Mandatory counseling flags in pharmacy systems

[Hels2007]

I don't know about other places, but at Walgreen's, some prescriptions are flagged by the system (the same flag can also be manually put in by the pharmacist either at the time of the data entry review or the product review) as requiring counseling - as in, the techs cannot sell it until the pharmacist goes in and signs off with their initials that they did the counseling or the patient refused it. Half the time I as the pharmacist don't even know that there was a flag until techs holler at me to release med for so and so.

They range from stupid, like "inform the patient about ability to order diabetes supplies, blah, blah, blah" on every diabetes med prescription month after month, to valid like "make sure patient is not pregnant and advise double protection due to risk of teratogenicity". When I am busy running around doing 50 million things, the last thing I want to do is to walk over to the register to tell someone for the umpteenth time that yes, you could order your diabetes supplies through Walgreens, haven't you figured out they want your money, you dummy! But I also kind of worry that by dismissing so many of them automatically I risk dismissing something more important because I get used to not paying attention to them.

How do you guys handle these flags, if your system even has them? And what would a company have to do to incentivize pharmacists to look at these flags seriously (other than obvious and extremely unrealistic solutions like "get rid of the stupid waste of time ones" or "pay pharmacist directly X dollars per flag properly addressed and documented").

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[Apotheker2015]

I don't know about other places, but at Walgreen's, some prescriptions are flagged by the system (the same flag can also be manually put in by the pharmacist either at the time of the data entry review or the product review) as requiring counseling - as in, the techs cannot sell it until the pharmacist goes in and signs off with their initials that they did the counseling or the patient refused it. Half the time I as the pharmacist don't even know that there was a flag until techs holler at me to release med for so and so.

They range from stupid, like "inform the patient about ability to order diabetes supplies, blah, blah, blah" on every diabetes med prescription month after month, to valid like "make sure patient is not pregnant and advise double protection due to risk of teratogenicity". When I am busy running around doing 50 million things, the last thing I want to do is to walk over to the register to tell someone for the umpteenth time that yes, you could order your diabetes supplies through Walgreens, haven't you figured out they want your money, you dummy! But I also kind of worry that by dismissing so many of them automatically I risk dismissing something more important because I get used to not paying attention to them.

How do you guys handle these flags, if your system even has them? And what would a company have to do to incentivize pharmacists to look at these flags seriously (other than obvious and extremely unrealistic solutions like "get rid of the stupid waste of time ones" or "pay pharmacist directly X dollars per flag properly addressed and documented").

I work in a state that requires counseling for every prescription - new/refill/new C-II but the patient has been on it for ever/transfer prescriptions; literally EVERY script. So yes, we are interrupted every 15 seconds and called to the counseling window for every script. Count your blessings.

I would probably smack the pharmacist who is flagging prescriptions for diabetic supplies, and instead I would have them slip advertisement of your diabetic supplies at the time the pharmacist bags the prescription.

 

[SELDANE]

I don't know about other places, but at Walgreen's, some prescriptions are flagged by the system (the same flag can also be manually put in by the pharmacist either at the time of the data entry review or the product review) as requiring counseling - as in, the techs cannot sell it until the pharmacist goes in and signs off with their initials that they did the counseling or the patient refused it. Half the time I as the pharmacist don't even know that there was a flag until techs holler at me to release med for so and so.

They range from stupid, like "inform the patient about ability to order diabetes supplies, blah, blah, blah" on every diabetes med prescription month after month, to valid like "make sure patient is not pregnant and advise double protection due to risk of teratogenicity". When I am busy running around doing 50 million things, the last thing I want to do is to walk over to the register to tell someone for the umpteenth time that yes, you could order your diabetes supplies through Walgreens, haven't you figured out they want your money, you dummy! But I also kind of worry that by dismissing so many of them automatically I risk dismissing something more important because I get used to not paying attention to them.

How do you guys handle these flags, if your system even has them? And what would a company have to do to incentivize pharmacists to look at these flags seriously (other than obvious and extremely unrealistic solutions like "get rid of the stupid waste of time ones" or "pay pharmacist directly X dollars per flag properly addressed and documented").

Unfortunately there's not much you can do. You are stuck between one floater/pharmacist who is so worried about getting sued that he or she would put a "consult" on Pez candy. On the other end of the spectrum you have the "emerging leader" whose had way too much company Kool Aid and they use the counseling time to push company propaganda (diabetic supplies, flu shots etc..). And yes valuable counseling will be obfuscated with such nonsense. I can't really tell you how to deal with this other than to say that you need to go in everyday and do your best and realize that the retail chains aren't paying you for your counseling skills as much as they are paying you for your willingness to risk your license.

 

[Lnsean]

I don't know about other places, but at Walgreen's, some prescriptions are flagged by the system (the same flag can also be manually put in by the pharmacist either at the time of the data entry review or the product review) as requiring counseling - as in, the techs cannot sell it until the pharmacist goes in and signs off with their initials that they did the counseling or the patient refused it. Half the time I as the pharmacist don't even know that there was a flag until techs holler at me to release med for so and so.

They range from stupid, like "inform the patient about ability to order diabetes supplies, blah, blah, blah" on every diabetes med prescription month after month, to valid like "make sure patient is not pregnant and advise double protection due to risk of teratogenicity". When I am busy running around doing 50 million things, the last thing I want to do is to walk over to the register to tell someone for the umpteenth time that yes, you could order your diabetes supplies through Walgreens, haven't you figured out they want your money, you dummy! But I also kind of worry that by dismissing so many of them automatically I risk dismissing something more important because I get used to not paying attention to them.

How do you guys handle these flags, if your system even has them? And what would a company have to do to incentivize pharmacists to look at these flags seriously (other than obvious and extremely unrealistic solutions like "get rid of the stupid waste of time ones" or "pay pharmacist directly X dollars per flag properly addressed and documented").

I do the clinical consults...i just hit pt declined on all the company propaganda like "have you considered transferring your other meds to Walgreens" bs. That kinda sht should not be put as a block...CAPs should be for clinical purposes only...fuk those guys in suits sitting around in some board meeting somewhere and decided this was the way to do marketing.

 

[beautifulrobot]

I do the clinical consults...i just hit pt declined on all the company propaganda like "have you considered transferring your other meds to Walgreens" bs. That kinda sht should not be put as a block...CAPs should be for clinical purposes only...fuk those guys in suits sitting around in some board meeting somewhere and decided this was the way to do marketing.

What about the argument that you are able to do a more accurate DUR/check for drug-drug interactions if the patient has all of their meds at one pharmacy? Sure transferring all your meds is a marketing thing, but it also serves a legitimate clinical purpose, no?

 

[Lnsean]

What about the argument that you are able to do a more accurate DUR/check for drug-drug interactions if the patient has all of their meds at one pharmacy? Sure transferring all your meds is a marketing thing, but it also serves a legitimate clinical purpose, no?

That can be communicated in other ways. It shouldn't be a block at POS just for that...and no...corporate's intention isn't that they're worried about DURs...they just want you to capture those diabetic supply sales.

 

[owlegrad]

What about the argument that you are able to do a more accurate DUR/check for drug-drug interactions if the patient has all of their meds at one pharmacy? Sure transferring all your meds is a marketing thing, but it also serves a legitimate clinical purpose, no?

I respect your opinion but I always found the "what about a complete DUR" line to be a load of crap. If 'corporate' really cared about a complete DUR you would be able to simply enter a med list into the patient's profile. It would be the simplest feature in the world to be able to add a field that includes medications not filled at the pharmacy, similar to how you enter allergies or conditions. Corporate doesn't care about a complete DUR because if they did it would be easy for them to make that possible without restricting the patient to only picking up at one pharmacy.

 

[beautifulrobot]

That can be communicated in other ways. It shouldn't be a block at POS just for that...and no...corporate's intention isn't that they're worried about DURs...they just want you to capture those diabetic supply sales.

I respect your opinion but I always found the "what about a complete DUR" line to be a load of crap. If 'corporate' really cared about a complete DUR you would be able to simply enter a med list into the patient's profile. It would be the simplest feature in the world to be able to add a field that includes medications not filled at the pharmacy, similar to how you enter allergies or conditions. Corporate doesn't care about a complete DUR because if they did it would be easy for them to make that possible without restricting the patient to only picking up at one pharmacy.

Fair enough. It would actually be kind of reasonable for boards of pharmacy to require pharmacies to perform and document a periodic med rec. Could stimulate more pharmacy jobs and/or dump more on pharmacists or techs, or maybe increase information sharing among pharmacies (pie in the sky). But it would serve a meaningful purpose. I kind of wonder why regulatory boards dont already require that (at least not any that i am aware of).

 

[Hels2007]

dump more on pharmacists or techs

This. I used to be excited about all the initiatives utilizing pharmacists' knowledge - some 15+ years ago when I started out. So far, everything has been just "do this in addition to all the crap you already do and woe is you if someone complains that they waited too long, etc." I just recently picked up a few shifts at Walgreens after having been away from it completely for some 4 years and I am amazed at how much it changed, and how little of the change is for the better.

I did a rotation at the Indian Health Service and we counseled on every prescription there, and it wasn't the quick 2-second blurb but a proper consultation with access to the full medical record - and I loved it. But in retail something like that would not be possible for all kinds of reasons, both within and outside the chains' control.

 

[txpharmguy]

I respect your opinion but I always found the "what about a complete DUR" line to be a load of crap. If 'corporate' really cared about a complete DUR you would be able to simply enter a med list into the patient's profile. It would be the simplest feature in the world to be able to add a field that includes medications not filled at the pharmacy, similar to how you enter allergies or conditions. Corporate doesn't care about a complete DUR because if they did it would be easy for them to make that possible without restricting the patient to only picking up at one pharmacy.

You can add additional meds on the profile not filled at WAG. Not at work, but on the profile screen, there's a button on lower left side where you can add additional medications

 

[PharFromNormal]

I respect your opinion but I always found the "what about a complete DUR" line to be a load of crap. If 'corporate' really cared about a complete DUR you would be able to simply enter a med list into the patient's profile. It would be the simplest feature in the world to be able to add a field that includes medications not filled at the pharmacy, similar to how you enter allergies or conditions. Corporate doesn't care about a complete DUR because if they did it would be easy for them to make that possible without restricting the patient to only picking up at one pharmacy.

Surprised this wasn’t a thing at all major chains... ask my cousin who is at CVS. He said you can add a DUR rx on a patient profile to do just that but no one actually does it

 

[owlegrad]

Surprised this wasn’t a thing at all major chains... ask my cousin who is at CVS. He said you can add a DUR rx on a patient profile to do just that but no one actually does it

I looked for that feature and never found it. No one I asked at Cvs knew how to do it either. I am not surprised though, there are lots of features that no one knew how to use.

 

[WVUPharm2007]

CVS has been firing people that don't get documentation on hard stops. If there is a hard stop, type something relevant, and say something to the patient. On that recent web meeting we all had to do, they specfically statedthat the company wants all hard stops thoughtfully reconciled. And someone asked about SSRIs and Wellbutrin/Effexor. They want us mentioning serotonin syndrome on new Rxs. Which is ridiculous IMO. It's pretty over the top. But cover your behind, people.

 

[BenJammin]

I don't understand why pharmacists aren't excited for these changes. We pound our chests every year that we want to be treated more like providers and demand our state legislature recognize us as such. Now you get to really analyze prescriptions in a clinical manner....and you're complaining?

 

[sozetone]

I don't understand why pharmacists aren't excited for these changes. We pound our chests every year that we want to be treated more like providers and demand our state legislature recognize us as such. Now you get to really analyze prescriptions in a clinical manner....and you're complaining?

Because its a smoke screen to push products like immunizations, diabetic supplies....whatever, before the customer....i mean patient .....walks away.