hospital months supply policy

[confused.com]

My cousin recently went to hospital and was prescribed by a consultant 2 months supply of antibiotics. However the outpatient dispensary only supplied her with 1 months supply. It was only when she got home that she realised that 1 was missing, so she rang the hospital pharmacy, where she was told to hold for 10 minutes while they check the script. They then told her it was hospital policy to only supply for 1 month. She was obviously angry because one she has to pay for her medication so she will have to pay again for her next supply, and secondly if it was hospital policy why did it take that long to tell her. If it was hospital policy why didnt they say so straight away.

But my main point is it acceptable that you only get a months supply when clearly the consultant wants you to have 2? And what if in community pharmacy you start telling patients that its company policy to only give you the quantity what they decide, therby making you pay more. Would they be able to get away with that?

[admin]

Re: hospital months supply policy

The scripts I usually get from hospitals have "one months supply" stamped on them. If you are a patient being discharged from a hospital you only get 7 days supply of medication, even if you're on the drug for the rest of your life.

As I understand, once in the community, the cost of your medication comes out of your GP's drug budget, not the hospitals.

If you were in community it would be different, as the GP would foot the bill for the full supply made on the script. The PCT's try to keep GP's to prescribing a month at a time of medication, to avoid wastage. For example what if your cousin took one tablet/capsule of the anti-biotic and came out in an allergic rash - two months worth of drugs in the bin, instead of just the one.

In the areas I work, your cousin would get one months supply of the drug, even if the consultant wanted her to be on it for six months. The GP would have to prescribe it after that month, and then it should be one month at a time.

As for her phone conversation, all I can guess is that she spoke to someone new, or junior or whatever, who did not know the hospital policy and had to wait until they got in contact with someone who did.

[Steve G]

Re: hospital months supply policy

A lot of hospital scripts I get have '28 days supply' stamped on them as well. However, the doctor can override this if they write the duration of treatment of the prescription - i.e. methotrexate 15mg weekly for 2/12

[admin]

Re: hospital months supply policy

A lot of hospital scripts I get have '28 days supply' stamped on them as well. However, the doctor can override this if they write the duration of treatment of the prescription - i.e. methotrexate 15mg weekly for 2/12

The two hospitals I've worked in both stuck to the "stamp" i.e. one months supply. I have seen scripts for six months supply of a drug (sometimes a very expensive one) but it was always a months supply given. If it's hospital policy, you can't really have any Dr just over riding it because he wants his own way can you, otherwise wants the point of having policies.

[Jeff]

Re: hospital months supply policy

The two hospitals I've worked in both stuck to the "stamp" i.e. one months supply. I have seen scripts for six months supply of a drug (sometimes a very expensive one) but it was always a months supply given. If it's hospital policy, you can't really have any Dr just over riding it because he wants his own way can you, otherwise wants the point of having policies.

On the other hand - if the doctors instructions are over ridden as a matter of policy you could ask the point of having doctors.

Jeff

[admin]

Re: hospital months supply policy

On the other hand - if the doctors instructions are over ridden as a matter of policy you could ask the point of having doctors.

Jeff

I can see your point Jeff, but where would it end. I have known Dr's who want to "let people off" paying the prescription charges, because they don't agree with it. Some want to be able to prescribe off hospital formulary, because they have a mate who's a rep. Some don't think they should have to keep within the law when it comes to writing CD scripts properly. Some want to prescribe for their family - always 3 months supply for the wife's one script charge etc etc etc

If there are going to be policies and rules then they should either be adhered to, or scrapped, in my opinion. If a consultant wants to prescribe a drug course that lasts six months, the patient will get those drugs for six months - they just have to get them from their GP after the first month, that's all. The Dr's treatment plan is still being carried out, so I don't see that their instructions are being over ridden and they are therefore not required.

[Raju]

Re: hospital months supply policy

On the other hand - if the doctors instructions are over ridden as a matter of policy you could ask the point of having doctors.

Jeff

Oh, poor doctors, all these bullying overbearing policies, rules and regulations that undermine their individual wishes! NOT.

Come on man...a viable health care system needs certain policies that are adhered to most of the time that all workers, including doctors, need to adhere to as far as possible.

The argument 'what is the point of having doctors,if taken to its logical conclusion would lead to a very messy situation, as Admin pointed out with a few examples.

[Jeff]

Re: hospital months supply policy

I can see your point Jeff, but where would it end. I have known Dr's who want to "let people off" paying the prescription charges, because they don't agree with it.

And I've seen pharmacists letting people off the 6.85 prescription charge and suggesting that they buy 28 aspirin 75m instead.

Some want to be able to prescribe off hospital formulary because they

believe it's in that patients best interest to do so.

Some don't think they should have to keep within the law when it comes to writing CD scripts properly.

If the instructions are clear - the rest is just BS - legal BS but still BS

Some want to prescribe for their family

and pharmacists never treat their own family.

If there are going to be policies and rules then they should either be adhered to, or scrapped, in my opinion.

Can't we just settle for guidelines with a target of being within them 80% of the time?

If a consultant wants to prescribe a drug course that lasts six months, the patient will get those drugs for six months - they just have to get them from their GP after the first month, that's all.

Not necessarily - the GP has an obliagtion to refuse to prescribe treatment with they are not familiar

The Dr's treatment plan is still being carried out

LOL have you ever investigated shared care and in particular the monitoring - or lack of it. I was looking at Lithium monitoring in the 80's everyone thought that someone else was doing it - I'm not convinced that much has changed across the primary/secondary care interface.
Have you failed to notice the GP scripts which attempt to abdigate responsibilty with doses such as " as instructed by the hospital, clinic or some other bugger who I hope will take responsibilty if this goes pear shaped"?

Regards

Jeff

[Jeff]

Re: hospital months supply policy

Come on man...a viable health care system needs certain policies that are adhered to most of the time

"most of the time" - I agree with "most of the time"

that all workers, including doctors, need to adhere to as far as possible.

"As far as possible" is maybe a little different from "most of the time"
and both are very different from admins black and white

If there are going to be policies and rules then they should either be adhered to, or scrapped

The argument 'what is the point of having doctors,if taken to its logical conclusion would lead to a very messy situation, as Admin pointed out with a few examples.

Both the "what's the point of having doctors" and "what's the point of having rules" argument fail if taken to extremes.
Most patients, most of the time should be treated within the agreed protocols, but to allow for the differences and preferences between individuals there has to be an acceptance that a significant proportion of patients will best be served by something outside the usual protocols.


Jeff

[the old merlin]

Re: hospital months supply policy

Surely, if a patient is on something for several months, his/her own GP should be aware of it? Whether or not s/he feels "confident" to re-prescribe it is another matter. To take a common example, what about Clopidogrel. Treatment is normally started by a consultant, concurrent with aspirin, but the best received wisdom is that such a course should only continue for 12 months. Are those advocating tht the hospital should be responsible for the supply of prescribed drugs suggesting that the patient shoud be given a years supply of clopidogrel?

[Raju]

Re: hospital months supply policy

Jeff - your initial point was that if it is "policy" to over-ride a doctor's wishes, then what is the point in having doctors.

That can easily be answered in the example in which this thread is based - to make the diagnosis and decide the treatment.

If to get the second month of the treatment course somebody has to go to their GP, that is hardly an extremely serious matter for the patient (or their carer) or the hospital doctor.

I've seen too many examples of patient's returning long courses of drugs that they couldn't tolerate to say that it could ever be a good idea to prescribe more than 28 days of a new medicine to a patient, even of the treatment was to be for longer.

[Jeff]

Re: hospital months supply policy

Surely, if a patient is on something for several months, his/her own GP should be aware of it? Whether or not s/he feels "confident" to re-prescribe it is another matter. To take a common example, what about Clopidogrel. Treatment is normally started by a consultant, concurrent with aspirin, but the best received wisdom is that such a course should only continue for 12 months. Are those advocating tht the hospital should be responsible for the supply of prescribed drugs suggesting that the patient shoud be given a years supply of clopidogrel?

OK a bit of quick and dirty research - next week at work check your clopidogrel and aspirin patients and make a note of the duration of treatment.
If more than a year - I suggest that the patient might have been better served if the prescribing had remained with the hospital.

Save the results as the clinical audit for the PCT.

Jeff

[johnep]

Re: hospital months supply policy

um err, why should clopidogel only be for year, sure some of my pts been on for years.
johnep

[admin]

Re: hospital months supply policy

um err, why should clopidogel only be for year, sure some of my pts been on for years.
johnep

The ACTIVE W trial compared clopidrogel plus aspirin (75mg to 150mg) and had to be stopped early because after a follow up of 15 months it found that clopidrogel plus aspirin was associated with a greater risk of major cardio-vascular events. At least that's the one I remember as it was on a MeReC Extra sheet sent to me (issue 24).

[the old merlin]

Re: hospital months supply policy

OK a bit of quick and dirty research - next week at work check your clopidogrel and aspirin patients and make a note of the duration of treatment.
If more than a year - I suggest that the patient might have been better served if the prescribing had remained with the hospital.

Save the results as the clinical audit for the PCT.

Jeff

Actually, that's on my list for this month (i'm a practice pharmacist, working on prescribing advice). So far I've found that most of those due to come off are marked to do so, although one or two have slipped through. So far I've one where the hospital missed the anniversary as well as everyone else.
However, there's a question for community pharmacists. Why don't you do that routinely? Your records of what a patient has actually had, certainly for regular patients, are better than the GP's