by Flora Y. Bessey Pharm.D., CGP

Sundays in our household are all about football.  Until, of course, a call comes in from a nursing facility saying: “We are out of Vicodin on a post op patient and the pharmacy can’t give us permission to use the emergency supply because they don’t have a valid order!  Flora, you have to help us!”

So I put the TV on mute and jump on the phone, first to the pharmacy to see exactly what is going on. "Physician has not replied to our fax request for authorization for a refill.  We sent it on Friday anticipating the patient would run out over the weekend.  Well, here it is Sunday and the patient is out of medication!"

Pharmacy and facility both acknowledge they have attempted to contact the physician by phone with no response.  Please note here, if the physician SIGNS the refill request (i.e. returns the fax request form), the pharmacy can send the quantity specified in the prescription, BUT for phone approvals (emergency supply) the pharmacy can only send a 72 hour supply.  So after 72 hours we will have to dance this intricate dance AGAIN!!

So, back to my Sunday.  With football on mute,  I text message the medical director asking for authorization. He responds saying he is not comfortable approving another physician’s order.  But, he did give me the doc’s home number.  So I called it, only to get yelled at because I was interrupting football!!!!  REALLY?!?!?!  Come on, MAN!!!  What I wanted to say is “If YOU had a better process for checking your faxes before the weekend, none of us would be missing football!”… but I digress.

I can only imagine the burden of phone calls and faxes because it is my colleagues, not me, who are sending the faxes and making the phone calls.  That doesn’t change the fact that we all have a job to do.  It also should be noted that the recent DEA changes which went into effect October 6 (making hydrocodone combos Schedule II controlled substances), didn’t happen without a comment period.  As a matter of fact, the DEA reached out to all stakeholders: ASCP, AMDA, etc… plus, there was an open comment period to all healthcare providers.  How many of you replied to the DEA with comments?

It’s really easy to complain about a system once it is in effect.  And truth be told, I have more physicians who respond in a timely manner and apologize when they have miss something.  But there are the occasional docs who make it difficult for all of us, especially the patient.

In this case, the doc did give me an irritated authorization to dispense an emergency supply, which solved the immediate problem of the patient getting the medicine.  My question still remains, will he sign the regular Rx authorization form before the patient runs out of the emergency 72 hour supply?

Please review your systems.  Ask your nurses, your consultant pharmacists, and administrators how you are doing.  Administrators and Directors of Nursing, will the pharmacy know to contact you if they can’t get in touch with a physician?  In the end, it’s not about the pharmacy or the physician or weekends being interrupted.  It’s about the patient and ensuring we get them the right medication at the right time.

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