Pills and Pharmaceuticals

In-Office Dispensing

Because of pressures to increase revenue and patient satisfaction, the practice of dispensing prescriptions in-office is becoming more common. Done safely, an in-office dispensing system can be a win-win situation for both patients and a practice.

In-office dispensing saves the patient time and increases convenience because it removes the need to pick up medications at the pharmacy or wait for them to arrive by mail. Because many prescriptions remain unfilled, the physician can feel more confident that the patient will take the medication if it is dispensed during the office visit. An in-office dispensing system also reduces pharmacy callbacks and provides additional revenue for the practice.

Select the Right System or Vendor

If you are considering implementing in-office dispensing, the system or vendor you select should include the essential capabilities shown below. To help decrease your risk, the in-house dispensing system you choose should:

• Interface with your electronic health record system and patient database.
• Have the capability to check for allergies, interactions, and contraindications online.
• Include patient education information that is similar to the information provided by a pharmacy.
• Provide patient information in a format and at a reading level that the majority of your patients can understand.
• Produce medication labels that include the patient’s name, date, physician and practice names with phone number, medication name, dosing information, and any warnings and/or specific instructions (e.g., “may cause drowsiness,” “do not drive or operate machinery,” or “take with food”).
• Offer an insurance/billing interface and have bar code or similar technology.

Consult Your State Boards

In-office dispensing is legal in most states, however, a number of jurisdictions either strictly prohibit or impose regulatory restrictions on the practice (including Massachusetts, Montana, New Jersey, New York, Texas, and Utah).

As many areas of medicine change, the rules governing in-office dispensing are undergoing reevaluation and revision. It is recommended that you consult with the medical board in the state(s) in which you practice to ensure that you are current with the most recent laws and regulations.

You should also know and follow the Board of Pharmacy regulations for your state as many regulate who must hand the medication to the patient. In many states, only the physician—not office staff—is allowed to hand the medication to the patient, and it cannot be left at the front desk for pick up.

Be Aware of Potential Risks

There are potential risks associated with in-office dispensing. Be aware of the following areas of concern:

• Do not practice outside of your specialty, and dispense prescriptions only for conditions that you treat.
• Be extremely reluctant to stock controlled substances as stocking them can raise additional concerns—from placing the office at a higher risk for break-ins to increasing the possibility of employee theft or robbery.
• Recognize that in-office dispensing takes the pharmacist out of the review process. Often, it is the pharmacist who alerts the physician to issues, such as prescribing errors or multiple prescriptions of controlled substances from other providers.
• Establish quality-control protocols to reduce the risk of medication errors.
• Educate office staff regarding the dispensing system and their roles. Establish clear policies regarding staff limitations in the dispensing process.
• Make sure that medication education is provided to the patient and documented in the medical record at the time of dispensing.

We encourage physicians to discuss concerns about in-office dispensing with their patient safety risk manager. Please call the Department of Patient Safety and Risk Management at (800) 421-2368, extension 1243, if we can assist you.

By Susan L. Marr, MSA, CPHRM, Senior Patient Safety Risk Manager, and Debbie Hill, MBA, LHRM, Patient Safety Risk Manager II.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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