Sunday, January 18, 2009

Some Pet Peeves Regarding Prescriptions

This post is for the doctors out there that might happen to stumble upon my ramblings. I've ranted about your worse than kindergarten level handwriting. This isn't the only problem with your prescriptions though.

Yesterday (which was Saturday, a weekend, when doctor's offices are closed), I received a prescription for Fentanyl Patches. The handwriting was beautifully legible. The directions were there, the quantity, the dosage. That part of the prescription was a thing of beauty. Then I look down to see who wrote the prescription. There was nothing but a scribble on the signature line with a DEA number written under it.

I thought to myself, "great! The doctor even wrote his DEA number on the script." Then I looked at the doctor's name on top of the prescription and realized that while it was written on Dr. John Doe's prescription blank, John Doe was not the doctor who actually wrote the script because the second letter in the DEA number began with a P and therefore, must have been written by a doctor who's last name begins with a P. I go to search our computer system by the DEA number and (surprise, surprise) no matches.

Just fucking wonderful! It's Saturday. The office is closed. I tried calling the answering service, and they were absolutely no help. I had a CII script without knowing what doctor wrote it. Technically, I should not have dispensed the Fentanyl patches to the patient without knowing the prescriber. However, since there was absolutely no way of finding the prescriber on that day, I was forced to use the doctor's name on top of the script (who didn't write it). This was the only way to ensure that this cancer patient would have his pain medication. I had to break federal controlled substance law in order to serve the patient. You're welcome!

Seriously... How fucking hard is it to write your name legibly? Here's my advice to you doctors: When you write a script, quickly look around for a small child, preferably in the range of 2nd or 3rd grade. Give that prescription to that small child and see if he can read it to you. You are only allowed to give the patient the prescription if the 3rd grader can read the script.

No small children around? It would take too much time? Then just imagine a small child reading the script yourself! If any part of that prescription is illegible, it should not go out the door. That includes your name. If you simply cannot write your signature neatly, then print your damn name under the signature. Some prescriptions even have a line under the signature line that says, "Please Print Name Here." I would say that no more than 5% of prescribers actually follow those directions.

Another thing (and I've mentioned this one before), write the patient's entire name on the prescription with the date of birth. This is what was actually on a prescription I received not too long ago:

Patient: R. Smith
Drug: Percocet 5/325
Sig: 1 tab q4-6h prn pain
Quant: #30

R. Smith was actually the patient, but I don't think the HIPAA police are going to come after me for posting that info on the internet. I wonder how many R. Smith's there are in this country. A few hundred thousand? That was how the patient's name was written though. No first name. No address. No date of birth. Just R. Smith. Does that mean that technically that prescription is valid for any R. Smith that just so happens to come in contact with it? Apparently it's just a blanket authorization for the R. Smith's of the world to get some Percocet.

The take home points for you prescribers out there:

- Write the patient's full name and date of birth.
- Include all necessary information on the prescription, which includes the prescriber's name.

- And finally... DOUBLE CHECK the prescription before it goes out the door. Pharmacists double and triple check pretty much everything we do before the patient gets a prescription. That's why we make so few errors. Yes, that's right... Despite the sensationalized stories you may hear on the news, Pharmacists make a ridiculously small number of errors as a percentage of the volume of work they do. Most professions should strive to reach the level of accuracy that pharmacists have. Maybe... just maybe... rereading the prescription you just wrote might cut down on a few of those prescriber errors.

I don't know... I think it's worth a shot.


The Ole' Apothecary said...

"Give me your answer, fill in a form, mine forever more..."

--The Beatles, 1967


Frantic Pharmacist said...

I agree with you -- extremely annoying. What is the deal with using someone else's prescription pad?-- I hate seeing that. If you know it is a cancer patient that's one thing, otherwise the 'forgery' red lights would be flashing. I'm willing to bet that since the prescription was written so neatly, some nurse did it for him and he just signed it. On the other hand, super-'neat' prescriptions are also a hallmark of forgery. Either way, it's left up to us to sort it all out on a Saturday. I HATE laziness.

PharmerGirl said...

I always wonder if the doctor cares about the patient. I always come to the conclussion they do not. If they did they would take the time to make sure the pharmacist knew exactly what to dispense to the patient. One more thought, why is the Doc annoyed when we have to call for clarification. They are the idiots who couldn't take the time to write the prescription clearly and accurately.

Jaded Rx Intern said...

We had a doctor at the nearby clinic who was habitually guilty of the "J Smith" prescriptions. Of course it was rarely the UniqueFirstName UniqueLastName patients - it was the John Smiths and Jane Browns. We got so sick of calling to verify the patient name ... and apparently, the nurses were too.

Once, a fellow intern had to call on one of the J Smith prescriptions, and when asked to give the patient's name in question, he said, "I don't know, that's why I'm calling." The nurse - kid you not - yelled out, "Dammit, [Dr's first name], stop writing just patient initials!" We nearly died laughing with that reaction.

Thankfully, they've got electronic...