Here’s a tale of two pharmacists and how they practice their profession.
An elderly gentleman was at our pharmacy with several prescriptions which were filled and ready for pick up. Our pharmacist counseled him on his meds, one of which was albuterol 0.083% for inhalation. We always make it a point to ask if the patient has an SVN or nebulizer at home. The medication cannot be used without a nebulizer and this patient did not have one. Our pharmacist immediately processed a new Rx for a nebulizer and it was covered by his plan and we were able to show him how to use his new device and medication for effective treatment. The prescriber was contacted for a corresponding order, which we received that day. The patient was well-served and we even kept Medicare happy.
Upon witnessing this transaction one of our techs told us how impressive that was. She had recently been involved in a similar situation at a sister store where this tech told the pharmacist that the patient would need a nebulizer in order to use his medication. Our tech had already told the parent that we routinely sold nebulizers for about $36, which was acceptable to the customer. The pharmacist at the store she was helping out at, however, said they did not carry SVN machines (“we don’t do that”) and directed the customer to a vendor down the street that might have them.
Many of the techs from my pharmacy pick up shifts at other locations and stories like this are not uncommon. If you are a patient, I urge you to choose your pharmacy wisely.
Each of these pharmacists graduated from the same college of pharmacy, at the same time. The difference in their responses bears some thought and elicits some questions.
Do you always make sure that the patient has any necessary devices or equipment to use the medications that you are supplying?
Do you believe that your education allows you to create a “presumptive” prescription for an item such as the SVN machine in the above scenario? How about a presumptive order for syringes or pen needles with a new insulin order? Test strips and lancets with a new BG meter?
Do you feel comfortable making clarifying decisions for things like product size or other minor discrepancies on an electronic Rx? For example, would you be OK to change an order for triamcinolone 0.1% cream 60 grams to an 80 gram tube, or would you dispense four 15 gram tubes?
You might have already guessed my answers. Young pharmacists, I encourage to use your education and serve your patients well. Delaying antibiotic treatment for a day or more because you must order amoxicillin 500mg tablets when you have thousands of capsules on your shelf is not good pharmacy. Particularly in this era of electronic prescriptions, we must stand ready to make good decisions and have the confidence to act for the benefit of our patients. Apply your knowledge appropriately!
I’m not advocating over-stepping our practice authority. Very often, you have to make a call to clarify a nonsensical Rx. Occasionally, you might even educate a prescriber!
Never forget the patient. Talk to your patients! “Mrs. Smith, is there any reason that your husband Charlie cannot take his amoxicillin as a capsule instead of a tablet?”
I will often indicate on a fax to the prescriber what action or changes I made and advise them to contact me if they disagree, otherwise please update the patient’s chart. I can recall only one call back from this procedure and that was to say thank you!