Techs and C-2s

[rx1983]

Scenario I'm often running into as a floater that is getting frustrating: tech is handed a C-2 prescription by a patient; they refuse to fill it for any of several reasons and hand it back to the patient. The decision to fill or not to fill is the practice of pharmacy and to me the pharmacist on duty has to make this decision. Otherwise the tech is practicing pharmacy. I don't particularly care if the pharmacy manager has guidelines, it's still my decision when I'm on duty, not the tech's. Reasons for the tech's refusal range from "the PDMP website is down" to "you normally fill at the store near your home (same chain) not this one near your doctor" to various others.

Problem to me is techs see things as black and white. Another example is how early to fill a controlled substance... yes a store should have guidelines, like generally 2 days early, but this is a decision that requires professional judgment. If a patient is getting 150 Norco 10 and they've gotten them 2 days early for the past 4 months they should in theory have an extra 40 tablets somewhere and maybe then you don't fill until the day it's due and have a conversation. There are other scenarios where to me the prudent professional judgment may be to allow an earlier fill.

I think what I'm going to do as a floater is start setting my expectations as to how C-2s are to be handled at the start of a day at a new store because this seems to be a major issue some places. Other places most if not all C-2s are handed to me for me to check which I think is the right approach. Thoughts?

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[Sine Cura]

You should consult the RXM regarding your concerns and go from there,

 

[Dr Wario]

I have found that the best way to handle CII scripts is for the tech to bring every one to the pharmacist for a "stock check" and the rph can make the decision from there.

 

[rx1983]

I have found that the best way to handle CII scripts is for the tech to bring every one to the pharmacist for a "stock check" and the rph can make the decision from there.

Good advice, I think I'll just incorporate that into what I tell techs at the beginning of the day working somewhere new, and remind them as needed. Then if they go on to make their "well the way we do things here..." statements I'll gently remind them that it's my license and my professional judgment. This technician mentality is fed into by pharmacy managers who post notes around the pharmacy that say "Floaters: only fill controls 2 days early, only from local doctors, only who use this pharmacy regularly, etc." It's not the place of the pharmacy manager to dictate to other pharmacists how they are to practice pharmacy.

 

[trailerpark]

The store I work at lets anyone get anything as long as it goes through insurance. I put notes on things like 3 days early is this date so we can fill it then but then the other 2 pharmacists will just let it go or release it in spite of my notes.

 

[owlegrad]

Good advice, I think I'll just incorporate that into what I tell techs at the beginning of the day working somewhere new, and remind them as needed. Then if they go on to make their "well the way we do things here..." statements I'll gently remind them that it's my license and my professional judgment. This technician mentality is fed into by pharmacy managers who post notes around the pharmacy that say "Floaters: only fill controls 2 days early, only from local doctors, only who use this pharmacy regularly, etc." It's not the place of the pharmacy manager to dictate to other pharmacists how they are to practice pharmacy.

Ah how we love floaters who will fill anything and leave us with patients who think they can keep coming back and get their ridiculous scrips filled (and early to boot). Is it really so bad just to follow the pharmacy managers instructions? Why not just let the techs make your day easier and also you will fill less sketchy scripts? Plus make everyone's lives easier (except the drug seekers of course).

 

[Sine Cura]

At least one person in the world appears to enjoy exercising corresponding responsibility.

 

[Rouelle]

My techs don't turn people away without checking with me first. However, if they come to me and express concern about a C2 script, I take their concerns very seriously.

 

[rx1983]

Ah how we love floaters who will fill anything and leave us with patients who think they can keep coming back and get their ridiculous scrips filled (and early to boot). Is it really so bad just to follow the pharmacy managers instructions? Why not just let the techs make your day easier and also you will fill less sketchy scripts? Plus make everyone's lives easier (except the drug seekers of course).

Bottom line is it's my license so it's my decision. Did I say "I will fill anything." Nope, so stop putting words in my mouth. Yes it is bad to follow a pharmacy manager's instructions when doing so would result in refusing to fill a prescription for an 88 year old woman who wanted to get her prescription filled at the pharmacy near her doctor rather than the pharmacy closer to her home that she goes to more often. We have a central database and a PDMP to check, there's no reason to not fill for a patient like this.

I worked in another area of pharmacy up to last year where I didn't deal with controlled substances and coming back to retail it has been amazing to see how people treat their customers. You realize that you don't have a job if not for them, right? So stop treating them all like criminals. Do your due diligence and follow up when you see abuse but the 88 year old Grandma who had a fall and ends up with a norco script from an orthopedic doctor next door shouldn't be refused service.

 

[owlegrad]

Bottom line is it's my license so it's my decision. Did I say "I will fill anything." Nope, so stop putting words in my mouth. Yes it is bad to follow a pharmacy manager's instructions when doing so would result in refusing to fill a prescription for an 88 year old woman who wanted to get her prescription filled at the pharmacy near her doctor rather than the pharmacy closer to her home that she goes to more often. We have a central database and a PDMP to check, there's no reason to not fill for a patient like this.

I worked in another area of pharmacy up to last year where I didn't deal with controlled substances and coming back to retail it has been amazing to see how people treat their customers. You realize that you don't have a job if not for them, right? So stop treating them all like criminals. Do your due diligence and follow up when you see abuse but the 88 year old Grandma who had a fall and ends up with a norco script from an orthopedic doctor next door shouldn't be refused service.

Yeah it's your license. And it's the pharmacy manager that has to deal with running out of the med for their regular patients or having to deal with the irate "I filled it here last month!" patient. And it is also the pharmacies license on the line too - or are you not aware that pharmacies (not just pharmacists) have lost their license for dispensing too many controlled scripts? So yeah, it's not JUST your license on the line, is it?

 

[Sine Cura]

What exactly is the big deal about guidelines? They aren't immutable law.

Understandably techs follow what the manager says because they ultimately answer to the pharmacy manager, not you. Of all the things to play armchair quarterback about a store you're floating at, the fact that techs actively turn away controlled substances without pharmacist intervention (as opposed to letting everything through) would be the absolute last thing a typical floater would have a problem with.

Of course, insubordination should not be tolerated, so if you ask techs to do something, they shouldn't have a problem with it unless it's illegal or violates company policy. If it's a store you regularly float to, you should really bring it up with the RXM so everyone is on the same page.

 

[wagrxm2000]

Please remember as a floater the rxm is your boss when you are at their store. The techs are following the rxm's guidelines not yours.

I don't want this to become another who fills what and when thread but every store fills certain scripts. You brought up pharmacy hoppers, don't you think its important a patient fills at the same place in case of interactions?

You also brought up the 2 day early date. While everyone may have their own opinion here, there are going to be days when they may need an extra norco and they know they can fill two days early so they'll be fine. Clearly the md knows, they are prescribing aren't they.

Finally, this is the most important, don't piss my patients off or you won't be coming back to my store. I have to deal with them not you.

 

[Rukn]

Its your license so your decision

If you are floating, then the RXM/PIC/Pharmacy manager is not there, so its your call

Personally I want all C-II scripts to come to me before anything happens

The techs can give you their input, but its ultimately up to you ... you run the show ... no one can force you to fill anything, especially a pharmacy technician

 

[owlegrad]

... no one can force you to fill anything, especially a pharmacy technician

This is the opposite, he wants the techs to NOT send people away that would normally be turned away.

 

[Rukn]

This is the opposite, he wants the techs to NOT send people away that would normally be turned away.

That too

The point is that the techs shouldn't be making any decisions

All these scripts should come to you and then you use your professional judgement ... techs are there to help you, that is all ... you are in charge for that day

 

[maria1oh]

Several years ago the DEA cracked down on two cvs stores in Florida for dispensing too many controls. It was not the rph or sup that blew the whistle. It was a tech who reported it.

 

[Old Timer]

You have a discussion with the Pharmacy Manager before you go there again. You need to follow his/her guidelines. (Within Reason). But if the tech tells you "We don't fill for Dr. X" You would be giant elongated butt nugget to fill it. When I floated, the techs were my guide posts. If you want to see all controls, tell them at the start of the shift.....

 

[wagrxm2000]

That too

The point is that the techs shouldn't be making any decisions

All these scripts should come to you and then you use your professional judgement ... techs are there to help you, that is all ... you are in charge for that day

This is not the point, the tech is doing what they're told. If I walk in who do you think the tech will listen to?

The point is, many pharmacies want to make sure they are not on the dea's radar. So don't fill what I don't want filled, I know what's best for my pharmacy.

 

[pillpharmer14]

Interesting topic. I've had the opposite issue where techs literally don't even look at the script (to check if its in stock, too early, expired or was ever even signed) before spouting out "15min!!!" and throwing it at me. I'm willing to bet these technicians are the seasoned types who have been doing this for years and think that = PharmD. While I agree that its your decision ultimately to fill the script, some RXMs go to great lengths to not have their pharmacy turn into a CII factory. As others have pointed out there are legal concerns, inventory concerns, workflow and also customer service issues if you're out of stock when the regulars come in. I'm not really sure what the right answer is here because I see both sides. Obviously its a case by case issue, but I think speaking with the RXM is the first step.

 

[zelman]

If you want to have a good time floating, just let the techs do their thing. If I get to a store and the store pharmacists want birth control left in the wrapper, I verify it in the packaging. If they want it taken out, I verify it that way. If techs refuse service, I let them. You and your judgement should only get involved when you are involved. If a tech tries to fill Vicodin 5/300 when a patient got #180 Norco 5/325 yesterday, you stop that from happening when it gets to you. Not by babysitting everything that happens at drop off. When techs are doing what they have been trained to do, don't stop them. You'll just make them confused and worse at their job. If you think they were trained incorrectly, take it up with the manager.

 

[Sine Cura]

You also brought up the 2 day early date. While everyone may have their own opinion here, there are going to be days when they may need an extra norco and they know they can fill two days early so they'll be fine. Clearly the md knows, they are prescribing aren't they.

Scrupulous doctors anyway. The less vigilant ones send them off a week or more early or issue a whole bunch of scripts without "do not fill before" dates and apparently leave it up to pharmacies to police early fills because when you call the office "they" apparently don't have a clue, so the whole "my doctor wrote it today so why can't I have it today" excuse doesn't fly

 

[wagrxm2000]

Scrupulous doctors anyway. The less vigilant ones send them off a week or more early or issue a whole bunch of scripts without "do not fill before" dates and apparently leave it up to pharmacies to police early fills because when you call the office "they" apparently don't have a clue, so the whole "my doctor wrote it today so why can't I have it today" excuse doesn't fly

Let me rephrase, as long as its a good office they know what's going on.

My main point is the rxm knows their offices, if they think its legit I'd go with it. Also instead of declining it, why not make the call and find out if its legit. I can't leave a message on all the scripts that I have fill dates on.


My concern is these floaters causing problems I have to fix or bringing me new oxy patients that aren't being managed by their doctor correctly. A floaters job is to keep the pharmacy open until I come back not to fill every script that comes in recklessly. Also the techs know the area too, rely on them.

 

[FarmD711]

My store has strict rules for what CIIs we will fill. They are in place to protect the store, the pharmacists that work there, and our regular patients who depend on our stock. Floaters who disregard these rules are floaters that aren't welcomed back. Yes it is your license. The PICs license is on the line for everything that happens in the store, even that done by a floater. Don't like it? Feel free to stay home and not float in my store. I'll say though that we've never had a problem, our rules are fair, and floaters love working in my store (and we love having them).