PHARMACIST STEVE

This is a comment on this blog by another Pharmacist/reader on this post https://www.pharmaciststeve.com/?p=12316  and points out the legal requirements of a Pharmacist in processing a prescription. A lot of things that are REQUIRED are based on facts. In dealing with subjective diseases many “facts” are not black/white but subjective and often fuzzy. 

One thing that I will disagree with my colleague’s opinion, is that many general practitioners develop a special knowledge or expertise over the years of practice in dealing with a certain category of pts with often complex or high acuity issues. To point this out.. today Pharmacists after the option after receiving their PharmD degree.. can spend another year in a residency in http://www.pharmacist.com/residency 

Community Pharmacy Residency Programs

Myself on the other hand opened/built several successful businesses including a independent community pharmacy and Home Medical Equipment company..  but I have no piece of paper on the wall stating my academic credentials of completely a residency in as a specialists in “community pharmacy practice”.

My colleague’s final statement I totally agree with.. when a pharmacist sends a pt away without medication or plan of treatment, especially when they have not had any discussion with the prescriber and the decision was made unilaterally by the Pharmacist. The Pharmacist and the system has failed the pt and totally discounted the time/trouble/expertise the prescriber had expended in evaluating the needs of this particular pt.

As the old saying goes… if you are not part of the solution… you are probably part of the problem..

Maybe the pharmacy practice acts and rules need to be modified, or if not, clarified so as to not leave a pharmacist feeling as if she is open to malpractice for just going along with doctors. Doctors are not gods and they are not always right. But pharmacists need to know that duty to collaborate and document does not necessarily mean a pharmacist has a right to refuse any prescription.

Pharmacy, as defined in one state’s statutes, is “Pharmacy practice is a dynamic patient-oriented health service that applies a scientific body of knowledge to improve and promote patient health by means of appropriate drug use, drug-related therapy, and communication for clinical and consultative purposes. A pharmacist licensed to practice pharmacy by the Board has the duty to use that degree of care, skill, diligence and professional judgment that is exercised by an ordinarily careful pharmacist in the same or similar circumstances.”

Here is what one state’s Pharmacy Board rules say about what is called drug utilization review. It is a REQUIREMENT that pharmacists perform it in most states. What is it?

(17) Participation in Drug Selection and Drug Utilization Review:

(a) “Participation in drug selection” means the consultation with the practitioner in the selection of the best possible drug for a particular patient.

(b) “Drug utilization review” means evaluating prescription drug order in light of the information currently provided to the pharmacist by the patient or the patient’s agent and in light of the information contained in the patient’s record for the purpose of promoting therapeutic appropriateness by identifying potential problems and consulting with the prescriber, when appropriate. Problems subject to identification during drug utilization review include, but are not limited to:

(A) Over-utilization or under-utilization;

(B) Therapeutic duplication;

(C) Drug-disease contraindications;

(D) Drug-drug interactions;

(E) Incorrect drug dosage;

(F) Incorrect duration of treatment;

(G) Drug-allergy interactions; and

(H) Clinical drug abuse or misuse.

SOOOOOOOOO…. one can understand how a pharmacist might feel as if drug abuse or misuse is a concern, because their own rules say so.

It’s not as cut and dried as the pro-pain advocates would like it. The point of change is new laws that require any pharmacist who wishes to refuse a prescription first reach the prescriber and inform them of such denial. If the prescriber cannot be reached immediately, the pharmacist must actively find a pharmacist who will take over care of that patient so that the patient is served in a reasonable amount of time.

And RSDLady, pharmacists are well educated on classes of medications. But like any general practitioner, deference must be given to specialists such as pain management doctors. BUT often in daily practice, family practice doctors (who treat ear infections and thyroid conditions) are trying to manage complicated cases with too quickly increasing doses of narcotics. Or with no safety nets for patients whose case becomes even more complicated. Not to mention, nurse practitioners and naturopathic doctors can prescribe in many states, and because of DEA interference they have started whole practices of pain relief, but they also are not specialists and a reasonable pharmacist would at least consider the legitimacy vs. misuse equation. But again, collaborate with prescriber or complain to the naturopath board…don’t PUNISH patients. Pharmacists cannot allow anyone to leave hurting without a treatment plan of action or they have shirked their duty.

Filed under: General Problems