CVS Production Safety Zone

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Sure rphs can run around between phone calls, qt, qp, drivethru and verification. They're not lazy but all the distractions really add up for medication errors. Also, blasting thru hundreds of prescriptions in 3 hours is crazy. RPH shouldnt be verifying more than 25-30 scripts an hour tbh.

See what chains are doing to us, Science? No time to concentrate on verification anymore! I quit CVS so I can stay just at verification at an independent. No, I'm not lazy. I care about my license.

It's all fun and games till someone makes a critical error

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my store has the highest wecare and service score and number one in sos....I purposefully keep my ready fill rate low. Its only 5 points who cares. And I always have more than enough tech hours. How do I do it? I fill my and my family members rx scripts every day for only 1 pill thru cash. My other pharmacists do to. That results in about 700 extra prescriptions per week. That allows me to staff extra techs per week to deal with all the bull**** work cvs has us do to meet their stupid metrics. No pharmacist in my store does anything more than verify and receive doctor calls. Now the drawback is that I never meet budget every year and my bonus is always horrible. But I don't give a **** about their little bonuses. My main priority is the quality of life of myself and my staff.
 
my store has the highest wecare and service score and number one in sos....I purposefully keep my ready fill rate low. Its only 5 points who cares. And I always have more than enough tech hours. How do I do it? I fill my and my family members rx scripts every day for only 1 pill thru cash. My other pharmacists do to. That results in about 700 extra prescriptions per week. That allows me to staff extra techs per week to deal with all the bull**** work cvs has us do to meet their stupid metrics. No pharmacist in my store does anything more than verify and receive doctor calls. Now the drawback is that I never meet budget every year and my bonus is always horrible. But I don't give a **** about their little bonuses. My main priority is the quality of life of myself and my staff.
Why not bill insurance?
 
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my store has the highest wecare and service score and number one in sos....I purposefully keep my ready fill rate low. Its only 5 points who cares. And I always have more than enough tech hours. How do I do it? I fill my and my family members rx scripts every day for only 1 pill thru cash. My other pharmacists do to. That results in about 700 extra prescriptions per week. That allows me to staff extra techs per week to deal with all the bull**** work cvs has us do to meet their stupid metrics. No pharmacist in my store does anything more than verify and receive doctor calls. Now the drawback is that I never meet budget every year and my bonus is always horrible. But I don't give a **** about their little bonuses. My main priority is the quality of life of myself and my staff.

Minimum cash price per script at CVS = $11.99. This must get very expensive on a daily basis
 
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scripts aren't actually picked up....its just to keep the weekly numbers up
 
We have about a 35-40% Readyfill rate and about a 10% waiter rate. We used to walk into 15 pages in the QT, and I'v seen QP get as bad as 8 pages in the red with 3-4 pages in QT. I used to think it was impossible too but I'm literally not exaggerating. We did get a new PIC who is VERY good. Plus, once you are able to clear the que on a consistent basis it gives you more time . It's because we have all of the readyfill printed and pulled within 30 minutes of opening, pharmacist jumps into QT and helps so drop off can feed production with the acutes.

I honestly wish we had such a good readyfill rate it would actually make life easier (less phone calls). We were around 200 hours in tech hours last year but they've really dropped it.

Again, you guys are EXTREMELY understaffed. Either everyone in your store is superb and transform into beast mode from morning to night, it's hard to believe a store with that script count can operate with that tech budget.
 
You can't print and pull 10 pages of QP within 30 minutes of opening and even if you could, it still has to be counted.

I could probably pull 10 pages in 30 minutes, not wait for them to print though. Usually the pharm has 2-3 pages already counted before we open because he/she sadly works off the clock (comes in 30-60 mins early).
 
I print pull and count 7 pages in 1 hour every week. Come in at 7 once a week and get production done because we have 1 extra hour of overlap we're not using elsewhere. It's doable.
 
I could probably pull 10 pages in 30 minutes, not wait for them to print though. Usually the pharm has 2-3 pages already counted before we open because he/she sadly works off the clock (comes in 30-60 mins early).

10 pages is 150 scripts. So you can pull 5 scripts a minute or one every 12 seconds? I guess if you are uninterrupted, every script is in stock, and you are on speed, it could be possible.
 
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I print pull and count 7 pages in 1 hour every week. Come in at 7 once a week and get production done because we have 1 extra hour of overlap we're not using elsewhere. It's doable.

105 scripts in one hour?! You sir are the man.
 
10 pages is 150 scripts. So you can pull 5 scripts a minute or one every 12 seconds? I guess if you are uninterrupted, every script is in stock, and you are on speed, it could be possible.
Also, everything that isn't a label probably goes into the trash. Misbranded prescriptions are faster to prepare.
 
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Interesting points from everyone, but I think the success of following work flow is largely dependent on volume and competency of staff.

My store for example is low volume, therefore I represent a larger portion of my staff. Because I do all the production myself I can utilize an unconventional work flow and keep it all straight. Volume dependent though I'm sure, probably doesn't work as well with higher volumes.
 
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I could make money coming up with these new schemes. I wonder what they pay the guys
 
We filled 2,800 scripts this week on 182 tech hours and had the QP empty by 11 AM on 5 of the days. Pharmacist jumps into the QT every 10 minutes to get acutes out quickly, and since the drop-off tech has help in the QT they can print and pull acute scripts along with readyfill and feed production. Third tech watches pick-up/drive through and does cardinal, and production serves as drive-through/pick-up if there are multiple customers.

Maybe this wouldn't work for you guys since you only verify and complain about the phone?

CVS has trained these monkeys well.
 
I could probably pull 10 pages in 30 minutes, not wait for them to print though. Usually the pharm has 2-3 pages already counted before we open because he/she sadly works off the clock (comes in 30-60 mins early).

CVS has trained this particular monkey so well he will burn out in a year or become depressed.
 
Sure rphs can run around between phone calls, qt, qp, drivethru and verification. They're not lazy but all the distractions really add up for medication errors. Also, blasting thru hundreds of prescriptions in 3 hours is crazy. RPH shouldnt be verifying more than 25-30 scripts an hour tbh.

See what chains are doing to us, Science? No time to concentrate on verification anymore! I quit CVS so I can stay just at verification at an independent. No, I'm not lazy. I care about my license.

It's all fun and games till someone makes a critical error

Multitasking = medication errors
 
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We can only print one batch of scripts at a time (3 patients).

So rather than having the production tech counting 24/7 while the other techs/pharmacist print and pull in their free time, the production tech prints one batch, pull the drugs, counts them, and as the next batch is printing puts the drugs away and repeats.

This is way slower. We used to have 2-3 pages pulled and ready at any given time without the counter having to stop.

How is this safer/efficient?
1) While working at production you retrieve a label from a production basket for a quantity of 90 tablets. The stock bottles contain 100 tablets when sealed. What is the proper method for counting out 90 tablets?
a. Select one sealed bottle and one opened bottle, count out 10 from the sealed bottle and pour the remaining 90 tablets in an amber vial. Place the 10 tablets into the previously opened bottle and complete production
b. Select one sealed bottle and one opened bottle. Count out 10 tablets from the sealed bottle and pour the remaining 90 tablets in an amber vial. Place the 10 tablets back in the bottle in which they originated and affix and “x” on the bottle
c. Select one sealed bottle and one opened bottle. Count the remaining tablets from the opened bottle, then open the sealed bottle to complete the count. Affix the newly opened bottle with an “x”
d. Select one sealed bottle and one opened bottle. Open the sealed bottle and count 90 tablets. Pour the 90 tablets in an amber vial and place the remaining 10 tablets into the previously opened bottle

2) You are filling a prescription for 90 tablets of a medication stocked in 30 count stock bottles. What is the proper method of producing this prescription?
a. Open 3 bottles and pour the contents directly into an amber vial
b. Open each bottle one at a time, count the contents, and add them to the amber vial
c. Open all three bottles, pour the contents out on a counting tray to verify consistency, remove packaging material and desiccants, and then add the contents from the tray to an amber vial
d. All methods are acceptable as long as desiccants are removed prior to dispensing

3) During the Production process, a patient approached the counter at Pick Up. You have Accuracy Scanned and poured the medication on the tray. What is the proper action to take?
a. Continue counting the medication and complete the Prescription Production process by labeling the amber vial and placing it with a label in a basket, then proceed to the register to assist the patient
b. Pause from counting and acknowledge the customer by making eye contact and stating that you will be right over. Complete the Prescription Production process by labeling the amber vial and placing it in a basket, and then proceed to the register to assist the patient
c. Greet the customer immediately. Stop Production and walk to the counter to assist the customer
d. Pour the tablets back into the stock bottle and greet the customer as you approach the counter

4) You are prompted to retrieve an RTS vial for a prescription, when you get to the shelf, you cannot find an RTS for this product. What should you do at production?
a. Bypass the RTS product, scan credentials and produce
b. Bypass the RTS product, scan the stock bottle(s) retrieved, credential, and produce
c. From the RTS maintenance screen, reprint the RTS label needed, scan the RTS label, credential, and produce
d. A or C

5) While producing a prescription with multiple stock bottles, you pour tablets from an open bottle on the tray, emptying the bottle. What should be done with the empty stock bottle and cap?
a. Immediately throw the empty bottle and cap in the green bag
b. Place the empty bottle and cap on the countertop off of the Production Safety Zone
c. Retain the cap and the empty bottle on the Production Safety Zone until the production process is complete
d. All actions are acceptable as long as the bottle is not reused

6) A label prints for 60 tablets of levothyroxine 25mcg. You walk to the stock shelf and find an open bottle that feels as though there are 60 tablets inside. How many bottles should be brought to production?
a. Just the opened bottle, since you believe there are enough tablets inside to fulfill the script
b. One unopened bottle and one opened bottle
c. A and B are acceptable
d. None of the above

7) Which team member is accountable for adherence to the Production Safety Zone and the production process?
a. Pharmacy Manager
b. Pharmacist on Duty
c. Technician at production
d. All of the above

8) Which of the following actions should never take place?
a. Combining two opened stock bottles to free up space on the stock shelf
b. Pouring the contents of an RTS vial into a stock bottle since the RTS label did not print
c. Producing a prescription accuracy scanned by another team member
d. All of the above

9) A label prints for 30 tablets of atenolol 25mg. You retrieve an open bottle and a full stock bottle which you do not believe you will need, but want to be sure you have enough. What process will you follow at production?
a. Scan the label, scan the opened bottle, count the product, scan credentials to close accuracy scan since you did not need the second bottle
b. Scan the label, bypass accuracy scan since you know you have the right product
c. Scan the label, scan the opened bottle, scan the second bottle, credential to close accuracy scan, produce with the open bottle
d. Scan the label, scan the opened bottle, count the tablets while leaving the accuracy scan prompt open, scan the second bottle if needed
 
CVS has trained this particular monkey so well he will burn out in a year or become depressed.
1) While working at production you retrieve a label from a production basket for a quantity of 90 tablets. The stock bottles contain 100 tablets when sealed. What is the proper method for counting out 90 tablets?
a. Select one sealed bottle and one opened bottle, count out 10 from the sealed bottle and pour the remaining 90 tablets in an amber vial. Place the 10 tablets into the previously opened bottle and complete production
b. Select one sealed bottle and one opened bottle. Count out 10 tablets from the sealed bottle and pour the remaining 90 tablets in an amber vial. Place the 10 tablets back in the bottle in which they originated and affix and “x” on the bottle
c. Select one sealed bottle and one opened bottle. Count the remaining tablets from the opened bottle, then open the sealed bottle to complete the count. Affix the newly opened bottle with an “x”
d. Select one sealed bottle and one opened bottle. Open the sealed bottle and count 90 tablets. Pour the 90 tablets in an amber vial and place the remaining 10 tablets into the previously opened bottle

2) You are filling a prescription for 90 tablets of a medication stocked in 30 count stock bottles. What is the proper method of producing this prescription?
a. Open 3 bottles and pour the contents directly into an amber vial
b. Open each bottle one at a time, count the contents, and add them to the amber vial
c. Open all three bottles, pour the contents out on a counting tray to verify consistency, remove packaging material and desiccants, and then add the contents from the tray to an amber vial
d. All methods are acceptable as long as desiccants are removed prior to dispensing

3) During the Production process, a patient approached the counter at Pick Up. You have Accuracy Scanned and poured the medication on the tray. What is the proper action to take?
a. Continue counting the medication and complete the Prescription Production process by labeling the amber vial and placing it with a label in a basket, then proceed to the register to assist the patient
b. Pause from counting and acknowledge the customer by making eye contact and stating that you will be right over. Complete the Prescription Production process by labeling the amber vial and placing it in a basket, and then proceed to the register to assist the patient
c. Greet the customer immediately. Stop Production and walk to the counter to assist the customer
d. Pour the tablets back into the stock bottle and greet the customer as you approach the counter

4) You are prompted to retrieve an RTS vial for a prescription, when you get to the shelf, you cannot find an RTS for this product. What should you do at production?
a. Bypass the RTS product, scan credentials and produce
b. Bypass the RTS product, scan the stock bottle(s) retrieved, credential, and produce
c. From the RTS maintenance screen, reprint the RTS label needed, scan the RTS label, credential, and produce
d. A or C

5) While producing a prescription with multiple stock bottles, you pour tablets from an open bottle on the tray, emptying the bottle. What should be done with the empty stock bottle and cap?
a. Immediately throw the empty bottle and cap in the green bag
b. Place the empty bottle and cap on the countertop off of the Production Safety Zone
c. Retain the cap and the empty bottle on the Production Safety Zone until the production process is complete
d. All actions are acceptable as long as the bottle is not reused

6) A label prints for 60 tablets of levothyroxine 25mcg. You walk to the stock shelf and find an open bottle that feels as though there are 60 tablets inside. How many bottles should be brought to production?
a. Just the opened bottle, since you believe there are enough tablets inside to fulfill the script
b. One unopened bottle and one opened bottle
c. A and B are acceptable
d. None of the above

7) Which team member is accountable for adherence to the Production Safety Zone and the production process?
a. Pharmacy Manager
b. Pharmacist on Duty
c. Technician at production
d. All of the above

8) Which of the following actions should never take place?
a. Combining two opened stock bottles to free up space on the stock shelf
b. Pouring the contents of an RTS vial into a stock bottle since the RTS label did not print
c. Producing a prescription accuracy scanned by another team member
d. All of the above

9) A label prints for 30 tablets of atenolol 25mg. You retrieve an open bottle and a full stock bottle which you do not believe you will need, but want to be sure you have enough. What process will you follow at production?
a. Scan the label, scan the opened bottle, count the product, scan credentials to close accuracy scan since you did not need the second bottle
b. Scan the label, bypass accuracy scan since you know you have the right product
c. Scan the label, scan the opened bottle, scan the second bottle, credential to close accuracy scan, produce with the open bottle
d. Scan the label, scan the opened bottle, count the tablets while leaving the accuracy scan prompt open, scan the second bottle if needed
 
LOL I remember that damn quiz.
 
1) While working at production you retrieve a label from a production basket for a quantity of 90 tablets. The stock bottles contain 100 tablets when sealed. What is the proper method for counting out 90 tablets?

Eyeball it then give a little extra. Customers appreciate a generous pour.

2) You are filling a prescription for 90 tablets of a medication stocked in 30 count stock bottles. What is the proper method of producing this prescription?

You must be licensed as a producer by the FDA to produce a prescription. Exercise your right to remain silent.

3) During the Production process, a patient approached the counter at Pick Up. You have Accuracy Scanned and poured the medication on the tray. What is the proper action to take?

Raise your hand to the customer giving them the universal symbol for stop/shut up/talk to the hand. If not successful follow up with a rapid slashing motion across your throat.

4) You are prompted to retrieve an RTS vial for a prescription, when you get to the shelf, you cannot find an RTS for this product. What should you do at production?

Wonder what the hell you are doing with your effing life and how it came to this.


5) While producing a prescription with multiple stock bottles, you pour tablets from an open bottle on the tray, emptying the bottle. What should be done with the empty stock bottle and cap?

Fill it with skittles and give to children of customers to teach them the fun of taking medications and how to remove childproof caps.

6) A label prints for 60 tablets of levothyroxine 25mcg. You walk to the stock shelf and find an open bottle that feels as though there are 60 tablets inside. How many bottles should be brought to production?

Why would somebody get 60 tablets of this drug when it comes in 50 mcg? You have never worked in a pharmacy. You make me sick. If I was in a room with you, Hitler, and a guy from Isis and I had a gun with only 2 bullets I would shoot you twice.



7) Which team member is accountable for adherence to the Production Safety Zone and the production process?

The one with a clipboard, hard hat, and a whistle.

8) Which of the following actions should never take place?

Eating or peeing in the pharmacy. Or leaving the pharmacy.

9) A label prints for 30 tablets of atenolol 25mg. You retrieve an open bottle and a full stock bottle which you do not believe you will need, but want to be sure you have enough. What process will you follow at production?

Deny any knowledge of the incident and destroy all evidence.
 
Can someone please help me with these assessment questions for LEARNet? My phone cut off the recording of the video and there isn't one online. If you can help that would be greatly appreciated.

1) Which team member is accountable for adherence to the Production Safety Zone and the production process?
a. Pharmacy Manager
b. Pharmacist on Duty
c. Technician at production
d. All of the above

2) During the Production process, a patient approached the counter at Pick Up. You have Accuracy Scanned and poured the medication on the tray. What is the proper action to take?
a. Continue counting the medication and complete the Prescription Production process by labeling the amber vial and placing it with a label in a basket, then proceed to the register to assist the patient
b. Pause from counting and acknowledge the customer by making eye contact and stating that you will be right over. Complete the Prescription Production process by labeling the amber vial and placing it in a basket, and then proceed to the register to assist the patient
c. Greet the customer immediately. Stop Production and walk to the counter to assist the customer
d. Pour the tablets back into the stock bottle and greet the customer as you approach the counter

3) Which of the following actions should never take place?
a. Combining two opened stock bottles to free up space on the stock shelf
b. Pouring the contents of an RTS vial into a stock bottle since the RTS label did not print
c. Producing a prescription accuracy scanned by another team member
d. All of the above

4) You are prompted to retrieve an RTS vial for a prescription, when you get to the shelf, you cannot find an RTS for this product. What should you do at production?
a. Bypass the RTS product, scan credentials and produce
b. Bypass the RTS product, scan the stock bottle(s) retrieved, credential, and produce
c. From the RTS maintenance screen, reprint the RTS label needed, scan the RTS label, credential, and produce
d. A or C

5) While producing a prescription with multiple stock bottles, you pour tablets from an open bottle on the tray, emptying the bottle. What should be done with the empty stock bottle and cap?
a. Immediately throw the empty bottle and cap in the green bag
b. Place the empty bottle and cap on the countertop off of the Production Safety Zone
c. Retain the cap and the empty bottle on the Production Safety Zone until the production process is complete
d. All actions are acceptable as long as the bottle is not reused

6) A label prints for 30 tablets of atenolol 25mg. You retrieve an open bottle and a full stock bottle which you do not believe you will need, but want to be sure you have enough. What process will you follow at production?
a. Scan the label, scan the opened bottle, count the product, scan credentials to close accuracy scan since you did not need the second bottle
b. Scan the label, bypass accuracy scan since you know you have the right product
c. Scan the label, scan the opened bottle, scan the second bottle, credential to close accuracy scan, produce with the open bottle
d. Scan the label, scan the opened bottle, count the tablets while leaving the accuracy scan prompt open, scan the second bottle if needed

7) While working at production you retrieve a label from a production basket for a quantity of 90 tablets. The stock bottles contain 100 tablets when sealed. What is the proper method for counting out 90 tablets?
a. Select one sealed bottle and one opened bottle, count out 10 from the sealed bottle and pour the remaining 90 tablets in an amber vial. Place the 10 tablets into the previously opened bottle and complete production
b. Select one sealed bottle and one opened bottle. Count out 10 tablets from the sealed bottle and pour the remaining 90 tablets in an amber vial. Place the 10 tablets back in the bottle in which they originated and affix and “x” on the bottle
c. Select one sealed bottle and one opened bottle. Count the remaining tablets from the opened bottle, then open the sealed bottle to complete the count. Affix the newly opened bottle with an “x”
d. Select one sealed bottle and one opened bottle. Open the sealed bottle and count 90 tablets. Pour the 90 tablets in an amber vial and place the remaining 10 tablets into the previously opened bottle

8) You are filling a prescription for 90 tablets of a medication stocked in 30 count stock bottles. What is the proper method of producing this prescription?
a. Open 3 bottles and pour the contents directly into an amber vial
b. Open each bottle one at a time, count the contents, and add them to the amber vial
c. Open all three bottles, pour the contents out on a counting tray to verify consistency, remove packaging material and desiccants, and then add the contents from the tray to an amber vial
d. All methods are acceptable as long as desiccants are removed prior to dispensing

9) A label prints for 60 tablets of levothyroxine 25mcg. You walk to the stock shelf and find an open bottle that feels as though there are 60 tablets inside. How many bottles should be brought to production?
a. Just the opened bottle, since you believe there are enough tablets inside to fulfill the script
b. One unopened bottle and one opened bottle
c. A and B are acceptable
d. None of the above
 
Safe Production and Production Safety Quiz (** =correct choice)

1) While working at production you retrieve a label from a production basket for a quantity of 90 tablets. The stock bottles contain 100 tablets when sealed. What is the proper method for counting out 90 tablets?
a. Select one sealed bottle and one opened bottle, count out 10 from the sealed bottle and pour the remaining 90 tablets in an amber vial. Place the 10 tablets into the previously opened bottle and complete production
b. Select one sealed bottle and one opened bottle. Count out 10 tablets from the sealed bottle and pour the remaining 90 tablets in an amber vial. Place the 10 tablets back in the bottle in which they originated and affix and “x” on the bottle
**c. Select one sealed bottle and one opened bottle. Count the remaining tablets from the opened bottle, then open the sealed bottle to complete the count. Affix the newly opened bottle with an “x”
d. Select one sealed bottle and one opened bottle. Open the sealed bottle and count 90 tablets. Pour the 90 tablets in an amber vial and place the remaining 10 tablets into the previously opened bottle

2) You are filling a prescription for 90 tablets of a medication stocked in 30 count stock bottles. What is the proper method of producing this prescription?
a. Open 3 bottles and pour the contents directly into an amber vial
b. Open each bottle one at a time, count the contents, and add them to the amber vial
c. **Open all three bottles, pour the contents out on a counting tray to verify consistency, remove packaging material and desiccants, and then add the contents from the tray to an amber vial
d. All methods are acceptable as long as desiccants are removed prior to dispensing

3) During the Production process, a patient approached the counter at Pick Up. You have Accuracy Scanned and poured the medication on the tray. What is the proper action to take?
a. Continue counting the medication and complete the Prescription Production process by labeling the amber vial and placing it with a label in a basket, then proceed to the register to assist the patient
b. **Pause from counting and acknowledge the customer by making eye contact and stating that you will be right over. Complete the Prescription Production process by labeling the amber vial and placing it in a basket, and then proceed to the register to assist the patient
c. Greet the customer immediately. Stop Production and walk to the counter to assist the customer
d. Pour the tablets back into the stock bottle and greet the customer as you approach the counter

4) You are prompted to retrieve an RTS vial for a prescription, when you get to the shelf, you cannot find an RTS for this product. What should you do at production?
a. Bypass the RTS product, scan credentials and produce
b. **Bypass the RTS product, scan the stock bottle(s) retrieved, credential, and produce
c. From the RTS maintenance screen, reprint the RTS label needed, scan the RTS label, credential, and produce
d. A or C

5) While producing a prescription with multiple stock bottles, you pour tablets from an open bottle on the tray, emptying the bottle. What should be done with the empty stock bottle and cap?
a. Immediately throw the empty bottle and cap in the green bag
b. Place the empty bottle and cap on the countertop off of the Production Safety Zone
c. **Retain the cap and the empty bottle on the Production Safety Zone until the production process is complete
d. All actions are acceptable as long as the bottle is not reused

6) A label prints for 60 tablets of levothyroxine 25mcg. You walk to the stock shelf and find an open bottle that feels as though there are 60 tablets inside. How many bottles should be brought to production?
a. Just the opened bottle, since you believe there are enough tablets inside to fulfill the script
b. **One unopened bottle and one opened bottle
c. A and B are acceptable
d. None of the above

7) Which team member is accountable for adherence to the Production Safety Zone and the production process?
a. Pharmacy Manager
b. Pharmacist on Duty
c. Technician at production
d. **All of the above

8) Which of the following actions should never take place?
a. Combining two opened stock bottles to free up space on the stock shelf
b. Pouring the contents of an RTS vial into a stock bottle since the RTS label did not print
c. Producing a prescription accuracy scanned by another team member
d. **All of the above

9) A label prints for 30 tablets of atenolol 25mg. You retrieve an open bottle and a full stock bottle which you do not believe you will need, but want to be sure you have enough. What process will you follow at production?
a. Scan the label, scan the opened bottle, count the product, scan credentials to close accuracy scan since you did not need the second bottle
b. Scan the label, bypass accuracy scan since you know you have the right product
c. **Scan the label, scan the opened bottle, scan the second bottle, credential to close accuracy scan, produce with the open bottle
d. Scan the label, scan the opened bottle, count the tablets while leaving the accuracy scan prompt open, scan the second bottle if needed
 
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CVS seems to have an overly convoluted filling process.
 
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CVS seems to have an overly convoluted filling process.
It's not convoluted at all. It's straight forward and simple.

DO ONE FRIGGIN THING AT A TIME ..... SO YOU DON'T KILL SOMEONE
 
It's not convoluted at all. It's straight forward and simple.

DO ONE FRIGGIN THING AT A TIME ..... SO YOU DON'T KILL SOMEONE

Actually there is not one question on the quiz that suggests you should do one thing at a time. Do one thing at a time while you watch register, get the phone, do PCQ? Multi-tasking is built into the workflow and you will be complemented for doing it.

Production safety protocol is there to protect CVS. If you make a mistake and they find you breaking protocol in the slightest form they will rid themselves of all liability. Don't get me wrong though, the points mentioned in the production safety protocol are common sense and good practice.
 
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CVS workflow may seem more convoluted because input verification occurs at the final step, so incorrect fills based on data entry errors occur far more often at CVS than at Walmart, thus more RTS amber vials generated. RTS vials are tracked in the system too (thus the system prompts you to use specific RTS vials first; that's why there is a question about when you can't find the specific one). Also at CVS you have to do accuracy scan for every stock product that you use (so if the Rx requires 16 boxes of Duonebs you have to scan all 16 barcodes), whereas Walmart only requires scanning one bar code at filling (if you have to pull more you need to be careful). The requirement to scan every bar code is good because I have/had mentally challenged techs.
 
[QUOTE="whereas Walmart only requires scanning one bar code at filling (if you have to pull more you need to be careful). The requirement to scan every bar code is good because I have/had mentally challenged techs.[/QUOTE]

That's not true. Say a duoneb has a quantity of 90 if the prescription calls for 360 the drug will be put on "single dispense" and then "duoneb #360 1 of 4" will pop up. You just have to make sure "single dispense" is checked on the drug. And at Walmart we will give patients multiple bottles. Say they have a rx for #90 omeprazole 40mg, we will put the stock bottles of 30 on single dispense, then the tech has to scan all 3 and put labels on each-we don't open all 3 and put them in a amber bottle. When a drug is on single dispense the labels will already print with "1 of 3" or whatever.
 
Actually there is not one question on the quiz that suggests you should do one thing at a time. Do one thing at a time while you watch register, get the phone, do PCQ? Multi-tasking is built into the workflow and you will be complemented for doing it.

Production safety protocol is there to protect CVS. If you make a mistake and they find you breaking protocol in the slightest form they will rid themselves of all liability. Don't get me wrong though, the points mentioned in the production safety protocol are common sense and good practice.

Exactly. It's there to only protect CVS and when a mistake happens, management can point a finger and fire whoever broke protocol. They say a tech is supposed to do one thing at a time, but it's impossible when they keep throwing multiple tasks to be done within set time frames, and if they are not done, then the store gets in trouble. Register, phone, PCQ, plus all the other countless responsibilities, and you are telling me all CVS wants you to do is grab one label, one bottle, and count for one prescription? LMFAO.
 
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CVS workflow may seem more convoluted because input verification occurs at the final step, so incorrect fills based on data entry errors occur far more often at CVS than at Walmart, thus more RTS amber vials generated. RTS vials are tracked in the system too (thus the system prompts you to use specific RTS vials first; that's why there is a question about when you can't find the specific one). Also at CVS you have to do accuracy scan for every stock product that you use (so if the Rx requires 16 boxes of Duonebs you have to scan all 16 barcodes), whereas Walmart only requires scanning one bar code at filling (if you have to pull more you need to be careful). The requirement to scan every bar code is good because I have/had mentally challenged techs.

For some reason, CVS has the workflow set up of a dumba**. Input verification happens at the last possible step before the drug goes out to a patient. How does this even make sense? A script can be entered in completely wrong, and it goes throughout the entire workflow being prepared wrong, labeled wrong, wrong drug, wrong count, etc, and finally at the last step before dispensing to the patient is where it gets accepted or rejected because of an error that happened at the first step?

In a hospital you will never ever see a doctor put in an order, and us preparing an expensive IV bag, and finally then us checking the order only to realize the prescriber f*cked up the entire order. Same at Walgreens, you would never see them start preparing a medication to be dispensed without a pharmacist checking the prescription. Same at my independent, I never start filling a prescription until I make sure the prescription was correctly typed and verified.

CVS has it backwards. That's why there are tons and tons of RTS vials left from daytime. Whatever, I threw them out in the green bags. Not my loss. Expensive brand name RTS? Went in the garbage.
 
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That's not true. Say a duoneb has a quantity of 90 if the prescription calls for 360 the drug will be put on "single dispense" and then "duoneb #360 1 of 4" will pop up. You just have to make sure "single dispense" is checked on the drug. And at Walmart we will give patients multiple bottles. Say they have a rx for #90 omeprazole 40mg, we will put the stock bottles of 30 on single dispense, then the tech has to scan all 3 and put labels on each-we don't open all 3 and put them in a amber bottle. When a drug is on single dispense the labels will already print with "1 of 3" or whatever.

Sorry, the Duoneb was a bad example. I meant required as standard operating procedure. (It is good that Walmart actually incorporates printing of multiple labels for a prescription involving unit-of-use packages and packages that aren't broken like diabetic pens or nebulizer boxes).

As you saw from the quiz, at CVS you are supposed to pull enough product so that you don't end up short (otherwise this will mess up the on hand numbers when you go to OOS it) because you start filling after scanning your credentials. At verification, you will see the message "multiple packages scanned" at the product verification screen.

At Walmart, you can go back and pull more if you find you don't have enough, but you need to check your work. There is no "multiple packages scanned" message at visual verify. Instead you have to rely on your techs following SOP and putting the used stock bottles in the bag for you to inspect. For example with CIIs if the filling tech finds he doesn't have enough, the RPH is supposed to make sure the next used bottle has the same NDC (no accuracy scans involved).
 
Allegedly there was a cvs fined $10,000 per RTS vial that did not have proper expiration and lot number of the stock bottle. The supervisor had us take all the RTS vials off the shelf to correct the expiration date (cvs by default used to just put 1 year and now I think it's either 3 or 6 months for RTS vial expiration) and we also were suppose to write the lot numbers from the stock bottle. It was a major hassle and very time consuming. Some RTS vials did not have corresponding stock bottles so we had to strongpack them. The supervisor now audits the stores to make sure they continue to follow writing lot numbers and expiration dates on all rts vials. Also they expect us to peel off the original label and then apply the rts label. It was so much easier when we could just slap the rts label over the patient label. I have nearly broke a nail peeling off the patient labels. Also there have been several occasions when I find out the tech or rph applied the wrong rts label to the wrong vial, so the rts label says atorvastatin 40mg but inside the vial is actually citalopram 40mg.

Also some stores take all their RTS vials and throw them in the basket expecting the night rph to take care of them. They want us to print out several custom RTS labels for unlabeled vials and also return the medications back to the automation machine (these machines are either kl-60, script pro 100 or script pro 200) meaning you have to pull out each cell to scan the RTS vial and scan the med back in the cell. The script pro 200 can hold up to 200 drugs. Very time consuming to add each rts vial back to the machine. Also sometimes during the day the machine would break so the techs would manually count every thing by hand and then the machine gets fixed and starts to spit out 20 vials for scripts that were already filled by hand. Guess who they expect to return all those 20 vials back into the machine? Yup the night rph as if they have nothing better to do. Also techs will double count the controls that come out of the machines and sometimes they over count by 1 tablet so they will put that 1 tablet in the rts basket and expect the night rph to later add these overcount tablets back in the machine. Keep in mind it takes at least a minute or two just to add the tablet. You have to find the right cell and pull it out, scan the cell then scan the rts vial, type in pin (script pro) or use finger print (kirby) then visually inspect the contents of the cell then re-enter credentials (either pin or finger print). It gets easier as you start to memorize the location of each cell but they frequently add or delete cells due to preferred NDC changes.
It sometimes would be easier to take the loss on some of these RTS vials instead of having a night rph get paid 50-65/hour for 1-2 hours of returning HCTZs, lisinoprils, aspirins, ibuprofens, metformins, and amoxicillins back to the automation machine.
 
Allegedly there was a cvs fined $10,000 per RTS vial that did not have proper expiration and lot number of the stock bottle. The supervisor had us take all the RTS vials off the shelf to correct the expiration date (cvs by default used to just put 1 year and now I think it's either 3 or 6 months for RTS vial expiration) and we also were suppose to write the lot numbers from the stock bottle. It was a major hassle and very time consuming. Some RTS vials did not have corresponding stock bottles so we had to strongpack them. The supervisor now audits the stores to make sure they continue to follow writing lot numbers and expiration dates on all rts vials. Also they expect us to peel off the original label and then apply the rts label. It was so much easier when we could just slap the rts label over the patient label. I have nearly broke a nail peeling off the patient labels. Also there have been several occasions when I find out the tech or rph applied the wrong rts label to the wrong vial, so the rts label says atorvastatin 40mg but inside the vial is actually citalopram 40mg.

Also some stores take all their RTS vials and throw them in the basket expecting the night rph to take care of them. They want us to print out several custom RTS labels for unlabeled vials and also return the medications back to the automation machine (these machines are either kl-60, script pro 100 or script pro 200) meaning you have to pull out each cell to scan the RTS vial and scan the med back in the cell. The script pro 200 can hold up to 200 drugs. Very time consuming to add each rts vial back to the machine. Also sometimes during the day the machine would break so the techs would manually count every thing by hand and then the machine gets fixed and starts to spit out 20 vials for scripts that were already filled by hand. Guess who they expect to return all those 20 vials back into the machine? Yup the night rph as if they have nothing better to do. Also techs will double count the controls that come out of the machines and sometimes they over count by 1 tablet so they will put that 1 tablet in the rts basket and expect the night rph to later add these overcount tablets back in the machine. Keep in mind it takes at least a minute or two just to add the tablet. You have to find the right cell and pull it out, scan the cell then scan the rts vial, type in pin (script pro) or use finger print (kirby) then visually inspect the contents of the cell then re-enter credentials (either pin or finger print). It gets easier as you start to memorize the location of each cell but they frequently add or delete cells due to preferred NDC changes.
It sometimes would be easier to take the loss on some of these RTS vials instead of having a night rph get paid 50-65/hour for 1-2 hours of returning HCTZs, lisinoprils, aspirins, ibuprofens, metformins, and amoxicillins back to the automation machine.

We are no longer allowed to do custom RTSs to SPC (script pro) meds since it just adds to the list of RTSs in the M2. I essentially have to work backwards returning PHI labeled RTSs into script pro first before starting on all labeled RTSs...organizing before hand to avoid having to take the same cells out numerous times.

Is there anyway to help cut down the RTS list in M2? The day timers just carelessly throw away all the RTS labels so my store is a nightmare in terms of RTSs.

A tip on preventing duplicate SP vials....finish QV before looking back at QP, then go into SP pending scripts and delete all the Rxs manually counted out. It's worth the frustration of having so many PHI RTSs.
 
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Safe Production and Production Safety Quiz (** =correct choice)

1) While working at production you retrieve a label from a production basket for a quantity of 90 tablets. The stock bottles contain 100 tablets when sealed. What is the proper method for counting out 90 tablets?
a. Select one sealed bottle and one opened bottle, count out 10 from the sealed bottle and pour the remaining 90 tablets in an amber vial. Place the 10 tablets into the previously opened bottle and complete production
b. Select one sealed bottle and one opened bottle. Count out 10 tablets from the sealed bottle and pour the remaining 90 tablets in an amber vial. Place the 10 tablets back in the bottle in which they originated and affix and “x” on the bottle
**c. Select one sealed bottle and one opened bottle. Count the remaining tablets from the opened bottle, then open the sealed bottle to complete the count. Affix the newly opened bottle with an “x”
d. Select one sealed bottle and one opened bottle. Open the sealed bottle and count 90 tablets. Pour the 90 tablets in an amber vial and place the remaining 10 tablets into the previously opened bottle

2) You are filling a prescription for 90 tablets of a medication stocked in 30 count stock bottles. What is the proper method of producing this prescription?
a. Open 3 bottles and pour the contents directly into an amber vial
b. Open each bottle one at a time, count the contents, and add them to the amber vial
c. **Open all three bottles, pour the contents out on a counting tray to verify consistency, remove packaging material and desiccants, and then add the contents from the tray to an amber vial
d. All methods are acceptable as long as desiccants are removed prior to dispensing

3) During the Production process, a patient approached the counter at Pick Up. You have Accuracy Scanned and poured the medication on the tray. What is the proper action to take?
a. Continue counting the medication and complete the Prescription Production process by labeling the amber vial and placing it with a label in a basket, then proceed to the register to assist the patient
b. **Pause from counting and acknowledge the customer by making eye contact and stating that you will be right over. Complete the Prescription Production process by labeling the amber vial and placing it in a basket, and then proceed to the register to assist the patient
c. Greet the customer immediately. Stop Production and walk to the counter to assist the customer
d. Pour the tablets back into the stock bottle and greet the customer as you approach the counter

4) You are prompted to retrieve an RTS vial for a prescription, when you get to the shelf, you cannot find an RTS for this product. What should you do at production?
a. Bypass the RTS product, scan credentials and produce
b. **Bypass the RTS product, scan the stock bottle(s) retrieved, credential, and produce
c. From the RTS maintenance screen, reprint the RTS label needed, scan the RTS label, credential, and produce
d. A or C

5) While producing a prescription with multiple stock bottles, you pour tablets from an open bottle on the tray, emptying the bottle. What should be done with the empty stock bottle and cap?
a. Immediately throw the empty bottle and cap in the green bag
b. Place the empty bottle and cap on the countertop off of the Production Safety Zone
c. **Retain the cap and the empty bottle on the Production Safety Zone until the production process is complete
d. All actions are acceptable as long as the bottle is not reused

6) A label prints for 60 tablets of levothyroxine 25mcg. You walk to the stock shelf and find an open bottle that feels as though there are 60 tablets inside. How many bottles should be brought to production?
a. Just the opened bottle, since you believe there are enough tablets inside to fulfill the script
b. **One unopened bottle and one opened bottle
c. A and B are acceptable
d. None of the above

7) Which team member is accountable for adherence to the Production Safety Zone and the production process?
a. Pharmacy Manager
b. Pharmacist on Duty
c. Technician at production
d. **All of the above

8) Which of the following actions should never take place?
a. Combining two opened stock bottles to free up space on the stock shelf
b. Pouring the contents of an RTS vial into a stock bottle since the RTS label did not print
c. Producing a prescription accuracy scanned by another team member
d. **All of the above

9) A label prints for 30 tablets of atenolol 25mg. You retrieve an open bottle and a full stock bottle which you do not believe you will need, but want to be sure you have enough. What process will you follow at production?
a. Scan the label, scan the opened bottle, count the product, scan credentials to close accuracy scan since you did not need the second bottle
b. Scan the label, bypass accuracy scan since you know you have the right product
c. **Scan the label, scan the opened bottle, scan the second bottle, credential to close accuracy scan, produce with the open bottle
d. Scan the label, scan the opened bottle, count the tablets while leaving the accuracy scan prompt open, scan the second bottle if needed


Thank you.
 
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