Its time to head back into posts about pharmacy for a bit. Pharmacy Chick has certainly had her fill of stupid human tricks and doctor errors the last few days. And without exception I seem to have to don boxing gloves to fend off the attacks. Am I to be everybody’s babysitter, overseer and keeper? Shall we commence with some of the stories?
A refill comes in from a patient.(note: Patient orders this med..not me, the doc, or our autofill feature) It needs a Doctor approval, which we get ON THE SAME DAY. We fill it, patient picks it up, goes home and calls us up and says ” you filled the wrong prescription”. (note: WE FILLED wrong rx). I pull hard copy and tell patient that a) patient punched in number with date and time it arrived…b) it was filled correctly by staff and c) dispensed and signed by patient. ” What exactly did we do wrong Ma’am?” Thats not the one I wanted. ” That doesn’t appear to be the pharmacy’s error”. She complains that we have POOR customer service. How is filling her prescription exactly as she ordered it POOR CUSTOMER SERVICE?
A doctor sends in an E-script for a patient with the same drug (Prednisone) with 3 ( count them!) 3 different sigs, all slightly different, over a period of 30 minutes. I call back to determine which pray tell is the RIGHT one? I get a snarky nurse who says ” WELL the LAST ONE ! isn’t that obvious?” Not exactly. Maybe I should have done all 3.
A clinic sends over a E-script for a patient. We fill it, the patients wife comes in , picks up her own and her husbands Rx ( with appropriate counseling). Hubby calls back and says he wasn’t supposed to get this rx. I( again, pull hard copy , verify it was for this patient) tell him that it was a new order from his doc, and if he has a question about the rx he may want to call the office…which he does and the med assistant says ” we sent no such rx to your pharmacy”…. Mama Bear goes in to full alert and contacts said Med Assistant and ask her ” why would you tell your patient that you sent ” no such rx to the pharmacy?” Because we didn’t…” would you like to see the E script you actually did send?” I produce the document…to which she says “I don’t know why we sent that” Well it doesn’t matter why, you did. Well he doesn’t need it, you can just refund him. “(WTF) and shall you reimburse the pharmacy for refunding the patient for a medication you ordered unnecessarily …and denied ordering at all?”
A Dr escripted a RX for buproprion HCL 100mg tabs. I filled it correctly. He meant to order SR 100mg It went to patient. What agency should I report a med error to? If this had happened to me I’d have a report 9 pages long to account for this error.
Another Rx came in for Nortrel 0.5/35. It was NOT a refill request, it was a new order.. We filled it, but noted that it was a different dose from the 1/35 that pt had before. Pt was counseled and I noted the dose change. ANOTHER error from the doctors office. Patient elected to leave rx here since she was sure it was wrong. It was. They sent over another rx in about 2 hours. No calls, no explanations, no ” hey thanks for catching that”..
A patient brought in a computer generated script from ER doc for Amoxil 250mg suspension..get this Dispense 187.5ml give 13.1 ml bid. WTF? Really? first off she is 7 years old and this is essentialy 750mg of amoxil twice daily for a 7 year old. and secondly, doesn’t anyone read these rx anyway? Dad asked if we had chewables instead of liquid which she hated. I asked them if they had discussed this before they left and he said no.. ” Ill call, but it will delay the rx considerably…and the dose is pretty wonky. I need to check on that too”. Sure enough the doc admitted he hadn’t even looked at the rx, he just signed it and changed it to chewable 25omg 1 bid # 14. ANOTHER clinic error. At least the doc was nice about that.. ” I better look better at these computer rxs”
A irate customer fills out a survey…this is what is wrong with OUR pharmacy and why he hates us: a) we are in the back of the store and don’t have a drive thru–well it is a grocery store sir and if you want us to remove the freezers, the entire back room and the loading dock behind the store then we can manage that drive thru for ya. most pharmacies ARE in the back of the store. b) auto fill “never ” works. well if you call filling your prescriptions and letting them sit til they are re-shelved and ignoring your 2 reminder calls as ” never working” then ya, I guess it never works for you. and c) we are too stupid to figure out his insurance .when ya enroll in medicare, you get new insurance right? that means you get new coverage and a NEW CARD.. which you really should give to us and not throw away. He transfers to competitor. We aren’t upset.
A man and his girlfriend bring in two rx’s from the urgent care next door. He is new but the girl said ” Ive been here before” . Great, I collect the rx and HIS insurance info, (both medicaid patients) and I see the prescriptions, one for her and one for him. These rx from urgent care are very complete. All patient info is preprinted on the form, so I find her in the computer at a different address than he is at but verify that they are living in His address now . I fill his but hers rejects ” coverage terminated”. I page her back but nobody comes. Eventually they find their way back to the blood pressure machine and I say ” Connie, your insurance is terminated”….and she ignores me. I say louder ” MAAM, I have Tom’s rx ready but yours rejected “. She looked at me as if I had grown horns and said ” I didn’t give you a prescription”. I pick up the 2 documents they gave me and I said . “here are the two prescriptions you gave me–one for Tom and one for Connie.” I am not Connie. and I think we only gave you one prescription.. “No, Tom gave both of these to me”. ANOTHER Dr error… The clinic gave a patient someone else’s prescription. At the very least its a HIPAA violation and at the worst he may have received someone else’s medication. I called the clinic to tell them of this error and this is their reply” oh dang, I wondered where that went”.
You know, its hard enough trying to keep my head above water and manage not making my own mistakes. and I have to wade thru everyone else’s muck too. I read the Facebook page ” this is a Pharmacy not a fast food restaurant” most days and I am astonished at the errors coming from drs offices nation wide. E-scripts and Technology haven’t reduced errors, they have magnified them exponentially with ridiculous decimal quantities, redundant and repetitive prescribing, and auto sig population with absurd verbiage that makes no sense whatsoever and patients often walk away with scripts in their hand that were also sent somewhere else electronically and end up with duplications. Doing a DUR becomes a nightmare when I look at a patients profile and see 6 scripts for every drug a patient takes with multiple refills because the office sends a new one every 3o days +6 refills. by the end of 6 months Joe Blow has 6 mirtazapine, metformin, lisinopril, fosamax etc etc etc.. rx’s with refills on his profile..and all of them filled exactly once. AND because people believe in and trust technology, ( like that doctor did) hard copy rxs aren’t being verified for accuracy before handing off to patients and they aren’t being looked at before being e-sent…
Oh the Joy…
and speaking of Joy, Have a very Merry Christmas to all of my readers who Celebrate the season! Happy Hanukkah ( which just passed) and Kawanza and New Year and Festivus for the Rest of ya!