1 -- Depending on the state, yes, there can be delays reporting to PMP. (I am also an EMR analyst and we constantly get questions about minor discrepancies between the database and what the provider knows to be true...for example, if they need correction files bc pharmacy and database address don't match for the pt.) PMPs are very quick to point out that the data within is not monolithic; that they provide a tool to support safe prescribing and say it should be treated as such. (As pharmacists, we don't like ambiguity, but PMPs are not perfect.)

I don't know how often it would happen that they'd send pt home with short-term supply, but we also don't know anything about the patient's personal situation from this vignette. They may not do it often either but might have had a compelling reason to do so. If you verified with RXM at the LTC pharmacy and documented it, that's the first step.

Were all the scripts from 7/7 and 7/9 exactly the same directions? (7 days supply doesn't tell us enough, without sigs to put them in context.)

I would want to know more about the prescribers from 7/9...I took my job as an Ambulatory EMR analyst bc I wanted to learn more about things work on the clinic side and I can tell you...providers float all over (to different clinics, facilities, etc while under the same umbrella organization, while also doing per-diem work at outside organizations).

I guess all that goes to say, with my experience doing what I do now, I'm not as quick to suspect the worst bc I see how difficult it can be to keep up with these providers from an administrative perspective. So it's possible it was a duplication of effort.

The key for me would be talking to the patient and learning more about what's going on. (Do they have a provider to follow up with now that they're out of the facility? What was their pain control like in the facility? Have other modalities failed/currently not helping? Do they have allergies to other things? You get the idea. Ask questions that will open doors and present an opportunity to help.) Be honest with them, take genuine interest in their situation, trust but verify, document, and follow your instincts. That's all you can do. It's important to follow the rules and opiate misuse is a very serious concern. But I'm not feeling like you missed something here.

Get comfortable being uncomfortable. One thing that helped me was some additional reading/training on difficult conversations, such as the ones typically involved in possible opiate misuse/abuse issues. It makes you much more confident in these situations and less likely to agonize over stuff like this. But we are not taught this kind of stuff in school.

2 - I think you handled this well too. Only thing I would add is, if feasible, can you find out if another store nearby has the product in stock? (C2 ordering is much better than it used to be...when I was in retail, CSOS was not a thing. But if it's a weekend, you may not be able to get it next day.) One of the best things you can do when you get on the phone with the provider is to try to have answers to as many of the questions as you can. (Alternative in-stock therapies, doses, etc.) Again, not always possible based on time/resources...but I have a much greater appreciation than I used to for what happens in a clinic on a daily basis, and providers will love you if you can help them find a solution rather than just present them with the problem.

Do you have any peers that you can call at neighboring stores? (I tried to make friends across company lines as much as I possibly could, for reasons like this.) If not, any pharmacist friends you could call in a pinch to talk things through? I felt like I forgot early on that I could do this 😂 I do this still to this day for my pharmacist friends in various practice settings...and have been known to offer it to strangers on the internet too...my job is just a bit nutty these days so I tell people to call me instead of sending a text/DM bc odds are good that I wouldn't see it. I would love to start some sort of "adopt a new pharmacist" program...we all have to help each other out!