GP's - Is it really that difficult?

locum-motion · 19-05-2018 10:15am #1

Dear GP's (I'm sure there's a few of you here!),

Is it really that difficult to feed GMS prescription paper into your printer in such a way that the details of the prescription aren't obscured and that the prescription tears off along the perforation?

I mean, seriously; you all got a great Leaving Cert, finished a difficult degree, completed advanced training... You're all intelligent people!

Yours,
A Frustrated Pharmacist (trying to string 1,000 sheets of paper onto a treasury tag, but the holes won't line up)

PS: While you're at it, please change the ink ribbon when it starts to fade!! Thanks!

locum-motion · 19-05-2018 10:38am

And before anyone points it out:

Yes, part of the frustration might just stem from the fact that - following getting a great Leaving Cert, finishing a difficult degree and completing advanced training - part of my 'career' still entails having to thread 1,000 sheets of perforated paper on to a treasury tag before the end of each month!!

The Hound Gone Wild · 19-05-2018 12:19pm

Also stop writing private scripts on GMS paper!

locum-motion · 19-05-2018 12:29pm

The Hound Gone Wild wrote: »

Also stop writing private scripts on GMS paper!

Actually, that doesn't bother me too much. But when they write a script for a person who has a 'Doctor Visit Only Card' on GMS paper...

Don't they realise that we can't tell the difference because both types of number have the same format?

echo beach · 19-05-2018 1:51pm

locum-motion wrote: »

Yes, part of the frustration might just stem from the fact that - following getting a great Leaving Cert, finishing a difficult degree and completing advanced training - part of my 'career' still entails having to thread 1,000 sheets of perforated paper on to a treasury tag before the end of each month!!

Have you never heard of delegation?

locum-motion · 19-05-2018 1:57pm

echo beach wrote: »

Have you never heard of delegation?

If I had someone to delegate it to, I would!!

Arbie · 19-05-2018 2:14pm

I'm neither a GP nor a pharmacist but I can understand the frustration on all sides. Surely the real question is why has the HSE not yet rolled out electronic prescribing for primary care??

We are a relatively small country. The vast majority of GPs use electronic health records (EHRs) and there are only 2 or 3 GP EHR systems available, which would make implementation even easier. Better for audit, cost control, workflow, patient safety...

I once went to a GP in the Netherlands, he wrote my prescription electronically, I walked down the road to the pharmacy, and my meds were there waiting for me to collect. That was 10 years ago!!

Vorsprung · 19-05-2018 6:56pm

locum-motion wrote: »

Dear GP's (I'm sure there's a few of you here!),

Is it really that difficult to feed GMS prescription paper into your printer in such a way that the details of the prescription aren't obscured and that the prescription tears off along the perforation?

I mean, seriously; you all got a great Leaving Cert, finished a difficult degree, completed advanced training... You're all intelligent people!

Yours,
A Frustrated Pharmacist (trying to string 1,000 sheets of paper onto a treasury tag, but the holes won't line up)

PS: While you're at it, please change the ink ribbon when it starts to fade!! Thanks!

Do you honestly think we like using 40 year old technology?

Dingle_berry · 19-05-2018 8:54pm

Arbie wrote: »

I'm neither a GP nor a pharmacist but I can understand the frustration on all sides. Surely the real question is why has the HSE not yet rolled out electronic prescribing for primary care??

If the MN-CMS is anything to go by I would rather the money was spent on paper and pens. Seriously, I wish I was joking or exaggerating.
The product itself is OK but expecting a clinician to think about what their trying to do is asking too much apparently. Everyone else should have stronger intuition!

palmcut · 20-05-2018 10:34am

Arbie wrote: »

I'm neither a GP nor a pharmacist but I can understand the frustration on all sides. Surely the real question is why has the HSE not yet rolled out electronic prescribing for primary care??

We are a relatively small country. The vast majority of GPs use electronic health records (EHRs) and there are only 2 or 3 GP EHR systems available, which would make implementation even easier. Better for audit, cost control, workflow, patient safety...

I once went to a GP in the Netherlands, he wrote my prescription electronically, I walked down the road to the pharmacy, and my meds were there waiting for me to collect. That was 10 years ago!!

There are nearly always errors on paper scripts. Why would you think that electronic prescribing would eliminate these errors?

Arbie · 20-05-2018 4:24pm

palmcut wrote: »

There are nearly always errors on paper scripts. Why would you think that electronic prescribing would eliminate these errors?

That's a fair question. Electronic prescribing can't solve all problems but it does offer significant benefits:

- Legibility. We have all seen handwritten prescriptions where the writing divides opinion like the infamous black-and-blue/white-and-gold dress. "Is this amitriptyline or ampicillin? 1 week or 7 weeks? Milligrams or micrograms? What is the doctor name?" Nightmare.

- Clinical decision support. Many systems will actively prevent incorrect prescribing of drugs if the system detects an allergy, potential interactions, duplication of drugs, etc. This means fewer errors at the prescribing stage and should relieve pressure on pharmacists who at the moment are the prescriber's safety net.

- Cost control. Electronic systems can notify prescribers of alternatives which are as effective but cheaper, e.g. generic versus brand name, PPI A versus PPI B, etc. When there is a choice between 2 equally effective drugs, doctors aren't always aware of cost differences. That would be important not just to the HSE but also to private patients who have to pay out of pocket.

- Audit. Auditing paper prescriptions is difficult, time-consuming, and error-prone. An electronic system can give you real-time data that can be used for prescriber feedback and education, as well as improving clinical governance and patient safety.

- Forced choices and data validity/integrity. Electronic systems can "force" prescribers to enter important data, e.g. allergies, route of administration, etc. This prevents incomplete prescriptions and ensures data entry is in a common format, eliminating confusion (such as OD meaning both Once Daily and Right Eye).

Dingle_berry · 20-05-2018 7:31pm

Arbie wrote: »

That's a fair question. Electronic prescribing can't solve all problems but it does offer significant benefits:

- Legibility. We have all seen handwritten prescriptions where the writing divides opinion like the infamous black-and-blue/white-and-gold dress. "Is this amitriptyline or ampicillin? 1 week or 7 weeks? Milligrams or micrograms? What is the doctor name?" Nightmare.

- Clinical decision support. Many systems will actively prevent incorrect prescribing of drugs if the system detects an allergy, potential interactions, duplication of drugs, etc. This means fewer errors at the prescribing stage and should relieve pressure on pharmacists who at the moment are the prescriber's safety net.

- Cost control. Electronic systems can notify prescribers of alternatives which are as effective but cheaper, e.g. generic versus brand name, PPI A versus PPI B, etc. When there is a choice between 2 equally effective drugs, doctors aren't always aware of cost differences. That would be important not just to the HSE but also to private patients who have to pay out of pocket.

- Audit. Auditing paper prescriptions is difficult, time-consuming, and error-prone. An electronic system can give you real-time data that can be used for prescriber feedback and education, as well as improving clinical governance and patient safety.

- Forced choices and data validity/integrity. Electronic systems can "force" prescribers to enter important data, e.g. allergies, route of administration, etc. This prevents incomplete prescriptions and ensures data entry is in a common format, eliminating confusion (such as OD meaning both Once Daily and Right Eye).

I don't like being the pessimist but have you spoken to your colleagues in hospitals that have gone live in the MN-CMS project?
With the improved legibility comes more nonsense, e.g. force them to input weight and you get "not assigned" or "n/a"
Try to add a feature like a rule check and you'll be threatened with industrial action over demarkation of clinical decision making. Same goes for best practice prompts.
The information from an audit would only be useful if the orders were correct and made sense.

Digital healthcare is a great tool. But like with any tool it needs to be used properly to be effective. It won't fix a cultural issue.

locum-motion · 21-05-2018 9:09am

Vorsprung wrote: »

Do you honestly think we like using 40 year old technology?

Nope, but we use dot matrix printers too, and I seem to be able to print things off correctly!

antonjoe · 14-06-2018 8:08pm

just how many surgians are qualified to carry out abortions .

Malmedicine · 16-06-2018 1:26pm

locum-motion wrote: »

Dear GP's (I'm sure there's a few of you here!),

Is it really that difficult to feed GMS prescription paper into your printer in such a way that the details of the prescription aren't obscured and that the prescription tears off along the perforation?

Yes! It's bloody miserable using a dot matrix printer from the 80's!

Malmedicine · 16-06-2018 1:27pm

antonjoe wrote: »

just how many surgians are qualified to carry out abortions .

5 and 1/4

L1011 · 17-06-2018 1:35am

Anyone who is using a flatbed printer and hand-feeding in the pages from a GMS pad - please stop. The tractor printers are cheaper, easier for your software provider to configure and with electronic referrals you shouldn't have much else left to print on a flat bed. And they don't eventually gum up from the glue strips.

Best years of my life lost to ML320s *shudder*

locum-motion · 09-05-2019 2:02pm

Here's another one:

Dear GP's,

Please stop telling patients/parents "Just buy over the counter Hydrocortisone" for their 2 YO kids, or for their face.

Hydrocortisone is a Prescription Only Medicine with specific exemptions that allow pharmacists to sell it without a prescription in certain circumstances. First on the list is that the patient has to be 12 YO or more. Second is that we're not allowed sell it for the face. Third is that it's for short-term use only.

If the patient is less than 12, just write the bloody prescription.

If the rash is on the face, just write the bloody prescription.

If you want them to use if for longer than a week, just write the bloody prescription.

By telling them to just buy it, you are:
a) pressuring pharmacists into breaking the law*
and/or
b) encouraging patients/parents to lie to their pharmacists.

Both of these are bad things.

*: And I for one am not going to break the law just because you're too lazy to write a few words on a piece of paper.

Graces7 · 15-05-2019 8:22am

Out here in the wide Atlantic.. we get a dr visit once every 3 weeks weather permitting. and heli pad. so in emergency they whisk you off to hospital. far faster than any ambulance would...

repeat Prescriptions are interesting too.. You phone the surgery and, theoretically (!) they fax it through to the nearby pharmacy. Then you have to collect it ( ferry plus 20 miles or more) or find someone to bring it over. As I am now housebound..

PS the pharmacy refuse to post it even registered post. Interesting thing is that our island postman is also the ferryman....

locum-motion · 15-05-2019 9:33am

Graces7 wrote: »

Out here in the wide Atlantic.. we get a dr visit once every 3 weeks weather permitting. and heli pad. so in emergency they whisk you off to hospital. far faster than any ambulance would...

repeat Prescriptions are interesting too.. You phone the surgery and, theoretically (!) they fax it through to the nearby pharmacy. Then you have to collect it ( ferry plus 20 miles or more) or find someone to bring it over. As I am now housebound..

PS the pharmacy refuse to post it even registered post. Interesting thing is that our island postman is also the ferryman....

Are you on an island? May I ask which? (Have visited a few of them)(Of course if you'd rather preserve your anonymity, don't answer)

The surgery can fax it all they want, but a fax is not a valid prescription. The pharmacy needs the original.

Irish legislation specifically prohibits "mail order" pharmacy. The patient (or their carer/representative) and the pharmacist must be simultaneously present in the same location at some point in the supply process (ie either when the prescription is handed in to the pharmacy or when the medicine is collected). This means that both the patient and the pharmacist have an opportunity to ask any questions, discuss any concerns that either of them might have, or to offer counselling on how to get the best out of the medication.

(Some pharmacy companies have tried/are trying to circumvent this legislation. This, to me, counts as another bad thing)

RoamingDoc · 15-05-2019 12:02pm

locum-motion wrote: »

The surgery can fax it all they want, but a fax is not a valid prescription. The pharmacy needs the original.

This is highly embarrassing, but I've been qualified for longer than I care to admit and never actually knew this.

Granted, it occurs extremely rarely. I've only faxed prescriptions for urgent situations (and always called in advance to discuss) and I've been requested to post on the script for the majority of these times (so I probably should have realised from this).

Hopefully things have got better since my time, but we weren't actually taught how to prescribe in medschool, we learned it on the wards (which is not really appropriate tbh, thankfully your ability to prescribe when you're an intern is quite limited so major mistakes have a safety net to try and stop them).

locum-motion · 15-05-2019 12:33pm

RoamingDoc wrote: »

This is highly embarrassing, but I've been qualified for longer than I care to admit and never actually knew this.

...

Think about it - If a faxed/e-mailed Rx was legal, then a person could send it to many pharmacies and get a much greater amount of the med than the Dr intended. All a fax or e-mail does is show the pharmacy that a prescription exists.

The sheet of paper that comes out of the printer/fax in the pharmacy has never been touched by a pen held in a doctor's hand, and therefore it has not been "signed in ink by him" (part of the legal definition of a prescription).

We treat a faxed or e-mailed prescription as an 'Emergency Supply at the request of a Prescriber'. The legislation allows us to do so, as long as the prescriber provides the prescription within 3 days.

locum-motion · 15-05-2019 12:35pm

RoamingDoc wrote: »

... but we weren't actually taught how to prescribe in medschool...

We know. Believe me, we know!!!

0lddog · 15-05-2019 1:33pm

Reminds me of running out of Humira a few months ago.

I did all the tests & paper work for a repeat. Hospital ( large public in Dub ) called me to say that I should blag a couple of months supply from my regular supplier as it would save them doing paper work and I would be in with them in six weeks.

It took some time to explain to them that this would not be happening, if only for the good commercial reasons of my supplier.

It was clear that the individual hospital side had no idea of prescribing rules or the cost of what was being prescribed.

Laugh or Cry ?

echo beach · 15-05-2019 6:57pm

Graces7 wrote: »

repeat Prescriptions are interesting too.. You phone the surgery and, theoretically (!) they fax it through to the nearby pharmacy. Then you have to collect it ( ferry plus 20 miles or more) or find someone to bring it over. As I am now housebound..

PS the pharmacy refuse to post it even registered post. Interesting thing is that our island postman is also the ferryman....

There were special arrangements for supply of medicines to the off-shore islands which were served by dispensing doctors. Does that not still apply?

Graces7 · 27-05-2019 3:20pm

locum-motion wrote: »

Think about it - If a faxed/e-mailed Rx was legal, then a person could send it to many pharmacies and get a much greater amount of the med than the Dr intended. All a fax or e-mail does is show the pharmacy that a prescription exists.

The sheet of paper that comes out of the printer/fax in the pharmacy has never been touched by a pen held in a doctor's hand, and therefore it has not been "signed in ink by him" (part of the legal definition of a prescription).

We treat a faxed or e-mailed prescription as an 'Emergency Supply at the request of a Prescriber'. The legislation allows us to do so, as long as the prescriber provides the prescription within 3 days.

Maybe I was not clear; the surgery fax it to the pharmacy who would know the number? I never see the prescription paper.

Anyways it is how they do it ....and surely a facsimile is lega l enough in this day and age?

Graces7 · 27-05-2019 3:22pm

echo beach wrote: »

There were special arrangements for supply of medicines to the off-shore islands which were served by dispensing doctors. Does that not still apply?

Maybe so. I have to get someone to collect the actual meds for me which can be very hard. So I keep well in hand..

Alun · 27-05-2019 3:24pm

Arbie wrote: »

I once went to a GP in the Netherlands, he wrote my prescription electronically, I walked down the road to the pharmacy, and my meds were there waiting for me to collect. That was 10 years ago!!

I did the same back when I lived in NL and that was well over 20 years ago!

locum-motion · 27-05-2019 5:54pm

Graces7 wrote: »

Maybe I was not clear; the surgery fax it to the pharmacy who would know the number? I never see the prescription paper.

Anyways it is how they do it ....and surely a facsimile is lega l enough in this day and age?

No, you were perfectly clear.

However, so was I. A fax is not a legal prescription. Never has been.

Graces7 · 28-05-2019 6:58am

locum-motion wrote: »

No, you were perfectly clear.

However, so was I. A fax is not a legal prescription. Never has been.

OK! not my responsibility. and maybe the rules were written before email and faxes were invented? and need updating. There really is little alternative for me. and this is the way island surgeries work it it seems. Mine is a regular monthly prescription with very occasional additions and there is no way I can access the surgery. we get a dr visit every three weeks . If the weather allows.

my3cents · 28-05-2019 9:12am

locum-motion wrote: »

No, you were perfectly clear.

However, so was I. A fax is not a legal prescription. Never has been.

Nothing to say the practice doesn't post the actual prescriptions out and only uses the fax so the pharmacy are notified of the prescription.

My wife can get her meds if she hasn't got a prescription but the pharmacy always get one eventually.

Still may not be legal but keeps the books straight at the end of the day.

GP's - Is it really that difficult?

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