Dear Dr. Smartass

Well, I’m going to begin today’s blog with a lesson with respect to requirements for prescription writing.  You see, due to the fact that there are a lot of slimeball narcs out there who will lie, cheat, steal and forge prescriptions for Narcotic and Controlled medications there are a lot of regulations around how physicians must write them.  Here in Saskatchewan we have the Prescription Review Program which is a program agreed upon by physicians, nurses and pharmacists as to regulations regarding how some prescriptions must be written.

I will point out one clause in the program of interest:

           
           Prescriber Participation:

Prescribers may prescribe any of the medications on the panel of monitored drugs so long as the following information is contained on each prescription in addition to the current legal requirements:

a)    The patient’s date of birth;

b)    The patient’s address;

c)    The patient’s health services number;

d)    The total quantity of medication prescribed, both numerically and in written form; except when prescribing electronically, by email, or by FAX when only one form is acceptable or available; and

e)    The prescriber’s name and address.

I have bolded d) because this one is of particular interest.  Keep in mind, there are added regulations regarding refills, signatures, etc. but that info will suffice for today’s rant.  Here’s why, lets say my Doctor gives me this prescription (and lets assume that everything else has been done as per the regulations, which is typically not the case).

Mr. Grumpy Oxycontin 40mg Mitte: 30

*By the way Mitte is loosely translates as “Please Give” for my non-pharmacist readers.

Now, here’s what I could do with this prescription if I was less than reputable:

Mr. Grumpy Oxycontin 40mg Take 1 Daily Mitte: 300

Or, if I were feeling super greedy I could do this:

Mr. Grumpy Oxycontin 40mg Take 1 Daily Mitte: 30000000000000

So, as you can see, the way to avoid this is to have the prescription written as per the bylaws so it looks like this:

Mr. Grumpy Oxycontin 40mg Take 1 daily Mitte: 30 (thirty)

Anyhow, when prescriptions are not written as per the guidelines it takes (ie: wastes) considerable amount of time for me to type up and then fax the doctor, who then has to read and sign and fax back the corrected prescription.  Of course the onus is on me to make sure the prescription is correct, not the person writing it, and if I were to get audited it would be me who gets my balls run through a meat grinder for not verifying the quantity or other info, not the person who screwed up initially

Anyhow, here is the prescription I was handed

Dr. Smartass Smartass Medical Clinic Big City, Alberta Phone: 403-555-1234                        Fax:403-555-2345             September 7th, 2011 Mrs. Happy, Health Services Number: 123 456 789 Address: Anytown, Sk, Canada Ph: 306-555-1234 Tylenol #3: 1 tablet every 6 hours when needed X 30     Dr. Smartass’ Signature

Now the one thing about Dr. Smartass is that she has very nice handwriting (weird, I know), so I was able to easily make out what was written.  Regardless, this does not meet the requirements so after I provided the patient with the meds (I could have been a real ass and made her wait, but I was confident it was for thirty tablets) I took a few minutes to send a fax.  What I do is I take a copy of the prescription, stick it on the paper and then in a box beside I type the message.  Here is what this particular message read:

            Dr. Smartass

Per Saskatchewan Regulations I must verify the quantity authorized for the Tylenol #3.  The quantity per Sask. Regulations must be written both numerically and in written form.

            As such can you confirm, by signing and dating below, that you have authorized:

30 (thirty) tablets

Thank you

Grumpy Pharmacist’s Signature

______________________________     ________________

              (Prescriber’s Signature)              (Date)

Pretty straight forward, just fax it and sign it back.  So, four days later I get it back with this snide remark written beside an arrow pointing to the 30:

            It would appear that way!!!!

Thankfully, she had signed the goddam thing so I wouldn’t have to fax her again, however, for those of you who know me know that you don’t make a snide little smartass remark to the J, the Grumpy Pharmacist, and not expect some sort of belittling comment back.  First, I photocopied the page of the Prescription Review Program that points out the requirements and put some nice big arrows and stars pointing at section d) (I figured that she seems to like stars).  Then I photocopied the fax and circled her little smartass comment with an arrow that read “Please see attached”.

Finally I typed her a new letter, I’m not sure if it was patronizing enough.  I welcome your comments below:

            Dr. Smartass

Thank you for signing and returning the request for clarification for Mrs. Happy (I have attached a copy for your reference).

Please note, as it relates to your written comment “It would appear that way”, I have also attached a copy of the Requirements for Prescribers under Saskatchewan’s Prescription Review Program.  As you can see, per the section I have indicated, as your prescription was handwritten I was required to confirm that this was indeed for 30 (thirty) tablets.  Thankfully as you have very clear handwriting I felt confident that it was for 30 tablets when it was dropped off four days ago and had provided the patient with the medication (something which I could have refused out of uncertainty).  Regardless, as you can see I am required to confirm (no matter how obvious or clear the prescription is) the total quantity as per the regulations.  Unfortunately for me, were I audited by the Saskatchewan College of Pharmacists I could be reprimanded for this simple oversight on your part.

I too share your frustration with this program, it does at time seem rather tedious, however I believe in the interest of preventing diversion of Narcotics it is a necessary evil.  Unfortunately, when prescribers do not write prescriptions properly it takes valuable time away from patient care to have to type up faxes, send them, have the prescriber review it, sign it and fax it back.  It is particularly unfortunate when I have to send another follow-up fax regarding this issue, again something which takes valuable time for both of us (for me to type this rather lengthy fax and for you to read it).

Regardless, should you have any further concerns regarding the Prescription Review Program I can provide you with the contact information for all of the participating partners (listed on the sheet I have attached).

Regards

 J The Grumpy Pharmacist