The Pharmacy Chick

Flying the coup in retail

Inappropriate SIG’s

Filed under: Uncategorized — pharmacychick at 10:05 pm on Sunday, June 6, 2010

I always bristle when the FIRST thing out of a patients mouth is one (or both) of the following statements: “How long is this going to take?” or “How much is this?”, without even so much of a “Hello” preceding it.  I bristle even more if I am treated like an afterthought by the so-called customer whose attentions are diverted by the cellphone fused to his/her ear ” Hold on hunney, the pharmacist wants something”.  ( EXCUSE ME? YOU ARE THE ONE WHO WALKED TO MY COUNTER..YOU WANT SOMETHING..NOT ME.) Honestly, can you imagine getting away with that in a doctors office?

I got the call before I saw her face.  Barely understood because of her crappy Bluetooth device she wanted to know if we had 120 Oxycontin 40 mg.  5 minutes later she was standing before me with the prescription.  The only words out of her mouth (to ME anyway) was “How long will this take. I got a plane to catch”.  One look and I knew we were going to have a problem.  Oxycontin 40mg # 120,  1 QID. 

Maybe if I knew her..maybe if she had been filling the same rx her for the past year…but that was not the case.  New patient… and I hate those kinds of sigs.  Its the same moron who writes Tussionex  1tsp q 4-6 hours… or  Proair HFA 4 puffs every2 hours.  Give me a break. I told her I needed to verify the directions on the blank.  They were not standard or appropriate for the dosage form…it wasn’t  2 tabs bid, something completely different.

First call to the office: Voice mail.  Second call to the office (asking for a humanoid)  :  voice mail.   Third call was made by the customer getting irate.  She handed me HER cell phone to talk to the office “they are getting  Kristin” …I handed it back:  Voice mail. I guess Kristin is a machine.  She was getting livid. 

I had her naked over a barrel, not by design but by necessity.  I needed to verify the sig…and wasn’t budging.  This script was only signed by the doctor. it was written in somebody elses hand.

It happens all the time.  We get some of the weirdest crap written, faxed and emailed to us every day.

We are a nation of people in pain apparently, and we are all about quantity and not quality.  I got some nutcase whose Oxycontin 80 script reads “take 5 tabs daily”.  Based on patient interview, he does at least take 3 am and 2 hs. That (while a HUGE dose) is at least prescribing within reasonable limits based on the drug itself.

I got a script for Fentanyl patches.  Apply 1 patch every 24 hours. No notes added or explainations offered.  Even after I verified it, I didn’t like it much. Neither did the insurance who even after PRIOR authorizing it, still audits my claims about once a year.  Stick it  Mr PBM, I have every I dotted and every T crossed.

I receive quite regularily a script (from the same Dr who  just doesn’t get it) ” Oxycontin 5mg  1-3 every 4-6 hours…etc etc”.  Granted, I know what he means, but it still is not written correctly or appropriately.

OR, the E-script I got last week for Azithromycin 250mg #30.. 1qd with prn refills.  I got it after office hours which meant I had to page him. He called us back. ” We got this escripted to us..Were you intending on prescribing Mr. X  Zithromax daily  for a year?”  He decided to be funny and replied ” No, I am intending on giving it to him the REST OF HIS LIFE”.  Well alrighty then. Thanks for  your help…( the patient never picked it up..I guess his life was pretty short)

It gets kinda old doing the call-back thing.  There are too many layers between me and the Dr, and “voicemail” is the lousiest of them all. Its the professionals version of the brush off.  Its the 21 century version of “have your people call my people” …only there aren’t any people.

What would really help (and I know this is a real stretch for prescribers)…is if when you write a script that is weird by intent or design…how about elaborating on it so we know you INTENDED on prescribing it like this?  A little help here perhaps?

I recently got a script for Cymbalta 60mg  4 caps qd.  That normally would necessitate a call to the office. But the kind dr included a tag at the bottom of the fax “Patient is a heavy metabolizer and requires excessive dose”.  End of story. Now was that so difficult?

“Kristin” finally called back and was just a bit put out that I called into question the sig on the Oxy. I said ” Look Kristin,  I have never seen this lady before and likely never will again. She is just stopping by on the way to the airport (her story not mine) and Oxycontin is 12 hour release, not 4 hour release.  I want YOUR name on this RX blank assuming responsibilty for this sig…..yada yada yada”

Every time I sign off on a prescription I am putting my stamp of approval on the contents of it, including the sig.  If I dont like the sig, even if its “correct as written” I am not going to fill it. “correct as written” does not make it “CORRECT”.

For every one I have verified as correct, I have found sigs that were unintentionally wrong.  We are humans. We make mistakes.  So if you are a patient reading this and the pharmacist wants to verify your prescription,  don’t take it as an afront to your personage. And, if you are a Dr reading, help us out a bit. If your script is over the top, leave us some indication that it was intentional.

Oh, and what about Ms Bluetooth?  “kristen” said “well, if you dont like the sig, change it to 2 tabs BID”. 

What the….?


Comment by Guzzo

June 7, 2010 @ 2:42 am

Man.. I’m such a cynic. I can’t help but think that Rx is fake, and that “Kristen” is her criminal cohort.

“Patient is a heavy metabolizer and requires excessive dose”

BTW.. I love the docs who head off potential problems.

No, actually the script was legit,I knew the prescribers signature very well, from a well known pain clinic. and I made some phone calls from my own phone to the office. And I think if “Kristen ” was her criminal cohort, she would have made herself a teeny bit easier to reach than to have to fight voice mail over and over.

Comment by Dr. Grumpy

June 7, 2010 @ 5:24 am

That’s just wrong.

Agree with Guzzo, though.

Comment by WagRph

June 7, 2010 @ 7:21 am

I had a dentist once call in a script for flexeril 10 mg 2 tabs QID! I called back to let him know that the dose was over double the recommended dose and I was not going to fill it that way. Not to mention the patient is VERY well known to us and likes her Tussionex and Vicodin. The dentist told me “well if you don’t like it, change it to whatever you want, but that’s how I always prescribe it.” How often do you see dentist’ writing for flexeril anyway?
very rarely and never 2 qid! maybe he was thinking Skelaxin….or robaxin

Comment by Cathy Lane RPh

June 7, 2010 @ 8:12 am

One afternoon a nurse called in, and left the perfectly dictated C-III script on voice-mail for an unknown patient. I called over to verify something for the ‘unknown’ patient and amazingly the nurse no longer worked there.

Yesterday’s medication reconciliation issue was for the unknown patient admitted through ER. Her med list included name of drug ‘methotrexate’ and dose ‘6 tablets’ and a few critical omissions translated to her order sheet as ‘methotrexate 6 tablets daily’.

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