Prescription Verification - Let's place everything on the doctor.

[KalipsoRed21, BSN, RN]

I hate how inefficient healthcare has become. My husband and I have Express Scripts.

They say they sent us an order of Losartan and my husband shouldn't be out. He would have been 30 days short. So I called his MD and asked if  we could have an emergency 30 day script I could fill until Express scripts would be willing to send me more. I paid out of pocket for it.

It is time for us to be able to get our script from express scripts, but they won't send it because they need clarification from the doctor. They only have 100mg tabs on formulary and need MD to approve 0.5mg tabs daily. The staff at the MD office printed it out and put it in the doctor's in basket to deal with sometime next week.

I find this absolutely the most disgusting thing about Texas. So MAs and RMs can refill scripts but do not have the wherewithal or the will to be accountable and thus they don't…”because the doctor has to do it.” .🙄

As I work at the same hellhole my husband and I get care. There at written protocols that go "Tamsulosin -if last office visit within a year go, submit the refill. If it is a few months after the LOV, refill once and tell patient they have to come in. But even this protocol and looking at the LOV note MAs and LVNs are not willing to do what I would find perfectly reasonable and within scope.

Call the patient let them know about the proposed change, if there is no reason by the patient that he can't take half a blood pressure pill then a RN would just send the script...well I would. But now they use MAs who don't see that kind of problem solving as within their scope....actually apparently neither do most of my BSN colleagues. So now my husband and I are waiting 2-4 more days to get the script sent back to our pharmacy once the doctor looks at it and says its okay for the pharmacy to use 0.5 a 100mg tablet.

So how does this help the doctor and clinic handle patients efficiently? It doesn't. Look pain meds, muscle relaxers....okay I see the issue. A script you can see the patient has been on for at least 3 years for blood pressure a RN can't make that call. WOW!?

[beachynurse, ASN, BSN]

Personally I don't think an MA, or secretary should be responsible for anything to do with medications. It should either be the MD or a licensed nurse.

[KalipsoRed21, BSN, RN]

beachynurse said:

Personally I don't think an MA, or secretary should be responsible for anything to do with medications. It should either be the MD or a licensed nurse.

And that I 100% agree with. But as a nurse, I am disturbed that even other LVN an RNs in an ambulatory office setting seem disempowered to do basic problem solving. My manager even supports such. I really do feel a nurse should be capable of thinking of going "well Losartan is not typically an abused medication like narcotics, muscle relaxers, and some antihistamines. The pharmacy just doesn't have 50mg tablets on hand at this time and are requesting to know if it is okay to fill this script with 100mg tablets and write instructions to take 0.5 tablets instead. Let me call the patient and see if they have an issue with that (they could have a swallowing issue or something that may make taking tablets hard instead of capsules or something.) Once patient is aware and okay of the change then just sign the effing order my name and the MD name and send it in. There is no effing reason to involve the doctor for a basic refill and change like this. Cover your *** by sending the Md a note of what you did and if they have an issue to let you know. But approving insignificant changes to medications that do not involve a dose adjustment are well within the scope of practice for an RN. But at my institution they pretty much rely on the doctor to review and approve EVERYTHING before taking action. Thus making the processes take FOREVER when they could be much more efficient and relieve the doctor of minor issues so he/she could actually use their highly educated brains for the more complex care issues. Just effing dumb.