Pharmacy callbacks to your office to correct or clarify prescriptions consume time and resources. I have spent the past five years conducting research with primary-care providers and pharmacists about the circumstances that generate callbacks. I thought it might be useful to share some quick ways you can improve the safety and efficiency of your prescriptions and reduce pharmacy callbacks.
As my 3-year-old would ask, why? Why do you want this medication for this patient? Keep in mind the pharmacist was not there at the appointment with you and your patient. With all of the medications that look alike and come in similar strengths, there is plenty of room for pharmacist confusion and resulting medication errors, so be sure to write the indication on every prescription. If you’re curious about common look-alike, sound-alike medications, check out the growing list at the Institute for Safe Medication Practices.
Hey Joe, do think this is an “e” or an “a”? Pharmacists carry a badge of honor in deciphering handwriting. It is a guild sign of our profession. But I could live with a few pharmacists missing the good old days of illegibility for prescriptions that can be easily understood. Block-letter the medication name or prescribe electronically. The Centers for Medicare & Medicaid Services (CMS) has begun offering an incentive payment of 2% of total Medicare-allowed charges during 2009 for prescribers who adopt electronic prescribing.
Alphabet soup, anyone?The FDA approvals of multiple formulations of the same medication are setting you up to fail. Beware of any medication that comes in XL, XR, XT, ER, LA, CD, and other such forms. For example, bupropion is a top instigator of pharmacy callbacks (Int J Qual Health Care. 2008;20:238-245). Why? It is commonly prescribed and available as generic bupropion, Wellbutrin, Wellbutrin SR, Wellbutrin XL, and Zyban. It may help to look at a patient’s prescription bottle before writing a new prescription or to ask the pharmacist which formulation the patient is taking before prescribing.
Can I get that furosemide tablet in 25 mg? Think efficiency—prescribing strengths that are not commercially available will generate a callback from a pharmacist. If you don’t know, don’t guess. Ask or look it up.This will save you time later.
Can I refill my fluoxetine and paroxetine, please? Check your state laws on this. Here’s the scenario: You write a prescription for an antidepressant with refills (e.g., fluoxetine [Prozac]). Later you decide to switch the patient to paroxetine (Paxil), and you write a new prescription with refills. Now the patient has two active and legal prescriptions. You can save yourself a phone call from the pharmacist and a potential medication error by writing, “This prescription replaces/discontinues fluoxetine.”
Last time the patient got 10 mg. Now you prescribed 20 mg. Was that an intentional change? These phone calls can be easily avoided. If you purposely change a dose, write “dose increase” or “dose decrease.”
Information, please. If you want to put a cherry on top for the pharmacist, indicate on the prescription whether or not the patient has renal impairment. Community pharmacists practice without a lot of clinical information; improving communication on the prescription will be safer for your patients and more efficient for you.
Amanda G. Kennedy, PharmD, BCPS, is a pharmacist and researcher at the University of Vermont College of Medicine in Burlington.