For the non-pharmacy folk: Schedule 2 drugs are the heavy hitters (Oxycontin, Percocet, Ritalin and many others with high abuse potential) that pharmacies are required to keep an exact count of. Every month we are required to count our inventory and make sure it reconciles exactly with the record of prescriptions dispensed, which are individually logged throughout the month.) Other bloggers have lamented how a Schedule 2 prescription used to be a rarity --- now, we shovel them out in buckets.
One of the pharmacies I cover occasionally has constant trouble with these counts. Some are over the expected amount and some are under. There's no real pattern to either the amounts or the drugs affected. Now, ordinarily this is how many a pharmacy employee has been caught stealing, but this is a small staff --- no turnover, long-term capable employees and honestly there's really no suspicion of diversion here (I know it sounds naive, but trust me on this.) In addition, most of these discrepancies are solved and found to be the result of error --- miscounts, addition or subtraction errors in the log, brand-name/generic mix-ups, prescriptions dispensed but not logged, new inventory received but not logged in correctly, etc. The mistakes appear to caused primarily by people in a hurry, as is the usual state of pharmacy.
There are a few that are never solved, though. It takes so much time, effort and teeth-gnashing to figure out the discrepancies -- there's always a little nervousness and finger-pointing and frustration involved, because it is a big deal and no one wants any cloud of suspicion hanging over them.
And then it came to me to ask out in the blogosphere if anyone out there has a good system going that keeps those Schedule 2 counts pristine? Other than counting the damn things on a daily basis?
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18 comments:
Use a Sharpie to write numbers on every pill. Tell the patient it's a factory mark.
We keep a book with name, strength, ndc of each medication on a different page. On the page has spots for whenever the medication is removed or added, for name, rx#, quantity, current count, total removed, final count. They are double counted then the bottle back counted for an exact number. Lot of work, but usually it's 100%.
I second Gwen: Back-counting is an essential step.
Also: In my career I have 3-4 times come across bottles that did not have 100 in them, but 99 or 101(Endo was a two-fer, one was Vyvanse, one I can't really remember)...I always have someone else (tech or RPh, whoever is available) triple count those.
A perpetual inventory like what Gwyn described is the only real way to be 100% accurate. I just make sure the drug is out of the safe a short a period as possible. It reduces the chance for errors. If that pharmacy doesn't have an electronic receiving system it could be input error. I also periodically spot check the fast movers.
Losing C2s sucks. I once had a bottle of oxycodone 30mg get get put on the shelf with the alprazolam 2mg. Both were made by the same manufacturer with the same color label. Normal product turnover eventually revealed the error, but that was a stressful week.
I only allowed licensed pharmacist to go anywhere near my C-II's. I still had RPh's who can't add/substract but no unsolved mysteries.
wv = dented -- 1st time I got an actual word.
having no experience or real world knowledge, this one is easy.
Weigh individual pill, know weight of bottles, measure when arrive, after each use, weighing with accurate scale.
Check what weight should be. maintain a record on bottle of current weight.
In addition to keeping a perpetual inventory book that each rx is logged in, we write the number of pills remaining in an opened bottle on the outside of the bottle or the lid. It's worked really well in the past year since we've started doing it.
Easier than keeping a book is to tape a piece of paper to the bottle. Note the date the product was received and log the date and quantity of each rx on that paper. Subtract the number of pills dispensed and keep a running total. This way you don't have to drag the book out for every C-II script you fill and the info you need is right there on the bottle.
Interesting and good suggestions... it really helps to hear how other places do it... Thanks!
I agree. The back counting is essential. You will rarely have trouble if you back count.
Seriously, Dr. Grumpy, now. A big Sharpie mark, from the factory? I can just imagine a scene out of Here's Lucy, counting the MS Contin with black sharpies, and the Concerta with green sharpies.
The only thing that worked 100% in hospital was perpetual inventory, counting the drug every single time it went into or out of stock. No double-, or triple-counting unless the books don't add up. Automated dispensing cabinet programs force an accurate back count or your name ends up on the miscount record and the whole hospital shuts down. (Joking)
As for weighing bottles. Accuracy of scales is an issue as well as the time to weigh the bottles.
Why is it I can't get my generic Schedule 2 (oxycontin)medications? It used to cost me $20.00 and now it's $70.00. You said they are always back-ordered but I don't understand why. All the pharmacies push the generics but don't stock them. Thanks
We created a excel workbook with a worksheet for each drug for our independent pharmacy c2's. It's basic and crude but works well, adding the numbers if data put into the invoice column( invoice number) and subtracting if put into the RX column (prescription number). Took a little work to set up, but easy and low maintenance, I was actually wondering if anyone marketed an easy to use software application that does the same thing, only better ways to print reports. Maybe I should :-)
Our pharmacy dispensing software can keep perpetual inventory; problem obviously is that there are multiple vendors on your generics, so using exact NDC dispensed is required or it's accuracy goes out the window. Also tough when the patient ends up getting a prescription for say, 60 oxycodone, but 42 were Qualitest and 18 were Mallincrodt, or whatever. Thats why we just have one tab per drug, regardless of generic manufacturer on the workbook. Brands obviously have a seperate sheet than the sheet for all generic equivalents. We just enter all RX's and invoices, and verify count on drugs as often as possible.
I appreciate all the comments and they were very helpful. This month the counts were MUCH better because we have made an effort to be a lot more attentive, spot-check and back count as frequently as possible in between monthly counts. It's amazing how often there are still simple math errors! We only had one discrepancy (short 2 tablets) which is still maddening but it's going a lot better.
We would count out the number needed for the rx. and then do the math; and count the number going back into the bottle. All new bottles had a full count (or a split count with the Rx to be filled) so we would catch the #99 and #101 bottles...
Really Oxytocin Guy? Call the FDA/DEA and complain... Patent issue takes generic off the market. You can have them file your complaint next the the Makena Mom's and the owner whose dogs have Shar Pei fever (colchicine brand name ...)
I work for a wholesaler and we have to not onot only balance CII's but reportable CIII's. Granted we only have to account for bottles and not pills, but with possibly thousands of bottles and sales, it gets fun. We have partners that is all their job entails, balancing ARCOS.
If "all" staff Rph's and manager Rph's count, back count, and MARK THAT AMOUNT on the last opened bottle and compare it to the balance remaning in the narc book, this is 100%. But it only works if everyone's 100% compliant.
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