Hi guys,
I am actually a technician but I need to ask pharmacists about this.
I just got hired at a pharmacy (and I won't give names out for my own protection, I'm based on the West Coast but I won't say any more). I have worked there for two weeks and I am concerned about the liberal dispensation of controlled drugs.
Here are my concerns:
1. People come from 50 miles away for narcotics and narcotics seem to be about 75-85% of the total prescriptions we fill. I did not fill an antibiotic prescription until my third day there and I have yet to fill any for birth control (and we do stock it). I fill an average of one blood pressure prescription and one diabetes prescription per day. I have no problem with dispensing controlled drugs for legitimate medical purposes I am concerned that we are too liberal in dispensing controlled drugs and we are more drug dealer than pharmacy.
2. The setup at the pharmacy is chaotic. There are usually at least four technicians in the pharmacy and we are frequently pulled from our stations while counting and dealing with controlled medication. There is no way to ensure a clear chain of custody of the medication while getting it to the pharmacist.
3. The pharmacy is located behind a cage but the C-II medications are not kept in a secure room or safe. They are kept in an unmarked drawer. There are two locked doors that someone would need to get in to (with one having an electronic lock and the other requiring either a key or being buzzed in).
4. They do tech check tech on C-II prescriptions and the places I trained at did not even let technicians deal with C-II prescriptions (But I did my training in another state so the regulations might be different). The pharmacist does not even usually do a final approval of C-II medications going to the customers.
5. There is not a live inventory of controlled drugs. The used bottles of controlled medication go on a shelf where they are restocked at the end of the day with the C-II drugs going to a special area near the pharmacist's station. I'd assume that the pharmacist does an inventory of the C-II medication at the end of each day but I have no idea if he does.
6. The offer to counsel patients is not made clear to patients when they check out. At the chains, they have a box to check to request it. At this place, they do not even ask patients if they wish to speak to the pharmacist about their medication. The best that we do is a sign on the wall in a fairly out of the way place saying that the pharmacist will answer any questions that you have. I believe (and correct me if I'm wrong) that OBRA 90 states that all patients must be directly asked if they have questions for the pharmacist.
7. When we have patients pick up controlled prescriptions, we take their ID number and we write down race and gender. I'm concerned that this might be discriminatory profiling (although we have security cameras that can do the same thing).
8. The area where we check customers out is too packed with people for there to be adequate privacy protection by HIPAA standards (or at least the way I read them which is to be as strict as possible). We call to people over the intercom by saying their first name and that their prescription is ready when I was trained to say that they should be asked back to the pharmacy. There is a window for counseling but it is hardly private.
I'm ethically torn as to whether I should continue there. There are two main problems. The first is that the job market where I live is not particularly great and money is tight for me. If I run out, I will have to move back in with my parents in Tennessee (and I worked damn hard to get to the West Coast). The other problem is that I genuinely like the people that I am working with.
But do I have an ethical obligation to resign in the face of systemically bad pharmacy practice? Or should I speak to the manager about my concerns first?
I am actually a technician but I need to ask pharmacists about this.
I just got hired at a pharmacy (and I won't give names out for my own protection, I'm based on the West Coast but I won't say any more). I have worked there for two weeks and I am concerned about the liberal dispensation of controlled drugs.
Here are my concerns:
1. People come from 50 miles away for narcotics and narcotics seem to be about 75-85% of the total prescriptions we fill. I did not fill an antibiotic prescription until my third day there and I have yet to fill any for birth control (and we do stock it). I fill an average of one blood pressure prescription and one diabetes prescription per day. I have no problem with dispensing controlled drugs for legitimate medical purposes I am concerned that we are too liberal in dispensing controlled drugs and we are more drug dealer than pharmacy.
2. The setup at the pharmacy is chaotic. There are usually at least four technicians in the pharmacy and we are frequently pulled from our stations while counting and dealing with controlled medication. There is no way to ensure a clear chain of custody of the medication while getting it to the pharmacist.
3. The pharmacy is located behind a cage but the C-II medications are not kept in a secure room or safe. They are kept in an unmarked drawer. There are two locked doors that someone would need to get in to (with one having an electronic lock and the other requiring either a key or being buzzed in).
4. They do tech check tech on C-II prescriptions and the places I trained at did not even let technicians deal with C-II prescriptions (But I did my training in another state so the regulations might be different). The pharmacist does not even usually do a final approval of C-II medications going to the customers.
5. There is not a live inventory of controlled drugs. The used bottles of controlled medication go on a shelf where they are restocked at the end of the day with the C-II drugs going to a special area near the pharmacist's station. I'd assume that the pharmacist does an inventory of the C-II medication at the end of each day but I have no idea if he does.
6. The offer to counsel patients is not made clear to patients when they check out. At the chains, they have a box to check to request it. At this place, they do not even ask patients if they wish to speak to the pharmacist about their medication. The best that we do is a sign on the wall in a fairly out of the way place saying that the pharmacist will answer any questions that you have. I believe (and correct me if I'm wrong) that OBRA 90 states that all patients must be directly asked if they have questions for the pharmacist.
7. When we have patients pick up controlled prescriptions, we take their ID number and we write down race and gender. I'm concerned that this might be discriminatory profiling (although we have security cameras that can do the same thing).
8. The area where we check customers out is too packed with people for there to be adequate privacy protection by HIPAA standards (or at least the way I read them which is to be as strict as possible). We call to people over the intercom by saying their first name and that their prescription is ready when I was trained to say that they should be asked back to the pharmacy. There is a window for counseling but it is hardly private.
I'm ethically torn as to whether I should continue there. There are two main problems. The first is that the job market where I live is not particularly great and money is tight for me. If I run out, I will have to move back in with my parents in Tennessee (and I worked damn hard to get to the West Coast). The other problem is that I genuinely like the people that I am working with.
But do I have an ethical obligation to resign in the face of systemically bad pharmacy practice? Or should I speak to the manager about my concerns first?
Those of us with actual pharmacy experience let her know that no, it wasn't.
I'm sure she's an excellent pharmacist now.
