Reckless QV2 speeds...you cant even see the pill!

[GP7777]

How are rphs so casually verifying #90, 180, etc, 540 pills with barely even a glance at the terribly blurry photos? Most don't even bother zooming in and spend about 3 seconds looking over 180 pills (60 pills a second? Really?)

I understand the technician scans the bottle before pouring out to count, but I'd assume that kind of defense wouldn't hold up if an error slips through and it gets legal between you/BOP/patient/employer as they would just point the finger at you and say it's your responsibility to spend as much time as you need to look at the photos to catch the error. I also understand a lot of rphs rely on shape and color, which again, is quite a meaningless defense once a significant error happens.

I've also seen the absolute worst photos that still get verified instantaneously with 0 concerns--90 pills bunched up all in one corner where you literally cannot see anything, or a label in front of the camera blocking 75% of the pills.

Can someone explain this concept, because frankly it sounds utterly insane.

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[owlegrad]

What’s the alternative, do you read the imprint on each tablet? After all, what if one of them is wrong?

In truth it is easy to get complacent. There is no “defense”, it’s just hard to be eternally vigilant and easy to start taking short cuts.

 

[JustFillIt]

How are rphs so casually verifying #90, 180, etc, 540 pills with barely even a glance at the terribly blurry photos? Most don't even bother zooming in and spend about 3 seconds looking over 180 pills (60 pills a second? Really?)

I understand the technician scans the bottle before pouring out to count, but I'd assume that kind of defense wouldn't hold up if an error slips through and it gets legal between you/BOP/patient/employer as they would just point the finger at you and say it's your responsibility to spend as much time as you need to look at the photos to catch the error. I also understand a lot of rphs rely on shape and color, which again, is quite a meaningless defense once a significant error happens.

I've also seen the absolute worst photos that still get verified instantaneously with 0 concerns--90 pills bunched up all in one corner where you literally cannot see anything, or a label in front of the camera blocking 75% of the pills.

Can someone explain this concept, because frankly it sounds utterly insane.

Are you a pharmacist? Have you ever worked in a pharmacy?

If not - your question is genuine and I would forward you to senior leadership to the national pharmacy chains as we really do not have a good answer for you. What was once within our control, is no longer in our control.

 

[GP7777]

What’s the alternative, do you read the imprint on each tablet? After all, what if one of them is wrong?

In truth it is easy to get complacent. There is no “defense”, it’s just hard to be eternally vigilant and easy to start taking short cuts.

What exactly are we verifying if #180 tabs are in the picture and we're spending 3 seconds looking at them? Isn't sending out the correct pills the most important part of the entire job? Seems to me if it gets legal all they do is show you the picture where you screwed up and all you can do is apologize but the damage is already done at that point.

Not an insult to you btw, it's just a safety issue that is frustrating to me. I have no alternative solution, just trying to understand why people would send out pills they can't even see.

 

[owlegrad]

What exactly are we verifying if #180 tabs are in the picture and we're spending 3 seconds looking at them? Isn't sending out the correct pills the most important part of the entire job?

Again, are you verifying the imprint on each tablet? If not, how do you know if they are correct? Where exactly do you think the line should be between reading the imprint on each pill and just glancing at a picture of hundreds of pills?

By the way, what system are you referring to, out of curiosity?

 

[WVUPharm2007]

What kills me are the DUR entries that just read "approved" or something like that. There was this one floater that would type "not clinically significant" for everything. Even if it was clearly clinically significant. Like being on Xarelto and Eliquis at the same time from different physicians as a good example. It's like...why are you even here? You can't even reconcile the errors the computer catches for you correctly. Or at all.

 

[RxPreceptor]

Seems reckless for those of us with strong memories, good nearsighted vision, and ages of experience/knowing product like the back of one’s own hand.

Product review speed seems to vary quite significantly between new hires and veterans. Seriously laughing my ass off when floaters start complaining about tablets not being center enough in the picture….><

 

[footfairy]

What kills me are the DUR entries that just read "approved" or something like that. There was this one floater that would type "not clinically significant" for everything. Even if it was clearly clinically significant. Like being on Xarelto and Eliquis at the same time from different physicians as a good example. It's like...why are you even here? You can't even reconcile the errors the computer catches for you correctly. Or at all.

Do you mean only serious DUR entries?

I ask because with Walgreens the system puts major clinical interaction on insane things. It will pull allergies/intolerances from the prescriber side and then I'll literally have to approve 8 "MAJOR INTERACTIONS" on each drug in the patient profile because the patient has lactose/milk/mill-derived/dairy intolerance (yes it will list multiple versions of the same allergy).

It feels like 95% of my overrides are things like that or opioid/benzo when it's from the same MD and it's been documented for 2+ years.

 

[WVUPharm2007]

Do you mean only serious DUR entries?

I ask because with Walgreens the system puts major clinical interaction on insane things. It will pull allergies/intolerances from the prescriber side and then I'll literally have to approve 8 "MAJOR INTERACTIONS" on each drug in the patient profile because the patient has lactose/milk/mill-derived/dairy intolerance (yes it will list multiple versions of the same allergy).

It feels like 95% of my overrides are things like that or opioid/benzo when it's from the same MD and it's been documented for 2+ years.

CVS makes you manually override serious interactions and write a little summary of why you decided to override. Some are stupid like a normal, incremental dose increase. Or being on like Wellbutrin and Cymbalta at the same time. Others are legitimate and require intervention. What I'm saying is that there are people I've seen blow by a lot of stuff that should at least require talking to the patient quickly all the way to potentially dangerous interactions.

 

[GP7777]

Seems reckless for those of us with strong memories, good nearsighted vision, and ages of experience/knowing product like the back of one’s own hand.

Product review speed seems to vary quite significantly between new hires and veterans. Seriously laughing my ass off when floaters start complaining about tablets not being center enough in the picture….><

Your excellent memory, eyesight, and knowing what the product is supposed to look like don't matter when your tech gives you 90+ tiny white pills where no rph can see anything. I'm sure you can see some of them, but for those tiny white pills I guarantee you cannot see most of them. Are you gambling when you send out #180, #540 without making an honest effort to look at all the pills?

By the way, we're going to be 100% correct most of the time without even looking at a single pill. Eventually we will be wrong though. Seems like common sense that the less time you spend checking the pills, the more likely some error slips through .

 

[owlegrad]

Why won’t you tell me if you read the imprint on each pill or not? That’s the only way to know!

Actually even the imprint could be wrong. Better break out the mass spectrometer and make sure it’s the correct active ingredient.

 

[JustFillIt]

Your excellent memory, eyesight, and knowing what the product is supposed to look like don't matter when your tech gives you 90+ tiny white pills where no rph can see anything. I'm sure you can see some of them, but for those tiny white pills I guarantee you cannot see most of them. Are you gambling when you send out #180, #540 without making an honest effort to look at all the pills?

By the way, we're going to be 100% correct most of the time without even looking at a single pill. Eventually we will be wrong though. Seems like common sense that the less time you spend checking the pills, the more likely some error slips through .

Look - you mention common sense, so I am going to share a little myself.

You are acting like everyone is out of line for not being thorough because we are, “moving to fast” or something if the sort. I suggest one of two things:

1) Work at an independent pharmacy that subscribes to your point of view. Because this is simply not an option at a chain pharmacy.

2) The things you say (to sift through every pill and ensure that every pill is individually checked to ensure accuracy) is simply not possible in chain Pharmacy. Talk to senior leadership and tell them your feelings - not us.

We all know that we are moving too fast in chain pharmacy. The reason why we are moving too fast is due to the fact that if we do not move fast we will simply loose our jobs.

I am guessing you either work at an independent pharmacy that allows you to take this position and you are now in a position to speak to your peers in a condescending way - OR you work in chain retail and your peers/management is breathing down your neck due to not moving fast enough and you are now venti g your frustrations here. Which one is it?

I am sorry that the current state of pharmacy sucks a** and all of the principles which we once stood by have been thrown out the window like a bucket of sewage in one of those poverty stricken cities in India…. But it is what it is..

Stop acting like you have more common sense than any of us that are simply trying to survive.

 

[Dred Pirate]

I don't work retail any more, but I can give my point of view.
1. When I did moonlight, I would open the bottle (we didn't do this virtual verification BS) I would check one pill against the standard, and just shake the bottle to see if they all looked the same.
2. When I check pyxis refills, I would read the label on one or two vials, and do the same. If all the vials looked the same, I called it good.

Could I miss the one odd pill/vial that looked similar, yes- but time simply doesn't allow one to check every single pill, especially in the retail world were you are checking 30 scripts an hour with 90/180/270 pills per fill. You have to strike a reasonable balance if you want to maintain any sanity.

 

[RxPreceptor]

Clearly not an RPh posting and/or zero real world experience

 

[mentos]

What kills me are the DUR entries that just read "approved" or something like that. There was this one floater that would type "not clinically significant" for everything. Even if it was clearly clinically significant. Like being on Xarelto and Eliquis at the same time from different physicians as a good example. It's like...why are you even here? You can't even reconcile the errors the computer catches for you correctly. Or at all.

That's impressive. It takes a bit of effort to type "approved" or "not clinically significant". I was used to seeing "ok".

 

[mentos]

View attachment 355230let’s play a fun game called how many different meds you can spot

Ibuprofen and metformin?

 

[RxPreceptor]

If you can’t read imprints simply reject Rx…OP acting like it’s not an option

 

[Dred Pirate]

educate the stupid hospital pharmacist. Is this all taking place at your current store, or are you verifying for offsite fills? If it is your store, why don't you just look at the actual pills?

 

[steveysmith54]

You hope for the best. In this case, yes hope is your strategy.

 

[Rainbowdash]

educate the stupid hospital pharmacist. Is this all taking place at your current store, or are you verifying for offsite fills? If it is your store, why don't you just look at the actual pills?

Nope. Pills are already in the waiting bin...hopefully, with a label attached (I've seen things...) You verify off of the picture... :-(

 

[Dred Pirate]

Nope. Pills are already in the waiting bin...hopefully, with a label attached (I've seen things...) You verify off of the picture... :-(

god that sounds like a horrible process. I remember my days it was just like an assembly line - you have the stock bottle, the paper rx, the filled bottle all in a basket - and I cranked them out - I could easily do 30 an hour in addition to the counseling, questions, etc and really never felt rushed. (I had like 4 techs thou). This new process just sounds like errors waiting to happen,

 

[RxPreceptor]

Yeah, plenty of backlash when this first was Implemented. Calibrating cameras and adequate/proper training go along way. The crappy picture posted does not portray what is typical (absolute garbage). System allows RPh to zoom in and out if needed and having perspective from doing RPh and tech work from doing overnights gives proper insight when going over picture taking training with techs…system allows for commentary with feedback notes as well with rejections

It is what it is

 

[masterdix]

Ibuprofen and metformin?

Close! Metformin and potassium. Saw the random stray after pressed the final button as the screen faded away and had to dig it out of the bins to double check my eyes