Thread by @pharmerfour

Yesterday I had two people where incorrect prescriptions caused significant delay to accessing treatment.

I've created threads about this before, but this needs to be addressed regularly

1/19

First principle
If you are making a recommendation to your patient, PLEASE write it on a prescription

PLEASE!

PLEASE PLEASE PLEASE PLEASE PLEASE PLEASE PLEASE PLEASE PLEASE PLEASE PLEASE PLEASE

PLEASE!!!!

2/19

I don't want to hear a person say to me "the doctor said you don't need a prescription for this"

Yes, yes you do.

doctors misunderstand scheduling regularly, but that's not even the biggest issue (yet it's a big issue!!!)

3/19

the purpose of a prescription is to ensure that your recommendation makes it from your office to the point of medicine consumption intact.

If this isn't written down, your directions WILL be forgotten or misunderstood.

4/19

Examples of "you don't need a script" medicines I encounter include:
Indomethacin (yesterday) & various other NSAIDs
Chloramphenicol
Many many things for kids under two years of age
Narcotic analgesics! (low dose, but still.....)
Vitamin D high strength
Multiple randoms

5/19

While I'm raising this with prescribers, #pharmacists also need to fix their practice too:
Just because something *could* be a PBS benefit, doesn't mean it is or that a prescriber intended it to be
Just because something *isn't* a PBS benefit doesn't mean it is non-script

6/19

Another issue with prescribers is to get the "red tape" of your prescription correct.

If you have a provider number, and you have a prescriber number, you need to know both, and where they are applied.

7/19

I had a person yesterday who could not get her pain relief for 45 minutes while I chased down the anaesthetist who wrote their provider number instead of prescriber number on the hospital prescription

She had been discharged after ankle surgery, & had nothing

8/19

I might add that there was no pharmacist involved at discharge. Hospitals need to fix this immediately.

Pharmacists must be involved at discharge & admission.

Hospitals that don't take this seriously must be attempting a horribly inapropriate "frequent flyer" system

9/19

It is also very helpful when I ring a hospital to organise a valid prescription when the prescriber refuses to talk directly about the issue because "I have to see patients"

10/19

Let me tell you that if you do as poor a job for them as you did for this patient, they won't be thanking you later... They'll be waiting for their own prescriptions to be corrected a few hours from now too

11/19

It is also very helpful when you speak via an intermediary (in this case a very patient nurse) & refuse to acknowledge the issue

"My number is on there" and "the prescription is completely legible" are not answer to the question you were actually asked

12/19

The final message before they refused to discuss it further was "I'm happy with the script, fill it as is"

That's wonderful that you're happy with mediocrity. Unfortunately it doesn't fix anything, and has just wasted everyone's time. Get out of medicine.

13/19

Huge thanks to the registrar who witnessed the nurse relaying each part of the conversation over the phone & stepped in to provide a replacement script. Thankfully they had consulted with the patient.

14/19

Leadership often comes from junior staff, especially when senior staff abdicate their responsibilities

15/19

I felt a lot of sympathy for the recipient of this prescription throughout this time.

Having to wait - in pain - with building anxiety at the prospect that this pain would remain untreated for longer due to the complacency of their health care provider

16/19

My intern asked me why doctors don't understand the legal requirements for their prescriptions, & I actually justified this inadequacy by saying I'd prefer they understand pharmacology over red tape, but we realised this is fundamentally wrong

17/19

I can fix an error in pharmacologocial or therapeutic application - I can't fix a problem with the legality of a prescription.

Without fail, a therapeutic error is quick to address.

Without fail, a red tape error is a nightmare to fix.

18/19

So please, write scripts for everything you recommend, AND get the script right. Make it legal. Don't quibble when I ring you to fix an error..... I don't want to talk to you, so don't act like YOU are the one who's time is wasted when I have to... Think of your patient

19/19