Quoted: ethical/legal question from a pharm intern

[All4MyDaughter]

For those working in community pharmacy:

I am a pharmacy intern, and, so far, I have had two experiences in retail pharmacy at 2 different stores. In my first experience, I had just finished a course in Pharmacy Law where we learned the rules regarding Controlled Substance Law- and one of those laws was that controlled substances MUST be called in by the prescriber him/herself and could NOT be called in by a secretary.

At my first place, I would get calls from secretaries asking for 20 day supplies of Lortab (maximum is 5 day), and they would not even know how to call in the Rx. I would tell them that this needs to be done by the prescriber OR they could fax it on the prescription they will be mailing (assuming they even have it written down and it's not just a secretary's whim). I was scolded for that by the pharmacist that day. And I came to think of retail in a negative light- as one that could even seek to skirt the rules for the sake of expedience. (And, to me, these are important rules- I've had family members who have died from prescription drug overdoses, so I actually do care about the law).

Now, at the place I work, a pharmacist has told me never to take phoned-in controlled 'prescriptions' from secretaries (because anyone could be a secretary, and they could be calling it in without the practitioner's okay, and in the end, if it's seen that you're taking controlled call-ins from secretaries, it's your license on the line...). He told me exactly what I learned in law class, and I was amazed at how he sticks to what is right, on the issue. He even said that nothing is so great an emergency where one needs to violate that. If all else failed, the patient could always be treated by a doctor at any time of the day and obtain those meds.

My primary doctor has phoned in every controlled substance he ever prescribed for 30 years.

This is a tricky issue for an intern, because I don't want to 'impede the flow' of the pharmacy, and I don't know if it's right for me to be the one to ask for the fax or for the prescriber for verification (because all one needs is a mangled message that gets back to others in the pharmacy). Would you recommend documenting these conversations?

My other line of reasoning would be to record on the pad, the messages 'as is' and give them to the pharmacist- like any other prescription- as the final check. Because, if I were the pharmacist, even if I were not going to fill these prescriptions due to legalities, I would still like to know where these prescriptions are coming from and which secretaries are phoning them in- so that you have a strong idea of what's going on in your pharmacy.
I am just surprised that so many prescribers do not educate secretaries when it comes to these Drug Enforcement laws.

Any ideas for how an intern could both, be ethical, and not conflict with preceptors' interpretations of laws?

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[bananaface]

In the scenario you gave, the secretaries who were calling in the CS prescriptions were often unable to give proper directions. Their mistakes are a red flag telling you that accepting Rxs from secretaries is something that could lead to a misfill - at least in your state where it's not allowed and they don't do it regularly enough to be good at it. Following the law is the best thing to do in this case, because it protects patients from harm. If you didn't follow the law, it wouldn't be a matter of "if" but "when" a patient would be harmed as a result.

As a new intern, you may not have felt as uncomfortable as you do now, because your ability to use your professional discretion was not as developed. That is okay and a part of the learning process. It's also why the consequences of actions taken in the pharmacy are borne by the pharmacist, not the intern. But, once you know something is not right, you should not compromise your morals and do it systematically. Passing the buck by saying the pharmacist is ultimately responsible may work for a tech, but should not fly for an intern. Learning to act responsibility and holding yourself accountable for the results of your actions is part of learning to be a pharmacist. If you can't do what a preceptor wants and feel comfortable about it, you need to get out of that internship site. Luckily, you are now working at a site that is supporting your efforts to do the right thing.

If you are asked to take call ins, then you are the right person to question irregularities as they arise, whether it be an unauthorized person attempting to call in a prescription, or being given a dose or directions that you know are incorrect. Those things are best dealt with up front when you have a live person on the line, and before you write something down that could lead to a misfill or otherwise improper prescription.