October - December 1995
(Volume VIII, Number 4)

In our ever-changing health care environment, there have been many changes in patients' prescription plans etc. some of which have given rise to difficulties for patients and the physicians who treat them.

Prescription Plans

Many patients now obtain their medications through mail-order plans, which often have minimum quantity requirements, such that the physician may be required to write a prescription for a quantity of medication that he would otherwise not write. Where the physician is concerned about potential abuse or over use, he may want to write for the lesser amount and note on the prescription that for medical reasons, the quantity must be limited.

Patients on Multiple Medications

Patients may also be receiving prescriptions for the same or other drugs from more than one physician; this may be inadvertent but in some cases is deliberate on the part of the patient. For the patient's protection and that of the physician as well, it is important that the physician obtains, as part of the initial history, information concerning all medications the patient is taking, including non-prescription drugs, and documents it.

Because some patients may be on multiple medications, it may be difficult for the physician to monitor his own prescriptions for these patients if the information as to their medications is not maintained in a central location. Some practices use medication tracking sheets for this purpose (see sample copy). In other practices software programs are utilized in prescription writing; these programs usually track all medications prescribed for a patient by the physician and many of them have a feature which will alert the physician to possible drug interactions.

A good working relationship with the local pharmacies is not to be discounted. Pharmacists will often advise physicians not only of potential drug interactions in medications prescribed for patients, but (s)he may also be the person who makes a physician aware of the fact that a patient may be receiving prescriptions from multiple providers.

Documentation

As previously noted, it is important that as part of a patient's history, the physician obtains and documents information as to any medication(s) which a patient may be taking.

Likewise, information regarding allergies to medications must also be documented and where they may be significant relative to future treatment, it is beneficial to document that information in a readily observed location, such as the outside cover of the patient's chart. Any medications prescribed by the physician should be documented as well. These notations should include:

• the name of the drug;
• the dosage;
• the amount prescribed;
• the number of refills being granted;
• instructions or warnings given to the patient regarding the medication.

Renewed Lasix 40 mg. p.o. QD as per Dr. Smith.

The note should be signed (or initialed) by the staff member.

If patients are given sample medications, the fact that dosage and any other instructions and/or precautions were discussed with them, should also be noted.

Many medical professional liability suits are brought by patients alleging that they received improper prescriptions/medications from their physicians. The absence of documentation as to medications prescribed, often poses a problem for these physicians. Every effort must be made to ensure good quality of care in this area of practice, as well as the necessary documentation.

Below is a list of our Loss-Prevention Techniques:

Telephone Matters | Patient Relations | Test Results and Follow-up Monitoring Patients | Patient Follow-up
Guidelines for Comprehensive Office Chart
Emergency Prepardness | Developing Telephone Protocols
Medical Office Personnel | Medication Matters
Issues in Physician Coverage
Discounting the Doctor/Patient Relationship