Please take into consideration the opinion of a pharmacist who has come out on the short end of the Walmart QA program.
During my work as a fulltime Walmart floater in 2005-2006, I was charged with 4 errors and sent to Bentonville for the class.
I was not allowed a copy of the "mistakes", even though it would have been very simple to remove any PHI. Would there not be some value in being able to recall the errors that I was held responsible for?
The class that I attended was in 2007. During the final session, in one of many that was open to discussion, I asked the official Walmart Pharmacy Trainer about one of my mistakes. It occurred one Sunday morning, in a pharmacy where I had never been before, working with a tech who may or may not have been qualified to perform the job.
This is what happened. She cleaned the counting tray with alcohol, but she apparently poured it a bit on the heavy side.
I ask that you keep in mind that this is not conjecture, but rather the conclusion that the tech and I came to within a matter of minutes following the event.
By not allowing the alcohol to dry completely, a 10mg fluoxetine tablet did not make it all the way through to the bottle. The tablet, miniscule in weight anyway, stuck to the pouring side of the tray.
The next prescription, and I'm being 100% honest here, was also a white tablet. It seems that it was haloperidol, but it was 6 years ago and, again, I don't have any records to refer to. I had been a pharmacist for over 30 years on this given day, and my memory is usually quite good.
The alcohol dried after a few more seconds, and the force of the second drug pushed the single fluoxetine tablet into the next bottle, at the bottom according to the patient's father. It was labeled, including auxiliary labels, inside an amber bottle, handed to me for a final visual check.
This is what I find so interesting. The trainer's initial response, before even discussing the specific mistake, was that she had reviewed my file and that "some" of my 4 mistakes should never have been qualified and that I never should have been sent to the class. But, we were 2 hours from completion, so why worry?
She was questioned by another RPh who pointed out a specific sentence in the policy manual, which indicated that an error exists if medicines are mixed inside a bottle. She went on to say that no RPh can possibly be expected to notice a single wrong dose, especially of a product that is similar in appearance, inside a bottle of 30 other tablets.
Granted, I have almost always double-counted controlled substances, whether the Rx was filled by a tech, another RPh or myself. For non-controlled medications, that's different. I can appreciate that some techs would be offended by a RPh doing that. The quantity appeared to be approximately correct, and there was no reason to be suspicious. Certainly, Walmart policy does not encourage emptying out filled vials, as pointed out by the trainer. She mentioned that it was probably a one-in-a-million mistake, and expecting anyone to notice it was beyond any reasonable standard. To the best of my ability, considering the volumes of Rx's that I have checked during my career, it was probably the only time it occured in my previous 500,000 fills.
I firmly believe that one of the other mistakes that she objected to being qualified was my approval of a Vivelle Patch being input by a tech instead of a Vivelle Dot. Other than the shape, the products are identical. Granted, I can appreciate that a patient had a personal preference, but they were the same price, same delivery system and bioequivalent according to both the manufacturer and the FDA. So, was it serious enough to throw away my career, 4 years later?
I made very few errors over the next several years. I was never in trouble until late 2010. On that occasion, the district manager told me after the 3rd mistake that I shouldn't worry, because after all, the entire staff was working under an incredible amount of stress. The pharmacy manager had filled a very expensive Rx under her mother's insurance, but was in fact storing and consuming it from inside the pharmacy food refrigerator. She was falsely billing $479 every 21-24 days, as soon as allowed by ins, but always making sure that I was not working on that day.
I have made a lengthy list of irregularities that occurred during my 5+ years at Walmart, such as outright theft of at least $500 in customer refunds and regular theft of general merchandise. In my 5 years, she never once produced her employee discount card, another clear violation of Walmart policy, requiring an override every single time. She undoubtedly gave it to her brother, who lives 100 miles away. Space prohibits me from listing everything, but suffice it to say, that it was the only dishonest pharmacy environment in which I have ever worked.
As with the others, the 4th mistake was one of not catching an input error by a tech. It was a faxed Rx, printed out in great detail. Unfortunately, instead of prescribing Effexor XR 75mg, it was written out as Venlafaxine 75mg Controlled-Release blah, blah, blah. I don't recall the exact wording, but it was one occasion on which a doctor's program was more detailed than necessary, and unfortunately, both the tech and I failed to catch it. My bad, no argument.
What about the Minocycline 50mg Rx that was also entered erroneously? It was entered as 100mg 2 bid instead of 50mg 2 bid. It was placed on hold, and again, it was my bad. I did wrongly approve it.
This is where my argument comes into play. When this Rx was eventually filled, the Walmart computer flagged it as an overdose. The insurance flagged it as an overdose and would not allow an override. So, what did the other RPh do? She filled a quantity of 60 on insurance and convinced the young lady to pay full price for the other 60. Doing so was not something that happened in a matter of seconds. We routinely called insurance to try for an override. Additionally, it took time to convince the patient (and her mother) that the Walmart and insurance computers were wrong and that this was not a serious overdose.
Then, she did it again, the next month.
The 3rd time, I was on duty and started doing the same thing, but quickly realized how wrong it was. I apologized to the girl and her mother and gave her full refunds for the previous fills. These two women were freaked out! She had been made so sick that she had been vomiting every day, for 2 months! Because the other pharmacist insisted that it was correct! I was the only person charged with the error, because Walmart policy does not address the final visual process. At least, that's what the DM told me.
The 2nd mistake of this group of 4 was a Nitroglycerin Ointment .2% BID to anus. I wasn't even there on the day that it was brought in. I think most of you will agree that it's not a common Rx these days. It had to be ordered, only it was supposed to have been taken to a compounding pharmacy in the 1st place. The commercially made product is 2%, not .2%.
My job, on the day that it came in, was to check for accuracy. According to the pharmacist and the DM, had I approved it without checking at all, the blame would have been 100% on the other RPh. But, I did question it. She had input directions of "apply to arms twice a day" instead of anus. Why would anyone apply NTG to their arms?
I thought it was kind of cool that I caught the mistake, but because I did correct the directions, I was blamed entirely for it being the wrong strength.
I could tell so many more things, but I realize that this is way too long already. This is the bottom line. Walmart was at that time involved in the Supreme Court hearing over discrimination. This female RPh could have committed murder, and they would have stood up for her. I am the easiest person in the world to work with, except for dishonesty in the workplace. I have no prejudice against females. I do have issues with all dishonest pharmacists, techs, district and regional managers.
According to the DM, on the night that I was suspended, he and the Regional Manager had been "haggling" for 6 weeks with the Bentonville trainer over my mistakes from 2005-2006. That's right, 6 weeks arguing with a professional, corporate trainer, not over just one mistake but multiple instances.
I was charged with 4 mistakes and fired. The regional manager implied that he had no choice. So, why was I suspended and promised a fair review? Why did the DM tell me about the other 3 RPh's that he had recently protected from termination? The other RPh made 6 mistakes during the same time frame, but only 1 was reported. Don't forget that it's an honor system. The DM knew, but chose to turn his head.
I was fired on January 25, 2011. I have only been able to earn $30K during the last 18 months, and my heart condition precludes me from getting life or health insurance. COBRA eligibility is over, and the ACA doesn't allow me to get insurance until 2014, assuming that it's not repealed.They had the ability to disqualify any one of numerous mistakes, but they chose termination instead. Did I mention that she was demoted to staff pharmacist?
To the extent that the trainers have control, the program is valid. During the class, the trainer constanly reminded us that we were not being punished and that punishment played no role in the program. Outside of that room, the rules are flushed down the toilet, at any given person's discretion. I was the only pharmacy employee there to have a Customer Service Award. I was regularly scored at the top on my evals with respect to customer service and teamwork. On the final eval, I was criticized for not abiding by the 10-foot rule. Bull...
So, everything that's been written by others up to this point has been both right and wrong. It all comes down to the individual circumstances. They can play either side of the coin, and they most certainly do. Does anyone believe that an RPh with 20 years of excellent service would be fired for making 4 mistakes this year, in addition to 4 from perhaps 15-20 years ago?
I ask that this post not be deleted. I realize that it's controversial, but sometimes the truth hurts. It has devastated my life. The Colorado Department of Labor approved unemployment, stating that the tech to RPh ratio was illegally high, and that I could not be expected to meet such high standards under the circumstances. Walmart did not contest it. I collected all of $4,000. I didn't file initially, because the store's HR director told me not to, that I had violated company policy.
No employment lawyer in Denver will even allow me a consultation. Have you ever heard of dozens of lawyers refusing a paid consultation?
Thank you for your patience. I do appreciate it.
