Several of the other pharmacy blogs have addressed the question of what we pharmacists actually do --- that we're not just robo-counting-technicians who dispense anything that's put in front of us. I think most people are unaware of how many mistakes doctors actually make on prescriptions. To them, that prescription is a sacred document ---- "I've been seeing the same doctor for 15 years !! That's what he wrote! Why do you have to call? The doctor WROTE the prescription!"
We see it even in simple things like Tylenol dosing for young children. Tylenol can cause liver damage if given in excessive dosages, and in children it's dosed by weight. We've called doctor's offices many, many times for Tylenol dosages twice the recommended amount. We contact doctors routinely to ask about prescriptions for medications that patients are allergic to -- and sometimes the allergy is documented right ON the prescription! I saw a hospital order once for Pencillin 1 million units IV every 6 hours --- right underneath a red stamp that noted "Penicillin Allergy." This week we got a prescription for a patient we had not filled for in awhile -- it was for a HUGE dose of a very powerful narcotic. The technician is concerned about us having it in stock --- I'm concerned about it killing somebody. Since it is for a liquid concentrate, and the dose is written in milliliters, not milligrams, the red lights are flashing as this is a really common source of errors, and people have died from this sort of confusion. It almost made me nervous just looking at it. The point is, we checked it out -- we did not just fill it and assume it was correct.
Your pharmacist may not be able to answer every question off the top of their head, but remember they have probably seen thousands and thousands of prescriptions. Knowing when something doesn't look right is what it's all about.
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Today, I'm a fill-in for the day. The guy comes up to the pharmacy wondering if he has any refills on his methotrexate. The tech looks it up. Nope, so he goes home to get his new script then asks us to fill it while he shops. The tech enters it in the system and I go to check and fill it. The script is for 0.6 cc methotrexate SQ once a wk. I say, "Hold on, I don't recall this being a SQ injection, what's going on here? Does the guy not have anyone to give him an IM shot?" I think, "Did the doc think the guy could only stand tiny needles?" Nothing in the package insert about SQ. The tech says the guy's been getting it for years this way. So, we fill it. We're slow enough to be able to yell over the counters. The guy comes back to pick it up. The tech calls over to me, "Did you want to talk to him about this?" "So, how have you been taking this?" He says, "In coffee or juice or water". I say, "Hmm, what?" He says he drinks the dose. I say, "The script says here to be given by injection, like with a needle, under the skin". He says, "What? I can't read that and I never read the label. I don't give myself no shots with needles, Y'mean like insulin?" I say, "Well, when are you going to see the doc next?" Tomorrow? Take this filled prescription to him and tell him this is how he wrote it. Tell him if he wants you to drink it, then he should write it that way. There's no problem as far as I can figure especially if injection drug is cheaper than tablets, but definitely there is something wrong with writing it one way and telling you to take it another way". I didn't like the idea that he was getting methotrexate in his drinking glasses either. But, maybe the doc thought insurance wouldn't pay for it if it was given a different route than prescribed, but if I filled a drug with directions to be taken by an unapproved or wrong route, my license would be the one messed up.
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