Prescriptions: Do you...

norrie rugger

Write them out or type them out.

Been a few times where I have had pharmacists not been able to read the "writing", on a prescription.
Now days I actually ask if I can have it printed, docs probably think I am an annoying git but it is peace of mind for me, as it cuts down on potential dispense errors

RobFowl

Always print mine. Use a software package called socrates which alerts you to interactions and allergies as well so I feel it's a bit safer as well.
Have seen xatral/xanax/zantac all mixed up in the past :eek:

norrie rugger

RobFowl wrote: »

Always print mine. Use a software package called socrates which alerts you to interactions and allergies as well so I feel it's a bit safer as well.
Have seen xatral/xanax/zantac all mixed up in the past :eek:

I have seen 10 times the dosage given out because a doctor's full stop was a circle and taken for 0

I have seen some of the prescription software and can not understand why people are still writing it manually.

DrIndy

This is why pharmacists are so important to help with patient care and why it annoys me when people call them overpaid shop keepers - it would be a complete disaster without them keeping an eye on things and preventing errors.

bleg

definitely prefer printed, i hate ringing up GPs about their writing, it's a waste of both of our time

Amnesiac_ie

As an NCHD I have to handwrite all inpatient and outpatient prescriptions but I do use block letters and mostly use the generic name as opposed to a trade name.

I think St James are piloting electronic inpatient prescribing with similar software highlighting allergies and interactions. I'd hope something similar is rolled out nationally soon!

Svalbard

norrie rugger wrote: »

Write them out or type them out.

Been a few times where I have had pharmacists not been able to read the "writing", on a prescription.
Now days I actually ask if I can have it printed, docs probably think I am an annoying git but it is peace of mind for me, as it cuts down on potential dispense errors

I print mine, usually. Unless the printer was acting up.

If a patient actually asked for a typed copy I'd give it to her, but would hold a grudge against her, possibly forever.

Vorsprung

I hand write my scripts, and try as much as I can to prescribe generically. in SVUH there's a (welcome) drive to encourage generic prescription, basically by not stocking brands such as Nexium.

Is it true that in SJH you're only allowed to prescribe one type of oral PPI?

SomeDose

Amnesiac_ie wrote: »

I think St James are piloting electronic inpatient prescribing with similar software highlighting allergies and interactions. I'd hope something similar is rolled out nationally soon!

We use electronic prescribing for discharges which, on balance, is an improvement on the handwritten system. I've heard of a few studies of electronic inpatient prescribing but I get the impression it's currently a bit clumsy from a logistics point of view i.e. the whole process from point of
prescribing to administration. I'm sure this will improve with time though.

Amnesiac_ie wrote: »

....and mostly use the generic name as opposed to a trade name.

...and brownie points if you're writing piperacillin/tazobactam now that Tazocin has gone generic!

Amnesiac_ie

bigjimthefirst wrote: »

I hand write my scripts, and try as much as I can to prescribe generically. in SVUH there's a (welcome) drive to encourage generic prescription, basically by not stocking brands such as Nexium.

Is it true that in SJH you're only allowed to prescribe one type of oral PPI?

Yup I think so, and I think the various pharma companies had to compete for the contract by agreeing to provide their drug at the lowest possible price to the hospital.

As an aside, I think PPIs are the most overly and inappropriately prescribed medications in this country, and I think consultants, NCHDs and GPs all bear some responsibility for that!

Vorsprung

SomeDose wrote: »

...and brownie points if you're writing piperacillin/tazobactam now that Tazocin has gone generic!

Your wrists will thank you for writing Piptazobactem

nesf

Amnesiac_ie wrote: »

As an aside, I think PPIs are the most overly and inappropriately prescribed medications in this country, and I think consultants, NCHDs and GPs all bear some responsibility for that!

Out of curiosity, what should PPIs not be prescribed for? Or is it similar to antibiotics with people getting them even with very minor stomach upset which don't require them?

charlieroot

On - PPI's I think alot of doctors consider them very safe and well tolerated, one of the possible reasons for over prescription, but there have been increasing reports of AIN (Acute interstial nephritis) with them.

A quick google for PPI and renal failure or AIN will bring up a couple of papers on it.

DrIndy

nesf wrote: »

Out of curiosity, what should PPIs not be prescribed for? Or is it similar to antibiotics with people getting them even with very minor stomach upset which don't require them?

many people get abdominal pain/gastritis in hospital from prolonged fasting and the drugs they get - so PPI's are commenced in hospital and then unfortunately continued on discharge.

tolerance and low incidence of side effects keeps it up. Overprescription of PPIs and double dosing is one of my bugbears.

norrie rugger

DrIndy wrote: »

many people get abdominal pain/gastritis in hospital from prolonged fasting and the drugs they get - so PPI's are commenced in hospital and then unfortunately continued on discharge.

tolerance and low incidence of side effects keeps it up. Overprescription of PPIs and double dosing is one of my bugbears.

This always seems a case of treating the symptoms, more than the patient.
I have given up on the number of prescriptions of Losec/Nexium that I have gotten.

nesf

DrIndy wrote: »

many people get abdominal pain/gastritis in hospital from prolonged fasting and the drugs they get - so PPI's are commenced in hospital and then unfortunately continued on discharge.

tolerance and low incidence of side effects keeps it up. Overprescription of PPIs and double dosing is one of my bugbears.

Hmm, what about long term gastritis caused by long term medication? I assume it's ok to prescribe PPIs in that context? (i.e. are you talking about situations where the person comes off those drugs after leaving hospital?)

DrIndy

long term symptoms need long term therapy - so a PPI is ok under those circumstances (for example someone who has stomach ulcers but needs aspirin for their heart condition)

I do see a lot of healthy people being prescribed PPIs in hospital because they are fasting a lot but its left on their going home prescription unneccesarily.

norrie rugger

DrIndy wrote: »

long term symptoms need long term therapy - so a PPI is ok under those circumstances (for example someone who has stomach ulcers but needs aspirin for their heart condition)

I do see a lot of healthy people being prescribed PPIs in hospital because they are fasting a lot but its left on their going home prescription unneccesarily.

With out getting into "advice" teritory!

There is nothing wrong with long term treatment of persistant symptoms.
But not diagnosing the issue and scripting treatment is wrong, IMO of course.

Everyone with a gastro problem seems to be given these pills and sent home, with a repeat prescription.

Anyway, I have steered us way off topic in my own thread!! apologies

AmcD

Overprescription of high dose PPIs is one of my bugbears too. But the strange thing is how defensive people get when you try to lower the dose or suggest it is taken as needed. I can understand that kind of reaction in response to decreasing or stopping benzos. Maybe people feel it is like a "safety net" or maybe it is revered because it was started in hospital. Do PPIs give some kind of nice side-effect that I have missed?

nesf

AmcD wrote: »

Overprescription of high dose PPIs is one of my bugbears too. But the strange thing is how defensive people get when you try to lower the dose or suggest it is taken as needed. I can understand that kind of reaction in response to decreasing or stopping benzos. Maybe people feel it is like a "safety net" or maybe it is revered because it was started in hospital. Do PPIs give some kind of nice side-effect that I have missed?

Could be a fear of recurrence. Long term gastritis is distinctly unpleasant and the kind of thing you might put off going to see a GP about. PPIs are like a magic pill, you can suffer for months with only partially effecting OTC stuff and suddenly a trip to your GP, a simple prescription and no more symptoms. I could understand why people might get very protective of it if they had a few months of gastritis.