Home Forums Discussions Feedback and Recommendations Another prescription writer wish

I'd like a 1/2 tablet, capsule... option.
Also to note if prescribed by another provider ex Cardiology prescribes Coumadin, etc...

Many prescription writers break the SIG in parts selectable from multiple drop down boxes:

Choose # (1/2, 1, 1 1/2, 2,...)
Choose Vehicle (Tablet, Capsule, Drop,...)
Choose Schedule (QAC, QAM, QD, QPM, QHS, BID, TID...)
Choose (PRN)
Choose (BY OTHER)

Maybe default to most common SIG.

When I'm am adding something prescribed by someone else, I indicate the name of the prescriber in the amount disp field.

What I've asked for and REALLY want to see in the script writer is:
1. Pharmacy name
2. Insurance

I also want to see if it's the MA who refilled something or me.

your assistant should NEVER be refilling any medications unless it is on your direct order! that person is not qualified to do so. set up AC with different levels of user access, with password protection.
if your assistant is acting as your agent, to refill medications, you still need to document that the rx was done by a qualified person. your statement indicates a breakdown in documentation, security and chain of command in your office.
could your assistant be refilling medications for patients and/or others not known to you?
best if all rx's are done directly by a qualified person, faxed directly to the pharmacy.
additionally, refills should ideally be done at the visit, with enough medication to last until the next scheduled visit.
fix this ASAP or you're asking for trouble!

I handle Rx's from consultants like Rainey. No number (and no refills) just the consultants name, ie: "by Smith, Cardiology" in the quantity box. Sometimes I use the yellow box for editorial content, ie: Coumadin for A-fib, in spite of age 95 and falls. That helps me avoid the point where I get involved in refilling something I wouldn't have Rxed in the first place.

Have to agree with you Larry. We have let the MA's do refills with way too much latitude. (IE: It is always ok to refill beta blockers until the next appointment) But we never should have let this happen. We had an MA a few years ago who refilled Vicodin for herself. (It was an Rx from an Ortho for a real surgery, but the refill was not indicated). After she was terminated we reviewed our policies, but still have MA's calling in the RX on the Doctors direct order. Still not a good idea, but it was the only way to function before AC. Now I foresee a point where the MA will be completely out of the loop on Rx's.

Result will be better security and less overhead, as well as more complete and accurate medical records.

Rainey I assume you are suggesting the insurance info and pharm would be a field populated by AC after we fill it out once on the demographics page? That would be really sweet.

i like the idea of fields in one place populating fields in other places, such as preferred pharmacy, of course with phone and fax #, possibly importable/exportable from/to ms outlook, and i like the idea of indicating who's prescribing what.
one other thing i'd like is that every rx has a unique identifier attached to it, which is also printed out on the rx, and as part of the rx on the chart note.
i don't know about other states, here in WA, c2's have to be written on tamperproof paper and cannot be faxed, the only exception is for hospice patients. i ordered two reams of tamperproof paper and had sequential numbering printed on each piece; when i rx a c2, i do so the normal way, but instead of faxing it to the pharmacy, i print it out on the tamperproof paper, and then document the unique identifier at the end of the rx in the chart note.
i'd like to avoid this step, and the additional expense of the printing of the numbers. i also think it would be good to track all prescriptions, not just c2's.

The MA is documenting the scripts from the fax refills I get from the pharmacy and only does so after I sign off the forms. I

While it is ideal that folks come in for their refills, they don't for some reason or another, and I'm not one to hold someones insulin or albuterol just to make them come in. If I've not seen them, they get 30 days only with a warning there are no more until I see them.

All narcotics that go out of this office, including C3's are on tamper proof paper. They are not called in. It's rare that anyone gets a refill.

I don't number the tamper proof sheets, but that's a great idea.

the key for me, in using an emr, is to have a central repository of information, for all aspects of patient care, with respect to documentation of visits, prescriptions, referrals and consultations, and billing and payment information.
anything which is done outside of the emr invites a source of confusion, in addition to double entry.
in addition, each potential point of confusion exponentially increases the confusion.
to top it off, if a non-qualified person performs the task of a qualified person, even on instructions, doing so, perhaps to
"make it done so we can get out of here", "we'll do that just this one time", may further increase the confusion and lack of appropriate documentation.
therefore, it would be prudent to minimize and even eliminate
the sources of extraneous data entry, and to make the circumstances which necessitate data entry as few as possible.
in other words, make your office flow such that you
#0)eliminate non-structured care and interactions.
#1)everything is done the same way every time.
#2)clear office policy on how things will be handled
#3)those who violate #'s 1&2 will walk the plank
#4)tasks performed will only be done by those qualified to perform them.
#5)appropriate and timely documentation by the person who has performed the task.
is everybody perfect? of course not, it's a constant process of working toward a better way.
hope that's helpful.

I just reviewed this thread. Wow guys! You have time to review every single refill! I have my RN or CNA review the chart to make sure the patient is keeping follow up appts and that the medication is prescribed by us. Then they print it out for me to sign. If anything is questionable I ask about or review the chart myself but that only happens once or twice a week. So far, this has worked great. Maybe you should hire an RN or CNA instead of an MA.

But that raises a beef I have about the prescription writer - my nurse should be able to act as my agent on prescriptions - that means that under my guidance she should be able to print out prescriptions that have my name at the bottom. The nurses should be able to act as an agent for any physician in the clinic which means they should be able to select different providers at the Rx Writer.

Yes, I review all my refills which ranges bet 12-22 a day. Being compulsive about reviewing refills is important. A colleague of mine was successfully sued for refilling the cholesterol medication prescription of a noncompliant patient who ultimately died of a heart attack. Lipid panels hadn't been tracked and while we may feel the suit was another example of lawyers gone wild, it is the world we live in. I'd like the prescription writer to give a tab to check on the history of refills. I'd also like it to easily link electronically with one of the electronic prescribing services so you could prescribe in the program and send the prescription instantaneously to the pharmacy. Of course the electronic prescribing is far from perfect and I have to phone in 3 refills tomorrow that I thought went through on the electronic refill.

Oh and one more huge wish: I'd love to have a drug interaction checker in the program so I could check interactions on the fly. That would easily be worth $200-$300 a year to me. Right now I have to enter everything into Epocrates on my palm pilot, and this does slow me down, yet it's an important step. (Hey I'm a compulsive internist. It's the way we're trained).

I don't work for AC but I know that an on-the-fly drug interaction checker would be a huge task for the programmers. Right now, the drug names in our database are just that: names. To check interactions, every drug name would have to become associated with its own table or mini-database, almost like each one was an individual patient.

I agree it would be nice. Here is a roundup of online drug interaction checkers:

http://davidrothman.net/2008/01/16/online-drug-interaction-checkers/

One solution I'm going to try is the Medical Letter Drug interactions software for windows (cost $98 for 2 updates a year). According to the web site, it will allow you to store patient info, brief notes,and has the all important add one drug feature so you can see if the new med interacts with the current meds (without retyping everything). Unfortunately it isn't available until 2009, so I'll limp along with Epocrates for now. Thanks for the blog reference.

Maybe we should talk to Epocrates about this. If they could develop a parser to simply take a text list of the meds as input, it would be far easier to check for interactions. Right now we have to go through and choose each individual medication from a drop down list. While we're at it, is there some way to speed up the interaction with epocrates?

That is a truly excellent idea, Kevin.

Even if it required some kind of special coding to accept it, Amazing Charts could be adapted to the task.

I think this would be much easier than devising a medication database from scratch, or adapting an existing one and grafting it into AC.

A long time ago I posted a wish and sent Jon an email on things like the Rx writer that would allow it to perhaps via the email feature, have staff create lots of things, letter, Rx's take your pick, and choose the provider whose signature should be on it, foward it to that doc for their approval and then the doc could even send it on to whoever he felt was best to finish it.

So like the MA, Nurse takes a call and creates an Rx based on the phonecall. She sends it on, prepped but not signed to the doc for final OK, the doc likes and then he sends it back to her or can even send it to the front desk because it is a patient pick-up or needs to get mailed out or what have. Also the feature should have the flexiblity to allow the doc to trash it outright, tweak it, send it back with a comment like, "Not until he gets his bloodwork done and has a visit based on his bloodwork" you get the idea.

But as I see it, in a paper office staff create all sorts of stuff in the doctors name that then the doc simply needs to say yes or no to. We need a feature that allows staff to do the same things via the EMR to assist the doc in keeping their desk clear and the day moving along. We frequently see the doc as the bottleneck in our office because she has to literally create, not just approve every last little piece of paper that moves thru the system with her name on it... Lastly these things should not be recorded or "offical" or saved until the doc says they are, via a sign off like feature.

I'm just a practice manager, but I can take a message, prep the refill, and send it up the chain for the doc and her clinical staff. This saves them all time and effort. But the letter, the Rx whatever only becomes real, official and recorded when the doc says it's good to go....

I've been trying to get all the staff to use the messaging system in AC. That way, I can forward an approval on to the RN who can save it to the chart or print or fax the prescription or order. This works with lab orders when the order is picked off of a right click on the patient name - a message is created after the order is printed. This can be forwarded to the doc for approval. Refills can also be printed and saved to a message that can be forwarded. All the messages can be saved to the chart.

Wow!!!! I doubly agree with Kevin. I don't know how I missed this the first time. Some of the statements on here have been rather harsh. Personally, we do the best we can. I had one MA do Vicodin for herself. She called it in. So, you can do all you want with AC, it still happens. And, I am not going to change my entire working office flow because someone is a drug addict.

My MAs fax in script but all scripts are sent to me so I see them within hours. I can't do everything, and I am not going to refill albuterol ten times in a day. If I can't trust my MAs, then what's the use of having them. I guess they can do blood pressures and walk patients to rooms. And, I never ask for trouble. I am really tired of giving less efficient care to 99 patients, because one may abuse us.

Kevin, there is a simply workaround for the signature. ALL of my scripts says, "Digitally signed by Albert Adams, MD."

I refill about 50 or more scripts per week of ADHD meds. These are printed on tamper proof paper via the TSP800. I sign them off. I would hate to have to print these all myself.

I'm with Bert here. It makes no sense not to give your staff refill privileges on AC when they can call anything in any time they want. As all my refills now come into my fax, I see everything but will move a request into a staffers Paperport folder to actually handle. They then refill it, fax it back and update it in AC. If there is a question about whether the patient has not been in for a while, I do check that before sending it on and then may send a reminder to the staff person to also call the patient in for follow up. Which brings me to another subject. How in the H#%@ does Congress think Eprescribing will improve drug control when pharmacies still accept things being called in. Just plain Bull CHitt.

Have a good Sunday,

Leslie

If E-prescribing were truly to improve safety, it would have real time drug interaction warnings pop up before you tried to send a med. My Allscripts service really doesn't seem to have this, yet unfortunately the only meds in there are the ones which have been refilled/filled electronically. (Remember a large part of the push for e-prescribing and EHR's is safety, not efficiency)

The bottom line on improving quality in medicine is we need more time to do the tasks adequately. This extends from the private office to the hospital setting. Electronics will only help so much. It's much more sexy however to talk technology than good old bread and butter patient ratios and numbers seen per day etc. And I would wager in the screwed up world of health accounting it (computerization) looks cheaper than increasing reimbursements to hospitals and physcians.

I'm sorry if the post is a little off topic-I didn't want to start a new discussion.

It remains to be seen what e-prescribing will look like when Jon fully implements it. I hope it will have some interaction and eventually pharmacists will be able to check on what prescriptions have been filled at all other pharmacies, regardless of insurance.

What I do think is great is that although it will be very convenient for us - I am friends with one of the pharmacists in our area and the current price for them to accept scrips is currently $1,000 to turn on the service and 0.40 per scrip - that means if I send them 100 per day (just one of the 4 full time docs in our town) it will cost them $40.00 per day. This is just another unfunded mandate from the government, but they have shifted the cost to the pharmacies.