Sunday, March 15, 2009

Random Things that Made Me Go Hmmm.....

A parent who rushes in to pick up a brand new prescription for a bed-wetting child who's going on a school field trip (like, leaving in a half hour). We don't have the strength they need, we call around to find it, get the Dr.'s office to re-send the script to the other pharmacy, and she rushes off. Hmmmm. You mean she's going to send this kid off on an overnighter with a brand new prescription he's never taken before and hope everything goes fine?

A female patient being checked out with a new prescription for a psychiatric drug. Paid up, ready to go, and then mentions that she and her husband are actively trying to get pregnant, and that she didn't mention this to the doctor. Hmmm. That definitely would have been a good thing to mention somewhere during the discussion -- this isn't M & M's we're taking here. In fact, we check the literature and find you don't want to be taking this drug during pregnancy, especially the early stages. We pony up with a refund and she decides to call her doctor tomorrow.

It's chaotic, and we're having the usual back-and-forth-question-and-answer discussion with a customer to try and determine the insurance plan to which we bill their prescription. Phone calls, trial and error, a few more questions, doctor NPI search, several interruptions, customer hovering and waiting expectantly and being told it's gonna be a few more minutes and we'll call you when it's ready and finally we are ready with the prescriptions and applicable co-pays. Customer looks wide-eyed and then informs us he didn't bring any money with him. Hmmm. I want to pound my forehead on the counter.

A customer who squawks about a 3.00 copay comes in for an antibiotic which, she informs us, is for an infection she contracted from a pedicure. Hmmmm. I've never had a pedicure. How much are they?

We always double-count controlled meds that are dispensed by the Scriptpro (automatic 'counting' robot machine). I decide to randomly double-count some other meds too. Every single damn one seems like it's off by one or has broken tablets or fragments in it. Hmmm. I wouldn't blame a customer at all for getting mad about that -- they're paying for it, after all. But we don't have time to double-count all of them, so I hold my breath and hope.

I LUV my great technicians, but I worked with one this week who I don't see that often. Every time she prepared an antibiotic suspension or tube of cream she covered up every pertinent part of the manufacturers label (that I obviously want to see in order to check the thing) with our store prescription label and wrapped it in enough tape to seal a mummy. I don't mean to be picky here, but when I check something I like to see the original label, NDC number and bottle size. Hmmm. I can't see through your label and I sure as heck can't peel it off through all those layers of tape. Maybe I could dig through the garbage to find the box? Whaddya think I'm doin' over here anyway? I'm checking! I REALLY AM!


Anonymous said...

Agree completely about the checking aspects about covering up labels. It was a particularly teeth-grit issue when I first came out of school in the 80's, because apparently, pharmacist DID not, nore NEVER made mistakes, and patients were NOT at all interested in double-checking strengths on products dispensed. As employee out-patient pharmacist in hospital setting, I thought everything that could be done to ensure correct prescription, including leaving original information intact on labels was important for me to be able to double-check, as well as for the patients e.g. reconstituted antibiotics, creams, etc. Later, when manufacturer bottles came ready to dispense (child-proof cap, and unit-of-use), same issue. Please, do not cover the label, if no further compounding!

Anonymous said...

As a customer, I would prefer that the original label was visible as well as the pharmacist's label, so I can double-check myself. I've had a mis-match once - I was given double the prescribed strength. Not a significant change, as I just took one tablet instead of two. What was important was that I know that the capsules were 20mg (as it said on the box) and not 10mg, as it said on the printed label and on my prescription.

Shalom said...

I got pretty good at fixing the Scriptpro machines when I was on overnights at a certain chain. (They'd bought them outright in an attempt to save money vs. leasing, which meant that they had to pay to get them fixed, which in turn meant that it wasn't something that was going to happen in the middle of the night.)

There's a setting you can set, per drug, that will "double-count" for you. In normal operation it spits out what it thinks is the correct number of tabs/caps and leaves it at that; if you check this box, I can't remember the title but it's something like "Verify quantity counted" or "Alert on overcount", something like that, it actually counts them as they go past an electric eye, and it sets up an alarm if there are extra tablets in the bottle. Every store with a SP machine that I floated in, I set this up for any controls in the machine, and it did catch a few. I can't promise that the software hasn't been changed in the past five years or so, but that checkbox still ought to be there somewhere.

(By the way, there's a failure mode where the gripper arm doesn't close so it can't grab the vial. The first time this happened, I called the service. In the fullness of time the tech showed up. He unhooked the two ends of a busted spring from the arm, then opened a door on the side of the machine, pulled out a new one from a little baggie of springs that he found in there, and hooked it on. I watched over his shoulder and thought, so that's all there is to it? Next time it went out, I fixed it myself. It's really not difficult.)