Don't Think Too Hard

CP: Since we constantly have this debate, and we like to involve our students to teach them how to think, we are going to play a game.
CPP: The Professional Judgement Game?
CP Yes.
CPP: My favourite! Is this because everyone likes to comment on your posts about how we should just call? Or how they wouldn't ever call? Or how a counsel with the patient would have cleared things? Or how a consul wouldn't have provided an answer?
CP: Like those cure-all natural oil remedies - essential-ly.
CPP: Nice. Let's see this test.

1. Amoxicillin 500mg - Take 1 tablet by mouth 3 times a day.
(Do we dispense tablets or capsules? Or does it matter on this particular Rx?)

2. Amoxicillin 500mg Tablets - Take 1 capsule by mouth 3 times a day.
(Do we dispense tablets or capsules? Or does it matter?)

3. Duloxetine 60mg Tablets - Take 1 capsule by mouth 2 times a day.
(How do you dispense this one? If you said tablets for either of the above based on the drug written, then you have to answer tablets here and you have to call the prescriber, right?)

4. Motrin 800mg Capsules - Take 1 tablet by mouth every 8 hours.
(Tablets? Capsules? Call prescriber? If you answered tablets to any of the previous 3, then this has to be tablets, rights? Or is it Capsules because it's in the name?)

5. Insulin Glargine
(Do you dispense Lantus or Basaglar? If you try Lantus and it requires a prior authorisation, can you just switch it?)

6. Levothyroxine Capsules - Take 1 tablet by mouth once a day."

(But the patient ALWAYS gets tablets. Med selection error? or did the prescriber want Caps?)

Answers:
1. It doesn't matter. Just because "tablets" is written in the directions does NOT mean the prescriber intended for tablets to be dispensed. Often it's a default sig. Or pre-printed. Either way, it does not matter.

2. Meh. Same answer. It does not matter. Maybe his drop down menu only had tablets; or it was listed first. Same with the directions. As long as the patient gets 500mg of Amoxicillin, it doesn't matter. But if you claim that #1 HAS TO BE tablets based solely on the sig, then you must abide by your rule and dispense capsules here. Otherwise, your "steadfast" rules conflict and have no basis in real e-prescribing/dispensing.

3. Capsules. It's the only way the product is available. This is to prove that just because the directions use one dose form and the drug name is selected as another, albeit unavailable dose form, does not mean we have to move heaven and earth and call the prescriber to fix this. . . unless of course you disagree with either of the first two answers. In that case, stop wasting time. You know you just dispense capsules, so use that logic on #1 and #2.

4. Tablets. Period. Even though I have seen this very same prescription multiple times, there is no way the prescriber(s) intended to give the patient 800mg ibuprofen capsules. Tablets all the way. Again, if you disagree with any of the previous answers, then you MUST call this prescriber and verify capsules was correct as submitted. Another waste of time.

5. Please tell me no one does this. If a patient asks for ibuprofen OTC you can give them Advil or Motrin. Same here. If Lantus is not covered, try the Basaglar. It's written for the generic name, NOT the brand. Had the Rx been sent over as "Lantus Solostar", then you'd have to call, per insurance pain-in-the-assitude. I hate floating to stores and my first doctor calls are about these exact scripts; fix it.

6. Patient gets tablets. Give tablets. New prescription and the patient never had any Levo previously? It doesn't matter. But be a good Pharmacist and, if you try the capsules (Tirosint) and they are ridiculously expensive, simply change it to the tablets and save them money. We'd rather they be compliant and take their medication than quibble over whether or not the prescriber chose the first option from the drop-down menu (which she did).

Every pharmacist has her own quirks and panty-bunching idiosyncrasies. Don't put your brain out to pasture by forgetting why you went to school: to learn HOW to think, not what.

CPP: Think everyone passed?
CP: Most likely. We have a great group of phollowers. I think we will catch shit from people justifying why they call (insurances and audits and on and on) but I stand by our answers. Even if I get audited on 1000 Amoxicillin Rx's over 5 years, I'm only out like $42.00.