THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com
S U M M A R Y
DIARY: July 15, 2014 04:14 PM Tuesday;
Rod Welch
VA Omeprazole ordered refill to treat achalasia.
1...Summary/Objective
2...Omeprazole Order Refill for Achalasia Blocked by VA Automated Ordering
ACTION ITEMS..................
Click here to comment!
1...Need link to letter to Doctor Alba on VA automatic prescription refill
CONTACTS
SUBJECTS
VA Pharmacy Denial of Service Omeprazole Refill Order Fill Date Sche
3703 -
3703 - ..
3704 - Summary/Objective
3705 -
370501 - Follow up ref SDS A8 0000. ref SDS A7 0000.
370502 -
370503 - There is enough Omeprazole for 8 days at current prescription taking 2
370504 - pills per day, so need to order refill in time to avoid running out.
370505 - VA Pharmacy online refill system shows 3 refills for Omeprazole, 3 for
370506 - Atorvastatin and 1 for Ezetimibe. The system reports "Refill in
370507 - Process" with fill date of 140725 for Omeprazole. ref SDS 0 4O6H If
370508 - refill is mailed to customer on 140725, then it may be received OA
370509 - 140730. ref SDS 0 HX5O Since there is no evident procedure to update
370510 - the VA processing schedule to fill the prescription, will take 1 pill
370511 - per day until refill is received. ref SDS 0 IP6K
370512 -
370513 -
370514 -
370515 -
370516 -
370518 - ..
3706 -
3707 -
3708 - Background
3709 -
370901 - EGD on 101210, seems to show progress recovering from esophagitis; the
370902 - doctor dilated the LESV from 11 to 14 cm, reported on 101210 0930,
370903 - ref SDS 51 XG6J
370905 - ..
370906 - Follow up EGD planned for February, ref SDS 51 L94L.
370908 - ..
370909 - Doctor Lee prescribed doubling dose of Omeprazole to increse recover
370910 - from esophagitis, reported on 101210 0930. ref SDS 51 ZN4M
370912 - ..
370913 - On 101216 appears Doctor Lee ordered refill for omeprazole. ref SDS 53
370914 - 8785
370916 - ..
370917 - On 110320 0750 ordered refill Omeprazole to treat Achalasia,
370918 - ref SDS 60 5N3O,
370920 - ..
370921 - On 110626 0721 ordered refill Omeprazole to treat Achalasia.
370922 - ref SDS 64 5N3O
370924 - ..
370925 - On 110913 2238 ordered refill Omeprazole to treat Achalasia,
370926 - ref SDS 65 5N3O
370928 - ..
370929 - On 120326 1549 ordered refill Omeprazole to treat Achalasia,
370930 - ref SDS 73 5N3O
370932 - ..
370933 - On 120330 1439 received refill Omeprazole to treat Achalasia.
370934 - ref SDS 74 5N3O
370936 - ..
370937 - On 120906 1100 Doctor Egan reduced dose Omeprazole 20 mg from 40 mg,
370938 - which increased effective treatments with current prescription.
370939 - ref SDS 77 W165
370941 - ..
370942 - On 120925 1300 Doctor Lee increased dose Omeprazole 40 mg from 20 mg,
370943 - which decreases effective treatments under current prescription.
370944 - ref SDS 78 K37G
370946 - ..
370947 - On 120927 1214 could not order refill prescription for Omeprazole.
370948 - ref SDS 79 3Z4M
370950 - ..
370951 - On 121001 0820 VA ordered new prescription Omeprazole with 3 remaining
370952 - refills, ref SDS 81 5N3O, VA also ordered Fluconazole 200 mg, which is
370953 - not explained in the record, ref SDS 81 EO5H, and further which
370954 - increases side effects for Rosuvastatin, ref SDS 81 0450, but on plus
370955 - side Fluconazole resolves electrolytes abnormalites, in this case
370956 - Total Bilirubin is nearly 100% over healthy range, causing peripheral
370957 - neuropathy. ref SDS 81 ZH6J
370959 - ..
370960 - On 121003 1438 received in the mail Omeprazole with incorrect dose
370961 - prescription. ref SDS 82 5N3O
370963 - ..
370964 - On 121003 1438 received in the mail RX # 10864663B which conflicts
370965 - with RX #10864663A, ref SDS 81 5N3O and dose instructions to take 2
370966 - pills twice a day, ref SDS 81 MH65, conflict with the doctor's order
370967 - to take 1 pill twice per day.
370969 - ..
370970 - On 130416 1100 Doctor Lee reported the VA placed hold that prevented
370971 - patient from ordering any of 3 refills of Omeprazole; the doctor
370972 - cancelled the prior order and placed new order for current
370973 - prescription with 3 refills of Omeprazole. 130416 1100, ref SDS 84
370974 - RG9K
370976 - ..
370977 - On 130423 1140 received refill for Omeprazole. ref SDS 86 5N3O
370979 - ..
370980 - On 131115 0800 meeting Doctor Lee EGD Dilation, continued prescription
370981 - for Omeprazole to aid digestion. ref SDS 89 R74M
370983 - ..
370984 - On 131121 1604 ordered refill for Omeprazole. ref SDS 91 AG9I
370986 - ..
370987 - On 131205 1448 received prescription for Atorvastatin 20 MG,
370988 - ref SDS 94 5N3O, ordered by Doctor Alba during the meeting at the VA
370989 - on 131121 0930. ref SDS 90 6H6K
370991 - ..
370992 - On 131219 0930 Doctor Alba ordered Ezetimibe 10 mg to take with
370993 - Atorvastatin 10 mg, during meeting at VA. ref SDS 95 6H6K
370995 - ..
370996 - On 131230 1450 received Ezetimibe from VA to combine with
370997 - Atorvastatin. ref SDS 96 5N3O
370999 - ..
371000 - On 140127 1821 ordered refill Ezetimibe from VA. ref SDS 97 5N3O
371002 - ..
371003 - On 140201 1353 received refill Ezetimibe from VA.
371005 - ..
371006 - On 140226 2035 ordered refill Atorvastatin and Ezetimibe from VA.
371007 - ref SDS A0 5N3O
371009 - ..
371010 - On 140311 1730 received prescription refill for Atorvastatin and
371011 - Ezetimibe, delivered by neighbor because mailman delivered to the
371012 - wrong mailbox; treatment resumed. ref SDS A6 YS4O
371014 - ..
371015 - On 140401 0734 ordered refill Ezetimibe from VA. ref SDS A7 5N3O
371017 - ..
371018 - On 140404 1328 received refill for Ezetimibe, ref SDS A8 5N3O and for
371019 - Omeprazole. ref SDS A8 ZZ9M
371021 - ..
371022 - On 140715 1614 have 8 days supply of Omeprazole at current
371023 - prescription taking 2 pills per day, so need to order refill in time
371024 - to receive Omeprazole before running out of pills. Opened VA Pharmacy
371025 - online medication refill system. ref SDS 0 5N3O VA system shows 3
371026 - refills for Omeprazole, 3 for Atorvastatin and 1 for Ezetimibe. The
371027 - system reports "Refill in Process" with fill date of 140725 for
371028 - Omeprazole. ref SDS 0 4O6H If refill is mailed to customer on 140725,
371029 - then it may be received OA 140730. ref SDS 0 HX5O Since there is no
371030 - evident procedure to update the VA processing schedule to fill the
371031 - prescription, will take 1 pill per day until refill is received.
371032 - ref SDS 0 IP6K
371033 -
371034 -
371036 - ..
3711 -
3712 -
3713 - Progress
3714 -
3715 -
3716 -
371601 - Omeprazole Order Refill for Achalasia Blocked by VA Automated Ordering
371602 -
371603 - Follow up ref SDS A8 ZZ9M, ref SDS A7 G54N.
371604 -
371605 - Have 16 Omeprazole pills, from last refill on 140404 1328. ref SDS A8
371606 - ZZ9M That is enough for 8 days treatment taking 2 pills per day
371607 - prescribed by Doctor Lee in the meeting on 140509 0900. ref SDS A9
371608 - JG4K
371610 - ..
371611 - Plan to confirm prescription from Progress Notes, has been disrupted
371612 - by ROI Department delaying submission of Progress Notes for past 2
371613 - months for the meeting with Doctor Lee on 140509, that shows the
371614 - current prescription.
371616 - ..
371617 - VA prescription refill website is at...
371618 -
371619 - https://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_nfto=false&_pageLabel=mhvHome
371621 - ..
371622 - Customer....
371627 - ..
371628 - VA's pharmacy website listed today...
371629 -
371630 - Refill
371631 - Submit Fill Refills
371632 - Date Date Remaining Prescription
371634 - ..
371635 - Active 140620 3 RX # 5786152
371636 - Atorvastatin Calcium 20 MG
371638 - ..
371639 - Active 140521 1 RX # 5787670
371640 - Ezetimibe 10 MG
371642 - ..
371643 - Refill 140401 140725 3 RX # 24515139
371644 - in Omeprazole 20 MG
371645 - Process
371646 -
371648 - ..
371649 - Omeprazole showing 3 refills pending resolves issue reported on 140401
371650 - 1659, ref SDS A7 G54N, and aligns with planning during the meeting at
371651 - the VA in Sacramento of 140509. ref SDS A9 RG9K
371653 - ..
371654 - VA system reports prescription for Omeprazole is not scheduled to be
371655 - refilled until 140725, which is 10 days from now. This may indicate
371656 - the customer will receive the refill on that date or a few days later,
371657 - when delivered in the mail. Since no refill has been ordered, Refill
371658 - Status of "in Process" for Omeprazole may indicated the VA is
371659 - attempting to increase efficiency by automatically estimating when
371660 - refills are needed and execute processing without support of the
371661 - customer.
371662 -
371663 - [On 120101 0900 did not receive Omeprazole refill from VA.
371664 - ref SDS 70 T56H
371666 - ..
371667 - Automatic refill worked well last month on 140626, when Atorvastatin
371668 - was received in the mail on the day when supply on hand required
371669 - ordering refill in time to maintain continuity of treatment, reported
371670 - in letter to Doctor Alba.
371672 - ..
371673 - Need link to letter to Doctor Alba on VA automatic prescription refill
371674 - system.
371676 - ..
371677 - Denial of service to VA prescription refill system provides no evident
371678 - process to update scheduled prescription refill date of 140725.
371680 - ..
371681 - This is the third denial of service (DOS) that delays prescription
371682 - refills...
371683 -
371684 - 140715............................ ref SDS 0 HX5O
371685 - 130406............................ ref SDS 83 5N3O
371686 - 120927............................ ref SDS 79 YK6F
371688 - ..
371689 - Seems similar to denial of service (DOS) problems accessing Internet,
371690 - reported on 101031 1719, ref SDS 48 6D5H, and previously on 071127
371691 - 1509. ref SDS 6 X95H
371693 - ..
371694 - Customer currently has 8 days supply under the current prescription
371695 - for taking 2 pills per day, as understood during post-procedure
371696 - meeting with Doctor Lee on 140509 0900. ref SDS A9 JG4K
371698 - ..
371699 - If the refill is shipped in time for delivery on 140725, treatment
371700 - will be paused for 2 days.
371702 - ..
371703 - If the refill is shipped on 140725, which seems likely, and takes 3+
371704 - days for delivery in the mail, then treatment may be paused for 5+
371705 - days.
371707 - ..
371708 - There is no communication with the VA EGD Department in Sacramento to
371709 - reconcile adjustment to prescription taking 2 pills per day, so will
371710 - reduce treatment to 1 pill per day until new prescription refill is
371711 - received sometime after 140725.
371712 -
371713 - [On 140718 1017 planning for notifying VA to update current
371714 - fill date for Omeprazole. ref SDS B0 U88L Kathy visited VA
371715 - in Sacramento, and requested changing refill date for
371716 - Omeprazole to 140718. ref SDS B0 OL5K VA representative
371717 - called customer, and said Doctor Lee would call back later
371718 - that day to consider action on updating scheduled refill
371719 - date of Omeprazole to 140718. ref SDS B0 U76M
371720 -
371721 -
371722 -
371723 -
371724 -
371725 -
371726 -
371727 -
371728 -
371729 -
371730 -
371731 -
371732 -
371733 -
371734 -
371735 -
371736 -
371737 -
371738 -
371739 -
371740 -
371741 -
371742 -
371743 -
371744 -
371745 -
371746 -
371747 -
371748 -
371749 -
371750 -
371751 -
371752 -
371753 -
371754 -
371755 -
371756 -
371757 -
371758 -
371759 -
371760 -
371761 -
371762 -
371763 -
3718 -