CP's Partner: Yes. Or if they just heard about it on TV, or from a patient who heard about it on TV and the prescriber shrugs and says "let's give this a go".
CP: Right. On the flip side of that, we have medications that we just KNOW the correct way they should be written.
CPP: True. There are a certain number of medications that we can tell by a glance are correct, are completely boffo, or that need a little of our professional massaging. We are the experts after all. What happened to initiate this conversation, again?
CP: My last weekend. I had another of those arguments with central processing.
CPP: Is this another one of those "not to denigrate another professional, but. . ." issues?
CP: It is. I like to think that we as pharmacists know the same things. Certainly there are specialists within each practise location. An expert in retail may be a novice when transitioning to hospital, or the reverse could be true. But I would expect a similar level of competence from a peer in my practise location.
CPP: Okay. What happened?
CP: You know how the central pharmacists review our prescriptions after they've been typed?
CPP: Right. They have a few dozen stores they help with verification.
CP: Since we aren't supposed to be typing and checking our own work, I entered a prescription so it would be worded correctly as the e-script left a lot to be desired.
CPP: Makes sense. You are the responsible pharmacist at the end of the day. I'm guessing this didn't go well?
CP: Nope. It was rejected. By a Pharmacist. Because the directions I typed did not match verbatim what was sent on the e-script.
CP: To make matters worse, I sent it back through, he rejected it again. I sent it a third time, he again rejected it. Finally, I selected "local" and finished it myself.
CPP: I'm guessing that's not the end?
CP: No. I took the package insert out of the box, enlarged the directions, then faxed them to him and his boss and our boss.
CPP: What did she say?
CP: Nothing. Just shrugged and said "we have no control over the central processing center".
CPP: So they are making more work for us instead of helping?
CP: That's the point.
CPP: So by now everyone wants to know what the medication was.
CP: It was for NTG 0.4mg sl tabs. The e-script directions were "1 tab every 5 minutes for chest pain".
CPP: Which is wrong.
CP: Which I corrected, as always, to: "Dissolve 1 tablet under tongue every 5 minutes up to 3 tabs in 15 minutes as needed for chest pain. No relief, call 911".
CPP: Which is in the package insert.
CP: Right. Can't you just see someone popping an entire bottle of 25 tablets, getting no relief, and suffering a heart attack while experiencing a wicked headache?
CPP: Okay. This then begs the question we have to ask everyone: What other medications do you just know how to type correctly, e-rx directions be damned?
CP: I'll give you three.
1. Lidocaine 5% patches - apply patch(es) to area and leave on for 12 hours then remove for 12 hours.
2. Clotrimazole Troches - Slowly dissolve 1 tablet in mouth.
3. Miacalcin NS - Use 1 spray in 1 nostril every day. Alternate nostrils daily.
CPP: Yeah, that last one gets entered incorrectly all the time.
CP: Can't you just see some pharmacists out there calling on these?
CPP: What's worse is them not fixing these mistakes or missing them altogether because they've never seen them written correctly; or weren't taught these during their retail experiences.
CP: Yeah. The preceptor site was either too busy or they used the students as free labour instead of teaching them the ways of the phorce.
CPP: I have one more to add.
CP: You have the phloor.
CPP: SL vs ODT. We receive prescriptions all the time that say "Take one tablet by mouth" or that confuse the two terms.
CP: What's the correct way to enter these directions, call center and e-script directions be damned?
CPP: SL is sublingual which literally translates to "under the tongue". ODT, or Orally Disintegrating Tablets should be remembered as dissolving On Da Tongue. ODT. Get it?
CPP: With that in mind, what else do you have to offer, oh mighty phans of CP?
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