Prescription writing

[True Anomaly]

For those of you who precept students on a somewhat regular basis, a query for you. I realize before I ask this that this may be a regionally-biased observation, but...

 

How many student do you see on rotation who cannot write a prescription? Or, better put, students who were not taught or were emphasized on how to write a prescription? The reason I ask is that more often than not, the students I have rotate with me seem to be lacking basic prescription writing skills, which was something that was really emphasized during the didactic portion of my own program. When doing clinical cases in the classroom, we were made to calculate out dosages and write out the script as if we were handing the patient the actual paper we were writing on, and made sure we knew the state laws for what needed to be on the prescription. Is this not a regular thing with most other PA programs?

[joanna.nola]

We did not really learn to write prescriptions in school. And I also barely did it on rotations (usually I just talked it over with my preceptor who was quickly doing it so we could move on to the next thing, usually writing it electronically). I'm about to start a job and feel like I should have pushed more to write scrips while in rotations.

 

correction: we spent *one* day writing prescriptions in PA school. I did write a couple of prescriptions in the hospital. but with electronic prescriptions in many of my rotations, I just didn't get the practice I wish I had.

[rcdavis]

Holy moley.

Other than the hx and PE, what separated pa from nursing generally was the cognitive and legal ability to write prescriptions.. And the new guys aren't EVEN BEING TAUGHT HOW TO DO IT???

 

And we want less supervision?

 

I am going out.

[primadonna22274]

I'm joining you Davis! Yikes.

[Joelseff]

SMH.....

 

I knew how to write a script before starting PA school. Learned as a corpsman. But as a civillian MA I read tons of rx's which I would suppose exposed MAs to scripts heck my MA knows how to write one out. But hey, these PA students will have a masters though won't they?

 

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[jen0508]

I dont precept but i'll comment as a semi-recent grad. We learned how to write Rx's in our pharmacotherapy class during didactic training. Also during our graded patient encounters (with payed actors as patients) we had to write them out. During clinicals there were several rotations where i wrote prescriptions for every patient I saw (and of course the doc/PA looked over it and signed it). doing them on my own was the best way to learn medication dose and duration of therapy. I struggled some with pediatric meds when i began my first job because I never wrote Rx's during my peds rotation. I cannot imagine starting a first job not having ever written Rx's period.

[LIPPER]

Rx writting should be basic.. Shadowing alone one should pick it up.... Over the years some things have changed, especially with controls (write out the month not just digits, write out quantity that sort of thing)....Otherwise I agree that's bread/butter stuff

 

I'd imaging the basics will further be lost to history as EMR takes over.

[EMEDPA]

I also knew how to write or call in an rx before starting school. many of my students today do not know how to do this and do not know how to use bid, tid, etc. or they write :

amoxicillin 500 mg

take 1 three times daily for 10 days.

# QS ( I hate that, you can't figure out 10 X 3?)

also they aren't taught to spell out the # for controlled substances

: Vicodin #20(twenty) so anyone can give themselves 200 vicodin with a minor change!

[mdebord]

We too, had a 30 min lecture on prescription writing during didactic, and that was it. It wasn't until my last rotation that the doc handed me the script pad close to the beginning. From then on, I wrote them all and she signed them. I'm very grateful for that!

[rev ronin]

We were taught to do it. Multiple practice sessions, including "racing" other students to get the correct script written the fastest out of the Sanford Guide ("A 26 year old otherwise healthy male has gonorrhea. Go!") which was really quite fun, even if I was never the fastest. We rechecked the skill at our pre-graduation professional practice seminar, and I know of no one who had to remediate it.

 

Now that I'm in practice? EPIC does it all for me. I don't even have my DEA number easily available when I'm at work.

[Just Steve]

Medex teaches scripts throughout the pharmacy lectures. Sometimes the grading will include price consideration as well so that we don't just prescribe the newest thing on the market without considering patients' resources. We are also tested on scripts, both on writing them correctly and also finding the mistake in written ones provided to us.

[ToppDog]

Wow, that's just sad...

 

Glad to hear that MEDEX is doing what they are though, as I hope to be there next year.

 

What's funny is that I was just thinking how I should be harder on my MA students in pharmacology :)

[True Anomaly]

 

I'd imaging the basics will further be lost to history as EMR takes over.

 

That's just what helped bring about this....well, I really wouldn't call it an "epiphany", but realization- on Saturday, my hospital system will be closing an old worn-down hospital with paper charting and paper rx's, and will open up a brand-spankin'-new glittering jewel of a hospital, which will feature our EMR we've used at our other facilities. And as such, there's no more written prescriptions at any of our ER's. Therefore, the need to emphasize proper Rx writing will get lost in the shuffle of the daily grind. So what I've taken to do now is to have the student write out the script as if they were going to hand the patient it to go home with on paper even though I discharge the patient with EMR rx's. There have been plenty of times when the EMR goes down for an extended period of time that I needed to write paper rx's, or I just can't make the stupid EMR recognize the prescription I'm trying to write, so I just bust out an old script pad.

[Joelseff]

That's just what helped bring about this....well, I really wouldn't call it an "epiphany", but realization- on Saturday, my hospital system will be closing an old worn-down hospital with paper charting and paper rx's, and will open up a brand-spankin'-new glittering jewel of a hospital, which will feature our EMR we've used at our other facilities. And as such, there's no more written prescriptions at any of our ER's. Therefore, the need to emphasize proper Rx writing will fall by the wayside. So what I've taken to do now is to have the student write out the script as if they were going to hand the patient it to go home with on paper even though I discharge the patient with EMR rx's. There have been plenty of times when the EMR goes down for an extended period of time that I needed to write paper rx's, or I just can't make the stupid EMR recognize the prescription I'm trying to write, so I just bust out an old script pad.

 

We also still have to handwrite schedule drugs so I think new PAs should still know how to do this. I prefer handwriting one vs eRX which many times, somehow, picks the wrong strength or formulation or some detail that I would not have missed had I handwrote it...I suppose "That's the way of the world.." (just had to stick a EWF line in there) :cool:

 

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[joanna.nola]

I'm bummed out that my program didn't force us to do it more. Even in our clinical testing, where we came up w/ differentials for scenarios, we talked over prescriptions (usually just drug & sometimes length if longer course mattered), but didn't actually write them. Like I said before, there were hand-written scrips in couple of my rotations, but many of my preceptors were in too much of a hurry to let me do it. Wish I had pushed harder. I always talked the pt over w/ the preceptor and that is usually when they'd write the scrip, often not letting me finish speaking. I think the speed writing for scrips sounds like a good & fun way to have done it! Wish my school had been creative like that!

[primadonna22274]

Always room for improvement--let your school know NOW that they let you and your peers down on this very fundamental task. Hopefully they will make an effort to rectify it for future students.

[physasst]

Never learned it in school......Of course, at that time, we weren't allowed to write prescriptions in that state. So the faculty didn't see a pressing need to teach us. Picked it up on rotations though. A couple of them would have you write it, and then bring it to them for them to review and sign.

 

Now, ALL of our prescriptions, including controlled ones are done on our EMR. DME prescriptions, therapy, you name it....ALL electronic.

 

I like it. I have a hotlist of favorites. It is a helluva lot easier and faster, and the best part is that it's safer and better for patients. Too many errors with written prescriptions. Too hard to read, some were like interpreting sanskrit.....The EMR is better for this. There is definitely a curve though.

[Doc Savage]

Every Pharm test that we had at the end there was a few practicals where you were given a "one liner" patient and then had to write the script for that patient.

 

LOL I remember getting 10 points off one test because I wrote a kid Augmentin instead of Amoxicillin. The rational was that there was no "indication in the history of resistance" so i guess I read into the question too much. He had recurrent ear infections and was 3 in the scenario...

[rev ronin]

We also still have to handwrite schedule drugs so I think new PAs should still know how to do this. I prefer handwriting one vs eRX which many times, somehow, picks the wrong strength or formulation or some detail that I would not have missed had I handwrote it...I suppose "That's the way of the world.." (just had to stick a EWF line in there)

 

They must be printed out and hand-signed per the DEA... but EPIC will automagically select the tamper-proof paper tray and put the prescription on it such that all a provider has to do is sign the printout.

[mackjacks]

We learned the basics on the first day of clin med. Every soap note we turn in that has a rx in the plan has to have a stapled script from a fake pad with it.