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The second in an irregular series of posts, because I can't be arsed to set up my own blog (and because who'd read it anyway, besides you guys, so I might as well just post it here to begin with).
So weird things happen in pharmacies. Mine is no exception.
So if you want me to dispense that, why don't you prescribe it? Part II
I've ranted about the "Notes" field on our e-scripts before. Background: The Notes field on our e-scripts doesn't show up on the main dispensing screen. It prints out on the hard copy, but if you want to see it on the screen you have to click on a button and then select a tab on the window that pops up. If you don't do that, you don't actually get to see the notes until you're checking the script, at which point it might be too late.
So. This was Monday evening. Patient gets a few scripts e-prescribed from the doctor's office. One of them is for omeprazole 20mg. Script gets typed and filled, and as I'm checking the prescription against the hard copy, I happen to notice the following text in the Notes field:
So just what does the doctor mean by this?
Is this merely informing us of what the patient is taking it for? Is it telling us that the doctor has provided the patient with the two stated antibiotics? Or is it the doctor's backhanded way of telling us that he wants us to dispense them? And if the latter, what dosages? (Sure, I know it's clarithromycin 500 BID and metronidazole 250mg QID, but he has to be the one say that, not me. I don't have prescriptive authority in this state.)
Tried calling the doctor: gone for the day. I left a note for the daytime pharmacist to call the doctor Tuesday morning, and sure enough, it was the latter. He sent us two more e-scripts for the antibiotics.
Sorry, doc. I can't read minds.
That's not a new printer
This one maybe belongs in Unsupportable, and I'll probably rant about it there with more detail in a couple days, but the cliff's notes version is: Our printer died on Monday. They overnighted us another one which we installed Tuesday. Note I don't say "a new one". I noticed that the chrome trim on the top of this printer, where the paper slides over it, was somewhat worn down on the edges. Takes a lot of paper sliding by to wear out chrome, but I didn't realise exactly how much, until I printed a test sheet and noticed the page count at the top of it.
Something over 625,000 pages have gone through this printer since it left the factory.
I wonder how much longer it's going to last.
One reason pharmacists haven't been replaced by machines yet
One of the doctors in the village hasn't really gotten comfortable with e-prescribing, so he mostly still handwrites his prescriptions. (He doesn't even have such terrible handwriting, I just wish he'd quit writing prescriptions in broad-tip magic marker. Most of the time, though, one of the office workers writes the script out for him.)
So we get this written prescription from his office today. Zithromax 250mg, 1 teaspoonful daily x10 days. OK, there's two problems with that. First, the 250mg dosage is a tablet, not a teaspoonful; the liquids come in 100 and 200 mg per teaspoon. The patient is a 3-year-old child, and can't swallow tablets yet. I could possibly see them wanting to use that many milligrams if it's a severe infection, but it should still have been written as Zithromax 200mg/5ml, give 6 ml daily for, uh, how many days . . . ?
Which brings us to the other problem: you don't take Zithromax for 10 days regardless. It's almost always five days, rarely three. Not ten.
So we call the doctor to find out what exactly we're supposed to do with this, and they inform us that it's not supposed to be Zithromax at all, despite that being clearly legible on the paper. No, it was supposed to have been Omnicef suspension. Which does come in 250mg/teaspoon, and is taken for 10 days.
If it wasn't covered last month, what makes you think it's gonna be covered this month?
Patient gets an e-script for clindamycin foam. This costs a couple hundred dollars, even for the generic. I try filling it; insurance rejects it as non-formulary, suggests using the gel or lotion instead.
I check his profile, he had the same thing prescribed end of November. It didn't go through then either.
Einstein defines insanity as doing the same thing over and over and expecting different results.
There ain't no sich animal.
This is a short one. Someone came over to the counter and asked for "non-drowsy Benadryl".
Yeah, good luck finding that.
So weird things happen in pharmacies. Mine is no exception.
So if you want me to dispense that, why don't you prescribe it? Part II
I've ranted about the "Notes" field on our e-scripts before. Background: The Notes field on our e-scripts doesn't show up on the main dispensing screen. It prints out on the hard copy, but if you want to see it on the screen you have to click on a button and then select a tab on the window that pops up. If you don't do that, you don't actually get to see the notes until you're checking the script, at which point it might be too late.
So. This was Monday evening. Patient gets a few scripts e-prescribed from the doctor's office. One of them is for omeprazole 20mg. Script gets typed and filled, and as I'm checking the prescription against the hard copy, I happen to notice the following text in the Notes field:
for treatment of h. pylori with flagyl+biaxin
Is this merely informing us of what the patient is taking it for? Is it telling us that the doctor has provided the patient with the two stated antibiotics? Or is it the doctor's backhanded way of telling us that he wants us to dispense them? And if the latter, what dosages? (Sure, I know it's clarithromycin 500 BID and metronidazole 250mg QID, but he has to be the one say that, not me. I don't have prescriptive authority in this state.)
Tried calling the doctor: gone for the day. I left a note for the daytime pharmacist to call the doctor Tuesday morning, and sure enough, it was the latter. He sent us two more e-scripts for the antibiotics.
Sorry, doc. I can't read minds.
That's not a new printer
This one maybe belongs in Unsupportable, and I'll probably rant about it there with more detail in a couple days, but the cliff's notes version is: Our printer died on Monday. They overnighted us another one which we installed Tuesday. Note I don't say "a new one". I noticed that the chrome trim on the top of this printer, where the paper slides over it, was somewhat worn down on the edges. Takes a lot of paper sliding by to wear out chrome, but I didn't realise exactly how much, until I printed a test sheet and noticed the page count at the top of it.
Something over 625,000 pages have gone through this printer since it left the factory.
I wonder how much longer it's going to last.
One reason pharmacists haven't been replaced by machines yet
One of the doctors in the village hasn't really gotten comfortable with e-prescribing, so he mostly still handwrites his prescriptions. (He doesn't even have such terrible handwriting, I just wish he'd quit writing prescriptions in broad-tip magic marker. Most of the time, though, one of the office workers writes the script out for him.)
So we get this written prescription from his office today. Zithromax 250mg, 1 teaspoonful daily x10 days. OK, there's two problems with that. First, the 250mg dosage is a tablet, not a teaspoonful; the liquids come in 100 and 200 mg per teaspoon. The patient is a 3-year-old child, and can't swallow tablets yet. I could possibly see them wanting to use that many milligrams if it's a severe infection, but it should still have been written as Zithromax 200mg/5ml, give 6 ml daily for, uh, how many days . . . ?
Which brings us to the other problem: you don't take Zithromax for 10 days regardless. It's almost always five days, rarely three. Not ten.
So we call the doctor to find out what exactly we're supposed to do with this, and they inform us that it's not supposed to be Zithromax at all, despite that being clearly legible on the paper. No, it was supposed to have been Omnicef suspension. Which does come in 250mg/teaspoon, and is taken for 10 days.
If it wasn't covered last month, what makes you think it's gonna be covered this month?
Patient gets an e-script for clindamycin foam. This costs a couple hundred dollars, even for the generic. I try filling it; insurance rejects it as non-formulary, suggests using the gel or lotion instead.
I check his profile, he had the same thing prescribed end of November. It didn't go through then either.
Einstein defines insanity as doing the same thing over and over and expecting different results.
There ain't no sich animal.
This is a short one. Someone came over to the counter and asked for "non-drowsy Benadryl".
Yeah, good luck finding that.
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