Calif RX multiples Rx's within 2 yrs

[Paul Smith LDO]

Always a big issue again came up here in this office. If Patient presents a new Rx and we have another within 2 yrs yet they request to use older one.......doesn't the newer one supercede?
Is there a rile or law for us to state ? I have worked in a lot of offices who make us say a dialog that by law we have to fill the most current RX.

Help???.,

Your not a Dr and you certainly don't want to play one in real life. Will you cause permanent damage, probably not. Each state defines what an optician can and can not do. What might be fine and above the law in one state might be beyond your scope; as defined by CA. If this is a reoccurring issue and a big one don't ask OptiBoard go straight to the source and consult the CA State DOH and get the right answer.

[drk]

Someone convince me that a .25D change in one lens or 5 degree axis change on a .50D cyl (or less) from that previous script means squat. I'll bet if John Q. Public goes to 3 different refractionists he's walking out with three different Rx's!!! PS- Only drk's is spot on!

I agree with this. (Both parts!)

[Hayde]

Someone convince me that a .25D change in one lens or 5 degree axis change on a .50D cyl (or less) from that previous script means squat. I'll bet if John Q. Public goes to 3 different refractionists he's walking out with three different Rx's!!!

PS- Only drk's is spot on!

True, but I also had a patient who after 2 redos with a quarter difference who came back with a 3rd Rx prescribed to the 8th in between. Sometimes it matters. Especially if there are multiple unexpired Rx's from the same doc...I wouldn't use an older without consulting the doc first.

It's not necessarily about 'accuracy,' it's about continuity of care. "Customers" cannot be relied upon to relay accurately tell the story of their eye care. Even bright and honest patients can hear things wrong and get confused...with high confidence in their own misunderstanding. Even if the doc owns some responsibility for the misunderstanding, I'd rather be the optician who helped catch it rather than the one who breezed over it just to close a sale.

There was a supervillain called 'The Quiz' who had every superpower you haven't thought of yet. Any encounter with him was a race to imagine all possible superpowers before he used them on you.

I know I can't imagine all the possibilities of what can go wrong with Rx A versus Rx B. Since I know I can't trust the patient to communicate like a responsible ECP, then I'd better simply call the doc who had 4 years of post grad education preparing to take down the Quiz.

If you make a habit of making the effort, you'll quite often be shocked to discover what your patient didn't tell you. (This is a very useful juncture to decide if you want the "customer" at all.) Some days you'll learn something new from the doc. Occasionally you'll be the one who caught a tidbit of info that the doc missed and change his/her mind. The point is you go back to the patient and say 'I spoke with your doc and here's what s/he said [x], so based on that what we can do is [y.] Then that patient knows they just experienced continuity of care.

A wise man recently said 'Either you're in health care or you're not.'

If a "customer" is coming to a brick-and-morter optical trying to find the difference between you and McGlasses Online, aren't we better off owning the responsibility of being a health care proivder?

[mervinek]

It's not necessarily about 'accuracy,' it's about continuity of care. I'd rather be the optician who helped catch it rather than the one who breezed over it just to close a sale.
+1




If a "customer" is coming to a brick-and-morter optical trying to find the difference between you and McGlasses Online, aren't we better off owning the responsibility of being a health care proivder?

+1

[Uncle Fester]

True, but I also had a patient who after 2 redos with a quarter difference who came back with a 3rd Rx prescribed to the 8th in between. Sometimes it matters. Especially if there are multiple unexpired Rx's from the same doc...I wouldn't use an older without consulting the doc first. You have a patient who can taste the difference a bay leaf makes in soup. Maybe .01% of patients. Two redo's then sensitive to the 1/12D? How much $oup did you eat with this job? Do you own your own store?

It's not necessarily about 'accuracy,' it's about continuity of care. "Customers" cannot be relied upon to relay accurately the story of their eye care. Even bright and honest patients can hear things wrong and get confused...with high confidence in their own misunderstanding. Even if the doc owns some responsibility for the misunderstanding, I'd rather be the optician who helped catch it rather than the one who breezed over it just to close a sale. It is about accuracy on a subjective observation. If they're putting on glasses from 2 rx's ago and not seeing a difference who's right? What if it's just an add change?

There was a super-villain called 'The Quiz' who had every superpower you haven't thought of yet. Any encounter with him was a race to imagine all possible superpowers before he used them on you.

I know I can't imagine all the possibilities of what can go wrong with Rx A versus Rx B. Since I know I can't trust the patient to communicate like a responsible ECP, then I'd better simply call the doc who had 4 years of post grad education preparing to take down the Quiz. Or you can write a letter to the Court explaining how the first time progressive wearer accidentally taking out the fire hydrant could be related to the new glasses as much as the OUI he was charged with! (true story!!!)

If you make a habit of making the effort, you'll quite often be shocked to discover what your patient didn't tell you. (This is a very useful juncture to decide if you want the "customer" at all.) Some days you'll learn something new from the doc. Occasionally you'll be the one who caught a tidbit of info that the doc missed and change his/her mind. The point is you go back to the patient and say 'I spoke with your doc and here's what s/he said [x], so based on that what we can do is [y.] Then that patient knows they just experienced continuity of care. Again it goes back to ask why first. And yes I will call the doc (if it's not one I work for) if what I hear is suspect or the change is more than minimal.

A wise man recently said 'Either you're in health care or you're not.' Sadly no more for retail eye wear. It's a commodity now.

If a "customer" is coming to a brick-and-mortar optical trying to find the difference between you and McGlasses Online, aren't we better off owning the responsibility of being a health care provider?

That train left the eye wear station a long time ago. The original question is can I "legally" fill it and the answer is yes!!!

[Hayde]

That train left the eye wear station a long time ago. The original question is can I "legally" fill it and the answer is yes!!!

Indeed! But I'm not sure about blue-colored fonts! There wasn't a disclaimer on your post to put on my Prevencia lenses before I read it! My poor retinas! [Sorry...joke referring to another thread, but I just couldn't help myself.]

[finefocus]

In CA an expiration date is required on an rx. If you bring me 2 rx's that are both current, I am going to recommend you fill the most recent. Nothing is stopping me from filling either one if they are both within the expiration date. Some people have their eyes examined yearly and the rx will be given an expiration date of 2 years, so they actually have 2 valid rx's. Our laws state that you can't fill beyond the expiration date.

Reviving this thread - Is an expiration legally required in CA? Most Rx forms have no space for an expiration date. Contact lenses, yes, but glasses? I have thought that without a written date, the Rx was usable for eternity (ignoring common sense). CME4, is this actual, legally binding fact?

[lensmanmd]

Several companies that I have worked for, including my current employer, requires the OD/MD to expressly override the expiration date on RXs, not the optician. The RX is then on the OD/MD. If the RX has an expiration date on it, then it's a no-go without a VA and authorization by the OD on staff. It's about playing it safe in this litigious society that we Americans have to deal with on a daily basis. It may be legal to fill an old RX w/o out an expiration date, but is it really the right thing to do? We have redo policies in place for these 'difficult' patients. Isn't that why we have Dr redos for our remake tracking purposes?

As for renewing expired pharmaceuticals, I have never met a Pharmacist that was willing to refill an expired Rx w/o authorization from the MD.

[bsst]

+1

[finefocus]

Several companies that I have worked for, including my current employer, requires the OD/MD to expressly override the expiration date on RXs, not the optician. The RX is then on the OD/MD. If the RX has an expiration date on it, then it's a no-go without a VA and authorization by the OD on staff. It's about playing it safe in this litigious society that we Americans have to deal with on a daily basis. It may be legal to fill an old RX w/o out an expiration date, but is it really the right thing to do? We have redo policies in place for these 'difficult' patients. Isn't that why we have Dr redos for our remake tracking purposes?

As for renewing expired pharmaceuticals, I have never met a Pharmacist that was willing to refill an expired Rx w/o authorization from the MD.

Yes, I get best practice, but the question is, what is the letter of the law? By the way, we have no OD on staff. The question isn't what we should do, it's what the doctor is required to do concerning expiration dates on Rx's, and our legal obligations if she/he does nothing. By the way, I've had time to do a bit of research on California regulations for OD's (not MD's yet). They must put an expiration date of "not less than 2-4 years" (??). An expired Rx may be filled to replace lost/broken glasses if the patient is directed to seek a new exam and the doctor is notified. "Not less", and not "not more", suggests that a million-year-old Rx can be filled if the doctor hasn't said otherwise.