New Pharmacist Having Trouble Verifying

[PharmCase]

Hi everyone. I just started and honestly I have no idea what I am doing. I currently work for cvs. I was hired only two months as a grad intern and never worked as a technician or intern during school. Are there any tips anyone can give me when verifying? I am having trouble figuring out what is important and what is not important when verifying. I want to be able to verify safely and effectively but everything always seems right to me and I am always left with doubt. What are the main things I can look for when verifying besides children's antibiotics. Are there any cheatsheets or documents anyone has that I can reference. I just don't want to do something stupid and lose my license over something stupid that I was unaware of. Any tips would be appreciated. Thanks!

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[Estrace]

And you spent 4 years in pharmacy school?

 

[pillpharmer14]

I had the same experience level as you when I started at CVS and yes it can be scary. First, if you're worried about losing your license over something stupid, pay the $200 for a mobile Lexicomp subscription. You can dose-check everything you're not familiar with (which should only be 10% of meds in retail). An added benefit is that lexi has a good catalog of available formulations and products for every drug, which is really helpful when trying to answer the daily question, "Does this drug/strength/formulation even exist?"

When verifying something that seems strange follow these rules:

Hit F5 to bring up profile

1. If they've had it before (for a reasonable amount of time) then its fine. This happens alot with drug interactions. If the same doctor has been prescribing the same meds for awhile and the patient is standing there looking at you, they're not dead and its fine. Things to watch out for with drug interactions are if the new drug being prescribed is from a new doctor/specialist who likely doesn't know the patient's meds. Only really need to pay attention to the interactions that are "Level 1 contraindications" or whatever CVS calls them now. If you have to speak to MDs about these say things like "Company policy requires me to call and notify the prescriber of this level of interaction before I can verify it." This saves you from the lecture from the MD about how commonly its used and how dumb you are for thinking its a serious interaction."

2. Keep in mind that your job at CVS is not to determine appropriateness, its to determine safety. When looking up abx doses for kids, check the max dose. If its under the max dose, verify it. Doesn't matter what the indication is.

3. If you look it up and think the dose/drug is wrong, call and left a message with the Doc. The nurses are the ones preparing most scripts so you'll usually have to do this several times per day. Sometimes you'll be on hold awhile, but luckily at CVS you'll find plenty to do while you wait.

You can always call another CVS pharmacist (who's been practicing longer than you). I'm sure you've met plenty through training and there are stores everywhere.

 

[bacillus1]

Only really need to pay attention to the interactions that are "Level 1 contraindications" or whatever CVS calls them now.

Be careful with this. This really depends on how good your interaction checker is. I don't work in retail, but I know our program sometimes lists lower-level interactions for things that are actually important (for example: amiodarone and colchicine, atorvastatin and protease inhibitors). We just admitted a guy because the MD and outpatient pharmacy didn't catch atorvastatin/darunavir interaction and the guy got rhabdo because PCP started him on 80mg/day.

 

[pillpharmer14]

Be careful with this. This really depends on how good your interaction checker is. I don't work in retail, but I know our program sometimes lists lower-level interactions for things that are actually important (for example: amiodarone and colchicine, atorvastatin and protease inhibitors). We just admitted a guy because the MD and outpatient pharmacy didn't catch atorvastatin/darunavir interaction and the guy got rhabdo because PCP started him on 80mg/day.

Good point. It definitely depends on your pharmacy/system. From my experience at CVS, I can't recall a serious interaction like that NOT being flagged as "Level 1 interaction / contraindication". I recall a CYP3A4 interaction with biaxin and alprazolam being flagged that way so it would probably flag the atorvastatin/darunavir one in the same way. Unfortunately at CVS there are lots of unnecessary ones that come up (non-level 1 kind of stuff) like metoprolol/lisinopril as a duplication because they are both antihypertensives. Thanks CVS

 

[rph3664]

I agree with Estrace. Are you for real?

 

[Estrace]

You had 2 months as a grad intern, I only had 2 weeks, no 10 days, of new pharmacist training when I started with Walgreens and never worked as a tech or intern during school either. What did you learn in that 2 months as a grad intern ? Didn't you learn about major interactions in school and on rotations? Don't you have a phone? there are free apps you can down to help you with interactions.....epocrates, medscape etc

 

[PharmCase]

I had the same experience level as you when I started at CVS and yes it can be scary. First, if you're worried about losing your license over something stupid, pay the $200 for a mobile Lexicomp subscription. You can dose-check everything you're not familiar with (which should only be 10% of meds in retail). An added benefit is that lexi has a good catalog of available formulations and products for every drug, which is really helpful when trying to answer the daily question, "Does this drug/strength/formulation even exist?"

When verifying something that seems strange follow these rules:

Hit F5 to bring up profile

1. If they've had it before (for a reasonable amount of time) then its fine. This happens alot with drug interactions. If the same doctor has been prescribing the same meds for awhile and the patient is standing there looking at you, they're not dead and its fine. Things to watch out for with drug interactions are if the new drug being prescribed is from a new doctor/specialist who likely doesn't know the patient's meds. Only really need to pay attention to the interactions that are "Level 1 contraindications" or whatever CVS calls them now. If you have to speak to MDs about these say things like "Company policy requires me to call and notify the prescriber of this level of interaction before I can verify it." This saves you from the lecture from the MD about how commonly its used and how dumb you are for thinking its a serious interaction."

2. Keep in mind that your job at CVS is not to determine appropriateness, its to determine safety. When looking up abx doses for kids, check the max dose. If its under the max dose, verify it. Doesn't matter what the indication is.

3. If you look it up and think the dose/drug is wrong, call and left a message with the Doc. The nurses are the ones preparing most scripts so you'll usually have to do this several times per day. Sometimes you'll be on hold awhile, but luckily at CVS you'll find plenty to do while you wait.

You can always call another CVS pharmacist (who's been practicing longer than you). I'm sure you've met plenty through training and there are stores everywhere.

Thank you pillpharmer14 this post was very helpful. I'll definitely use those tips. For all those wondering, I do know the major DDIs but CVS seems to flag a lot of DDIs that arent important at least I don't think they are and every time I verify I am left with doubt because of it. Also there is not a lot of time to be checking all these doses and all these interactions. CVS stores in my area are overloaded and I constantly feel rushed. So i was looking for a faster way to verify safely to be able to meet CVS standards.

 

[gwarm01]

Eh, I'm not surprised. Pharmacy school doesn't really teach you how to be a pharmacist, it just gives you the background knowledge. That's why its so important to work during school, or to get those intern hours in.

 

[PharmCase]

Eh, I'm not surprised. Pharmacy school doesn't really teach you how to be a pharmacist, it just gives you the background knowledge. That's why its so important to work during school, or to get those intern hours in.

Agreed. That is my biggest regret. I should have worked during school. At this point the technicians know more than me. It is really sad. Eventually, I'll get the hang of it. I hope.

 

[Estrace]

Eh, I'm not surprised. Pharmacy school doesn't really teach you how to be a pharmacist, it just gives you the background knowledge. That's why its so important to work during school, or to get those intern hours in.

As someone who also didn't work during school, I agree that pharmacy school doesn't teach you how to be a pharmacist, but it does give you the knowledge. I would have been more empathetic if the OP was asking questions about dealing with difficult customers, or insurance issues or senior techs who think they know more than the pharmacist. But as a pharmacist, knowing drug interactions is the most important thing you have over the techs. Even during my new pharmacist training, I never asked the pharmacist I was training under anything about drug interactions. I trusted my instinct and looked up anything I had doubts.. that's the only way to build confidence in yourself. There's no room for self doubt in this profession. I have apps on my phone and it doesn't take a sec to look up drug interactions. As a new pharmacist, safety comes first before speed. I made a total of 2 errors my entire first year as a pharmacist even with 6 months of floating. I was that careful and didn't let anyone push me. I even knew I was getting those 2 errors because that tech and I hated each other the week I covered shift at her store so she typed everything wrong and scanned multiple prescriptions under the wrong patients all week long.
I have over 7 errors this year alone with 3 years experience, go figure!

 

[Estrace]

Agreed. That is my biggest regret. I should have worked during school. At this point the technicians know more than me. It is really sad. Eventually, I'll get the hang of it. I hope.

Don't worry yourself too much, you will be fine. It took me about three months to comfortably walk into a store and not worry about working with a new tech. It's even better if you are not a floater, then your senior tech is your best asset at this point except he/she is one of those Nazi techs.

 

[gwarm01]

Expect some bumps along the way. It probably took me six months before I felt comfortable being alone in the hospital. You just never know what is going to come your way, and a lot of it will be strange and novel circumstances. Once you get a little experience and grow your confidence it will be okay.

 

[Son_Goku]

As someone who also didn't work during school, I agree that pharmacy school doesn't teach you how to be a pharmacist, but it does give you the knowledge. I would have been more empathetic if the OP was asking questions about dealing with difficult customers, or insurance issues or senior techs who think they know more than the pharmacist. But as a pharmacist, knowing drug interactions is the most important thing you have over the techs. Even during my new pharmacist training, I never asked the pharmacist I was training under anything about drug interactions. I trusted my instinct and looked up anything I had doubts.. that's the only way to build confidence in yourself. There's no room for self doubt in this profession. I have apps on my phone and it doesn't take a sec to look up drug interactions. As a new pharmacist, safety comes first before speed. I made a total of 2 errors my entire first year as a pharmacist even with 6 months of floating. I was that careful and didn't let anyone push me. I even knew I was getting those 2 errors because that tech and I hated each other the week I covered shift at her store so she typed everything wrong and scanned multiple prescriptions under the wrong patients all week long.
I have over 7 errors this year alone with 3 years experience, go figure!

I'm an intern right now and I'm experiencing this treatment... and maybe rightfully so. But when I'm fully licensed and I'm getting that treatment I wouldn't know how to respond. How did you deal with those types of Senior techs that think they run ****?

 

[farmadiazepine]

I had one day to train. Most CVS pharmacists who were interns have zero days to train. Why? ...because the company if f*cking dumb and cheap.

When I was a grad intern, my supervisor, (I loved her so much, she was the best, and the only reason I stayed with CVS for so long) had me go into one of her stores where we would fill 4300 to 4400 a week, and there were already 2 pharmacists working, and she just literally had me check for 8 hours. It was the best practice I ever had. The girl RPh who was working at the time gave me advice that I will never forget. She said, look at the refill number. This is not a blanket statement advice, so take it with a grain of salt because everyone will have a different opinion, but it is very general.. refills, once its the second and so on, just check and make sure the pills in the bottle match the pills on the screen. That's it!

Again, take it with a grain of salt, because I know like 50% of people on here will disagree or say another version of their own like always check every refill, or start doing that on the third and so on, or do it all the time except for narrow TI drugs, etc

 

[pillpharmer14]

I had one day to train. Most CVS pharmacists who were interns have zero days to train. Why? ...because the company if f*cking dumb and cheap.

When I was a grad intern, my supervisor, (I loved her so much, she was the best, and the only reason I stayed with CVS for so long) had me go into one of her stores where we would fill 4300 to 4400 a week, and there were already 2 pharmacists working, and she just literally had me check for 8 hours. It was the best practice I ever had. The girl RPh who was working at the time gave me advice that I will never forget. She said, look at the refill number. This is not a blanket statement advice, so take it with a grain of salt because everyone will have a different opinion, but it is very general.. refills, once its the second and so on, just check and make sure the pills in the bottle match the pills on the screen. That's it!

Again, take it with a grain of salt, because I know like 50% of people on here will disagree or say another version of their own like always check every refill, or start doing that on the third and so on, or do it all the time except for narrow TI drugs, etc

Yes this can save you a lot of time. But, it's important to remeber that 00 = first fill, 01 = first refill, 02 = when its ok to start blowing through the hardcopy image. Like farmadiazepine said, some will disagree with this practice but its never gotten me into any trouble. ALWAYS check the pills in the bottle. There was a discussion about his in another thread and it was scary how many people don't look at the pills.

 

[Estrace]

I'm an intern right now and I'm experiencing this treatment... and maybe rightfully so. But when I'm fully licensed and I'm getting that treatment I wouldn't know how to respond. How did you deal with those types of Senior techs that think they run ****?

I don't care how many years of experience a tech has, I'm still the pharmacist and I never let them run anything. I disliked a lot of senior techs in my district when I first started out because they were used to treating new grads like crap and I wasn't having it. I was lucky to have a few really nice ones on speed dial for when I was working with the Nazi techs.

 

[maria1oh]

Cvs in central ohio has given out visual verification trays to each pharmacy and pharmacists are required to pour ALL the pills out on the tray for visual inspection. It's required for EVERY rx and it slows things down a lot. I hope this is just pilot program....

 

[sosoo]

Cvs in central ohio has given out visual verification trays to each pharmacy and pharmacists are required to pour ALL the pills out on the tray for visual inspection. It's required for EVERY rx and it slows things down a lot. I hope this is just pilot program....

did the stores get more tech hours or more pharmacists hired to do the extra work?

 

[trailerpark]

did the stores get more tech hours or more pharmacists hired to do the extra work?

 

[NateRobinson]

PSA to pharmacy students in school right now: WORK DURING SCHOOL. Don't be a ****** who doesn't work and just thinks that everything will fall into place once you graduate. It doesn't work that way. You need to work to acclimate yourself with what goes on.

The interns who work during school and then graduate do 10x better than others.

 

[northeast-southwest]

PSA to pharmacy students in school right now: WORK DURING SCHOOL. Don't be a ****** who doesn't work and just thinks that everything will fall into place once you graduate. It doesn't work that way. You need to work to acclimate yourself with what goes on.

The interns who work during school and then graduate do 10x better than others.

This is true but also make sure you enjoy college to the fullest.

Also, "******"? damn. I dont think of myself as someone who cares about political correctness, but damn...

 

[Son_Goku]

This is true but also make sure you enjoy college to the fullest.

Also, "******"? damn. I dont think of myself as someone who cares about political correctness, but damn...

He's been thugging it out his entire life at CVS.

 

[pillpharmer14]

PSA to pharmacy students in school right now: WORK DURING SCHOOL. Don't be a ****** who doesn't work and just thinks that everything will fall into place once you graduate. It doesn't work that way. You need to work to acclimate yourself with what goes on.

The interns who work during school and then graduate do 10x better than others.

PSA to pharmacy students in school right now: If you're having a hard time handling the workload of school, but work a job anyway because this guy says to, you can flunk out and then your pharmacy experience is worthless. PharmD comes above all else.

 

[NateRobinson]

Haha, nope. I got C's and D's in pharmacy school. And yet, I'm still here working as an rph just like the rest of you. I worked 25-29 hours during school, made $$$$$, made connections, networked, my rxSUP loved me, my DM loved me, other sups and DM's loved me, I was guaranteed a job when I was a 4th year. They pretty much told me I would be a PIC when I graduate in any store I wanted. Bosses know the potential of good employees and will bend over backwards for you.

But go ahead, give the advice of the pharmD comes above all else. Lock yourself in a room all day, work 7 hours a week, study all day, shoot for an A++ only to get a B because professors make exams hard and impossible on purpose. See where that gets you. On your graduation day, make sure to give a high five to the person who did what I did but now has a job lined up anywhere they want while you sit there post your resume on every site on the internet, and then post on SDN wondering 'WHY CAN'T I FIND A JOB???????? PHARMACY IS SO SATURATED!!!!""

 

[Son_Goku]

Haha, nope. I got C's and D's in pharmacy school. And yet, I'm still here working as an rph just like the rest of you. I worked 25-29 hours during school, made $$$$$, made connections, networked, my rxSUP loved me, my DM loved me, other sups and DM's loved me, I was guaranteed a job when I was a 4th year. They pretty much told me I would be a PIC when I graduate in any store I wanted. Bosses know the potential of good employees and will bend over backwards for you.

But go ahead, give the advice of the pharmD comes above all else. Lock yourself in a room all day, work 7 hours a week, study all day, shoot for an A++ only to get a B because professors make exams hard and impossible on purpose. See where that gets you. On your graduation day, make sure to give a high five to the person who did what I did but now has a job lined up anywhere they want while you sit there post your resume on every site on the internet, and then post on SDN wondering 'WHY CAN'T I FIND A JOB???????? PHARMACY IS SO SATURATED!!!!""

I'm with you on the mentality of "C's get degrees" but which pharmacy school did you go to that D's were acceptable?

And lol at the any store. CVS are begging people to be PICs and which store did you end up selecting? What state?

 

[doublehh03]

Haha, nope. I got C's and D's in pharmacy school. And yet, I'm still here working as an rph just like the rest of you. I worked 25-29 hours during school, made $$$$$, made connections, networked, my rxSUP loved me, my DM loved me, other sups and DM's loved me, I was guaranteed a job when I was a 4th year. They pretty much told me I would be a PIC when I graduate in any store I wanted. Bosses know the potential of good employees and will bend over backwards for you.

But go ahead, give the advice of the pharmD comes above all else. Lock yourself in a room all day, work 7 hours a week, study all day, shoot for an A++ only to get a B because professors make exams hard and impossible on purpose. See where that gets you. On your graduation day, make sure to give a high five to the person who did what I did but now has a job lined up anywhere they want while you sit there post your resume on every site on the internet, and then post on SDN wondering 'WHY CAN'T I FIND A JOB???????? PHARMACY IS SO SATURATED!!!!""

Then the district you went to must suck if they would put you in any store that you wanted.

 

[doublehh03]

Hi everyone. I just started and honestly I have no idea what I am doing. I currently work for cvs. I was hired only two months as a grad intern and never worked as a technician or intern during school. Are there any tips anyone can give me when verifying? I am having trouble figuring out what is important and what is not important when verifying. I want to be able to verify safely and effectively but everything always seems right to me and I am always left with doubt. What are the main things I can look for when verifying besides children's antibiotics. Are there any cheatsheets or documents anyone has that I can reference. I just don't want to do something stupid and lose my license over something stupid that I was unaware of. Any tips would be appreciated. Thanks!

Go at your own pace.
1) Patient correct
2) Drug correct
3) Direction correct
4) Qty/refills correct
5) DURs (CVS system is really good at this so use your clinical knowledge - you just graduated so you should be fresh and compare)
6) Pills match

 

[farmadiazepine]

Always go at your own pace. It is not worth rushing, only to make a mistake. Thank God I am now working in a hospital, where every emphasizes DO NOT RUSH!

If you work for CVS, and are feeling overwhelmed, join the club. The best advice: leave. If you are working for another chain and feel overwhelmed, just give it some time because you are new, and it takes time to learn. In one year, look back, and if you feel the same way in a year from now, then you know you aren't in the right place for yourself.

 

[BMBiology]

Haha, nope. I got C's and D's in pharmacy school. And yet, I'm still here working as an rph just like the rest of you. I worked 25-29 hours during school, made $$$$$, made connections, networked, my rxSUP loved me, my DM loved me, other sups and DM's loved me, I was guaranteed a job when I was a 4th year. They pretty much told me I would be a PIC when I graduate in any store I wanted. Bosses know the potential of good employees and will bend over backwards for you.

But go ahead, give the advice of the pharmD comes above all else. Lock yourself in a room all day, work 7 hours a week, study all day, shoot for an A++ only to get a B because professors make exams hard and impossible on purpose. See where that gets you. On your graduation day, make sure to give a high five to the person who did what I did but now has a job lined up anywhere they want while you sit there post your resume on every site on the internet, and then post on SDN wondering 'WHY CAN'T I FIND A JOB???????? PHARMACY IS SO SATURATED!!!!""

All of that hard work and your reward is to work for CVS? Come back in a few years and tell us you still love CVS.

 

[pillpharmer14]

Haha, nope. I got C's and D's in pharmacy school. And yet, I'm still here working as an rph just like the rest of you. I worked 25-29 hours during school, made $$$$$, made connections, networked, my rxSUP loved me, my DM loved me, other sups and DM's loved me, I was guaranteed a job when I was a 4th year. They pretty much told me I would be a PIC when I graduate in any store I wanted. Bosses know the potential of good employees and will bend over backwards for you.

But go ahead, give the advice of the pharmD comes above all else. Lock yourself in a room all day, work 7 hours a week, study all day, shoot for an A++ only to get a B because professors make exams hard and impossible on purpose. See where that gets you. On your graduation day, make sure to give a high five to the person who did what I did but now has a job lined up anywhere they want while you sit there post your resume on every site on the internet, and then post on SDN wondering 'WHY CAN'T I FIND A JOB???????? PHARMACY IS SO SATURATED!!!!""

Haha I'm not discounting your logic here man, but I'm saying its a gamble. I definitely had people fail out of my class. Maybe working wouldn't have sunk me in school, but one poorly timed shift the night before a key midterm easily could've. Then repeat a year and spend tens of thousands? Big risk to gain a few extra bucks and approval of the almighty CVS sup (who might be replaced by the time you graduate)

 

[SClENCE]

Cvs in central ohio has given out visual verification trays to each pharmacy and pharmacists are required to pour ALL the pills out on the tray for visual inspection. It's required for EVERY rx and it slows things down a lot. I hope this is just pilot program....

This is the result of a fatal mistake in the region and is here to stay for the state.

 

[PharmaSex]

Make sure you get the days supply correct for all drugs, especially birth control and insulin. 28 days for most BC and calculate the days use of the pens. Round down if you don't get a whole number. Make sure they are exact! If they are not the insurance does not have to pay you for the claim. They can also pull back payments already made on the same script if they find the past refills are billed incorrectly.

 

[rph3664]

PSA to pharmacy students in school right now: WORK DURING SCHOOL. Don't be a ****** who doesn't work and just thinks that everything will fall into place once you graduate. It doesn't work that way. You need to work to acclimate yourself with what goes on.

The interns who work during school and then graduate do 10x better than others.

Even better advice: Get a job in a pharmacy BEFORE you enroll. That way, you will know before it's too late if it's really what you want to do for the rest of your life.

 

[BidingMyTime]

Absolutely work. Yes, school should come first, but there is no reason not to work during the summer and breaks at least.

This is the result of a fatal mistake in the region and is here to stay for the state.

I have not heard about this, are you able to provide any details? If this is a state issue, then why aren't all retail pharmacies doing this?

 

[Sine Cura]

You are supposed to verify the entire contents of the vial to check for commingling errors, especially for scripts filled via automation. Do not underestimate the ****tiness of techs who manage to commingle a single, completely different color tablet for a given fill, or manage to use gabapentin 800 for a gabapentin 600 script (G13 vs G31 imprint for the Glenmark generic).

Do I actually do it? 99% no TBH.

 

[SClENCE]

I have not heard about this, are you able to provide any details? If this is a state issue, then why aren't all retail pharmacies doing this?

It's voluntary as far as I'm aware and only implemented in a few states

 

[SouthernRetailRPH]

the verification trays are supposed to be used to all automation (robot) fills in all locations, but in my store at least they are not used

 

[brianuseruser]

Create your own method and stick to it. I look at name, then dob, drug name and strength, Sig, quantity written/dispensed, days supply refills, then Dr name. Finally, I open each vial and check the shape color imprint. If there's a dur our system requires it to be taken care of before the qa screen. Start to finished takes no more than 10 to 20 seconds a script assuming no issues.

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