Monday, April 21, 2014

Fun With Pharmacy

What did the pharmacy find fault with this order:

18 comments:

  1. You didn't write 'instill' or they prefer that you write 'ou' instead of per eye.

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  2. which eye? both eyes, right eye, left eye? JCAHO won't like this order.

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  3. Easy, the 1-2. That's a big JHACO or TJC no-no.
    Not the pharmacists care, but the upper managements

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  4. Gasp! 1-2...what were you thinking?! Should they get 1 or 2? How will the nurses know how many to give?

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  5. 1-2 + prn with no maximum 24 hour dose.

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  6. They're afraid some idiot will put all 4 drops into one eye because the patient has 2 eyes and 2dops x2eyes = 4drops total.

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  7. I'm an ophthalmology resident and to me the obvious thing would be: which artificial tears? There are hundreds of different preparations with different active ingredients. Fair enough, it may not always matter clinically which one they get. But it might sometimes. Nikki

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  8. Which eye? Would you like me to just guess-because that would be pharmacist prescribing, which is illegal. Also, which of the 100 artificial tears would you like? We have several on formulary, but, again, me choosing which would be me prescribing. These are things frowned upon by the government, joint commission, and management.

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  9. Should say "to each eye".

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  10. 1-2 drops -- dose ranges must be specific.

    Most regular hospitals don't have several brands of artificial tears on formulary so depending on the hospital, generic "artificial tears" is fine. "Per eye" implies instillation in both eyes and requires no clarification.

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  11. Most of you correctly guessed that the problem was the 1-2 range. Although I do remember we were allowed to write ranges when I was a resident.

    I understand why this isn't allowed but in the case of artificial tears it just seems ridiculous. You just squeeze the artificial tears over the patients eye and whatever goes in is the dose!

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    Replies
    1. It is a newer no-no per TJC ( within the last 5 years)
      And it is a blanket no-no for them, no matter how ridiculous it is in real life.
      The joys of the joint

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    2. We were entering those orders as two separate orders (one for 1 drop and one for 2 with a note "patient may have 1 or 2 drops") when I first started (our system won't allow range orders) and we were dinged majorly for it. The pharmacy hates it too. For some things (like pain medication) it makes sense, but for things like this?

      On the other hand, the physician cloud just write "2 drops" and make it easier for everyone. Does it really matter 1-2? It's like those docs who still insist on writing q 4-6 hours prn (also not allowed, but they do it all the time). Do they not really realize that every 4 hours prn covers every 6 and is easier for everyone?

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  12. The joint commission that is

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  13. I don't know which joint commision you all have to put up with but I write prescriptions with ranges all the time and have never been called on it unless the range is greater than 3x (1-3 is OK, but 1-4 implies I have no idea what dose is needed). And this is in an institution where the pharmacists routinely call the cross cover intern at night about duplicate PRN Narcan orders.

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  14. Also, the handwriting is too legible. ;)

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