Which rph is responsible for what was filled?

[Curiousone1111]

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Hi everyone.

I am having a little dilemma with my friends. I think whoever bills and fills an rx, meaning their initials are on it and they verified/bagged it... the responsibility is on them.

My friend, on the other hand, says since you are required to counsel on new rx and offer counseling on refills, it is on the rph who is on duty the day it is rung out. I’m sorry but how is it my responsibility to go back and do an interaction check on their whole profile, or go on pmp to make sure they are not early for a control etc? I can provide general counseling on the medication at hand but everything else should be on the rph who fills it. As for controls, in my state, the law says corresponding liability lies with the rph who FILLS the rx..not the one who is on duty/counseling.

The only time I am concerned with being the one on duty is if lets say the rx is fentanyl and pt tells me they are not currently on opioid.. that makes them naive. At that point i think i would refuse to dispense although it shouldve been original rph’s duty to contact md to verify that pt is not opioid naive and to verify dose. I also worry if i’m busy and tech doesn’t tell me rx is new, pt may leave pharmacy and it’ll be on me just because it was rung out on my shift even though i didnt get a chance to talk to them.

Any opinions? Thanks guys

 

[Digsbe]

The DUR review, Rx accuracy, etc. is all the responsibility of the verifying pharmacist with their initials on the Rx. Counseling requirements are on the pharmacist on duty at the time of sale.

 

[Rouelle]

^^^That

 

[Curiousone1111]

That’s what I thought too, but if tech doesnt notify u theres a new rx being rung out, and i miss counseling, my question is if something happens and a lawsuit comes up, wouldn’t the rph who filled it be the one brought into light as they should have done their part in determining accuracy (i.e. that a patient isnt opioid naive when filling fentanyl?! Or any major DDIs to put a note on bag for rph to counsel on)? Anyhow even if u counsel pt could easily say theyve been on it before, or on any opioid before, not like ur going to check profile or pmp or act like the rph who originally filled it did.

Also they could always hit “no” on the prompt for questions, which would make it appear they refused counseling. If i did actually counsel and pt said they are not on an opioid, aka naive, then I would step in and refuse to ring it out. But if i never got the chance to counsel or they refused, i’d think it is original rph’s duty.

For other meds (not fentanyl lol) i wouldnt even have major ddi’s or anything to counsel on as original rph who verified should have placed a note for me to see. I would only be able to counsel on the med at hand.

The DUR review, Rx accuracy, etc. is all the responsibility of the verifying pharmacist with their initials on the Rx. Counseling requirements are on the pharmacist on duty at the time of sale.

 

[Digsbe]

In the case of Fentanyl to the opioid naive if something happened I'd say the pharmacist who did the verification and DUR would be liable, does your system allow a pharmacist to put a consultation cap on the prescription?

 

[Curiousone1111]

No it’s an independent and they don’t let us put caps like walgreens does 🙁
Thats why if theres a ddi i try to call pt to counsel and if no answer, I write on the bag so rph can counsel at pick up. However, if other rph doesn’t write on his bags, I won’t really know what he needs me to counsel on (besides general info on the drug itself).

In the case of Fentanyl to the opioid naive if something happened I'd say the pharmacist who did the verification and DUR would be liable, does your system allow a pharmacist to put a consultation cap on the prescription?

 

[PA_dud3]

No it’s an independent and they don’t let us put caps like walgreens does 🙁
Thats why if theres a ddi i try to call pt to counsel and if no answer, I write on the bag so rph can counsel at pick up. However, if other rph doesn’t write on his bags, I won’t really know what he needs me to counsel on (besides general info on the drug itself).

Have you checked the pt profile or the rx profile? The independent pharmacists I worked with almost always put any counseling notes on the rx profile or maybe the pt profile. If it was of extreme importance they always put a note on the bag though, which obviously yours is not doing this.

 

[Curiousone1111]

Yeah they sometimes annotate there but barely haha

Have you checked the pt profile or the rx profile? The independent pharmacists I worked with almost always put any counseling notes on the rx profile or maybe the pt profile. If it was of extreme importance they always put a note on the bag though, which obviously yours is not doing this.

 

[Dred Pirate]

That’s what I thought too, but if tech doesnt notify u theres a new rx being rung out, and i miss counseling, my question is if something happens and a lawsuit comes up, .

when you are the RPh on duty - you are responsible for your techs - if they fail to do something while you are there - you are responsible. (obviously the tech is as well from a disciplinary view

 

[Curiousone1111]

when you are the RPh on duty - you are responsible for your techs - if they fail to do something while you are there - you are responsible. (obviously the tech is as well from a disciplinary view

True, but realistically, u cant control or watch over their every move. If you’re on the phone or busy verifying, you can’t go to the register and make sure the tech is asking if the patient ever got it from us before etc. I guess malpractice lawyers know how to handle it 🙂

 

[Lnsean]

True, but realistically, u cant control or watch over their every move. If you’re on the phone or busy verifying, you can’t go to the register and make sure the tech is asking if the patient ever got it from us before etc. I guess malpractice lawyers know how to handle it 🙂

That's never an excuse in court

 

[Dred Pirate]

True, but realistically, u cant control or watch over their every move. If you’re on the phone or busy verifying, you can’t go to the register and make sure the tech is asking if the patient ever got it from us before etc. I guess malpractice lawyers know how to handle it 🙂

that is where "being the boss" comes into play - you need to set up an environment where the techs do what you want them to do (and what they are supposed to do) - if you can't do that - you are failing at your job as a supervisor.

 

[CetiAlphaFive]

Hi everyone.

I am having a little dilemma with my friends. I think whoever bills and fills an rx, meaning their initials are on it and they verified/bagged it... the responsibility is on them.

My friend, on the other hand, says since you are required to counsel on new rx and offer counseling on refills, it is on the rph who is on duty the day it is rung out. I’m sorry but how is it my responsibility to go back and do an interaction check on their whole profile, or go on pmp to make sure they are not early for a control etc? I can provide general counseling on the medication at hand but everything else should be on the rph who fills it. As for controls, in my state, the law says corresponding liability lies with the rph who FILLS the rx..not the one who is on duty/counseling.

The only time I am concerned with being the one on duty is if lets say the rx is fentanyl and pt tells me they are not currently on opioid.. that makes them naive. At that point i think i would refuse to dispense although it shouldve been original rph’s duty to contact md to verify that pt is not opioid naive and to verify dose. I also worry if i’m busy and tech doesn’t tell me rx is new, pt may leave pharmacy and it’ll be on me just because it was rung out on my shift even though i didnt get a chance to talk to them.

Any opinions? Thanks guys

Your friend is objectively wrong and probably dumb.

How could it possibly be anyone other than the verifying rph?

True, but realistically, u cant control or watch over their every move. If you’re on the phone or busy verifying, you can’t go to the register and make sure the tech is asking if the patient ever got it from us before etc. I guess malpractice lawyers know how to handle it 🙂

Yes, you can control their every move.

Just pick out different points during the day to audit them when they don't realize it.
Catch them doing it wrong then come down on them like a hammer.