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  • Who thought this was a good idea?

    We got some prescriptions in today for one of our regulars.

    Not to violate HIPAA, I'm not gonna identify him, his doctor, or his medications except for the following: There were two e-scripts (which transmit directly into our computer), one for an antipsychotic and one for an antidepressant, and then there were two e-faxes from the same doctor, one for a lower dose of the same antipsychotic and one for a different antidepressant.

    See, some doctors don't have direct connections from their computers to ours; as a result, when they try to e-prescribe, instead of it popping up right on our screens, it goes through a mail-to-fax gateway and shows up on our fax machine instead. Some do both. (There's one doctor in our neighborhood who sends all his Flonase prescriptions that way and e-mails everything else, and I can't figure out why he does this. Drives me batty.)

    So that''s not all that unusual, to get them by both routes. My boss, the pharmacy manager/head tech, typed them all out on the computer and then passed them to me for verification before counting, as is usual procedure in this store.

    When I took a closer look at the two faxed prescriptions, though, I found something weird.

    These e-faxes usually have some boilerplate at the top and bottom, saying something like "This prescription has been transmitted by [Company Name, LLC] on behalf of [Prescriber's Name, M.D.] If you have any questions about this script, please contact the prescriber directly. Contacting [Company Name, LLC] is a HIPAA violation." and so forth.

    However, the boilerplate on these two documents was rather different in nature. The following text was at the top, verbatim as follows:

    VOID VOID VOID VOID VOID VOID
    This is NOT a new prescription. This transmission is to indicate that a previously sent prescription is VOID and should not be filled. If the prescription has been picked up, please contact the physician's office.

    To: [My store's name address phone and NCPDP number]
    [there follows what looks EXACTLY like a freaking prescription right here]

    VOID VOID VOID VOID VOID VOID
    So basically, what they've just sent me are two anti-prescriptions. I mean seriously, if you cut off that part, just like we generally do with the boilerplate on most e-faxed scripts, what's left looks like every other e-faxed prescription we get. If someone hadn't been paying attention, not only wouldn't the undesired scripts not have been canceled, they'd have been filled twice...

    I don't know what the hell they want me to do with this. I have no idea whether the prescriptions that these were ostensibly intended to cancel were in fact filled, but if they were, they went out days ago. I tried to call the doctor, but his office was closed, so I left them for the morning guy to deal with. Guess I'll find out tomorrow, but seriously, ?

  • #2
    It may be that the physician decided lowering the dose of the one was a bad idea.

    Maybe there is a contraindication for the new antidepressant.

    My guess would be not to fill them, and call the doctor's answering service to get clarification from the MD on call.
    They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

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    • #3
      I have no problem with the MD changing doses, or changing medications.

      What I had a problem with was his sending the changes in a format that could, and almost did, result in the perpetuation of the wrong meds/doses.

      I'm telling you, these things looked exactly like prescriptions, except that they said "Don't do this:" at the top. I haven't worked hospital pharmacy since before I graduated, but I've never seen an inpatient med D/C order that was an exact copy of a med administration order, except for the one line at the top that said "D/C this." It's just too easily misinterpreted, I think.

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      • #4
        Agreed. That's the kind of thing that leads to systems errors. My suggestion would be to kick it to your boss and communicate with the physician to set boundaries on faxing scripts.
        They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

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        • #5
          If a doctor wanted to cancel scripts, wouldn't it be more prudent to call the pharmacy immediately?
          Don't wanna; not gonna.

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