Why is diagnosis not required on prescriptions & medication orders?

[Truthspeaker]

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What do the pharmacists think about this requirement for safety? I'm thinking that if a prescriber were REQUIRED to put the diagnosis on every retail prescription & inpatient medication order that the errors would drop drastically. It may cause some delays at first, but if this became common practice it would prevent a lot of harm. Would the benefit of an additional safety check outweigh the additional time it would take?

The bottom line is the pharmacist dispensing the medication is a provider and should be informed what the medication is being prescribed for.

 

[KennethCool]

Who would be the entity making the requirement?

 

[zelman]

What do the pharmacists think about this requirement for safety? I'm thinking that if a prescriber were REQUIRED to put the diagnosis on every retail prescription & inpatient medication order that the errors would drop drastically. It may cause some delays at first, but if this became common practice it would prevent a lot of harm. Would the benefit of an additional safety check outweigh the additional time it would take?

The bottom line is the pharmacist dispensing the medication is a provider and should be informed what the medication is being prescribed for.

It was required at my last hospital. It is a helpful piece of info, and should take basically zero extra time. The only reason it’s optional for outpatient prescriptions is because laws are a pain in the butt to change.

 

[awval999]

Let me get this straight, you wanna micromanage doctors even more to save your own a**?

LOL

 

[smercer]

Let me get this straight, you wanna micromanage doctors even more to save your own a**?

Because no medication has more than 1 dose for all indications. However, this is the exact attitude that I hate when dealing with Docs. At least at my institution every doctor I follow up with about a possible issue is always grateful we are checking with them.

 

[Dr Wario]

If you want more safety, how about outlawing phoned in scripts by office janitors?

 

[CetiAlphaFive]

Let me get this straight, you wanna micromanage doctors even more to save your own a**?

He's a medical student that overshares his grand ideas for fixing the system he gets while on the pot.

Lol

 

[CetiAlphaFive]

Let me get this straight, you wanna micromanage doctors even more to save your own a**?

He's a medical student that overshares his grand ideas for fixing the system he gets while on the pot.

Lol

 

[Truthspeaker]

Doctors love diagnosing patients so you'd probably rarely miss putting it on there if it was required. That's what I'm thinking, resistance from pharmacists is they don't want to do more work hunting down the diagnosis if it's missed or contacting them if it doesn't make sense. However, if the doctor is putting they are prescribing Lexapro for dx. hypertension, I guarantee 99% of pharmacists would have dispensed Lexapro (if that dx was missing) instead of figuring out it should have been Lisinopril instead. Wouldn't that be an error worth taking the time to prevent by calling the doctor? How can pharmacists get provider status if they aren't required to know the medication they dispense will treat the patient?

 

[Truthspeaker]

If you want more safety, how about outlawing phoned in scripts by office janitors?

That sounds like a short staffing issue. If you know you are talking to a janitor and have questions about the therapy, what's stopping you from saying "Sir, please get me your office nurse, I need to clarify the prescription" or even asking for the MD if it needs to be changed. You have the right to refuse any prescription you have safety concerns about.

 

[Rouelle]

Name + full address of patient is required on all controlled substance scripts, yet prescribers rarely write the address. Why do we think requiring a written diagnosis would actually result in a diagnosis being written?

 

[Truthspeaker]

Name + full address of patient is required on all controlled substance scripts, yet prescribers rarely write the address. Why do we think requiring a written diagnosis would actually result in a diagnosis being written?

If I prescribe something and knew a pharmacist was going to call me every time I forgot to put a diagnosis, I would remember to put the diagnosis on there every time real fast. I know what goes down when a patient is waiting for their medications. The pharmacy staff is telling the patient "Sorry, I'd like to dispense this, but your doctor FORGOT to fill out A, B & C on the prescription and it is required by law". It really makes the pharmacist the hero and the doctor the villain in that kind of situation. Why would a doctor want to risk losing confidence and possibly a patient over something so simple. It's really a win-win for both parties involved.

 

[Ra1nMak3r]

Doctors love diagnosing patients so you'd probably rarely miss putting it on there if it was required. That's what I'm thinking, resistance from pharmacists is they don't want to do more work hunting down the diagnosis if it's missed or contacting them if it doesn't make sense. However, if the doctor is putting they are prescribing Lexapro for dx. hypertension, I guarantee 99% of pharmacists would have dispensed Lexapro (if that dx was missing) instead of figuring out it should have been Lisinopril instead. Wouldn't that be an error worth taking the time to prevent by calling the doctor? How can pharmacists get provider status if they aren't required to know the medication they dispense will treat the patient?

This mistake can be avoided during counseling session. I do agree though , I would feel more comfortable verifying new scripts if the dx code is provided. What's annoying is when the same office keeps sending rx for Medicare part B patients without dx code. It's such a waste of time.

 

[Rouelle]

If I prescribe something and knew a pharmacist was going to call me every time I forgot to put a diagnosis, I would remember to put the diagnosis on there every time real fast. I know what goes down when a patient is waiting for their medications. The pharmacy staff is telling the patient "Sorry, I'd like to dispense this, but your doctor FORGOT to fill out A, B & C on the prescription and it is required by law". It really makes the pharmacist the hero and the doctor the villain in that kind of situation. Why would a doctor want to risk losing confidence and possibly a patient over something so simple. It's really a win-win for both parties involved.

I agree: I would love the diagnosis on the script (I get this when I work inpatient). Unfortunately, not all providers are as progressive, understanding, and responsive as you appear to be. I think there would be a lot of push back and failure to return phone calls. At least with the cohort of prescribers I have experienced.

 

[Rouelle]

While we’re at it, let’s also ask for weights on weight-based pediatric scripts. I love having the ability to do my job properly.

 

[Rouelle]

If I may argue one more point on here today: Medicare B has been requiring numeric diagnosis codes on scripts for diabetic testing supplies for quite a while now. There is still a measurable percentage of PCPs and endocrinologists who don’t get it. We commonly see no diagnosis code, or it’s ICD9 and not ICD10. This is repeat behavior; calls/messages go unreturned. Patients are left not taken care of. Some prescribers have the “they’re not standing in my office now so it’s not my problem” or the “if the pharmacy can’t figure it out go to a different pharmacy” philosophy.

 

[Apotheker2015]

What do the pharmacists think about this requirement for safety? I'm thinking that if a prescriber were REQUIRED to put the diagnosis on every retail prescription & inpatient medication order that the errors would drop drastically. It may cause some delays at first, but if this became common practice it would prevent a lot of harm. Would the benefit of an additional safety check outweigh the additional time it would take?

The bottom line is the pharmacist dispensing the medication is a provider and should be informed what the medication is being prescribed for.

I am in retail. I personally like seeing diagnosis codes on prescriptions because it helps me make sense of the treatment plan, verify whether doses/or frequency are appropriate or not. I think it would be helpful. Checking whether a drug is indicated or not, requires that you know the diagnosis. 100% yes vote

 

[CetiAlphaFive]

If I prescribe something and knew a pharmacist was going to call me every time I forgot to put a diagnosis, I would remember to put the diagnosis on there every time real fast. I know what goes down when a patient is waiting for their medications. The pharmacy staff is telling the patient "Sorry, I'd like to dispense this, but your doctor FORGOT to fill out A, B & C on the prescription and it is required by law". It really makes the pharmacist the hero and the doctor the villain in that kind of situation. Why would a doctor want to risk losing confidence and possibly a patient over something so simple. It's really a win-win for both parties involved.

The reality is that the doctor never hears about the problems they're causing because it's always handled by an MA or LVN that thinks the pharmacy is just doing it to be annoying

 

[BidingMyTime]

Requiring (or at least strongly encouraging) diagnosis codes has been talked about since at least the early 90's. Probably before then as well. Just like MTM/Pharmaceutical Care/Whatever It's Been Called Over The Years is never going to be the financial lifesaver for pharmacy, so also, doctors adding diagnosis codes is never going to happen. I agree, it's a GREAT idea, but after seeing it be talked about for 30 years, I realize it will never happen.

That sounds like a short staffing issue. If you know you are talking to a janitor and have questions about the therapy, what's stopping you from saying "Sir, please get me your office nurse, I need to clarify the prescription" or even asking for the MD if it needs to be changed. You have the right to refuse any prescription you have safety concerns about.

Yeah, well the annoying thing is when they leave messages, especially on a Friday night at 05:30pm along the lines of "Hi, I'm Buffy the Office Janitor Extraordinaire calling in a prescription for the doctor[from a clinic of 5 doctors, and Buffy forgets to mention which one.] He wants Mrs Smith to have Raprazolome......hmmm, that doesn't sound quite right. Well, I'm sure you will figure it out. Raprazolome 5mg BID, er that might be QID. Just give her whatever she has been on. "

Yeah, of course, nobody can fill the prescription, since without a birthdate, nobody has any idea who "Mrs. Smith" is. And when a Mrs. Smith does show up 2 minutes before the pharmacies closing time, she says the doctor was calling in a new prescription for her mood and she has no idea what the name of it is. And then she's mad at the pharmacy that the pharmacy can't fill it even though the doctor called it in.

The real question is, why would a doctor allow such an untrained person to call in a prescription? I love, love, love e-rx's. Sure dumb stuff happens on those too, but at least it's clearly on the doctor/office janitor fault, and not the pharmacist for not transcribing a garbled message correctly.

 

[lord999]

A relic of the old prescribing laws where diagnosis was forbidden to be on prescriptions. Also, despite multiple efforts to get diagnosis on prescriptions, AMA has been a reliable opponent of those measures and lobbies openly about it.

 

[KimChiSlap]

Let me get this straight, you wanna micromanage doctors even more to save your own a**?

Why can't we see it as patient safety?
Rather than wasting my time, saving my own @$$?

Priorities

 

[Apotheker2015]

If I prescribe something and knew a pharmacist was going to call me every time I forgot to put a diagnosis, I would remember to put the diagnosis on there every time real fast. I know what goes down when a patient is waiting for their medications. The pharmacy staff is telling the patient "Sorry, I'd like to dispense this, but your doctor FORGOT to fill out A, B & C on the prescription and it is required by law". It really makes the pharmacist the hero and the doctor the villain in that kind of situation. Why would a doctor want to risk losing confidence and possibly a patient over something so simple. It's really a win-win for both parties involved.

Great point. I have had, however, patients and prescribers upset at me for requesting a new script from the prescriber when there's just too much information missing.

 

[Apotheker2015]

While we’re at it, let’s also ask for weights on weight-based pediatric scripts. I love having the ability to do my job properly.

You hit the nail in the head. I have drilled that into my techs' head to ask parents for patient's weight when they check in. I will hold up the prescription. Our system does not record when you updated the weight. So you have to also enter a counseling note if you want that to be on the record.
And if the prescriber is noting the weight on the script, it should be in kilograms. You'd be surprised how many times I've called to double check and the NP had calculated the dose with lb. No joke.
With e-scripts it's simple to have the IT department just add such pieces of info - from address to patient weight- by default. It really isn't a big deal.

 

[Apotheker2015]

Pretty terrifying really - I would gain access to a growth chart if you fill pediatric scripts. Our EMR has one and it's awesome for checking weights when the RN entera something that seems blatantly wrong

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Of course, that's an option but we still have to check. And well, I'm in the Midwest. Our children are typically very well nourished.