repeat prescriptions

Re: repeat prescriptions

Anthony Todd — Thu, 22 Apr 2010 01:04:11 GMT

[quote user="Jill Nute"]Client is wrong, absolutely a clinical decision for the vs dealing with the case,[/quote]

Perfect answer IMHO for client and vet, no stupid irrational time limits or constraints at all

Re: repeat prescriptions

Anthony Todd — Thu, 22 Apr 2010 01:02:17 GMT

Surely the most sensible and logical protocol would be to base it on clinical grounds bearing in mind that the VS will be responsible for the prescription whatever protocol, policy or rule applies.

We have had cases where patients haven't been seen because the "policy" was decreed by the attending vet to be within 6 months and was interpreted by the staff and owner as "just before 6 months" so the dog in heart failure wheezed and coughed on, because the drug dose was too low and "I was told to get another prescription within six months".

Epileptics still fitting because of low dosage, again because of a misinterpreted policy, protocol or rule, or even "law".

And making a client bring an animal in for repeat wormers or flea treatment because it is just over 6 months or some other arbitrary time period is plainly daft and this is why the clients get very very cross.

Similarly a terrible and bloody incident with a geriatric hyperthyroid cat, lethal to handle who had to be presented [you couldn't examine it] because it was the "law" that repeat prescriptions had to be seen every six months.

We prescribe potent drugs all the time, I'm happy to take a sensible view on a case by case basis and take full responsibility for it

Time is only a minor part of this assessment, common and professional sense the major.

Re: repeat prescriptions

Clive Ansell — Wed, 21 Apr 2010 08:27:07 GMT

This particular practice has a protocol of a 6 month maximum for medication checks and for written prescriptions, ilogical it may be, but there has to be a cut off somewhere, and even being a little flexible 8-9 months is well outside the ballpark. Of course, some cases are seen more often. I was not happy to deviate from policy unless the practice owner gave permission, and on his return he fully supported my actions.

The client was angry because "I refused to provide a script, which I am legally oblige to do", in fact I did not, I offered one for 180 tablets, a 6 month supply. I would really not be that happy with prescribing, and signing a document to that effect for, 8-9 months worth, and claiming the animal is "under my care" A grey area I know.

The client could also discuss with the online retailer, and ask why they will not supply 180 tablets; but that is an issue between them, and not a veterinary one.

Re: repeat prescriptions

Anthony Todd — Wed, 21 Apr 2010 01:18:15 GMT

[quote user="Clive Ansell"] practice policy is checks are strictly at a maximum of 6 months[/quote]

Of course the client usually is objecting to the fee, which is considered to be unnecessary and a total rip of by some clients.

As far as I am aware there is no set time limit and certainly no "law" as sometimes is presumed.

To have a practice policy of six months or whatever seems to me illogical. What, six months and one day you refuse? Is there any clinical risk in giving the script for 250 tabs? Certainly I would be an angry client, not because it was my wont but because it was illogical.

And the reverse applies; six months is too long for an epileptic or diabetic, so clinical judgement must apply rather than a "rule", and this should apply to animals under our care as well.

Re: repeat prescriptions

Vikki Halliday LLB — Tue, 20 Apr 2010 23:02:00 GMT

[quote user="Evelyn Barbour-Hill"]Mandy Rice-Davies[/quote]

she's not on trial for bringing down a government here!

Re: repeat prescriptions

Evelyn Barbour-Hill — Tue, 20 Apr 2010 20:21:47 GMT

[quote user="Vikki Moran"]the online pharmacy she wants to use have told her that if she asks for a 6 month repeat to be written, I have to provide it.[/quote]

Mandy Rice-Davies.

Re: repeat prescriptions

Clive Ansell — Tue, 20 Apr 2010 18:11:30 GMT

You're the veterinary surgeon, you are in charge, it is your call. If you say checks are needed monthly, then monthly it is. If clients doesn't like they need to go elsewhere.

I had a similar case last autumn. The practice policy is checks are strictly at a maximum of 6 months, One client wanted a written script for 250 soloxine tablet as the internet pharmacy will only sell unopened bottles. I refused pointing out the maximum I can prescribe for is 6 months, or 180 tablets. This client also has a history of not keeping check up appointments. Angry client, but the answer is still no.

Re: repeat prescriptions

Vikki Moran — Tue, 20 Apr 2010 17:42:21 GMT

thank you all for your replies.

PM had asked me to post this as she wanted to know what other people thought. I'm glad I'm in the right.

sadly yes, mr shark (sans partners) does operate a mile or two away, and probably would do the scrip. hopefully she won't go there though as he turned away the comatosed dog during his lunch hour, which is why we saw it. and then refused to give us any history, but allegedly telephoned the owner and told her we were only after her money and the dog should be pts, before we put it through un-necessary suffering (that's the owners report though so taken with a pinch of salt - that said it does sound like mr shark!)

Re: repeat prescriptions

Vikki Halliday LLB — Tue, 20 Apr 2010 16:16:56 GMT

Totally agree, with Wynne, Jill et al, and I too have had this problem with clients. The issue then is will they then go up the road to Mr Shark and partners M's RCVS who may well decide to issue 6 monthly prescriptions thus losing you a client and making you look like a fool.

I think it's time the RCVS took more of a stand on what is an acceptable time, and actually took the pressure off practitioners having to defend their stance, which is after all, largely dictated by the GtPC.

Re: repeat prescriptions

Hannah Wynne Richards — Tue, 20 Apr 2010 16:10:26 GMT

Vikki

SVP of RCVS is a good one to have on your side in any legal dispute

Wynne

Re: repeat prescriptions

Jill Nute — Tue, 20 Apr 2010 16:03:26 GMT

Client is wrong, absolutely a clinical decision for the vs dealing with the case,

Re: repeat prescriptions

Charlotte Marshall — Tue, 20 Apr 2010 15:41:57 GMT

I agree. As I understand it we have to be satisfied that the animal is under our care. That requires regular check ups and the frequency of these is up to the vet to decide on a case by case basis though most practices have a maximum length of time between check ups (ours is 4 months).

The BVA guidance on 'Under our care' has this to say:

For small animals, in the case of routine prophylactic anti-parasitic agents the time interval between re-assessments should be no longer than twelve months. All other re-assessments should be carried out at intervals which do not exceed six months, but in many cases professional judgement may require a considerably shorter period.

I should stick to your guns if I were you!

Re: repeat prescriptions

Hannah Wynne Richards — Tue, 20 Apr 2010 15:26:41 GMT

Vikki Legally, what prescription only means is that the control (and responsibility ) are entirely yours. Clients are not allowed to buy POM-V drugs "over the counter " because of the potential for harm if wrongly used. That is why the law states that a prescription is needed, and it is the responsibility of the veterinary surgeon , to only supply a prescription only drug, (or written prescription ) if satisfied that that is the correct drug, and dosage for that animal. So, if your professional opinion is that a 3 monthly (or even monthly ) check up is necessary, then as long as your clinical judgement would be backed up by other independant veterinary surgeons, who would have acted exactly as you have done, then the law is on your side. There shouldn't be a prob with an unstable diabetic-in fact you could be accused of negligence if you kept issuing scrips without regular check ups

Wynne