Maybe why people don’t understand what we do

As a recent quote from one of the heads of a PBM… Nexium is Nexium… it really doesn’t matter who COUNTS IT!. Could it be that we are our own worse enemy?
Look at your practice setting… the most contact the people have with us in the retail/community setting.

What do we do when we notice something wrong with a Rx? In correct dose, drug allergy, drug interaction…. some other things that puts all the brakes on in proceeding with filling the Rx…

Generally what do we do… we tell the patient that there is something that needs CLARIFICATION… usually in an apologetic tone… could it be viewed by the patient that we are so incompetent that we can’t simply read a common prescription…

Would the impression of us be different.. if we told the patient that their doctor F-upped.. and that the dose,drug could have cause significant harm to them or even death… That would really endear the prescriber to us… but isn’t that what happens more often than we would like to see it?

I temp in LTC… I recently had a written Rx faxed in for Morphine 20mg/ml with a dose of 1 ML SL q 1 hr prn pain/SOA.. this was a end of life patient. The order entry tech – dozen of years of experience – was smart enough to question this dose… she sent me the image and I told her to mark on it .. this is a LETHAL DOSE — DO NOT FILL … and my initials…

I proceed to call the nurse taking care of this patient at the nursing home… I explained my concern.. this was a LETHAL DOSE …and she got pretty indigent.. and told me that is what the doctor wanted… I told her I was NOT GOING TO FILL IT AS WRITTEN… well… she is going to call the doctor… great… that is what needed to be done… IMO… this conversation actually lasted much longer than it should have taken between two “learned healthcare professionals”

10 minutes later… we receive a faxed Rx from this doctor and for this patient Morphine 20mg/ml … 5 MG SL q 1 hr prn pain/SOA… that sounded more reasonable…

10 minute later… I get a phone call from the prescrber… VERY GRATEFUL… that I caught the error.. never heard from the nurse.. I know that this was a end stage patient and probably actively dying… the patient… the family… doesn’t know me… won’t ever know what I did.. on their behalf…

After all .. it was just Morphine and Morphine is just Morphine… as per the head of the PBM… it really doesn’t matter who dispenses it !

2 Responses

  1. That story highlights one of the problems with our profession. We do lots of things behind the scenes that don’t get recognized by anyone including the patients involved. But, if a mistake is made, we are highlighted with questions like “how did this happen?” being asked by everyone involved. We don’t market ourselves enough and educate the public about exactly what we do for them.

    I’ve had nurses insist that a doctor’s order was correct even if it was obviously mistaken (like OxyContin dosed every hour for example). I’m thankful that usually the prescriber is very appreciative of any mistake we catch and is grateful for the professional courtesy we extend by calling them to clarify a prescription order.

    I just wish the general public knew about all of these interventions we do so when some idiot like George Paz runs his mouth, they would all realize just how ignorant and misguided his statements really were. I know, I know- that is wishful thinking.

    • It IS wishful thinking to even remotely believe that only a very few are in the know about all the empirical data. In a perfect world, A consultation on most scripts would be required . SORRY- NO TIME!

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