Prescription Blanks Research Articles

Who Should Have Access to the Controlled Substances in Your Office?

Who Should Have Access to the Controlled Substances in Your Office?

Preventing drug diversion

Preventing drug diversion

Benzodiazepine Prescription Regulations-Reply

In Reply. —As noted in our article, 1 my colleagues and I agree with Dr Sampson that triplicate prescription blanks for benzodiazepines create important practical impediments to appropriate prescribing. Control mechanisms always have positive and negative aspects. Perhaps the self-regulation imposed by the multicopy prescription programs will lead to more thoughtful prescribing and better patient outcomes. The programs may also lead to the prescribing of less effective, more toxic, but uncontrolled alternatives, as our study indicated. Even worse, regulations may lead to failure to prescribe indicated therapy. I do not believe that a complete assessment of the benefit-to-detriment relationship of the triplicate prescription program for benzodiazepines has yet been carried out. Several states have instituted programs in which pharmacists computerize information on the patient receiving and the physician prescribing certain medications. While perhaps avoiding some of the practical problems noted by Sampson, such a system still intrudes on the patient-physician

Pharmaceutical expiration dating advice given by retail pharmacists.

There is presently no uniform legislation requiring or standardizing the expiration labeling of prescription drug containers dispensed to patients by retail pharmacies, and most communities in the United States do not require such labeling. Expired medications can suffer changes in toxicity, potency, or palatability. Inadvertent use because of incomplete labeling can impact negatively on good patient care. A telephone survey of 124 retail pharmacists in a community suburban to New York City was conducted using a prepared script. When a caller requested "do not use later than" advice for 10-mg propranolol tablets said to have been purchased 6 months earlier, responses ranged from 3 to 60 months. Most pharmacists recommended discarding medications 1 year (31 percent) or 2 years (27 percent) following purchase, but fewer than one-fourth of those responding attempted to verify expiration dates before answering. Physicians counseling patients to use prescription medicines within 1 year of purchase are giving advice consistent with that offered by 85 percent of the responding pharmacists, but physicians should be aware of the limitations of this recommendation. In the absence of uniform expiration-dating policies, physicians can minimize potential risks to patients by printing the instruction "label expiration date" on prescription blanks.

Drug Abuse Control and the Pharmacist's Role in the Legislative Decision-Making Process

A random sampling of Florida community pharmacy practitioners was taken to determine their preferences for proposed additional restrictions on the prescribing and dispensing of prescriptions for certain Schedule II controlled substances. In addition, they were asked the degree to which they would favor or disfavor: (A) enactment of a state law which would make invalid any prescription for a Schedule II substance after seven days from date of issue, and (B) several alternative proposals for restricting the prescribing and dispensing of certain classes of specifically named Schedule II substances such as a 48-hour waiting period, color coding of prescription blanks, numerical serialization, purchaser identification, etc., either alone or in combination.Of the 440 community pharmacists mailed questionnaires, 210 (47.7%) responded. Comments and suggestions provided by the respondents varied greatly according to their perceptions as to the necessity or desirability for further encumbering the processing of Schedule II drugs.

Therapeutic substitution and the hospital formulary system

Physicians consent and statutory regulations relating to therapeutic substitution are discussed. Some hospitals have adopted policies allowing the interchange of a chemically inequivalent product deemed therapeutically identical by the P & T committee. In the absence of statutory regulation, hospital pharmacists usually refer to (1) the physician's agreement to abide by hospital bylaws (including the formulary system) when joining the hospital staff, or (2) prescription blanks and order sheets preprinted with the statement "substitution permitted unless otherwise indicated" as the legal authority for therapeutic substitution. Only two states have addressed the legality of therapeutic substitution. An opinion of the Oregon Attorney General and a Washington state statute both authorize therapeutic substitution under certain circumstances if the prescriber has given prior consent. Neither of the states specifies, however, whether the agreement of prescribers to abide by hospital bylaws constitutes authorization of therapeutic substitution. It is proposed that state boards of pharmacy and state legislatures draft laws that address therapeutic substitution and specify acceptable methods of consent.

Prescribing psychotropic drugs: whose responsibility?

Through the use of a questionnaire it has been ascertained that a significant number of second-year graduate school social work students at the Columbia University School of Social Work are called upon to monitor and dispense psychotrophic drugs in various placements where they receive their practical clinical training. In some instances they may even fill out prescription blanks that are signed by psychiatrists who do not have the time to see the patients personally. This situation not only represents the abdication of medical responsibility, frequently leaving non-medical personnel with functions beyond their training and professional competence, but also raises important ethical and legal problems. Non-medical professionals in mental health settings should receive appropriate instruction in the essentials of psychopharmacology. Such training should not be left to chance as apparently is the case now. Non-medically trained members of the mental health team, if properly instructed, could cooperate more effectively with the psychiatrists who must in any event retain primary responsibility for pharmacotherapy.

Institutional control of prescription blanks

A system designed to eliminate the illegal use of hospital prescription blanks to obtain Schedule II drugs is described. Several community pharmacies had reported receiving forged prescriptions for Schedule II drugs on hospital prescription blanks. The system places controls on prescription blanks for Schedule II drugs. Hospital physicians may prescribe these drugs using only special prescription blanks which are sequentially numbered. The blanks must be obtained by the physician in person from the pharmacy. Community pharmacists in the area are alerted in cases of lost or stolen prescription blanks.

Use of Hospital Prescription Blanks

Use of Hospital Prescription Blanks

Prescription Blanks for Narcotics

To the Editor.— Dr. Karakashian's comments on physician's narcotic prescription blanks (226:1572, 1973) bring to mind a system allowing the institutional control of prescription blanks for schedule II drugs only, implemented at the University of Kentucky hospital. Under the system, to each legally eligible physician wishing to prescribe schedule II drugs is issued (by the pharmacy department) a pad of 25 consecutively numbered prescription blanks. Records are kept on a control card in the pharmacy. The physician writes all prescriptions for schedule II drugs on the assigned blanks. It is the responsibility of the physician to report to the pharmacy any lost blanks. In addition, all of the hospital's routine prescription blanks distributed throughout the hospital bear the following statement, Caution— This prescription is invalid if used for schedule II controlled drugs. All pharmacies in the central Kentucky area have been informed of this system and have been most cooperative

Take as Directed?

To the Editor.— Prescriptions labeled directed have aroused my concern as well as that of pharmacists Powell, Cali, and Linkewich (Inadequately Written Prescriptions, 226:999, 1973). Frequently, I write a prescription for a medication and Sig: With manufacturer's directions. Almost inevitably, if I have occasion to see the label, it reads, Take as directed. All too many pharmacists disregard the instruction on our prescription blanks to Label as Such. They will not take the trouble to transcribe the recommended dosage provided by the manufacturer. A dose of vermifuge is dependent on the child's weight. Is it asking too much, if the mother provides the weight of each child, for the pharmacist to provide the dose for each child? Verbal instructions are unreliable; my handwriting is not very legible to patients. Cannot the pharmacist type out the manufacturer's instructions— or better still—give the patient the package insert, underlining the dosage instructions?

Letter: Physician's narcotic prescription blanks.

To the Editor.— In the enforcement of federal and state laws on the use of narcotic and dangerous drugs, one item has been left without proper supervision: the physicians' prescription blank. It is not difficult to have the blanks duplicated by a cooperative printer, and a good handwriting expert could imitate the penmanship of any physician. Therefore, I believe the Federal Department of Narcotics and Dangerous Drugs should take steps to close this loophole. This can be done by a law requiring that all narcotics and dangerous drugs be written on a special blank provided by the Bureau, on paper available only to the Department of Narcotics. The physician would be permitted to order 500 blanks in the style he desires at a set price. His signature should be recorded with the Bureau. These narcotic blanks would be kept separate from other prescription blanks at drug stores, where the Bureau's

Pathologic Physiology: Mechanisms of Disease.

Some months ago, hard pressed to define the peculiar genus internist, I described him as a general practitioner of medicine attempting to pursue his art without benefit of instruments beyond those required for physical examination, plus the hypodermic syringe and book of prescription blanks. I might have added that to be a good internist or teacher of medicine he needed more than a passing acquaintance with the kind of knowledge contained in Sodeman's text. With today's insistence on understanding of the reasons behind abnormal functioning of tissues and organs rather than a chief reliance on the morphologic changes detected grossly or microscopically by the pathologist, physiology takes its place as the primary discipline of the student of medicine. No longer will a thorough knowledge of the history, etiologic factors, pathologic changes, and clinical manifestations of an abnormal physical condition suffice in explaining a disease process to students, patients, or the

METRIC VS. ENGLISH MEASUREMENTS

To the Editor:— The following sentence is from a recent article appearing in the proceedings of one of our large clinics: During the 200 mile (322 kilometer) drive he became steadily worse and by noon somewhat stuporous. The conversion of miles into kilometers seems to me to be quite unnecessary and, in fact, annoying. It does bring up the subject, somewhat indirectly, of the use of the metric and other systems in medical practice and the report of cases. Like a great many physicians, I approve of the metric system in prescription writing, although I rarely use it. I suggest that in the printing of prescription blanks there be printed in the lower left hand corner a table such as the following:By forcing ourselves to convert the apothecary measure into the metric equivalent no doubt within a reasonable time we would be able to write the metric system without

BUDAPEST

<h3>New Rules for Writing Prescriptions</h3> The Ministry of Public Health issued a booklet, compiled by Dr. Joseph Melly, with the title "The Duty of Practitioners Toward the Magistrates," which contains some new rules for the filling of prescriptions. The main paragraphs are as follows: 1. The prescribing of drugs necessitates that prescriptions be signed with the full name of physicians. In urgent cases any plain paper may be used but, as a rule, prescription blanks shall bear the printed full name and address and the telephone number of the physician, particularly if the prescription embodies drugs that are declared in the pharmacopeia to be poisons. If drugs are ordered which are marked in the pharmacopeia as + or ++ poisons, the physician is obliged to give in writing full directions; it is strictly forbidden to write "according to directions" or "instruction." Pharmacists must not deliver poisonous drugs so prescribed. Prescriptions containing poisons

NEW WALL BOARD

The wall board is a new type of office equipment for the otolaryngologist that I have found to be most convenient. The physician can make a thorough routine examination of the ears, nose and throat and give treatment without leaving his chair. New wall board. Provision is made for all the routine medications, spray bottle heater, series of five drawers for instruments, table to place instrument tray and space for eight spray bottles and nine solution bottles. The top shelf can be used for cotton jars, nose wipes, alcohol lamp, etc. A pocket behind this shelf provides for the history card, prescription blanks and other material. When compressed air is present in the building, the gage and air pressure regulator is introduced into the equipment. A transilluminator can also be added. The whole device is hung directly on the wall at the height convenient for the individual. Being compact,

GANGRENE OF THE ARM AND DEATH FOLLOWING HYPODERMIC INJECTION

As the result of the high pressure salesmanship methods of some pharmaceutic houses, the use of hypodermic and intravenous medication is growing by leaps and bounds. Some physicians have almost discarded prescription blanks, and their offices are veritable stock rooms filled with hundreds of ampules of various kinds. That there is real danger in needle administration of drugs is proved by the cases of Tennant and of Doane mentioned by Fantus. 3 The case here to be described, which concerned a relative, is similar and warrants the warning not only to use the same strict asepsis in administering a hypodermic injection that one would use in a major operation, but also not to use hypodermic or intravenous medication except with those drugs which have little or no effect when administered by mouth. M. L., a woman, aged 32, married, complained of weakness and lassitude. Her physician found a moderate anemia

"GUARDING AGAINST VIOLATION OF THE HARRISON ACT"

To the Editor: —I note with appreciation the warning in regard to prescription blanks (The Journal, June 14, p. 1984). The thing happened to me not very long ago and gave me an uncomfortable conversation with the office of the internal revenue inspector. I gave a patient a prescription blank in lieu of a card. She filled it in for a tube of quarter grain hypo tablets and signed my name. If she had not presented the prescription to a druggist familiar with my signature, she might have obtained the tablets. I now keep my prescription blanks locked up.

GUARDING AGAINST VIOLATION OF THE HARRISON ACT

<h3>To the Editor:</h3> —Probably there is no legislation of recent times of a purely public health nature from which the public should derive as much benefit, as from the Harrison Narcotic Law. We wish to call attention to a practice of many detail men who call on the physician, and who frequently request a prescription blank, as evidence of their visit. Without the slightest reflection on any detail men, we wish to condemn the practice of distributing prescription blanks in lieu of business cards, on account of the ease with which forgeries can be perpetrated. Many times the physician is asked for one of his cards by people who wish to have his name, address, and telephone numbers for future reference, and the physician gives them a blank prescription blank, which may fall into the hands of some one who may be an expert on writing narcotic prescriptions, and the

A NEW OPHTHALMIC VISITING CASE.

This little visiting case which I present to the profession and which is herein portrayed is of especial interest to oculists; it can, of course, be used by the physician in general work in connection with his ophthalmic cases. As will be seen by the cut, it contains all the essentials commonly used in the treatment of eye cases, each dropper being marked in a manner indicating its contents. The case contains cocain, atropin, eserin, homatropin, two bottles of silver nitrate in different strengths, a phial for toothpicks and a reservoir for cotton, beside a bottle intended to hold a relaxing tablet, a spud and a pair of epilating forceps, a pocket in the side of the case for prescription blanks, cards, etc. While the case is primarily intended as a visiting case it