit this action currently. The law does not favor pharmacists, and it certainly hasn't adapted to the changes in the profession over the past 15-20 years.

Remember, for every MD who wishes pharmacists could do this and thus not be a pest, there is an MD (or maybe it's 2:1 or 3:1, who knows) who believes that pharmacists have no right to make any therapeutic interchanges. So as long as the law is in place, it's just the way it's going to be.

Yeah I know. It's mostly older dinosaur MDs who think that way, fyi.

like i said, i ok'd the change myself bc mondays are busy as fck

You did a Good Thing™.

 

[MountainPharmD]

I really wish pharmacists would just use their brains more and switch drugs and directions at their professional discretion rather than calling for every little minor change, but I realize it is pounded into everyone's mind in retail pharmacy not to do this. I suppose if pharmacists did this their malpractice rates would increase and they'd have more responsibility, but it'd be really nice.

Oh well.

Doctors can help facilitate this. I have seen Doctors write on a script Nasonex or therapeutic substitution covered by patients insurance. I have seen them do this on cholesterol meds as well as proton pump inhibitors. Its not that hard and it covers us legally and saves us both alot of time.

 

[jawnly211]

whenever we call for these changes.....lord knows who is picking up the phone on the other line....nurse, reception, janitor?!?!?!

plenty of times i call on a prescription and the person on the other end often asks me "what is covered" or "what do you normally change it to"

just make sure to always document, document, and document....

 

[MountainPharmD]

whenever we call for these changes.....lord knows who is picking up the phone on the other line....nurse, reception, janitor?!?!?!

plenty of times i call on a prescription and the person on the other end often asks me "what is covered" or "what do you normally change it to"

just make sure to always document, document, and document....

Exactly why it is pointless to call.

 

[meister]

Doctors can help facilitate this. I have seen Doctors write on a script Nasonex or therapeutic substitution covered by patients insurance. I have seen them do this on cholesterol meds as well as proton pump inhibitors. Its not that hard and it covers us legally and saves us both alot of time.

Not that I give a crap about the exact details of retail pharmacy law but I wonder if that's legal in the strict sense. If so I'd have my prescriptions print it automatically, heh.

Though to be fair, and maybe y'all are better at this than my former coworkers were, most pharmacists I worked with rarely bothered to take a history from a patient or get a specific list of medications already tried. So if there were some sort of annoying insurance problem and you were going to switch it'd be necessary imo to actually talk to the patient.

Exactly why it is pointless to call.

qft

 

[meister]

Though on second thought I have seen some really really bad pharmacists who I wouldn't necessarily want switching up meds on a whim without more direct guidance.

 

[J ROD]

It was Ciprodex to Ofloxacin for a 2 day old ear ache nothing too urgent. Just wish indications were on scripts it would cancel out a lot of the guess work.

This isn't the first time they approve something and hang up without a sig or anything. I enjoy the trust and we aren't just robots if I felt really uncomfortable then it would be a call back for sure.

all that over eardrops....

just look up the dosing guidelines.