MAPS information

and another thing...

One more reason that dispensing from your office is an unnecessary hassle...

If you are dispensing controlled substances you are required to report patient identifiers to MAPS also.  These identifiers are: name, date of birth, address and either driver's license # or a state issued ID#.

Just one more thing you need to do if you're dispensing controlled substances from your office.  It just keeps getting better!

Also, here's a few other good reasons not to dispense from your office.

source: Download mdch_MAPS_patient_identifier_info_212395_7.pdf

Frogs vs. Toads

Toads are frogs, but not all frogs are toads. 

As a member of the MDA Care and Well Being committee I have run into dentists and team members who have chemical dependence issues.  People involved in health care who are addicts often find themselves using opiate pain medications (Vicodin, Oxycontin, Lortab, etc.) due to easy access. 

Most of the dentists who have a problem with opiate pain medication make a point of having it available in their office.  With an account and a DEA# most any supply house (Schein, Darby, etc.) will send you pretty much any pill you might want.  This is a drug addict's dream, and any addicted dentist can get away with it.

There are Michigan dentists who keep controlled substances in the office (frogs).   Some of them have them in the office for good reasons, but some keep them around so they have access to them for the wrong reasons, like personal use (toads).   

There could be a good reason to keep controlled substances in the office, but it's easy to allow a pharmacy to deal with the headache of keeping track of them.  To dispense medications from your office you need a drug control license, a lock box, a procedure for keeping track and you need to dispense them in properly labelled and child-proof containers.  If you dispense controlled substances, you need to do all this and electronically submit your dispensing information to MAPS twice per month.  Why go through the hassle?  I can maybe see dispensing Chlorhexidine and Prevident from the office, but not much else. 

The moral of my story:  don't be a toad! 

The seven habits of highly effective prescribers

What kind of prescriber are you?  Have you ever written a prescription without a diagnosis?  Have you ever diagnosed a condition over the phone at a patients urging?

I have.  I'm not proud of it and I know it's sloppy.  So, I'm trying to get better at it.  Here's some ideas to help you tighten up your prescribing protocol.

1. No refills
   • I rarely write for refills of anything.  I try to write enough to treat what I'm trying to treat.  If that doesn't take care of the problem then I want to see the patient again to get a look. 
2. Limit who can call in a prescription for you
   • Make sure you know who's calling prescriptions in for you.  This should be a task specifically delegated by the prescriber.  The Care and Well Being committee has helped offices whose employees were calling in fake scripts for themselves and others.
   • The safest bet is for the prescriber to call in scripts in person.
3. Don't prescribe for yourself.  Ever.
   • If you have a medical or dental problem that needs treatment, see a doctor or a dentist.
   • Even if you think you know what's wrong it's much better to get an objective opinion.
   • Self prescribing is very typical of doctors/dentist who are chemical dependent...this can raise flags to the pharmacy or MAPS
4. Don't prescribe for your family.
   • Unless you are treating your family, don't prescribe for them. 
   • It's very difficult to be objective when it's your family...be wary.
5. Don't attempt to diagnose over the phone
   • Telecommunications technology hasn't reached this level yet.  Subjective patient symptoms can help you determine diagnosis, but are almost never enough to diagnose by themselves.
   • Unless it's a patient of record with a known condition I don't prescribe on a simple phone call.  I've been tempted to because the patient REALLY wanted me to.  As recently as last week...cooler heads (e.g.--my business operations manager) prevailed and I "just said no."
6. Prescribe for a diagnosis, not a condition
   • teeth that need root canals (a treatment plan) don't need antibiotic...some teeth diagnosed chronic apical periodontitis could (arguably) benefit from antibiotics
   • I might be splitting hairs, but we're doctors here!
7. Don't prescribe for stuff you don't treat
   • I've had patients come in with a cold and ask me to prescribe an antibiotic.  That seems crazy, but to them you're a guy/girl with a prescription pad. 

Just be glad that a lot of the "healing arts" of dentistry involve procedures and procedures almost always involve a diagnosis and a treatment that takes care of the diagnosis.  I'm grateful every day that I'm not an ER doc!

File under "practice what you preach"

I got a drug control license.  Now, if I want to dispense medications I'm legal.  Right now, I only dispense Chlorhexidine, MI Paste and high fluoride toothpastes.  It was a piece of cake to get, will expire at the same time as my dental license and now I'm legit to dispense if I so choose. 

If you wanna get one too...you can download the application, fill it out and send it in!

Are you "legal?" Dispensing medications from your practice

Did you know that your dental license alone does not allow you to dispense medication from your office? 

We aren't just talking about regulating controlled substances (opiate pain meds, anti-anxiety meds) but ANY medication meant to be taken away from the office.  All of the following typical scenarios require more than just a dental license to dispense:

• antibiotic premedication for a patient to take prior to a dental appointment
• NSAID's for post-op pain
• Chlorhexidine rinse
• high fluoride toothpastes/rinses

It turns out that you are required to have a Michigan Drug Control license to dispense ANY medication from your office. 

The good news is that a drug control license is easy to apply for.  You can download the application and send it in with a check and in a matter of weeks you'll be "legal" to dispense from the office.  The cost is $85 or less, depending on when your dental license renews. 

Administering vs. dispensing vs. prescribing

• Administering a medication:  given in the office as a part of a procedure
  • giving local anesthetic to do a filling
  • giving a patient 600mg of ibuprofen in the office prior to a root canal
  • a trained and licensed practitioner giving IV sedation for 3rd molar extraction
• Dispensing a medication: given at the office to be taken off site
  • a pharmacy filling a prescription for a patient
  • a dentist (with a drug control license) giving a patient a bottle of Chlorhexidine rinse to be used at home
• Prescribing a medication:  written instruction given by a licensed practitioner to be dispensed by someone off site
  • prescription for post operative pain medication
  • prescription for antibiotic premedication

Did you know that to dispense any medication from your office (even Peridex or Amoxicillin) you must have a drug control license and follow similar packaging standards to that of a pharmacy?