Calling In Scripts

  1. My hospital has been trying to nudge the physicians into writing more prescriptions for patients to take to their pharmacies to get filled instead of calling them in.

    In the past, the dr's just wrote out discharge meds and left it up to nursing to decide what is an old med and what is new and needs to be called in. There were rarely instructions for # and refill, it was just left up to nursing to figure it out.

    This still largely occurs, but dr's ARE writing more scripts, which I think the gold standard is for the patient to present it personally to the pharmacy so they have it right in front of them when filling. Second best is faxing it. But then you have a variety of things that people do with the originals, everything from handing them back to the patients (amazingly, this happens frequently on my unit!) to writing "faxed" on it and placing it on the cahrt, to destroying the original.

    My problem is with patients who won't take the paper prescription and insist it be called in. There are a few pharmacies around here that either don't have faxes or have been known to "lose" the fax and the patients end up with NO meds (of coarse it is the nurses's fault).

    I always insist if the dr writes a paper script that the patient take it, even if they give me a hard time (and mostly, they do).
    I explain that it is a safety initiative, that by physically taking the script to the pharmacy they are significantly reducing the chance of a med error, and point out how med errors have been cited in the news as so dangerous.

    Does anyone see this reluctance to take their own scripts to the pharmacy or is this a regional thing? Our patients ARE pretty used to being spoiled by the hospitals areound here and pretty much getting anything they want. (I don't feel like going home yet. Maybe tomorrow. The food is so good!)
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  2. 15 Comments

  3. by   CaseManager1947
    I work in hospital based case management, and most of the docs I work with are pretty good at writing scripts. Some are not. what you do have to watch for, though, is the attending writing rx for pt. and 3 or 4 consults coming along and changing doses or dcing meds. I will call them in for pts. , but sit down with them and go over it all in my dismissal discussion with the pt and or family.
  4. by   meownsmile
    I dont like calling in scripts either. And i hate when doctors dont write their own.
  5. by   RunningWithScissors
    Another question I forgot to add is, how common is it for the physicians to leave it up to the nurse to figure out what med and how much to give the pt?

    To me, this is prescribing and against our practice act. I've tried tracking down dr's to get specific meds and rx orders; it usually takes 4-6 HOURS to get this accomplished! So, I've gone back to giving the pt one month's worth and no refills if I can't reach the dr.

    Is this, again, a regional thing or do y'all see it too?
  6. by   Mulan
    I've never heard of that. All I'm familiar with is the patient being given hand written scripts (written by the doc) that they then have to take to a pharmacy to be filled.

    Where I am now has this med reconciliation thing, where there is supposed to be a list of the home meds plus what the patient was on in the hospital printed out for the doc, and he is supposed to check continue or discontinue. It's a real PIA because meds are not put in correctly on admission, the patient doesn't know the dose or whatever and the doctors don't read what they check and sign so there are glaring errors and things that don't make sense and then the pharmacy expects the nurses to get clarification. What a PIA! Another JCAHO thing I think.

    What part of the country are you in?
  7. by   RunningWithScissors
    I'm in the midwest.

    We have a med reconcilliation tool as well, only it is OPTIONAL for the physician to use it!

    Most of the time they don't, but when they do it's great.

    There are currently 4 different forms a dr can use for discharge meds, instead of one universal form. That's a big part of the problem.
  8. by   SharonH, RN
    Quote from RunningWithScissors
    Another question I forgot to add is, how common is it for the physicians to leave it up to the nurse to figure out what med and how much to give the pt?

    To me, this is prescribing and against our practice act. I've tried tracking down dr's to get specific meds and rx orders; it usually takes 4-6 HOURS to get this accomplished! So, I've gone back to giving the pt one month's worth and no refills if I can't reach the dr.

    Is this, again, a regional thing or do y'all see it too?

    I doubt this is even a regional thing. I have never heard of this. This is a very dangerous practice and it is a complete failure of nursing management that this is allowed to go on. The physicians should be writing out discharge prescriptions....completely......PERIOD. Otherwise both nurses and physicians are in violation of their respective nurse and physician acts. Do you have clinical nurse specialists at your facility?
  9. by   santhony44
    If meds are being called in, there should be a clearly written order, no guesswork:
    Zyrtec 10 mg, one by mouth daily, #30, 2 refills
    A written prescription is better in that it leaves a paper trail. If something is called or faxed in, then the script or the order needs to be on the chart.
  10. by   RunningWithScissors
    If something is called or faxed in, then the script or the order needs to be on the chart.
    You are right about this.

    We had, years ago, been told to destroy written prescriptions if they were called in to avoid duplication; but now I see where this has been a big mistake.....no paper trail. (not that I call in those that are actually written anymore).

    I had worked critical care for so many years, it had been over 20 years since I discharged anyone and this is the only facility since then that I've worked the floor.

    We keep getting lip service from administration that they are "trying" to get the docs to write scripts but still few do.

    They leave us with a list of discharge meds and we have to figure out what's new and what's old, hoping that home med list is accurate!

    What gets me is when people also want me to call in new prescriptions for their old home meds because they're "almost out". :angryfire

    No, we don't have any clinical nurse specialists, it is a small community hospital (200 beds).
  11. by   Mulan
    Okay, I guess I'm a little confused here. How do you call in a script? Don't the physicans have to have some kind of ID number? Do you have that number?
  12. by   RunningWithScissors
    Believe it or not, their DEA# is openly posted on the hospital computer system for all to look up (whoever has a password to log on to the system.

    Once, I was asked to call in Tylenol #3 for a pt who had no written script, just a # and refill amt on the order sheet. I felt uneasy about this, and my unit manager stomped to the computer and said "see, here is the DEA#, you can call this in". Of coarse, I did just as the boss said.

    I won't go into any more detail about it, as there are non-nurses who lurk here and it may be a safety issue.
  13. by   Mulan
    Wow, it sounds like someone could really abuse that if they wanted to.
  14. by   CaseManager1947
    The way I do it, and I am a Mid-Level Practitioner at our hospital... dr gives a written order for dismissal -- dc pt to home.... continue the following medications, doses written duration etc. Don't get me wrong, I'm not pulling rx's out of thin air, its what the doc wants at dismissal. Some of the physicians who have NP's or PA's will do that, but some hospitals are not staffed with this level of care or docs don't employ them. NO NURSE can call in scheduled drugs without her own DEA#, even though I am an ARNP, in my state you have to be "prescribing under physician protocols ", that is a doc u work for. If nurses are calling in scheduled drugs, and giving the doc's DEA #, and he's OK with that, both are in for a big surprise one day. Nurse Manager too. And why in God's name are these #s on the computer system... I mean that is really crazy. Computer systems get hacked, no matter where u are, and that is asking for trouble, IMO. Oh well, this is turning into a rant.... sorry . :angryfire
    Just watch what u do, because the state and pharmacies will.

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