Pharmacy Tips & Tricks

In recent years, the VDFP has been working towards improving connections and communication between family physicians and community pharmacists. With enthusiastic support from the Care Transitions Steering Committee, these 10 “Tips and Tricks” were compiled from Victoria pharmacists and VDFP physician leads as a starting point for further conversation.

 

1) DID YOU KNOW?! Prescription refills are now accepted by renewal for up to TWO years!

Since the dawn of pharmaceuticals, when physicians would chisel medication names onto prescription stone tablets (ha ha), renewals for medications have been limited to 365 days from the date of the prescription. But the Times Have Changed, and prescription rules have finally changed with them. Check out the exciting new extension to medication renewal regulations!

This is a great option for low-risk medical issues and stable medication use, especially for conditions that don’t require annual review. For example, ocular antihistamines for allergic conjunctivitis, steroid creams for atopic dermatitis, vaginal estrogens for genitourinary syndrome of menopause, and more! Save your patients, yourself, and the medical system time and money by using this expanded prescription duration.

 

2) Writing prescriptions for blister packs

When family physicians send in prescriptions for blister packs, we may not think about the patient’s over the counter (OTC) medications. This can create confusion over whether they should be stopped or if it was an accidental omission.

TIP:

When sending in a prescription for a blister pack, consider including OTC prescriptions. If you don’t have a full list in your EMR, you could ask the patient or a family member to bring the list to the pharmacy to be included.

 

3) Doctor headers and signatures on prescriptions – an EMR issue

Pharmacists notice that some prescriptions include the header for one doctor, but the signature of another. This can create errors if pharmacists can’t recognize the signature and fill the prescription under the wrong doctor.

TRICK:

Ensure each provider at your clinic, including locums, has their own EMR login so that the prescription headers accurately reflect the signature field.

 

4) Oops! I sent a prescription to the wrong pharmacy!

It would be helpful to notify both pharmacies about the mishap. Ask your MOA to inform the incorrect pharmacy to ignore the fax and include a comment on your new prescription to the correct pharmacy indicating where it was initially sent. This is important in case the prescription was already filled, or you could not get hold of the first pharmacy to cancel.

TRICK:

To reduce these hiccups and avoid duplicate faxes/prescriptions, try confirming the preferred pharmacy of choice in your EMR at the beginning of your prescription discussion, similar to asking about changes in allergies.

 

5) NEW! Controlled prescription pad quantity section

The devil dwells in the details of new controlled prescription pads. Warning: You may need reading glasses and a calculator to fill them out correctly… Don’t get tricked!

The new controlled prescription pads have a quantity section that is different from the old pads.

The new pads have a “Quantity (in units)” section that is supposed to be written in the total number of units, such as mg or mcg. However, pharmacists often receive prescriptions that don’t include units, which can create confusion around whether the physician is referring to units or capsules/tablets/patches, and this can result in significant dispensing errors.

For example:

Prescribing Hydromorphone Contin 3mg, 1 capsule twice a day for 30 days, should ideally list ‘180 mg’ in the quantity section. (3 mg x 2/day x 30 days)

TIP:

If you are pressed for time to calculate the units (or do not have a “growth mindset” for math), it is also acceptable to write the number of capsules/tablets/patches with the appropriate descriptor.

(e.g., “60 caps”, as in the above example).

 

6) Prescribing dose increases for patients

What are three things to think about when changing medication doses? Be kind, be bold and be clever!

When increasing a prescription dose, for example, candesartan from 8 mg to 16 mg, take a moment to ask yourself:

“Can the increase be administered as a single 16 mg pill, or does the patient need access to multiple smaller doses, to adjust it if needed?”

TIP:

Be Kind!  Reducing the total number of pills taken by patients can make it easier for them to take their medications and reduce errors and costs.

TIP:

Be Bold!  If changing a medication after a LONG period on a stable dose, consider adding “DOSE INCREASE” or “DOSE DECREASE in the comments section so the pharmacist doesn’t miss the change.

TRICK:

Be Clever!  Most EMRs have the ability to make Macros which are abbreviated words that when clicked on will turn into a longer word or phrase. As an example, you could type “dd” to turn into “DOSE DECREASE” and “di” to turn into “DOSE INCREASE”.   Save yourself time and reduce medication errors!

Not sure how to build macros? Contact the Practice Support Program for help!

 

7) Arghhh! Frustrated with faxes back from pharmacists asking for a specific refill interval on certain medications??

When prescribing refills for targeted, controlled, or narcotic medications, a specific frequency/interval is required that clarifies the minimum number of days at which the refills can be provided.

Example: “Clonazepam 0.5mg 1 tablet once daily for 30 days with 2 refills, may refill no earlier than 28 days apart”  Or “Dispense 30 tablets every 28 days for 30 day use”.

It’s good to think about how many days the patient will need to pick up the new Rx before they run out: How easy is it for them to get to the pharmacy? How organized are they in picking up their meds? How high is the risk of overuse?

TIP:

Don’t forget intervals for these commonly missed meds: stimulants for ADHD, testosterone replacement therapy, benzodiazepines, and liquid codeine formulations.

TIP:

In case you missed it, triplicate prescriptions now only need to be faxed and scanned into the chart.  The original paper copy is no longer required to be mailed to the pharmacy.

 

8) Adding clarifying comments to atypical prescriptions

If prescriptions have an unusual dosing or duration, pharmacists may need to contact the prescribing doctor, which takes time for everyone involved. Consider what might be helpful for pharmacists, and add comments to your prescription when you first send it in.

Include information such as:

• diagnosis, especially when dose and frequency are uncommon (e.g., diabetic foot infection, amox/clav 875/125mg po TID for 6 weeks)
• weight for children
• indications
• explanations of unusual quantities

Or comments such as:

• “Please don’t fill until requested.”
• “Contact patient when ready.”

TRICK:

Many EMRs will allow you to create a Macro for frequently used phrases. For example, “File” to turn into “Please file until patient calls to fill”, or “Call” to turn into “Please contact the patient when ready to pick up”. Once you have set up your Macro, you can type in your keyword, double-click the word, and your full phrase appears!

Not sure how to build macros? Contact the Practice Support Program for help!

 

9) Calling in verbal prescriptions – what to do if you actually reach a live human being…

TIP:

The first person to answer pharmacy phone lines is usually an assistant who cannot take verbal orders. It helps to first-off identify yourself as a family physician and state that you are looking to speak with a pharmacist or a pharmacy technician (if not a controlled/targeted/narcotic prescription) regarding a verbal prescription.

 

10) Sending multiple prescriptions at once

Pharmacists sometimes see five separate faxes for five medications, resulting in 10 pages if each has a cover page. This makes losing a fax page more likely.

TIP:

Try to keep as many medications as possible on a single page. This is best done at the end of a visit, after all the issues have been discussed, rather than after each issue.