Refills

  1. I have somewhat of a problem in my office and was wondering how other office nurses handle it. When patients call for refills on their medications they want them NOW. I have a million and one other things that need to be done and that is not on the top of my list. What do you tell them? Also sometimes it is late before the doctor looks at the charts on his desk to approve medications. Do you go home or do you stay and call in the medication? Also on Friday morning they know that we close at noon so the phone rings non-stop will requests for refills. Any suggestions on how to handle this without having all my patients complain?
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  2. 15 Comments

  3. by   Jeansky
    Yes,we have had the very same problem but now over time it is so much better....
    What we did was post a big "Attention "notice in the waiting room that said Effective immediatly a 24 hr notice is required on all prescriptions.
    Of course this took time to educate the patients but around 90 percent are compliant now. There are a few that still do it but we remind them we will call it it before we leave for the day this time and to remember in the future a 24 hr notice is required. There are some that "Just stop in" also to get a written rx and we also do the same thing with that...they can wait or come inback the next day.(and I do make them wait...lol...It kind of gets the point across)
    Yes I do stay over to wrap up loose ends that need immediate attention. I also go in the next day 1 hr earlier than when we start seeing patients to get a jump start on my day.
    Hope this helps....Jeansky
  4. by   KeniRN
    I don't know how many RNs are in your office. In our peds practice we have 3-4 most of the time and have 2 in phone triage (when the appt schedule allows it). The RNs doing phone triage are responsible for refills. As with all our calls we prioritize. If someone is calling for hydrocortisone cream or for Albuterol, the Albuterol request is handled first. We call them back and find out the pt's resp status and how much they still have left at home. (Most often than not they have NONE ) If they are stable and have enough for 24 hrs then we inform them that we will get the chart and it will be called in w/in the next 24hrs. If they are low or out of their med we counsel them to NOT WAIT UNTIL THEY ARE OUT TO CALL FOR REFILLS (sorry, just venting:imbar )
    We have a pretty large practice so our office hours are generally 0830-2030 and there are several MDs on who will write & sign for meds. If your practice is small with 1-2 MDs maybe the notice in the waiting area in addition to phone counseling & prioritizing will help. Good luck
    Last edit by KeniRN on Mar 5, '02
  5. by   darla80
    I just had to take minute and respond

    I have been in and out of office nursing for twenty years and the expectations of People have changed dramatically

    People do seem to have a "Fast food" approach to medications..


    Have you experienced this phone call from a patient??
    " I am at the drive in window at Walgreens and I need my RX!!! why hasn't it been called in?" they ask with a whine and a twist of anger

    Often the patient is queried and it turns out they "Called for a refill AN HOUR ago and they want it NOWWWWW"


    Makes me a little crazy..the patients being seen in clinic, the accurate BP and office eval., the glucometer teaching, the ECG, the time in clinic med reviews etc etc.. They have to take priority over those darn refills

    It is the EXPECTATION that thier needs will be met on Demand that makes me pause and reflect at our impatient culture.

    I work Internal Med so you can imagine the number of RX a day.. we do need to get a handle on this

    I like your idea about Posting a 24 hour rule
    We have policy for written RX that outlines a 24 hour notice but the refills are sometimes out of control

    How can we educate people?

    As always I appreciate your input and chatting with all of you

    Joy and Smiles *DARLA**
  6. by   MassLPN
    I've always found that the offices I've worked in, as well as the offices where I've seen physicians have always had a policy in place.. Use it, or suggest they come up with one. Usually something like 'requests made by noon will be refilled by 6pm the same day, after noon will be made by the end of the next day" It also helps if the docs. are compliant with the policy.. ie.. the requests are reviewed by 3pm so you can call them in before the end of the day.
  7. by   nurseratchett29
    we have a new system in place. The prescription line has voice mail that includes a notice with information required for refill and a reminder that refill requests need to allow 48-72 hours for processing. We usually have them processed the same afternoon that they're submitted. Also our parent hospital's policyrecently changed to state that no call ins are accepted. Everything must be faxed now so after I order entry in the computer, I have to call the pharmacy and ask for the fax if I don't already have it. What a pain the the ass!!!!!!My personal favorite is the patients who leave 5 or 6 messages in our script line in the course of a morning and yell and scream that they they need a refill now because they have been out of medication for over a week. (Maybe they should have called a week ago? Do you think?) There is no simple solution to this problem and I think every practice will have it's own special problems no matter how it's handled.
  8. by   Lisamrod

    In our office the receptionist takes the call and puts it in "callbacks" , a file in our computer. The pt is told that the nurse will look at the messages at the end of the day before she goes home. If it is any emergency, (I've been out of my breathing meds for a week and I can't *gasp* breathe!) then the pt is transferred to me and I either have them come into the office or call in the med.
    Yes, we have our problem patients who want that med refill called in yesterday and either don't want to come in for their follow up or want to be squeezed in RIGHT NOW and "I don't want to wait!" But for the most part, "callbacks" works for us. I do stay very late some nights to finish paperwork and callbacks though. :zzzzz
  9. by   goldawgz
    I work for one internal medicine doc and am the only nurse--there's a medical assistant/labtech with me in the back, and a receptionist/office manager and a billing clerk/receptionist in the front. (as you can see, we all wear the hats of more than one job). I also do lab, ekg's, and stress tests, along with returning and taking all the call the girls up front happen to put bac while we're seeing patients--. I have to call all refills in before I leave. It's a pain because there's no policy on this at all--"That's the way it's always been" mentality is the norm in this office. If the patient hasn't been in in over 6 months,I give them a 2 week supply and request on " appointment please or must see doctor" on the med script when i call it in-------But, the hours are Monday thru Thursday, and the pay is good, and I know all of the patients, so it all evens out--- gold
  10. by   MommyRn39
    Really depends on the med and the patient.

    Most times, the parent will go to the pharmacy for a refill and the pharmacy will fax in a renew req. The doc will either sign the req and it will be faxed back or ask that the child be seen first.

    When a parent wants a script NOW, we usually tell them that the doctor doesn't phone in prescriptions. (although I will occasionally with the doctor's premission) Depending on how long ago the child was seen, the parent either has to bring the child in for a reassessment or the parent has to swing by and pick up a script. If the parent doesn't have enough med to last until the next appointment (which is usually within less than a week) and it's a necessary med (like seizure med, for example) then we will write a script for just enough med to last until the next appointment.
  11. by   nurseratchett29
    When I last posted on this topic, our system and new policy was just up and running. We have had a lot of problems but for the most part, most patients have accepted that this is not DRIVE THRU SCRIPT SERVICE. My personal favorite is Monday moring when everyone calls and says " I was supposed to start my birth control yesterday, but I ran out and need it NOW. My personal theory is LACK OF PLANNING ON YOUR PART DOES NOT CONSITITUTE AN EMERGENCY ON MINE. i process everything the day i get it but sometimes the docs aren't in and I need a partner to wirte the script.
    If a partner is out, they get one month with no refills and the partner reviews in the next day or whenever they come in. It all depends on the med. For cholesterol agents, they have to have had a cholestero screening within the past year. For Birth control, they need to have had a pap in the last year. For BP thats stable with meds, six month checkups, unstable-2-3months. Each doc has their own quirks (I do scripts for 6 of them) but for the most part it runs smoothly except for those patients who have the SERVE ME NOW, FOR I AM GOD attitude. These people want it now, immediately. This is why our script line has the part about requiring 48-72 hours to process scripts because sometimes there are glitches and I also am in charge of all triage for 3 of the docs (including scheduling the appts for those who need them when I triage them), Putting patients in the rooms for those 3 docs, and processing all the lab letters for those 3 docs
  12. by   melsay
    I think ALL offices have the R/F problem. We have inforced a "one week rule", I typed up a letter for all my patients to read while waiting that read....Please note that as of today NO refills will be called in on the same day requested, we need a one week notice on refills of your everyday medications , we apologise for any inconvience this may cause" And when someone that hasn't been to the office since I enforced this "rule" I tell them on the phone that they need to call a week in advance for all med R/F's, it has been working great, although their are always those few patients that feel they are special, or "forgot", etc...We have the same problem all of you seem to have, the Dr. doesn't get to the messages until late in the evening, and we are open 9-5 M-F, and open during lunch. The messages are killing us!! I'm trying to figure out a way to charge legally per R/F.....LOL I bet that would stop some of the calls.
    Hope it gets better for all of us.
    As I type I can't help but think of the 2 piles of messages I had to leave this evening for tomorrow...didn't leave until 6:30. Couldn't take anymore....lol
    Tomorrow is another day
    Keep smiling
  13. by   MrsK1223
    We don't call in refills generally or any prescription. On rare and special occasions we will but it kept hush hush. So we rarely ever have to call in a prescription and if they need a refill they have to come pick it up only after we review the chart and see that they don't need to come in...it's very individual. We have computer charting so it's very easy to bring up their charts and check.
  14. by   shudokan-RN
    I work in home health, we encorage all our clients to use weelky pill organizers( most drug reps will give them away) that way they know a week in advance when to call in refills.. for medication set ups we RN's always call them in at least 1 week in advance, or if its a long term med,like lipitor we will call it in on the first day allowable by insurance (ex Medicaid)that way you can have a cushion.
    marci

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