Home Forums Discussions General Discussion how do others document refills - eprescribing

When a pt calls for a prescription, the staff sends a message to the doctor and he authorizes the refill or tells what antibiotic he wants, etc.

The staff member saves the message to the chart, opens the prescription window, enters the prescription, noting in the comment field which pharmacy it was called into. That way the med list is updated and there's documentation in the chart that the doctor authorized the prescription.

Our staff likes having the addendum so that when the patient calls back an hour later from the drugstore, whoever takes the call can see that yes, it was in fact called in.

It's also a good tip when we see a bunch of refill addendums that we need to address the situation.

When the doctor does a refill himself using eprescribing it's a lot faster (obviously) and the med list is updated, but there's no documentation that it was a refill.

And should the doctor then sign the chart or just exit? We don't want to have a potential billing errors.

How do other offices handle this?

I have 3 methods -

1) Staff takes a message and e-mails me - I just hit refill meds and do the scrip - takes as long to type an e-mail with the med name, sig, qty, etc as it does to do a scrip and I never have to worry that my staff did it exactly as I want.

2) Pharmacy faxes - I look at fax on screen and open chart - do refill and send - I don't document a chart note as refill - history for med shows refill.

3) E-refills - come in and I look under e-prescribing, see pt name, open their chart and use NEWCROP SCREEN to refill/deny - it saves to chart and I go to next person and do theirs. This is the most cumbersome, but the lead programmer at AC is working to improve this and move it to AC screens. Hopefully will be done soon.

A note on our philosophy here.... We try very hard to give the patient the number of refills we think they should have at the time we write it to last until they need to be seen next. There are a few exceptions, but ALMOST ALWAYS when a patient seeks a refill, they need an appointment. Consequently, I rarely respond to refill requests from pharmacies. On the surface that sounds really rigid, buy it really cloaks a pretty liberal initial fill policy (you have refills on your lisinopril for a year. If you need a refill, you really need to come in for an appointment), and it keeps me out of trouble ("what do you mean, doctor, you refilled her vicodin and methotrexate eleven times and neglected to measure her lab or enquire about her continued narcotic use?" This technique cuts down on a lot of work in the office, and assures that a patient is getting seen appropriately. I recognize other practices will differ ... you don't maybe need a visit because your UTI flared up... but our practice is pretty much all chronic illness, and we have felt good about our approach.

We have pretty well trained our patients to call their pharmacy, not us, and have them fax a request. It comes in electronically, I do the refill, fax back and then store the fax for 60 days in a Paperport file.

If you open the medication button in the patient's cahrt, highlight the medication and look at history it will tell you when the medication was last refilled.
When we receive a refill request ( TC from patient, fax from pharmacy) the staff sends me a message that the patient is requesting refill of X. I open the chart, review and refill ( if approprite of course) and send the prescription electronically ( print it if a controlled med) and save the message to the chart. That makes the refill show up in the patient visit history. The visit history is getting long on some of the patients...I wish there were a way to add a label to the message...
I am trying to find ways to eliminate faxing/handling/storing/filing/shredding paper...

I don't know if this will help, I use templates for the Chief Complaint:
- "As a consequence of labs:"
- "Telephone call, the patient relates:"

This is then the label in the prior visits and I have the option of adding things to the FAM/SOC etc when talking on the phone, or making a clear connection between the lab result, my assessment and the plan, (what Rx resulted).

Simple refills I relied on the dates recorded in the RX writer, so I didn't previously save a note. I haven't decided how I will handle this in the future.

Wow, I don't know if it's because I am peds or just lazy, but my documentation is horrible compared to all of yours. (which is commendable).

I just refill the med and move on. This is a criticism on me, not you guys.

Thank you all so much! I'm always loathe to reinvent the wheel - asking smart people how they manage is a much better strategy.

In general I like Martin's way but I shudder thinking about how bulky and messy the Past Encounters section will look after several of years of this. Again, I would love to see separate categories for past encounters, for example, Messages, Office Encounter, Hospital Encounter, Telephone or Email Encounter, etc.
So, in practice, I have to agree once again with Bert (Ho Hum). I just refill and move on unless it is a scheduled drug and then I go into AC and update there.

We get lots of call backs about refills.
I do all the refills, so whenever I receive a fax or a nurse message, I write the name of the med in the message line. That way, if they call, the front desk can tell I already did the refill.
The nice thing about sending the refill by attaching the pt name to a message is that it prints in the message box "transmitted to pharmacy". Would be even more super duper if it said "transmitted to Walgreens".

I do keep my faxed refills requests for 60 days. They are stored in a Paperport folder so everyone has access to them.

Great idea Leslie. Since I don't write on them anymore I have been chunking them. Probably should hang on to them for a while.

Great idea Leslie. Since I don't write on them anymore I have been chunking them. Probably should hang on to them for a while.