|
STATE BOARD NEWS - FEBRUARY 2000 ISSUE(State Section Only) |
<><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><>
CORRECTION:
The February 2000 issue of the Ohio State
Board Newsletter that was mailed to all pharmacists and pharmacy interns
holding a current license in Ohio contained an error. The reference to Percocet containing hydrocodone should
have read oxycodone. The
correct wording appears here. I
apologize for any inconvenience.
--- William T. Winsley, Executive Director
<><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><>
GOOD NEWS FROM DEA
As you are probably
aware, Endo now has four different formulations for Percocet: Percocet-2.5 (2.5mg of oxycodone and 325mg
of acetaminophen), Percocet-5 (5mg of oxycodone and 325mg of acetaminophen),
Percocet-7.5 (7.5mg of oxycodone and 500mg of acetaminophen), and Percocet-10
(10mg of oxycodone and 650mg of acetaminophen). Based on the number of telephone calls received by the Board
office from pharmacists and physicians, the information regarding the new
strengths and labeling for the Percocet products was not widely
disseminated. In fact, the Board staff
was unaware these products had been released until the requests for information
began. Since we had received no
information from the manufacturer, we had to request the necessary information
from Endo. Telephone calls were coming
into the Board office from pharmacists frustrated over the lack of information
provided to physicians about the Percocet strength changes. This deficiency was causing pharmacists
problems when the prescriptions being written for Percocet did not have any
strength designation. The improperly
written prescriptions made it difficult to obtain new prescriptions for the
Schedule II medication. Because of the
continuous stream of calls from pharmacists, the Board office contacted the
federal Drug Enforcement Administration (DEA) to see if there could be
agreement on a suitable solution.
To our
surprise, DEA has a policy in place that enables pharmacists to deal with
problems related to Schedule II prescriptions without the need for the
prescriber to issue a new prescription.
This policy is in keeping with the Board’s philosophy that pharmacists
need to act in the best interest of the patient and, therefore, it is a policy
the Board strongly supports. The policy
is reproduced here. Please review and
follow it carefully; it will save prescribers, pharmacists, and patients a
great deal of time and frustration.
Policy Received From DEA (Reproduced
verbatim)
SUBJECT: Information That
Can Be Changed on a Schedule II Prescription
POLICY: The majority of
changes can be made only after the pharmacist contacts the prescribing
practitioner. After consultation with
the prescribing practitioner, the pharmacist is permitted to change the
patient’s address, drug strength, drug quantity and directions for use. The pharmacist is permitted to make
information additions that may be provided by the patient or bearer such as the
patient’s address, and such additions should be verified. The pharmacist may also add the dosage form
to the prescription order after verification with the prescribing practitioner.
The pharmacist is never permitted to make
changes to the patient’s name, controlled substance prescribed (except for
generic substitution permitted by state law) or the prescriber’s
signature. These types of changes
challenge the necessity of the original prescription and would require a new
prescription from the prescribing practitioner.
In those cases where a
prescriber either omits the strength, quantity, or directions or where the
pharmacist doing prospective drug utilization review discovers an error in any
of these required elements, this policy allows the problem to be dealt with by
a telephone call rather than a trip back to the prescriber’s office. The pharmacist should always document the
time and date that the prescriber was contacted about the correction, and
should always ask the prescriber to document the change in the patient’s chart
so that both the prescriber and the pharmacist have a record of the
conversation. Please contact the DEA or
the Board office if you have any questions about this policy.
The Board has
conducted several hearings recently regarding dispensing errors that have led
to serious patient harm. The common
factor in all of these cases was that the patient harm could have been avoided
if the pharmacist had taken the time to follow up on a telephone call received
from the patient.
In one case, a patient
received a refill of a Coumadin prescription that was double the prescribed
strength. When the caregiver called to
inquire about the different color of the tablet, the pharmacist dismissed the
difference as “probably a generic” without verifying the markings and color of
the dispensed tablet against the original prescription. The patient took the double-strength
warfarin for some time and required two surgeries to deal with the side effects
that resulted from a pharmacist’s failure to follow up on a call that should
have been recognized as a potential problem.
In
another case, three pharmacists were involved in the dispensing of the wrong
drug to a child, which caused the child to suffer severe psychological trauma
and be set back a year in school. In
this case, one pharmacist took a telephone prescription and wrote it out with
the wrong strength. The second
pharmacist, on checking the filled prescription, noted that the technician who
entered the data into the computer system had typed incorrect directions for
use, but missed the entry of the wrong drug name into the computer. Since this was a continuance of the
patient's treatment, the patient’s mother called to question the appearance of
the tablets before she gave any to the child.
The third pharmacist dismissed her inquiry with a statement to the
effect that the drug was “probably a generic,” without looking at the original
prescription or the patient profile. It
took the patient quite some time to recover from the effects of receiving the
wrong drug.
It is not our intent
to embarrass or ridicule the pharmacists who inadvertently dispensed the wrong
drugs. The Board recognizes the fact
that pharmacists are human and will, occasionally, make a mistake. The majority of times a mistake occurs, the
pharmacist handles it appropriately, and the Board never hears about it. The Board, however, also recognizes the
great amount of trust the public places in the pharmacist. The public does not expect to receive the
wrong drug and, when told by their pharmacist “it is a generic”, they trust the
pharmacist and take the medication.
Neither the public nor the Board is willing to accept a pharmacist who
fails to follow up when a patient calls and questions the appearance of the
drugs they have received. Every time
this happens, the pharmacist should review the patient’s profile, the original
prescription, the dispensing log, and should also verify the dosage form’s
color, shape, and markings with the patient or caregiver. In both of the cases described here, as well
as in others that have come to the Board’s attention, had the pharmacist who
received the telephone call taken the time to do these few things, the patient
would have been spared a great amount of suffering.
Unfortunately errors
occur, and it is sometimes difficult, and always embarrassing, to have to deal
with them. The Board has never accused
a pharmacist of committing an error on purpose. However, covering up an error or failing to deal with one when
approached by a patient can only be viewed by the Board as an intentional
act. At that point, it ceases to be
just an error and approaches unprofessional conduct. There is no excuse for failing to care for a patient.
DISCIPLINARY ACTIONS
Anyone having a
question regarding the license status of a particular practitioner, nurse,
pharmacist, pharmacy intern, or dangerous drug distributor in Ohio should
contact the licensing board that regulates the profession or activity, as
follows:
State Dental Board (614/466-2580)
(www.state.oh.us/den/)
State Medical Board (614/466-3934)
(www.state.oh.us/med/)
State Nursing Board (614/466-3947)
(www.state.oh.us/nur/)
State Optometry Board (614/466-5115)
(www.state.oh.us/opt/)
State Pharmacy Board (614/466-4143)
(www.state.oh.us/pharmacy/)
State Veterinary Medical Board
(614/644-5281)
Drug Enforcement Administration
(800/230-6844)
STATE
PHARMACY BOARD:
Only
disciplinary actions that suspend, revoke, or restrict an individual’s license
to practice are normally listed here.
Due to space constraints, none are listed in this issue. However, all actions taken by the Board may
be viewed on the Internet (go to the Board's home page address listed above,
then click on the Board Minutes box).
STATE
MEDICAL BOARD:
A
document of legal actions taken by the Medical Board may be accessed on the
Internet at the Medical Board's home page (see address above) then click on Monthly Formal Actions. If you would like a more detailed history of
a legal action for an individual practitioner, return to the Medical Board's
home page, click on the Licensee Profile
& Status tag, then follow the instructions. Please contact the Medical Board if you have questions.
<><><>