Home Forums Another TSP800 Thread

Hey guys, with the help of this forum I actually got my TSP800 Ethernet Printer on my SBS2008 Network and it runs, can print more than one Rx and everything. Now my problem. When making adjustments in the admin section to get everything to line up on the Rx, I still need to move the print down and I've maxed out the adjustments that I can do on AC. Is there anywhere else I can make adjustments to bring the text down to fit in the right spaces? I still need about 1/4".

Are you using the prescription paper with the black marks on the back? The TSP-800 can be programmed to line up each Rx uniformly using these marks. The setting for enabling this setting is Printer Properties --> Device Settings:

yeah I've done that. I did find one area where I did not have it set to 104x200 so I'll see if that works in the AM.

Hi Scott,

You mean you are having problems with the easiest print driver ever made? LOL

Can you tell us what you twip settings are? I haven't experimented with it, because I hate to change anything that is working on the Star, but there seems to be a huge leeway on the horizontal and vertical settings. Does it stop at certain settings? Mine is at -100 twips. Not sure if they are the same on each.

Yeah, the driver install was horrible. It's like create a port and install the network printer like it's a local printer because that makes total sense. Then log onto the forum and find ryanjo's secret settings that no one else seemed to mention in the manual....

Yes Bert I'm talking about the twip settings. I have my vertical at -1440 right now and it's still not low enough and that's the max.

I'm confused as it states that (-) makes the prescription go up. And, you are trying to make it lower.

ok Bert, I'm an idiot. That fixed it. lol Is there such thing as adult onset dyslexia?

No, but there is such a thing as that is the first helpful thing I have done in six months.

I bought a cheap Lexmark refurbished network printer ($75 on Newegg)
Set the paper size to 5"x6" (custom size)
Use prescription paper that comes scored into quarter sheets.
Load quarter sheets into the paper tray.
Print prescriptions as "1 per page" from AC prescription writer.
Set the print option to "scale print to page"
It prints out the prescription quite nicely; if you have multiple prescriptions, they all just print out. You have to check the "print 1 prescription per page" option each time, otherwise you get really, really, tiny print in the upper left corner of the quarter sheet. Can't find anywhere to make that a default.

Being a network printer, you can easily access it from anywhere.
Of course, the printer is quite a beast, since it is designed for full size sheets of paper -- but it's cheap and easy.

Thanks Tom,

What happens when you print one or two scripts to the remainder of the sheet?

Do you use it again?
Do you throw it away?
Do you have to shred it as it is for controlled substance scripts?

Thanks.

I don't throw anything away (except my own mistakes!)
The RxWriter software in AC is set up so you can print 4 Rx to a page (so you can use full size sheets in your printer)

You can also print 1 Rx to a page, which by default comes out to a standard 81/2 x 11" size.

The Rx paper can be purchased either in solid sheets, or 1/4 scored sheets.

I buy scored paper, and divide it into quarter sheets, and put a stack of quarter sheets into the paper tray in the printer. Most printers will take the small sheets.

The next thing is to use the printer options (its in the print driver software) to print to the quarter sheet.

If you set set up a custom paper size (5 x6" works well), and set the printer driver so it automatically sizes the print to the paper size, then print "one Rx per page" from AC Rx writer, you have a decent Rx printer.

Sounds sort of complicated -- it's not, once you figure out the options in the printer driver.

Advantage is any laser printer (maybe inkjet too) will work as Rx printer. And since used printers are cheap -- even network printers -- you don't have much invested. I would put one in every exam room except for the clutter, so I just use one printer out in the hall.

The full size printers are big, of course -- I'm sure the dedicated Rx writers are smaller

I do a modification of Tom's method.

I have a laser printer in each exam room and do not use the perforated sheets but non-perforated.

I cut the sheets in half horizontally and do not use the quarter sheets because of propensity of jamming.

I print to quarter sheet in the print options, and just leave it set there.

So I get a prescription on just the left side of a horizontally cut piece of paper, which is not real pretty but works.

I do not do much pain management or treatment of ADHD so I have not even gone through a stack of Rx paper in a year.

The only time I manually print otherwise, which is more often than printing scheduled drugs, is for the patients that have to go out to the local base pharmacy, and in that instance I use regular paper with 4 prescriptions on one page, which I do not cut into 4.

I should add the main reason I have a laser printer in each room is not so much for prescription printing onto paper, but rather for educational information and medication information from Up to Date. I have found the dedicated patient information on any number of conditions invaluable for teaching at the time of the visit. And most patients appreciate a stapled handout from Up to Date given to them at the visit for their particular condition.

jimmie,

Is this for controlled substances?

The printed ones on the Rx paper, such as percocet, oxycontin, morphine, or ritalin, yes. So it may be different from state to state, but have had no problems with rejection from the pharmacy or any issues doing it this way.

I have never had a jamming problem with the 1/4 sheets. Not to say it couldn't happen. Of course, if I forget and let it print "4 per page" it comes out in teeney weeny print (4 prescriptions per 1/4 sheet).

You can even buy refurbished laser printers with 2 or more paper trays, selected from software. We use one of those up front, but I'm thinking of putting them in the exam rooms so I can print handouts and Rx from the same machine. It's just that they are so beastly BIG. I have the printers in the hall just outside exam room doors, so it isn't really a huge hassle.

I have a lot of "chronic pain" and "ADD" folks in the practice, and I make anyone who needs even C3-5 come in for Rx. For medicare and welfare, at least in OR and WA, they have to be printed on tamper-resistant paper, so I do go through a bunch of it.

I write three months worth of schedule 2 drugs at a visit, so there was a lot of writing (and I made a lot of mistakes) until I figured out how to print them out of AC

How do you keep the tamper-proof paper secure, e.g. from the patients?

Tom,

I should be more precise with the language. By feeding the 1/4 sheet of the Rx paper I had more of a problem with the prescription coming out "sidewickered". The horizontally cut half sheet when fed into the printer rarely comes out crooked on the page. It may just have to do with the type of paper I have and the particular laser printers.

I initially had just 2 laser printers, one for my office and the other for my nurse. Early on in the go live process with AC, my brand new HP laptop malfunctioned, so I spent the first month or so thinking and re-thinking what I absolutely had to do in the exam room with my lap top. One of the redundant time wasting machinations was running back and forth to my office printer for educational material and scripts. Once I got my laptop up and running, I wanted to minimize any interruptions and give my full attention to the patient. It became abundantly clear I needed two additional printers, one for each exam room with plain paper and special prescription paper. This has saved a significant amount of time doing these tasks in the exam room while still engaging the patient.

jimmie,

How do you keep the tamper proof paper secure?

Do you have one or two printers in each room? And, if there is tamper-proof paper in the printer, is it secure?

Bert,

I keep the tamper proof paper in my office or in the exam rooms out of sight, but I suppose if a patient wanted tamper proof paper they could order easier on line than lifting it from my office or exam rooms. Plus they wouldn't get much. I only keep a few sheets cut in half in each exam room at any one time. The big stockpile is in my office.

I am not aware of patients around here stealing tamper proof paper.

How do you keep it secure?

I do not use prescription pads much anymore, but never keep prescription pads in the exam room.

I only keep regular white paper in the printer at all times and feed the tamper proof paper one at a time into the printer only when printing a scheduled drug.

Only one printer per exam room, one in my office, and one for my nurse--a total of 4 printers.

We have printers everywhere, but only two tamper-proof paper. One at triage on the right side away from patients and locked. And, one up front. So, when we print it goes to reception who proofreads and stamps it. The CMA's script is literally two feet away.

Not to be offensive but how do you know no one steals them up there. You are right about online ordering. They have to know name, DEA, license number. All on our paper scripts. They do need NPI. They ask for some other stuff so not sure if they call. But, I don't recall their calling me.

Not for me to say how to do it. If it works that is great. Just that the Star Printers are rather nice.

No offense taken, just nothing I have heard of, but does not mean it does not happen. I will ask some of my partners to see if they have heard of this around here.

I have the exam room printers set up primarily for educational materials and secondarily for printed non scheduled drug scripts, and lastly for printed scheduled drug scripts, but you have alerted me to this idea of stealing the tamper proof paper. Hopefully will never happen, but I can lessen the chances further by taking the tamper proof paper out of the exam rooms altogether. It may be a bit inconvenient but certainly doable.

Well, I certainly don't want to make it inconvenient. We have to figure out a way to keep your numbers from showing. Maybe only click on DEA when you use that paper.

A ways back, you could download AC and have a script you gave them and have a field day. Which is why not being able to use eRx is so silly. I'll try to think of something. I just have a habit of walking the patients to the front, so printing a sheet there would be easy.

Maybe have a carpenter or someone custom build you something you could lock over the paper sheet feeder.

I think the whole idea of tamper proof paper is that you would be the only one with it and, of course, it can't be tampered with, supposedly.

Wanna hear something funny. We have these rolls that go in the Star TSP800 printer. We have always bought from the same company. Printed for five years with no issues. Another doctor had some extras because she didn't need them any more. Exact same paper. EXACTLY. Except for one, tiny, little feature or should I say non-feature. This paper was used for six months and no pharmacist caught it. So, of course, I went back and forth with this pharmacist who wouldn't fill oxycodone. Turns out he was right.

Now, the second funny thing is throwing it away. Sure, throwing it in the dumpster would likely have taken care of it. But, we took every roll, unrolled it and shredded it.

Jimmie,

A pretty typical solution is a fabricated aluminum bracket that the printer sits in that has a locking lip over the paper trays.

Used to be you could find them by printer model number, might require a bit of custom fab to fit your printer, but not a big deal.

or eBay....

This is all total overkill.
When is DEA going to let us ERx controlled drugs.
Surely, that is more secure than "tamper resistant" paper.
And all those printers and stacks of paper!

I agree.

I think when we can unionize
When two of us can go in a bar and talk about dumping Anthem and it isn't anti-trust
When the Maine Medical Society's idea of helping physicians is a picnic
When the AMA stops sleeping with...well you name it

You're right, but we allow it
What if every doctor stopped writing for narcotics?
That would work, but who would suffer?
What if every doctor in Maine stopped seeing MaineCare?
The EDs would be overrun and they would have to sit down with us and talk,
But, like the traffic controllers, the board would simply pull our licenses.
LAWYERS WOULD NEVER TAKE THIS

I have never understood the DEA stance on not being able to e-prescribe.
Maybe I am in a Jack None Reacher frame of mind, as I just had a Lee Child bookfest over the weekend, but, it seems to me to be [censored] backward.

Any Joe could get his hands on tamper resistant paper, a laser printer and the ability to print up smart looking scripts and be virtually untraceable. Try to do that with e-prescribing and with an IP address--Bingo, this might make the job of tracking the perp a bit easier!!!!

And that is without getting the NSA involved to track his cellphone in real-time.

The government doesn't think at all. In Maine, it is required to write scripts for Melatonin or amoxicillin on tamper-proof paper if the patient is MaineCare. I wrote a letter to the director of Medicaid explaining that not many patients will falsify an amoxicillin script to make it 14 days. BUT, I told them diversion will go up at least 20% because now doctors would have to walk around with tamper-proof paper. When I wrote on a script pad, an MA would hand me the pad at least three times a day when I left it on the desk.

Stupidity.

@ Indy--a fellow Reacher fan????