Length of time between repeats

Re: Length of time between repeats

Alice Courtney — Thu, 17 Feb 2011 14:06:09 GMT

OK, I"ll play devil's advocate, since you imply that some of us aren't taking responsibility and are instead just following orders (perhaps some of us are). 'Rule' implies there's no room for negotiation, & I agree this isn't appropriate as it doesn't make allowances for clinical decision making and taking responsibility for those decisions. However a policy that acts as a guide ensures that cases are reviewed regularly, and takes into account that the primary veterinary surgeon in charge of the case is not always available to do the prescription. It acts as a back-stop, metaphorically.

On this front, how does everyone organise their repeat prescriptions? Are you all responsible for repeat prescriptions for particular cases, and does this help case continuity? We have a vet allocated each day to do prescriptions, which unfortunately means that long-standing medical cases (thyroid, renal, in some cases DM) often see different vets each time (often the vet who last did the prescription, as this is the name that reception sees on the most recent clinical notes). And because I'm a medic, that's so many missed opportunities in my eyes!

Re: Length of time between repeats

Anthony Todd — Thu, 17 Feb 2011 13:25:07 GMT

[quote user="Alice Courtney"]In this case there was no one vet who could reasonably claim to have her cat 'under his or her care'; no vet had seen any of her home BG curves and made any clinical assessment of the cat's diabetes. Policies/rules help to stop such cases from slipping through the net, I think.[/quote]

Er, no, this one's just too easy, so you don't need a rule, and IMHO you never do. Will mean you have to take responsibility though.

Re: Length of time between repeats

Alice Courtney — Thu, 17 Feb 2011 12:53:15 GMT

As a guide (not rule!) we have a "checkup-every-3-months" policy for repeats including written prescriptions, however there are individual cases where 6 months is deemed suitable (e.g. stable HAC dogs with self-funding owners, some OA cases but most will be checked 3-monthly, etc), this is at the discretion of the vet in charge of the case.

I think in some cases it is important to have some guidance on this, if not a practice policy/rule, particularly when you have clients who shop around between vets and branches/hospitals to get their medication. This weekend I came across a client who did home BG curves and decided her cat's own insulin requirements, and phoned various parts of our practice (branches/hopsital) when she needed more insulin. Often at weekends she would phone the hospital, knowing that the branches would be closed, and demand urgent insulin...not only that but she said she wouldn't pay and it had to go on insurance, even though we hadn't seen her for ages at the hospital!!....In this case there was no one vet who could reasonably claim to have her cat 'under his or her care'; no vet had seen any of her home BG curves and made any clinical assessment of the cat's diabetes. Policies/rules help to stop such cases from slipping through the net, I think.

Re: Length of time between repeats

Anthony Todd — Wed, 16 Feb 2011 11:51:54 GMT

[quote user="Peter Ding"]A rational approach would be not to have a set rule and only decide on the basis of clinical need for repeat checks, competence of owner, type of drug etc.[/quote]

Sanity at last. I have had this argument with colleagues many times; some even insist that there is a "law" that there is a maximum time.

This boils down to "animals under his or her care" and should be decided on a rational, scientific and commonsensical basis, not by a "rule".

Of course, having a "rule" means that the VS doesn't have to think, nor use common sense or judgement nor take responsibility for actions.

Re: Length of time between repeats

Peter Ding — Wed, 16 Feb 2011 10:44:14 GMT

A rational approach would be not to have a set rule and only decide on the basis of clinical need for repeat checks, competence of owner, type of drug etc.

Re: Length of time between repeats

bob lehner — Tue, 15 Feb 2011 18:39:16 GMT

[quote user="alison howell"]

I can't remember for sure, but I think we once had a prescription for phenobarb returned because the pharmacy would only allow 1 month to be supplied at once when I had put repeats on it.

[/quote]

Phenobarb is CD Sch 3 - VMD Guidance Note 29 (Controlled Drugs) says :

8. For controlled drugs in Schedules 2-5 it is considered good practice for only 28

days worth of treatment to be prescribed unless in situations of long term ongoing

medication, for example, when treating epilepsy in dogs. If prescribing an

extended prescription, the veterinary surgeon must be assured of the competence

of the owner regarding the safe use of the product before issuing.

Re: Length of time between repeats

salome2001 — Tue, 15 Feb 2011 15:56:41 GMT

for prescription flea and worm products: 12 months (unless exceptional medical circumstances)

for other ongoing medication it will depend on the practice policy where I am working. My previous practice required check every 3 months maximum. My current practice sets a usual 6 monthly recall.

My personal interpretation is that it depends on the condition and the amount of care: an unstable diabetic would not be suitabel for a 6 month recall!! I prefer 3 months in most conditions.

One thing I am trying to do in some cases (eg long tern hyperthyroid cats, CRF etc) is try to get the client in for a weight check (free) with the nurse more often than the (paid) vet consult. If there is weight loss present or something the nurse is concerned about then at least they can bounce it to the vet sooner than would have otherwise been done.

Re: Length of time between repeats

Thomas Johnson — Tue, 15 Feb 2011 15:42:32 GMT

[quote user="Laurence Webb"]

[quote user="Thomas Johnson"]

[quote user="Laurence Webb"]

I don't distinguish between this protocol for written prescriptions and those dispensed by the practice. If you're charging for written prescriptions this would contravene the GtoPC anyway.

[/quote]

From the GtoPC, Part 1D, clause 8:

j. from 31 October 2008, a reasonable charge may be made for written prescriptions; such prescriptions for POM-V medicines may be issued only for animals under the care of the prescribing veterinary surgeon and following his or her clinical assessment of the animals.

[/quote]

A misunderstanding. That wasn't what i meant. You can charge for writen prescriptions but it would not be permissable to make one rule for people picking up medication for the surgery (you can buy 3 months at a time) and another rule for those wanting written prescriptions (only prescribing one month's at a time and making 3 charges for 3 month's medication).

[/quote]

Sorry, that makes complete sense now!

Re: Length of time between repeats

Laurence Webb — Tue, 15 Feb 2011 14:25:45 GMT

[quote user="Thomas Johnson"]

[quote user="Laurence Webb"]

I don't distinguish between this protocol for written prescriptions and those dispensed by the practice. If you're charging for written prescriptions this would contravene the GtoPC anyway.

[/quote]

From the GtoPC, Part 1D, clause 8:

[/quote]

Re: Length of time between repeats

Thomas Johnson — Tue, 15 Feb 2011 12:41:27 GMT

[quote user="Laurence Webb"]

I don't distinguish between this protocol for written prescriptions and those dispensed by the practice. If you're charging for written prescriptions this would contravene the GtoPC anyway.

[/quote]

From the GtoPC, Part 1D, clause 8:

Re: Length of time between repeats

nikki — Mon, 14 Feb 2011 23:34:42 GMT

[quote user="alison howell"]

I can't remember for sure, but I think we once had a prescription for phenobarb returned because the pharmacy would only allow 1 month to be supplied at once when I had put repeats on it.

[/quote]

We've had that too. I dont think it's allowed to write a script for epiphen for more than a month.

Re: Length of time between repeats

vs0u — Mon, 14 Feb 2011 23:05:43 GMT

I can't remember for sure, but I think we once had a prescription for phenobarb returned because the pharmacy would only allow 1 month to be supplied at once when I had put repeats on it.

But normally I would be happy to give meds/prescription for as long as the client wanted within the check-up time. Most only want a months worth though.

Re: Length of time between repeats

nikki — Mon, 14 Feb 2011 21:36:58 GMT

depends on the drug and the client. phenobarb they only get a month. metacam they can have 2 x 100ml bottles for a Lab if they want. if we write a script then I will write it for as long as until I want to see the dog back but normally do 1-2mths lots and allow a few repeats.

Re: Length of time between repeats

Catherine Williams — Mon, 14 Feb 2011 17:43:20 GMT

I find it varies a bit from client to client.

If it's a written prescription then I will do it for 6mths supply, I try to ask clients if they want a script that allows for 6mth in 1 go or to order in 2 or 3mth supplies and repeat it. some on-line suppliers seem to be happy to have a 6mth script + allow clients to buy in portions, others will only supply exactly as written on the script. As we charge for written prescriptions it seems wrong to make a client have a fresh script every month and I suspect the more difficult we make it to get a script the more clients who will go elsewhere or try the fraudulent approach.

For in house supply of meds most seem to prefer to collect medication every 1-2mths but we do have others who prefer 6mth supply in 1 go. I guess it does depend a little on the medication - how likely I think it is that the dose may change at a later date, whether I'm concerned about storage and how comfortable I am with a client having a stockpile. I wouldn't let a client take 6mth worth of insulin in 1 go as I'm not confident it would be stored correctly. I'm less comfortable with a client taking 6mth worth of phenobarb than I am soloxine - not sure that I have much reasoning behind that beyond the fact that our phenobarb is locked up and recorded and it wont be once it leaves our doors

Re: Length of time between repeats

Michael Woodhouse — Mon, 14 Feb 2011 17:16:51 GMT

It would depend what it was and I have never had an owner ask for a full 6 month supply. We offer a discount on full pots of Rimadyl so frequently sell that in 100's. They can have 6 months worth if they want it. I wouldn't give 6 months worth of Tramadol.

Re: Length of time between repeats

Bob Russell — Mon, 14 Feb 2011 14:51:01 GMT

As a general guide 6 monthly checks (as long as clinically justified). We do supply one months medication as a rule and prescriptions cover a similar amount of medication.

Re: Length of time between repeats

Laurence Webb — Mon, 14 Feb 2011 14:37:31 GMT

If I have judged that an animal doesn't need to be examined for X months then I'll dispense as much medication as they need to take it up to that point. Most client's don't want to purchase that much in 1 go but others do. It saves the owner having more trips to the vets, saves us time looking at records and less parperwork if the pet is insured.

I don't distinguish between this protocol for written prescriptions and those dispensed by the practice. If you're charging for written prescriptions this would contravene the GtoPC anyway.