Dispense as written


I am a complex pharmacy nurse for Sedgwick which means my mission in life is to restore injured workers’ lives. I work collaboratively with doctors to change prescribing practices and follow best practices based on national guidelines and the individual patient’s needs. Sometimes my job requires me to be a detective and sometimes I uncover things that even surprise the prescriber.

Recently I connected with a doctor who had been treating an injured worker for many years. For the most part all was going well. We were working collaboratively to lower the prescription opioid dosage the injured worker was taking. I was thrilled with the results achieved except for one issue that remained unresolved. I had asked the doctor multiple times to prescribe generic instead of brand medication; the physician was frustrated because he insisted that he was not prescribing brand medication. Yet after another costly refill of brand medication came in, I followed up again and asked to speak with the doctor’s office manager; she supported the physician’s stance that brand medication was not being prescribed to the patient in question.

So here’s where I put on my detective hat. I called the pharmacy to see if they could pull the image of the prescriptions. I asked the pharmacist on duty if perhaps the prescriptions had “dispense as written” (DAW) documented. At that point I wondered if perhaps the patient wrote a DAW note on the prescription themselves; this can be a tactic of an opioid abuser. The pharmacist who was speaking with me pulled several months of the prescriptions and saw that one of the other pharmacists had written a note on the script that said "patient called and wants brand name medication only." The pharmacist indicated that he had called the doctor’s office and gotten approval from an individual there and provided me with a name. I now had something to go on; I called the doctor’s office manager and told her what I had uncovered. She relayed that the staff member noted in the pharmacist’s record had not worked there in over a year.

Just like in a good Law and Order episode, diligent detective work solved the case. After further investigation, we found that the pharmacist, in an effort to make the patient happy, wrote “DAW approved” on the prescriptions. Alongside, he provided the name of the person previously employed with the physician because, at some point, he had spoken to her in that office. You may imagine my surprise – and that of the doctor’s office and the pharmacy – at this discovery. The pharmacy agreed to reimburse the difference in cost for all of the prescriptions filled.

It took some digging, but tracking down the underlying cause of this prescription’s inconsistency paid off in multiple ways. Not only was I successful in saving a significant amount of money for my client, I also more importantly was successful in lowering the morphine equivalent dose and helping to restore this injured worker’s life. I get excited about my job every day because I know what I do is making a huge difference for injured workers and their employers! At Sedgwick, caring counts℠ is part of what we do every day when we come to work. This is exactly the kind of outcome we strive for when supporting the people who count on us in a time of need. Do you have similar stories to share? How have you turned a simple request into an impactful result?

Jamie Waits, RN, Complex Pharmacy Nurse

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