The fun of Discharge Medication

Whats more fun than a kick in the balls? More exciting than seeing plastic bags full of random pill bottles plunk on your counter? More uplifting than seeing that 65 year old who cant tie her own shoes walk in the front door with yet another barrage of same questions she asked yesterday? More hilarious than watching an Alzheimer’s patient go greeting card shopping?
DISCHARGE ORDERS!
Thats right! Pages upon pages of fun!
Let me explain why they frustrate the hell out of us:
If they are phoned in, they are usually called in by a nurse (i use that term VERY VERY loosely) who cannot speak english. They usually involve 20 some-odd drugs, and the nurse cant figure out how to fax them over, and demands to just verbally give them. After 20 mins of ‘eye tink dats hydoxyzyzine (?!?!?)’ sort of mayhem, they want you to READ back to them all of the medications they called in, upon which they somehow get really confused and make you start over not once, not twice, but three times. Did I mention that she cannot read the doctors handwriting, so shes GUESSING at most of these? Yanno, people really throw the term ‘Nurse’ around like it means something now days.. You a MA? You’re a NURSE! You’re a Nursing Assistant? NURSE FOR YOU! You clean the floors? NURSE! If I were a ‘real’ RN-type nurse, and associated with these types of ‘nurses’, i’d be pissed. Of course I’m in the camp that gets pissed when PharmD’s call themselves “Doctor”. Anyhoo, I digress, back on track.
When you are fortunate enough to get a REAL nurse who calls you and spends all of 30 seconds getting your fax number and saying “i’ll send it over” (thank you, we love you). One of the following will (not maybe, will) happen:

• The page will fax so horribly, it looks like a 2 year old took a dump on a piece of paper and then scribbled with it.
  • The doctor will sign but not print his name, so these drugs are written by Rsquiggle Mcsqiggle
    • The hospitals letterhead will be written or scribbled over so you have no idea where to call for clarification
      • The patients name wont fax, or better yet, you get just random letters in the persons name (Vanna, can I buy a vowel?)
        • The fax goes to the wrong pharmacy
          • The order finally comes in.. 10 min before closing.. Before a 3 day weekend…
            Now all of these are really that bad, so why do we hate discharge orders?
            Because the patient picked up all of his medication from your store…. Last week…. And they’re all on this discharge sheet… All changed…. I can hear the collective sigh from pharmacists across the nation. Here is why we’re screwed in this case:
            • Insurance is going to balk at filling the same medication with a different strength and sig. Their systems are going to show it filled 3 days ago, so its going to reject.
              • The patient is 99% of the time not mentally able to comprehend taking 1/2 of this drug, while taking 2 of these. Even if you make them bring in all of the bottles and stick new labels on them, they are going to take them the way they have been taking them for the last 5 years.
                • The doctor is going to see his patient in 2 weeks, freak out at what the dipshit resident did while he/she was in the hospital, and change things yet again.
                  So yeah, for pharmacists, its a lose-lose situation. You’re getting screwed by the insurance company; you’re getting screwed by the patient who has the understanding of a turd when it comes to what medication does what and changes; and you’re just bending yourself over to just have this all happen again in 2 weeks when he has an appointment with his primary care doctor.
                  DrugNazi/Monkey – Lets go out drinking. Seriously. I dont care where you are, I will drive, fly, hitchhike, etc to you. We need to meet up, plunk down a few hundred on a nice bottle of expensive scotch, and see who’s store is more hellish. email me: [email protected]
                  Oh, and the rest of the internet is posting these wierd numbers on their webpage, so I will too dammit! I’m internet hip! Maybe i’ll win a prize or something.
                  09-f9-11-02-9d-74-e3-5b-d8-41-56-c5-63-56-88-c0

Comments #

Comment by Valerie on 2007-05-02 10:38:29 -0700 #

You could not have put it more succinctly. Who said hell is for after you die?

Comment by Henry on 2007-05-02 17:47:27 -0700 #

I work for a call center that deals with Medicare part D and I have to say that I love your blog. I didn’t know how much of a hassle it was for pharmacies to deal with the discharge medications. but I knew it was bad because every time the pharmacist or tech calls in to get the override they sound incredibly frustrated. The other fun ones are when the doctor decides that the patient needs to take twice what they were taking before but they always make the change the day after the pharmacy filled it. so they run out early.

Comment by stlcoptony on 2007-05-02 18:09:32 -0700 #

The RIAA will now be out to get you too!!! Seriously though, nothing beats the hellish-ness of Walgreens

Comment by Matt Crowley on 2007-05-02 19:46:47 -0700 #

I just found your blog today via Metafilter. I too was a pharmacist here in Seattle for a number of years, from 1987 to 2002. It is somewhat painful to read your blog because it is so true. I’ll have to take it a little bit at a time. It is very refreshing to find someone in pharmacy with the guts to simply tell the honest, ugly truth about all that is so wrong about pharmacy and the medical profession in general.
It got so bad for me that I quit the profession and I am now a welder.
Yeah, discharge meds… Right before I quit we started getting faxes from Seattle Cancer Care Alliance, an outfit so pathologically disorganized that it actually beat out Harborview for #1 screwed-up medical facility!
The worst was when these idiots would fax in med orders “for our own records” i.e. not really to be filled… But they wouldn’t tell us this, so we would waste mountains of time on nothing.
We would call the facility asking the eternal “who is the doctor” but there was never any system on their end to track the faxer down.
Keep up the honesty.

Comment by geena on 2007-05-03 08:55:37 -0700 #

Very refreshing to read blogs that tell it like it is. I had no idea from my end (nursing – A REGISTERED NURSE with a BSN! :)) that that’s what goes on at discharge.
Unbelieveable.

Comment by Nic on 2007-05-03 17:55:12 -0700 #

One of the hospitals around here is too retarded to just fax discharge orders, or to have the docs write out prescriptions. They print out EVERY med the patient had on their MAR, and mark “continue” or “discontinue”. They’re supposed to write a quantity and number of refills on anything we’re supposed to dispense, but most of the “nurses” think they can just mark continue and we’ll fill it. I especially love when they do it on percocet or oxycontin. The patient can never understand why we have to send them back to the hospital for the written rx.

Comment by Sean RPh. on 2007-05-03 19:33:21 -0700 #

My favorite is when they get to the prn meds.
The nurse: “Tylenol w/codeine, 1-2 q4-6 hours as needed.”
Pause…
Me: “How many do you want on that?”
Nurse: “Hmmm, it doesn’t really say…a month, like the other meds”
Me: “…”
Nurse: “Hello?”
Me: “Yeah I’m here…look, I don’t think the doctor wants me to dispense 360, so why don’t you check and call me back.”

Comment by Marty on 2007-05-04 08:27:06 -0700 #

Actually discharge orders from our local hospital are extremely neat and legible. They use the lottery system for writing out prescriptions on the discharge sheet. The patient gets a discharge sheet with all their meds and dosages and then get prescriptions for those meds. EXCEPT the joke is that the patient then has to figure out which freaking rxs are missing. Either the doctor doesn’t bother to write them all out or the discharge nurse is playing “hide the Rx” so when the patient gets home and tries to match the meds we filled with the discharge sheet we get to spend 20 minutes sorting it out and then another 20 minutes making multple phone calls to doctors offices. Don’t even think about calling the hosptial because the discharge “nurse” you need to speak to is now on vacation in Tibet.

Comment by RxTech317 on 2007-05-09 20:41:18 -0700 #

Um, did u forget the patients’ written orders which the patient things are actual prescriptions?? Like a patient discharged on a Sunday who brings in directions to take Vit D 50000 on Friday, b/c of course they need to take it the next day. But luckily they come back w/an actual prescription they had tucked away at home, but alas there are no directions, the doctor is gone and not on call (shocking!) and no one can find any other orders on how she is to take it. Who’s fault is all of this?? Mine of course!!! But shit, my crystal ball broke last week, and I seem to be getting a bad connection when I try to telepathically reach the physician. If it’s that urgent bring it in sooner or shut the fuck up and try to contact the doctor yourself!!! ohhh there I go again assuming people have some common sense.

Comment by Joyce on 2007-05-10 09:37:29 -0700 #

Ps: That number is the encription key for HD-DvDs. YaY for burned/bootLeg HD-DvDs!

Comment by medstudentwife on 2007-05-22 18:17:34 -0700 #

I sorta think Im outta my league.. not a nurse or a doc… but have worked pharmacy.. not emerg.. but chronic/complex continuity of care & pall.
For 99.99 % of those you serve..patient or health care clients… none of its going to be right or good enough….
Maybe the following arent quite in sync to the comments,etc… but
your comments make me think of what we tried to do to ease the “the 4:30 pm ( pharmacy closing) discharge orders” from an acute care hospital to a chronic care hospital.. where the patient was D/C’d at 10 am (or before), has meds that are not in formulary, 2o meds easily anyways & we only got the frantic call at 4:15 that orders are just in.
Nothing we did worked 🙁
Fax was bad & so was verbal, cause the D/C meds and the admitting meds never really jived.. or there was always some strange med on the admitting that wasnt on the D/C.. go figure.. or or
when I left.. it still wasnt figured out…
Ever spent 2 hrs on a sealer doing weird med combos/ doses for 45 meds???..or trying to get meds same day at days closed end ?
*sheesh*

Comment by StephRx on 2007-08-29 12:20:41 -0700 #

Yaaaaaaaaaaaaaaaay! I heart this site so much. I’m not dealing with the hateful public much in my desk jockey job now, as opposed to my former…what did that Darvo/Vico-Head call me?…PILL Jockey job. Your rants bring back so many fond memories. High-five on the PharmD’s calling themselves “doctor.” Give me a freaking break. Yer NOT THE DOCTOR! Much love, Steph PharmD (not doctor)

Comment by BrianTM on 2012-03-03 13:26:05 -0800 #

Wow, now im in the situation of trying to decide to be a pharmacist or a nurse, which is the better choice for me, and that is why im here, to read and learn. now im also just getting out of the navy, so when someone im working with is clearly not doing their job right, i have the mindset of “its time to do some training so these idiots can do their job right! not i fully understand you pharmacist typs are very busy, and I say this with the highest respect for what you do, but from what I can tell from the reading I have done so far, it sounds like some of you pharmacist types need to pay a visit to some of these jacked up hospitals and train them on how to do the job properly so they can stop making your jobs that much harder. When ignorance rears its ugly head, its time to beat some knowledge into it. Know that what you guys do is truly appreciated and I hope you keep it up even with all the bullshit. Same to the real nurses.

Comment by CanadianPharm on 2013-11-07 12:32:26 -0800 #

Just read this after a lovely discharge script. A couple of key points to remember about discharge prescriptions for physicians:

1.)Discharge planning is the last step in leaving a hospital. So, whether you’ve been in for a day or a month, make sure its done in the last 30 minutes.

2)Drugs are available in all dosage forms, strengths at all pharmacies at all times. Therefore, there is no need to plan ahead, as most pharmacies will carry the $8000/month use-it-once-in-a-year flippin PAH drug. And every insurance company will gladly pay for it without prior authorization. Its What they are there for.

3. Once you have written your novella of a discharge prescription at 4:30 pm, turn your pager off at 5. You’ve done your job, its now up to the pharmacist to do his/hers.

BTW, I recognize that this post is 6 years old and probably lost in the pages of the web, I just needed to rant.

CanadianPharm