Saturday, May 17, 2008

I think 60 Minutes should do a show about horribly written prescriptions

The general public has absolutely no idea how many prescriptions errors pharmacists prevent. The only publicity pharmacies ever get is if they make a mistake (or hand out $4 prescriptions, but that's another story). However, if you take away pharmacists, medication errors would probably increase 20-fold.

First of all, simply interpreting every prescription that comes in can be an amazingly hard job. Many times the patient's name isn't even completely written on the script. Note to prescribers: "J. Smith" is not adequate to put for a patient's name. Every patient has a first name. Please write it on the script. It's really not that hard. While you're doing that, could you just possibly include the patient's date of birth? I know you're so busy seeing ONE PATIENT AT A TIME and you only get that 1.5 hour lunch break to relax, but I think you just might be able to work in those 2 extra seconds to give me all the information I need to be sure that the prescription is intended for this specific person.

Then there's the whole signature thing. If you are signing a prescription blank that has the name of all 10 doctors in the practice on the top of it, please please please sign your name neatly enough so I can tell which doctor wrote it. Every prescriber went through many many years of school. Somewhere along the line, probably in first grade, you were taught how to write neatly. Does it really take that much longer to write legibly? Does it inconvenience you that much?

Since I'm just spewing out random bad prescription thoughts: Why does it seem that very few prescribers have any idea how to dose Vicodin. Regular Vicodin has 500mg of tylenol in it. Vicodin ES has a whopping 750mg of Tylenol. The first thing about drugs we all learned is that the maximum dose of Tylenol is 4,000mg per day. That means that a patient can only take up to 8 regular Vicodins and only 5 Vicodin ES tablets per day. That seems like common sense, right? I would have thought so, but I keep on seeing presctions that read "Vicodin ES, 1-2 tabs q4-6h prn pain." Sure Doc, that patient's liver will be just fine taking over 8,000mg of Tylenol per day. Those kind of prescriptions aren't a rare occurrence mind you. I would saw the majority of Vicodin ES scripts are written for well over the maximum daily dose. You can rest assured though because I never let the prescription leave my pharmacy with directions like that. I always make sure to put "Maximum dose is 5 tablets per day" on the prescription. I actually think the liver is an important organ. - Oh yeah... and it's spelled Vicodin, not Vicodan. And Percocet is not Percocette. Just in case you were wondering...

Back to poor handwriting... I would venture to say that at least 60% of prescriptions brought to a pharmacy could not be read by a member of the general public, yet somehow people seem to think doctors' poor handwriting is something to joke about. You know what often is the first thing I get asked when a non-healthcare professional learns that I'm a pharmacist? Well- Actually it's the second thing behind, "Can you get me some Oxycontin?? ha ha" (by the way, every pharmacist in the entire world is sick of that joke. It wasn't funny the first time we heard it, and it's still not funny now). I often get asked, "How do you read doctors' handwriting?" The public actually thinks that part of a pharmacists job is to decipher those unintelligible scribbles. Some people even think we take classes to learn how to read it.

I might as well mention all the dosage and directions errors that we catch on a daily basis. The mistakes themselves I don't really mind. We're all human. Everyone makes mistakes. However, it's the general attitude that we have to endure when we try to correct those mistakes. First of all, why is it that every receptionist and nurse working in a doctor's office fears the doctor's wrath if they ask them a question? Do prescribers torment and torture their staff? Could you imagine how that would be if it was the same way between pharmacists and technicians?

(Patient comes to the counter)

PT: I think there's an error with my prescription.

Tech: I'll take a look in the computer. Well, the computer says that you should be taking your Coumadin 5 times a day, and that's what it says on the bottle, so it must be right.

PT: Are you sure? I think you should check with the pharmacist.

Tech: The pharmacist is very busy right now, and he'll get really mad if I interrupt him. Let me take a message, and I'll give it to the pharmacist to look at when he's less busy.

PT: How long will that take?

Tech: Well, the pharmacist is very busy. It might take a day or so before I have an answer for you, but I'll be sure to call you right away.

Don't you see how ridiculous this scenario is? How is it any different than when a pharmacist asks a nurse or medical assistant to double check with the doctor because he thinks an error might have been made? Why do I and the customer have to wait up to a day to hear back from the office when we suspect an error in directions or dosage? As a pharmacist, someone can interrupt me every 2 minutes to ask where the bread is, but a doctor can't even be interrupted to make sure that he really didn't want to give one of his patients that massive overdose he accidentally prescribed.

In addition, why, no matter what I'm calling about, does the receptionist put me straight through to the prescription voice mail line the second she hears that I'm a pharmacist? Sometimes all I need is the stupid DEA number, but before I can even get the request out of my mouth I get transferred to a voice mail box. And while I'm on the subject of DEA numbers... Did you know it's supposed to be written on all prescriptions for controlled substances? I would say in reality, it probably gets put on 10% of controlled substance prescriptions.

I can go on all day about this stuff. Pharmacists already have enough to worry about dealing with insurance companies all day long. The fact that they have to make 30 phone calls to doctors' offices every day just to clarify a poorly written prescription is giving us a lot of unnecessary stress.

To all the prescribers out there that actually take the 2 extra seconds to write neatly and include all the necessary information on the prescription, kudos to you. You are part of a great minority.


Jaymz said...

While they're at it, perhaps some doctors could learn the strengths of Vicodin, Lortab, and Norco. It's not that hard - if you could just remember that Lortab is always 500mg of APAP, Norco is 325, and Vicodin covers the rest that would be a start. I spent 10 minutes yesterday explaining to a patient's wife that Vicodin 5/325 simply does not exist and that we did not fill her husband's prescription wrong.

And while electronic prescriptions do help and I wish that they were required, it doesn't help when the "nurse" can't find lancets from the drop down menu and picks the meter adding a comment that says "Need's needle's for testing hoe that is what these are." Anyone want to translate that into English for me?

Anonymous said...

Amen brother...preach it! I'm in a busy long term care pharmacy where we receive about 80% of our work from faxed physician order sheets which just adds another level of distortion to the already illegible handwriting. I would love to see a segment on 60 minutes, 20/20, or whatever on what pharmacists do right, but I guess the negative pieces get the higher ratings.

PS Really glad your back.

The Bitter Pharmacist said...

Back with a vengeance! All right, good to have you back kicking ass.

I have another question why do the secretaries at the doctors office feel they don't have to use the voice mail for a simple prescription. When was the last time I called a MD office and got right through to the doctor. Never. But they think the Amoxil 500 tid needs my urgent attention. Quick drop everything secretary on line one!

The Pharmacy Kid said...

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From now on, I'm going to comment as Pharmacy Kid instead of Manu.

Anonymous said...

I have called on a poorly written script and had to fax back to the office to see if they could read it becaue either the dr hadn't charted it or they couldn't read the chart. Also have had to fax in scripts with a mistake because the office staff could not believe they had actually made an error.

Anonymous said...

In England and Wales each Pharmacy is allowed to perform 400 MURs or Medicines Use Reviews(approx 10min consulation with the patient explaining how to use their meds correctly) for which the government pays approx $54 each.

The errors you describe would be and intervention that would lead to an MUR... easy money.

But in the UK the vast majority of scripts are computer printed.