Albuterol question....

KelRN215, BSN, RN · Apr 7, 2012

I always thought it was the exact same thing too but this also begs the question of why is a pharmacist calling the nurse to verify substitutions? Shouldn't said pharmacist be calling the prescriber for that?

I don't think this would be an issue in my state because prescriptions always have a little disclaimer on them that says something like, "substitutions are mandated unless the prescriber writes 'no substitutions'". That's, of course, usually referring to using generics in place of brand-name drugs but if you come in with a prescription that says "albuterol", the pharmacy can give you whatever brand of it they have in stock... ventolin, proventil, whatever.

caliotter3 · Apr 7, 2012

I try to explain the process of writing the order with the generic name of the medication to other nurses and they insist on using the brand name. When I explain that it is to avoid problems like this, they still object, because writing "tylenol" is "how it is always done". That was not how I was taught in school and not how it was done at my first place of employment. When I asked about this on my first job it was explained to me the same way it was explained in school. It is too bad that when people insist on something like this, they are not the ones to confront problems when they arise.

It is best to prevent the situation in the first place by seeing that the doctor writes the script using the generic name to preclude any misunderstandings. It should also be written on the order sheet and on the MAR in this manner. An order for albuterol could have been filled with any brand of albuterol, the brand named drugs also give the generic information on the package. And I agree the pharmacist should have been talking to the doctor about this. Suspect that a new pharmacy technician was involved here.

wooh, BSN, RN · Apr 7, 2012

We always get calls from pharmacists after discharge with questions on hospitalist prescriptions. Usually it requires calling the current hospitalist that's on. Sometimes it's just that they want to make sure the number of days that was prescribed. (How many days left post-hospitalization on an antibiotic, and the patient thinks it should be different than what was prescribed. I can read in the note, something like, "to complete 10 day course" and count the days on the MAR and then the family is happy.) Sometimes it's a worry about an allergy (on a med they've gotten for three four days and it says on their chart that the doctor ok'ed it. But this one was just so odd to me. Just give him an inhaler!!

kids · Apr 7, 2012

It could be an insurance issue.

If a med is written as the generic sometimes the insurance only wants to pay the generic reimbursement even if it's only available as a brand name.

I also know that in some places that 'substitution permitted' means the pharmacist can only go from brand name to generic, they can't 'up sale' from generic to brand name (I ran into that recently with one of my scripts, pharmacy was out of the generic but wasn't allowed to sub the brand name).

caliotter3 · Apr 7, 2012

Knowledgeable providers put the most prevalent brand name in parentheses following the generic name on the order. This is the way I see it done a majority of the time. Precludes the "payor" and "availability" issues most of the time.

Esme12, ASN, BSN, RN · Apr 7, 2012

The pharmacy need to have it specifically stated to get reimbursement for the patient from the insurance co. I know it seems like a no brainer.........but insurnce co don't have brains

GitanoRN, BSN, MSN, RN · Apr 7, 2012

i know it seems like a no brainer.........but insurnce co don't have brains

i'll 2nd that emotion

Double-Helix, BSN, RN · Apr 7, 2012

An insurance issue was my first thought as well. In order for the pharmacy to get reimbursed for the medication by the insurance company, they have to prove that they filled the right medication, and if the insurance plan required generics, they have to fill with the generic unless specifically stated by the doctor.

In this case, I'm guessing the pharmacy was out of albuterol and thus needed to use the brand name Ventolin (more expensive). There's probably some sort of box the pharmacy tech needs to check on the insurance form that say "Brand name required by provider" or something similar. Calling you was the pharmacy tech's way of covering his butt in order to get insurance approval for the brand name medication.

wooh, BSN, RN · Apr 7, 2012

Thanks guys!

I know it seems like a no brainer.........but insurnce co don't have brains

That's probably the biggest thing there! :)

OCNRN63, RN · Apr 7, 2012

I always thought it was the exact same thing too but this also begs the question of why is a pharmacist calling the nurse to verify substitutions? Shouldn't said pharmacist be calling the prescriber for that?
I don't think this would be an issue in my state because prescriptions always have a little disclaimer on them that says something like, "substitutions are mandated unless the prescriber writes 'no substitutions'". That's, of course, usually referring to using generics in place of brand-name drugs but if you come in with a prescription that says "albuterol", the pharmacy can give you whatever brand of it they have in stock... ventolin, proventil, whatever.

Because other departments fob off their problems on nursing. Dietary can't make it up to the floor to deliver turkey sandwiches? Send a nurse. Housekeeping is short staffed? Nurses have to clean the beds.

We have pharmacy substitution as well. For a while, pharmacy would call us if there was an issue with an order; now they've been told it's their responsibility to get an order clarification.

KelRN215, BSN, RN · Apr 7, 2012

Because other departments fob off their problems on nursing. Dietary can't make it up to the floor to deliver turkey sandwiches? Send a nurse. Housekeeping is short staffed? Nurses have to clean the beds.
We have pharmacy substitution as well. For a while, pharmacy would call us if there was an issue with an order; now they've been told it's their responsibility to get an order clarification.

Isn't that the truth. The other day I had to go searching the hospital for the specific supplemental drink my patient takes because he was admitted at 6pm and, naturally, the hospital (which loves to advertise its absurdly high US News and World Report rankings as being the "best" in the country) only cares about providing nutrition to its patients from 9-5. The person in the stock room advised me that the kitchen was really in-house until 9pm (lies, their phone number shuts off at 6:30pm) so I at least tried to call... the voice mail advises patients/families to "contact your nurse for food needs after hours." Can't really say I'll miss hospital nursing.