The Pharmacy Chick

Flying the coup in retail

A Sampling of Todays Work

Filed under: Uncategorized — pharmacychick at 9:52 pm on Thursday, March 19, 2009

Today was dumb prescription day.  A couple of weeks ago I wrote about the fact that electronically derived Rx’s weren’t necessarily the answer to our problems with errors or misfills.  Trust me, some of these issues are alive and well, even with Rx’s that are handwritten and clearly understood.

Rx number 1:  computer generated:  Peridex Solution  1 bottle, sig:  1 tab po qid x 10d.   This was actually a signed document.  Do you suppose if I slipped a blank check in there, the dentist would have signed it?

Rx number 2.  Handwritten by nurse/cna/or janitor (who knows?) Oxycontin 80mg #120 Sig: 1-2 tabs every 4-6 hours as needed for pain.  You’re kidding right?  One phone calls reveals the truth. 1q12h. Quantity changed to 60. My interview with patient didn’t seem to confirm that he is as opiate tolerant as this kind of dose would call for…but then again, he may not be telling the truth about his opiate usage.

Rx number 3.  Restoril 30mg #30.  1 q am.  This person does NOT work the graveyard shift. This rx was completely handwritten which means the dr wrote this in his own hand….but not brain engaged apparently. Patient interview confirms 1 hs.

Rx. number 4.  Phoned in: Vagifem Tablets #30, “1 po qd 11 refills”.  A phone call confirms what I thought all along. 1 per VAGINA daily for 14 days then twice weekly thereafter.

Here is the thing:  These are 4 prescriptions that went out of a doctors office with a glaring error.  We caught them.  We are just one pharmacy among thousands in the US. We are that last guard before the patient and the drug they are about to ingest, the last degree of separation between the Dr and the patient. 

Something to think about the next time somebody tries to rush you.  We dont have any degrees of separation.  Our mistakes end up in the hands of the patient.

Take your time. Keep your license. 

5 Comments »

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Comment by The Ole' Apothecary

March 20, 2009 @ 5:00 pm

“I need an order.”

I say that all the time to nurses at my hospital. I need it in some kind of writing. I need a document, because, often, the spoken word has no bearing on reality. They say one drug, but mean another. Nurses have no wish to be constrained by such small things as “orders.” The presciption system of medication ordering saves lives and limbs every day.

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Comment by Frantic Pharmacist

March 20, 2009 @ 8:31 pm

The carelessness with which these electronic prescriptions are generated makes me furious sometimes. What good is a clear, legible prescription that makes absolutely no sense? Whether they are handwritten or electronic, sometimes I want to scream “Doesn’t ANYONE take this seriously???”

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Comment by Cathy Lane RPh

March 21, 2009 @ 11:44 am

Good thing I don’t base job self-satisfaction at temp jobs on majority of stated opinions of patients or even shop staff!

It was a Friday in the middle of the month, not supposed to be a mad rush, I thought. The day started out well enough as I had managed to sleep before the out-of-town shift. (I usually find it difficult to get enough sleep the night before due to lingering concerns about travel routes, time, making connections with security, etc.)

I’d worked there before several times including at least two desperately busy shifts and a slow Sunday afternoon and recalled a particularly pleasant well-experienced lead tech. I hoped she’d be there. When I arrived, I found I hadn’t underestimated the time, as I hadn’t been behind too many farm tractors, so arrived a little early to figure out correct combinations to get in. The pleasant tech was scheduled that day, and we greeted each other as old comrades. The other techs were new, including one with cashier job description ONLY written all over her attitude.

I felt an ominous premonition however when I saw the sign prominently displayed over the sink from the DM. ‘Awesome’ was the comment comparing this particular store’s wait time to the other 9-10 in the region. The bottom-performing stores had not a comment and a collective admonition from the DM, ‘let’s work together to improve…’

We had 30 min. to build up speed for the onslaught, and when it came it was non-stop. Back and forth from checking to counsel. ‘No, you cannot take that with this.’ ‘Yes, so and so.’ ‘No, your doctor did not call it in’, etc.

I could hear the techs growling when the pick-up line kept lengthening and exclamations about updates on pick-up time. At one point I asked cashier ‘should chip’ to listen to the call-ins for who had scripts called in (there were 7 call-ins with 5 scripts on one call, and I would be darned if I was going to stop for the next 15 min. to take them off, while 4 patients were lined up waiting for me to check!) ‘But, I can’t do anything about the script–are you asking me to take them–that’s illegal, if they call.’ (I thought, believe me I would get you in trouble if your were taking scripts off without my say-so.) ‘Just listen to them –push this button to go on to the next–and, you can figure out who has their script called in. Write it down.’ (She was writing down names of people that were waiting in the line already, why not write down more names?)

My old comrade had her hands full dealing at the other end of the line with training the tech with a lot of life experience, but too much over-confidence (I kept sending her order- entry back because she’d guess on meanings of sigs faxed to us electronically.) By noon I had 3-4 scripts I’d left messages on dr’s office phones with questions about faxes (or that I could not understand from voicemail). Others, she’d gotten the drug wrong or the physician. And, the other tech was anticipating starting another job in a week and working through her ‘notice’ and downright showing ‘bad attitude’.

At one point ‘shoulder chip’ involved the store manager who came back and questioned me about where I came from which I should have been upset, I suppose, but simply could not get my anger to rise.

Occasionally various items of equipment were not working; the cash register quit several times, The printer needed figuring out what was wrong and to be fixed. There was an issue twice where scripts for various people were put together in the order-entry queue which I ‘separated’ at the end while checking, but the situation wouldn’t let patients just pick up theirs only, as it kept linking others patients prescriptions with theirs.

I was NOT fit to be tied, as I was feeling pretty good. I had managed to catch a lot of mistakes. But, the main reason why I was not anxiety-ridden was that I’d been keeping up on some of these working conditions blogs and did not have the sense of panic and desperation present when I started temping a couple years ago. I remember early in the experience I had tried a multi-operation method to verify, check, and bag scripts that had resulted in scripts getting wrong receipts and misplaced. So, after that I developed a process of routinely double-checking patient profiles (although it did slow things down) but it kept me from rejecting scripts for glipizide 20 mg BID, methotrexate 7 x 2.5 mg once weekly, etc., and finishing each patient’s scripts before starting on the next. Also, I circumvented the ‘tech talking to patient’ issue by calling out to speak to patients directly when there was a problem.

My feet, back, shoulders were aching badly by the time I had a chance to stop to sit down. And, then it was on again at the races.

At one point a patient agitator showed up complaining that she’d left her prescription before lunch and it still was not ready. I explained. ‘We were backed up before lunch, and you left the prescription 10 min. into when the half-hour for pharmacists to take a break, and then you came back right after lunch; (when was I going to be able to fill your prescriptions?) There are other patients both the ones you see and the ones I’m working on. I’m sorry that ‘cashier shoulder-chip’ didn’t give a more reasonable estimate of time when your scripts would be ready, but they will be ready soon and within the hour’.

Agitator Patient came back in half an hour. Though I could not see her I could hear her under the window loudly talking on a cell-phone about the pharmacy. My voice rose incrementally on the phone as I was talking to patients and MD office personnel–‘I am sorry that it sounds like I am yelling into the phone, but I cannot hear you over all the background noise’.

So, it went on, almost endlessly it seemed, up to the time when the techs left and the metal window shade went down. Physically, I was fatigued to the bone, but did not feel badly about my job–I could imagine what the techs were saying about effect on turnaround time bragging rights.

I look forward to working with old comrade another time when it not so busy. I have my doubts about seeing the other techs again at that store.
If I could buy you a drink, I would…..

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Comment by Carol

March 27, 2009 @ 10:35 am

We got an rx for B. Johnson. for Viagra. The only B we had was a 10 year old. hmm, maybe they are using for pulmonary hypertension. But the dose is high. Call doctor office. Nope it’s for dad. Who’s name also starts with a B. But has never had rx’s with us. If the doctor had written the whole name out “bob” “bradley” it would have saved us all a lot of time and aggravation….

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Comment by Loren Pechtel

August 24, 2011 @ 1:58 pm

1 per VAGINA

I know enough med-speak to understand what this means but since it’s not my field I see it as English and my first reaction: She has two vaginas and is supposed to put a tablet in each? >G<

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