20/20 show on prescription errors...airs FRIDAY

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I watched the 20/20 segment last night and was flabbergasted by the one Walgreens employee who did not even know that she had made a mistake till she was contacted by an attorney THREE YEARS LATER!! If I had made a mistake, I would want to know right away so I could make sure to re-evaluate my process or figure out what needs to be improved.

The quality assurance and error reporting needs to be mandated by pharmacy organizations because there is NO incentive for each pharmacy retail chain to report how many errors are being made. To the contrary, they will be making themselves look bad by reporting each and every single one. Giving out someone's meds to an entirely different person is also a serious error that I have seen being treated nonchalantly in too many a store.

The viewpoint that pharmacists should just slow down and not care what your DMs or upper management say is too simplistic. There is too much pressure (especially as a pharmacy manager) to keep things moving and not have customers waiting for a long time. The retail chain spokesperson in the 20/20 show kept reiterating that "patient safety is our number concern" but in retail, they are not even considered "patients" - they are "customers" because the number one concern is not safety, it is "profit profit profit".

As a pharmacist, I was ashamed to watch the segment last night. There definitely needs to be change in the retail sector of our industry. We feel like we need pats on our backs because we catch errors and interactions - but dammit, we go to school for 6 years and train to do this very job!!!! It's not an extra aside to filling every prescription, it's part of our job. And we are human, and errors will be made, but we at the very minimum need to know the rate and kinds of errors that are being made.

Okay - I will get off my soapbox. I left retail because I felt the support from upper management was lacking and I felt like I was treating all of my "patients" as a number in a line - so I gave up and went to hospital. But for those of you still in retail - there really needs to be some serious changes made in staffing more pharmacists (and not technicians) and in quality control of the kinds of technicians hired.
 
Da Alchemist said:
Im just curious. why can't pharmacist get fired if their "boss" complains about them being slow on daily routine. Is it that hard to replace a spot? will the boss ignore the pharmacist's slowness everyday they work? forever? If a pharmacist works with a slow tech. would the pharmacist work with this tech every day? forever? what is the difference?
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Unfortunately, it is that difficult to replace a pharmacist. At least that's been my experience. This one pharmacist I work with is extremely slow. And I don't mean that in itself is what makes him not a very good pharmacist. He still makes mistakes, leaves tons of work for the night pharmacist (like leaving all the C2's that he's gotten over the course of the whole day for the night pharmacist to fill, that's not very nice), is not very good dealing with the patients. A couple of them just come in when the one of the night pharmacists are there because they don't like dealing with this pharmacist. His scores are very very low (which supports my argument that the company does not care about your scores! It's just a psychological thing they use to try to make you work faster so they won't have to get more help!). Once, my night pharmacist filled more scripts on her own without any help than this pharmacist filled while he was working during the day with lots of help (about seven technicians and another pharmacist). He's been working this way at my current store for about two years.
 
Cocogirl said:
I watched the 20/20 segment last night and was flabbergasted by the one Walgreens employee who did not even know that she had made a mistake till she was contacted by an attorney THREE YEARS LATER!! If I had made a mistake, I would want to know right away so I could make sure to re-evaluate my process or figure out what needs to be improved.
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I totally agree with you. It is ridiculous to think that it took three years to find out you made a mistake and unrealistic to think you will remember that exact prescription three years later.


Cocogirl said:
The quality assurance and error reporting needs to be mandated by pharmacy organizations because there is NO incentive for each pharmacy retail chain to report how many errors are being made. To the contrary, they will be making themselves look bad by reporting each and every single one. Giving out someone's meds to an entirely different person is also a serious error that I have seen being treated nonchalantly in too many a store.
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Pharmacy organizations have no power over any pharmacy or pharmacist. They are mearly advocates for the profession. What really needs to be done is the passing of laws in all states that make it okay and not punishable to report errors to protect pharmacists. After all, why would anyone one to implicate themselves and put their jobs in jeopardy. In Florida, such a law has passed that allows this. Pharmacists are required to keep a history of "Quality Related Events" and show what they have done to improve quality and safety to make sure the error does not happen again. I


Cocogirl said:
The viewpoint that pharmacists should just slow down and not care what your DMs or upper management say is too simplistic. There is too much pressure (especially as a pharmacy manager) to keep things moving and not have customers waiting for a long time. The retail chain spokesperson in the 20/20 show kept reiterating that "patient safety is our number concern" but in retail, they are not even considered "patients" - they are "customers" because the number one concern is not safety, it is "profit profit profit".
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The only pressure one faces is the pressure one puts on themselves. Many pharmacists do not have any backbone whatsoever to do what is right and the profession is plagued by this. I thought interviewing the NACDS chairwoman was an appropriate choice, but it was clearly obvious she was not trained to perform interviews. Instead of saying "I don't know the whole story", she should of said something with an admission of guilt with a promise to work on this. Fact is, quality control is a serious issue that needs to be dealt with instead of sitting on our hands. Numbers should not be made public, but some sort of tracking system should be in place as it is in Florida. Publix is a model pharmacy chain for this. All of their pharmacies are required to report any errors made. This is to stay within accordance to Florida law, and they did not have to roll it out to the other states they are in. But they did and the chain is better off for doing so.

Also, how many here are guilty of saying signing the logbook is just a way to keep track of who picked up what instead of saying you're signing that we did offer you counsel you on your medication? I know I am guilty of doing it from time to time. I think John Gans, CEO of APhA could of done a better interview than the NACDS lady.


Cocogirl said:
As a pharmacist, I was ashamed to watch the segment last night. There definitely needs to be change in the retail sector of our industry. We feel like we need pats on our backs because we catch errors and interactions - but dammit, we go to school for 6 years and train to do this very job!!!! It's not an extra aside to filling every prescription, it's part of our job. And we are human, and errors will be made, but we at the very minimum need to know the rate and kinds of errors that are being made.
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No need to be ashamed. If anything, hopefully it will highlight some major issues that need to be changed within the retail industry. Plus it provides the perfect opportunity to bring pharmacists into more "direct patient care" that we have been fighting for for some many year, but of course thats if chains really want to change their model. More pharmacists need to be out talking to the patient. That is THE best way to catch errors.

Cocogirl said:
Okay - I will get off my soapbox. I left retail because I felt the support from upper management was lacking and I felt like I was treating all of my "patients" as a number in a line - so I gave up and went to hospital. But for those of you still in retail - there really needs to be some serious changes made in staffing more pharmacists (and not technicians) and in quality control of the kinds of technicians hired.
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Apperently you have a backbone and did something about your situation. Congratulations. We need more people like that.
 
seriously, could that post have been any longer?
 
sdn1977 said:
Sorry gaba - just clarifying. But...the BS pharmacist won't fade fast - the last class graduated in 1999. So...a little arithmetic, that 25yo in 1999, working for 30 years....hmmmm may retire in 2029. We'll have them for awhile & they need to have particular respect paid since they really are the end of a particular time - at least for now (altho our educations were the same).

I've never worked for a non-pharmacist DM, so I don't know your circumstance.

But.....I've worked for a** who are PharmDs - both as dms & dops - if they're bad......imo, the degree doesn't make them any better. They are just poor managers of people. Not everyone is suited to that job (just like instructors) & if you've got a bad one....its awful!! That - I've encountered!
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I was not aware 1999 was the last class to have a BS Pharmacy degree. Glad to know! 👍 SDN, sorry to hear about your awful experience. Perhaps I am wrong (and perhaps someone can find statistics on this??) but don't most upper management (DM, DOP, retail chain managers) NOT have pharmacy degrees?? If that IS the case (most upper management lack PharmD/BS Pharm), then SDN your case (awful upper management ppl w/ the same degree as you!) is just sad but a minority...suggesting the root of the problem could be that these upper management ppl have never gone thru pharmacy school to work/iintern as a pharmacist and feel the pressures of retail pharmacy and hence, are less (if at all! :laugh: ) responsive to your constant complaints of more help and better help, the errors that accompany "faster faster!" etc...I'm NOT saying having a PharmD/BS Pharm upper management makes everything better 100% but what I AM saying is that things will definitely improve. Plus, it sucks to have to answer to a @$$hole of an upper management who breathes down your neck and does not treat you well when you went thru extra yrs of schooling to get that higher degree and this @$$hole went to some community college and maybe transferred to some state school for 1 yr to get some masters or business degree or something (I don't know what's required to get the upper management positions)--should respect the pharmacist, who knows best on how to safely manage pharmacy, etc . 👍
 
sdn1977 said:
What is the worst that could happen? Your DM comes and says you're too slow - ok.....next! Your store manager says you're too slow......tough s*#t!

Are they going to fire you? Aaaah - not probably - who will they replace you with? Will you not get your bonus??? - ok you can live with that if you can live with your own timing every day you work.
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Sorry if it was confusing. But what i meant was, if the DM says you're too slow the store manager says your too slow. They might not fire you on the first occasion right? But if they noticed that you don't meet the requirements concerning the work tempo(lol 4give me if my vocabs are wrong english is not my primary) and told you many times you're slow. You will eventually get on their bad side and when you get on their bad side can't they afford to replace you with another pharm.d? Now, about the pharm.d and pharmtech case, I was only using that as a sample because a pharmtech can be slow at start but if the pharmtech keeps it that way then eventually the pharmacist will do something about it just as the DM will also with the pharm.d?
 
There are a number of issues which are difficult to sort out-

As Caverject mentioned - there is no one organization which is responsible for accumulating, recording & reporting all drug errors. The ISMP does its best to make those which are reported to them known to those of us in the business, but again....its on reporting.

Recognize - there is no ONE regulatory authority over pharmacy at all. It is regulated by 50 different entities. So, you take a corporation like Walgreens which might operate in 40 of those states....they must comply with each state's regulations about drug errors, but they have their own internal drug incident report.

I have never worked anywhere where there has been a punitative drug incident reporting system. We are always encouraged to report when one occurs. However, it relies on the individuals to do the reporting. These are also proprietary. The incident reports are never reported to anyone else unless it involves a drug adr which was previously unknown or unreported or a malfunction of equipment. This makes complete sense - these are legal documents & should not be made public. However, in all my places of employment, the incident reports were shared, in a general fashion, among the staff in an effort to educate.

Which leads to the second issue - the individuals within pharmacy. Many, many pharmacists are like sheep. They will do what they're told, when they're told to do it & they won't openly complain or offer suggestions. Most of them don't actually want to be part of a solution either. They just want to go to work, get their shift done & be gone. Many don't want to be involved with patients so they put their tech or clerk out there in the front. Studies have documented, fewer people will sue in med mal cases when the practioner making the error is open, honest & communicative with the pt.

Some will complain about work being left, without acknowledging the stresses which occur during the day which resulted in work left. Perhaps, the better method is to only accept those rxs you can fill in your shift. This comes back again to pharmacists controlling the environment. Techs are the ones who often accept the rxs & often without knowing if the drug is in stock, the rx has "issues", there are particular problems with the dosing, etc...then promise something which cannot be delivered. It has taken me 2 years to retrain my technician to actually "read" the rx before committing me to it. Again - a different mentality.

Some of these "best" sheep learn how to climb the ladder & become management. Not all managers are bad - but the bad ones are very, very bad. Its good to learn how to work with them, because, everyone above pharmacists will be someone other than a pharmacist - the CEO, CFO of a hospital is not likely to be a pharmacist.....the CEO of XYZ Retail Pharmacy may or may not be a pharmacist. They are not usually the problem - it is the middle managers who like to "boost" their numbers - on your back!!

Cocogirl - how is slowing down simplistic??? I don't get it - if you can't do the work well & keep your sanity....why not slow down so you can? When I work retail, each & every patient is my patient - not my customer - I don't care what my corporation says. I can appreciate you not being able to find it in yourself to determine the sanity of your day because I also left a job due to staffing - it was a hospital job I had for 20 years. So....landing yourself in a hospital doesn't keep you immune from staffing issues. You just know faster when you kill them - because you can hear the code called.

Gaba - you're not going to change the corporate structure. But, you can change the environment which dictates our profession. Caverject mentioned the changes within Fl. In CA, it took years, but the corporations now have to pay us overtime for working >8 hrs & they MUST provide a lunch (which means - you leave the pharmacy for lunch). It is at our discretion to close the pharmacy to accomplish this. In our state, we had lots of evidence to document that long, uninterrupted hours & the inability to have a defined time to eat & rest led to increased errors. I know pharmacists who still refuse to take their breaks & this is at the expense of the rest of us.

But - this takes years of pharmacists getting involved and lobbying. In CA, we actually had to battle APhA, ASHP, CPhA & CSHP since they were all against the legal changes which were improvements for pharmacists (they are on the side of hospitals & corporations for the most part).

But....as an individual - stand up & say "no more. I don't care what your "clock" says...I don't care if I have to leave rxs"....as long as you've done your job your whole shift & done it well - you cannot be responsible for more work than you can handle. What I can handle & what someone else can handle may be different, but there are indeed markers - one pharmacist with one tech can comfortably do 150 rxs/8hrs, sometimes more, sometimes less.

You don't have to be angry, mean, use poor language - just honesty. I cannot do this many rxs at this pace - simple (perhaps simplistic, but when it comes to filling an rx wrong - it is just that simple).

I, also, am not ashamed. I have made my share of mistakes & they are awful! We indeed are humans, but - we have the ability to control our environment & we should do what Coco & I have done - work to change the environment & if it can't be changed - leave it. Then.....speak openly about why you did when asked. (Don't get me wrong - I don't believe in randomly smearing a business!!)

I agree with Caverject - pharmacists should have a backbone - not just in finding their place within healthcare - but being strong within the most visible part of our professsion - retail. Until we find our own individual voices....you'll always "worry" about that clock ticking.

Good luck! The profession is only what you want to make of it and you control the kind of pharmacist you want to be.
 
Da Alchemist said:
Sorry if it was confusing. But what i meant was, if the DM says you're too slow the store manager says your too slow. They might not fire you on the first occasion right? But if they noticed that you don't meet the requirements concerning the work tempo(lol 4give me if my vocabs are wrong english is not my primary) and told you many times you're slow. You will eventually get on their bad side and when you get on their bad side can't they afford to replace you with another pharm.d? Now, about the pharm.d and pharmtech case, I was only using that as a sample because a pharmtech can be slow at start but if the pharmtech keeps it that way then eventually the pharmacist will do something about it just as the DM will also with the pharm.d?
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Righty - my circumstance is not the same as everyone else's...but my store manager has no authority over the pharmacy - NONE!

I'm accountable to my dm only.

Now....if I'm slow....someone else will have had to report that. The dm doesn't much care what pts say - they hear pts whining all the time - ok - they move on.

What they do care about is how the pt was treated - if the pharmacist was slow - did they apologize for the delay in when the rx was promised? If they did - no problem. If they told the pt to shove it, now the pharmacist is in trouble (however...I have done this - long store & involved MS IR in an addict....a story for another thread).

If the dm heard about it because another pharmacist reported it...or the pharmacy manager reported it....there would be more investigation. Why was the pharmacist slow? Because he/she was new, ill, pre-occupied, without regular ancillary help? All these are things which require employee intervention first.

The one time I know a pharmacist was "let go" - not actually fired - but my pharmacy manager would no longer allow that pharmacist to work in our facility, was when she previously could do the work without problems. Then, she started having issues - very, very slow, leaving lots of unfinished business, leaving the pharmacy a mess.....she was suspected her husband of an affair, was in the middle of a house remodel, had teens who were dancing on the edge of trouble & spending far too much time on the telephone on unrelated pharmacy business.

She was "let go" because she was a mistake waiting to happen - not because she slowed down.

Tech issues are a bit easier. As a pharmacist, I am their supervisor, so I can educate them or move them to a different area until they become skilled enough to rely on them.
 
SDN1977 and Caverject - thanks for your responses! I had no idea about the regulatory processes overseeing retail pharmacies so it is indeed enlightening for me to learn how complicated the process really is.

I can't speak to other people's experiences in retail, but for me it was my first job out of school at a young age (25), but the tendency is for a new eager grad to want to succeed in their new employment. When "success" in a retail environment is defined by how many prescriptions you are able to complete with minimal help, it creates either a spoken or unspoken (depending on where you work) pressure to do "more, more, more". I think at that point in your career, you are emulating the pharmacists around you that you know and respect, who may not be the ideal role models - since they are also following the retail model of multi-tasking up the wazoo (talking on the phone to the MD fixing mistakes, providing directions to techs about insurance problems and checking prescriptions the whole while). I think that some of the onus to "slow down" needs to be a directive from upper management by providing more staffing -more pharmacists and support for their store. You can do the best you can to slow down - but my point is simply that there needs to be recognition from the power figures deciding the staffing hours for your pharmacy that the potential for errors is rising exponentially with the workload you place on your pharmacists.

I know a lot of pharmacies have internal error reporting but I don't see any reason why this needs to be kept confidential. The concept of ISMP and learning from each others' mistakes is a great one. The model i have now seen in hospital (although I'm still in residency phase) has been an excellent one. Non-punitive error reporting will I'm sure drastically help reduce error rates (not that we even know what they are right now!).

Thanks for the input and keep it coming - I'm learning tons from all this! 🙂
 
My company actually requires to call in errors to the incidence/error reporting line. I think that the amount of mistakes that you make depends on the staffing conditions and competency of the techs. In my practice as a pharmacist I have made numerous mistakes mostly when I was overworked in understaffed pharmacies. Check out my last entry at my weblog at www.xanga.com/rphgirl!
 
In California, if there's only one pharmacist on duty, you can only have one tech. If there are two pharmacists, then you can only have three techs. Most pharmacies I know do not follow this policy and I blame it on the board of the pharmacy for not enforcing it.

I can't stand rude patients. I refuse to provide service to them. Last week, I hung up on a patient who was not only rude to me but also to the pharmacists. It actually felt good. It's something I wish I had done a while ago. This person is just unbelievable and I hope she knows we have our limits.
 
BMBiology said:
In California, if there's only one pharmacist on duty, you can only have one tech. If there are two pharmacists, then you can only have three techs. Most pharmacies I know do not follow this policy and I blame it on the board of the pharmacy for not enforcing it.

I can't stand rude patients. I refuse to provide service to them. Last week, I hung up on a patient who was not only rude to me but also to the pharmacists. It actually felt good. It's something I wish I had done a while ago. This person is just unbelievable and I hope she knows we have our limits.
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This seems like a strange policy. I understand that it is a supervision issue but our store always runs better with more techs. Someone to answer the phone, get the drive-thru, etc. We have 8 technician work-stations (never have that many techs) so there are lots of areas to cover. I hate it when I have to work by myself with the pharmacist. It's so hectic.
 
i also just watched the 20/20. i thought it was very wrong that they mislead the public into thinking that 16 year olds getting GEDs would "fill" their Rx without making it clear that a pharmacist always verifies and initials that it is filled correctly!

And I wonder if that coumadin rx was handwritten and said "1.0mg." I'm not making excuses for the mistake but I am just curious. Also, who wasn't monitoring INR!?

And for the "study" that the researchers did, i would hope all pharmacists would see the asprrin being bought with coumadin....but they are always able to view all non-rx purchases done at their register and i don't know who expects them to!. I wish the 20/20 made a point to encourage patients to ASK about OTC products that might interact with their meds!

It is also my understanding that high risk anticoag patients may be on both aspirin and coumadin. Although, yes, I realize it is a counseling point if you don't know the patients history and you should tell them not to take any extra aspirin for pain or whatever reason.

As for the signature log,at CVS we trained to say "do you have any questions" before having the patient sign (although I think the signature really was for proof that they were given the notice of privacy practices...). And i dont think it's LAW that you have to offer counseling unless it's medicare/medicaid (forget which one). At walgreens that I have worked at and filled Rxs at, the techs at the register just say "sign here"

It was clear that every interview was butchered and edited to make the pharmacists and their representatives sound ignorant. No solutions were suggested and no advice to patients (such as, if you have internet access, look up the color/shape of the pill...sure, we will get calls about it looking different if the manufacturer is different, but i'm happy to help a patient who is trying to check that...and i KNOW some patients can't check those things, but if they can, it's not bad advice).
 
All4MyDaughter said:
This seems like a strange policy. I understand that it is a supervision issue but our store always runs better with more techs. Someone to answer the phone, get the drive-thru, etc. We have 8 technician work-stations (never have that many techs) so there are lots of areas to cover. I hate it when I have to work by myself with the pharmacist. It's so hectic.
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States of Florida, Georgia, and South Carolina have the same law. However, pharmacies can apply for a 2:1 or 3:1 exception if they wish and are usually approved. So with an approved exception, there can be 2 techs to 1 rph or 3 techs to 1 rph.
 
pharm765 said:
As for the signature log,at CVS we trained to say "do you have any questions" before having the patient sign (although I think the signature really was for proof that they were given the notice of privacy practices...). And i dont think it's LAW that you have to offer counseling unless it's medicare/medicaid (forget which one). At walgreens that I have worked at and filled Rxs at, the techs at the register just say "sign here".
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Good lord! You're claiming to be a P4 graduating in May??? Good luck on your MPJE! 😱
 
Caverject said:
Good lord! You're claiming to be a P4 graduating in May??? Good luck on your MPJE! 😱
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what is the point of being so rude? i'm not "claiming" anything, it's true. if what i wrote was wrong, which I also started with "i think" not "i know" than why not explain rather than mock what i said. i took Pharmacy Law almost 2 years ago and will study for it soon. however what i recall was that the signature logs were for obra 90 compliance and all states may have different laws for what they require for all patients.

so does anyone mind actually clearing up the point for me (is there a federal law that requires signatures)? Thank you.
 
pharm765 said:
And i dont think it's LAW that you have to offer counseling unless it's medicare/medicaid (forget which one).
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I believe that is what he is talking about.. I could be mistaken, but I believe you are supposed to offer counseling to every patient that is getting a new drug.
 
pharm765 said:
what is the point of being so rude? i'm not "claiming" anything, it's true. if what i wrote was wrong, which I also started with "i think" not "i know" than why not explain rather than mock what i said. i took Pharmacy Law almost 2 years ago and will study for it soon. however what i recall was that the signature logs were for obra 90 compliance and all states may have different laws for what they require for all patients.

so does anyone mind actually clearing up the point for me (is there a federal law that requires signatures)? Thank you.
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Omnibus Budget Reconciliation Act of 1990 (OBRA ’90)The U.S. Congress enacted the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) on November 5, 1990. This legislation contains thirteen titles addressing a variety of areas. Many provisions included in Section 4401 of OBRA '90 however, directly affect Medicaid pharmacy programs and Medicaid pharmacy providers.

While state Medicaid agencies will set up the programs mandated by OBRA '90, pharmacy providers are responsible for performing many required provisions. OBRA '90 requirements, in support of state Medicaid recipients, make pharmacists responsible for the following, effective January 1, 1993

Prospective Drug Use Review (ProDUR)
Patient Counseling
Maintaining Proper Patient Records


Health Insurance Portability and Accountability Act of 1996 (“HIPAA”)
Health care providers must comply with a new set of federal regulations. These regulations are a part of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), which addresses your right to privacy and the handling of Protected Health Information (PHI).

One of the new regulations requires that all of our patients receive a Notice of Privacy Practices prior to or when we provide health care services. We are also required to ask each patient to sign an acknowledgment indicating receipt of this notice.
 
This show is ******ed. It not only put our pharmacy profession to look bad in front of public, but also show how ignorant the public is. The public will never get it...and that's why i wanna get back to med school so badly....
 
All4MyDaughter said:
This seems like a strange policy. I understand that it is a supervision issue but our store always runs better with more techs. Someone to answer the phone, get the drive-thru, etc. We have 8 technician work-stations (never have that many techs) so there are lots of areas to cover. I hate it when I have to work by myself with the pharmacist. It's so hectic.
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I think the policy makes sense as it is supposed to force pharmacies to staff enough pharmacists. There's no point having a lot of techs when there's only one pharmacist on duty because this will only put more pressure on the pharmacist. It may be easier for you as an intern pharmacist or tech but it's not for the pharmacist. I am sure many pharmacists would rather have an additional pharmacist than two additional techs on duty.
 
BMBiology said:
I think the policy makes sense as it is supposed to force pharmacies to staff enough pharmacists. There's no point having a lot of techs when there's only one pharmacist on duty because this will only put more pressure on the pharmacist. It may be easier for you as an intern pharmacist or tech but it's not for the pharmacist. I am sure many pharmacists would rather have an additional pharmacist than two additional techs on duty.
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Possibly so. I do think that Walgreens (where I work) has designed their workflow to have a lot of techs and less pharmacists, for obvious cost reasons. I should look up what the law in Kentucky is as far as pharmacist:technician ratio.
 
All4MyDaughter said:
Possibly so. I do think that Walgreens (where I work) has designed their workflow to have a lot of techs and less pharmacists, for obvious cost reasons. I should look up what the law in Kentucky is as far as pharmacist:technician ratio.
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You may find that they are not in compliance. CVS just got dinged by the Georgia board for too many techs per pharmacist on duty. Apparently, there is some difference in having techs vs. CPhT certified techs? (i.e. you can have more techs if some of them are certified). Maybe Caverject can clarify this - I am only working a few hours a week, so I didn't see the initial e-mail on this.
 
BMBiology said:
I think the policy makes sense as it is supposed to force pharmacies to staff enough pharmacists. There's no point having a lot of techs when there's only one pharmacist on duty because this will only put more pressure on the pharmacist. It may be easier for you as an intern pharmacist or tech but it's not for the pharmacist. I am sure many pharmacists would rather have an additional pharmacist than two additional techs on duty.
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It's important to be very clear when referring to pharmacy laws because they often are not confusing.

For retail & ambulatory care, this is indeed correct - if only one pharmacist is working, then there can be only one TECHNICIAN...however, there can also be an intern & clerical (register) help as well. So, it is not strictly a 1:1 supervision. (And...this is changing currently as well & is proposed to be 1:2)

For the second pharmacist, they can indeed increase the technician ratio, but ONLY if the second pharmacist agrees. There is a provision to allow the second pharmacist to refuse to have more technicians.

Again - here in CA...we feel strongly that the pharmacist should determine the individual work environment - not a corporate headquarters located in some other state. BM - you should not place blame on the State Board - you should place it on the pharmacists who allow themselves to be trampled on. You can NEVER be forced to break the law - EVER!!! This is the problem with pharmacists - they are too timid to speak up!

And...if you've not been the only pharmacist - you have no idea the kind of pressure multiple technicians &/or interns can place on you. As Coco pointed out, particularly with young &/or inexperienced or nonassertive pharmacists, they can be pulled along with a flow which they are not determining and find themselves in trouble when its too late.

For hospitals & "closed door" pharmacies, these ratios do not apply - in fact, we currently have tech check tech with specific training required of the checking tech.

Coco - the reason incident reports are not published is because they are not just proprietary, they may be used in litigation sometime down the road. It is the same reason you cannot share your price list, a pts hx & subsequent tx with your husband over the dinner table or even the rebate or return goods charge backs your wholesaler negotiates with your company. This is true for retail, hospital, any & all pharmacy locations unless you own your own company & choose to share it yourself. But.....your lawyer will not recommend you to share any potential evidence of wrongdoing or malpractice with anyone else since that could affect the outcome of whatever case which develops. I hope this clarifies this aspect for you since it is true in hospitals as well - you can share the information within the system you are working in...but, not outside that system.

If you ever have the need to report something to ISPM (I have) - they don't ask for actual names of pts, etc... They may later down the road, but not for reporting purposes.

We have had mandatory counseling in CA since 1990. These regulations preceded the federal mandate & were more stringent. A two year summary was done 2004-2005 by the Center for Health Improvement in Collaboration with the CA State Board of Pharmacy & CA AARP. The focus was on seniors age 65 &> since approx 90% of these take at least 1 rx drug & nearly 50% take 5 or more different drugs.

The study found that in the ambulatory setting, 27.6% of the documented ADE's were preventable. The two barriers to pharmacist intervention were:

1) pharmacist time & insufficient compensation (thus...the development of MMT)

2) pharmacist-physician communication.

Thus, staffing ratios, regulatory barriers to technology, development of greater use of e-prescribing, promoting consistency within insurance & many other recommendations have begun to improve the whole consultative process which will reduce the error rate, but only to the extent it exists when an intervention can indeed be a factor. For some errors, pharmacist communication cannot prevent the error.

The whole drug error issue is a huge and highly complex problem with no one actual "fix". I am concerned about techs who work in high volume stores then go on to pharmacy school & don't see the need for change because it was ok when they did it. Somewhere in their education, they are not learning the assertiveness to be vocal about limits they should have the ability to place.

But....as a pharmacist, you're on the other side of the fence - you're the one with the responsibility - not all those technicians who really didn't look at an rx the same way the pharmacist does.
 
I think the people on this forum know I am referring to community pharmacy since this thread is about prescription errors in the retail setting. If you didn't, then now you know.

I do blame it on the Board of Pharmacy. What's the point of passing a policy when they don't even enforce it? I don't think they should put a pharmacist in that predicament especially when the pharmacist is only a floater. If the pharmacy is already understaffed with you as the only pharmacist, are you going to ask the tech (s) to leave? If you don't, then you are breaking the law but if you do, then you're making the situation worst. You cannot win in this situation.

You can disagree with me regarding who should enforce this policy but I think we agree that the policy is being abused. Therefore, it's up to the Board of Pharmacy, as a regulatory agency, to enforce its own policy meant to ensure patient's safety.
 
pharm765 said:
what is the point of being so rude? i'm not "claiming" anything, it's true. if what i wrote was wrong, which I also started with "i think" not "i know" than why not explain rather than mock what i said. i took Pharmacy Law almost 2 years ago and will study for it soon. however what i recall was that the signature logs were for obra 90 compliance and all states may have different laws for what they require for all patients.

so does anyone mind actually clearing up the point for me (is there a federal law that requires signatures)? Thank you.
Click to expand...

I hate the fact you think im being rude, but your're going to face much harsher critics than me in the real world. I pointed out you're a P4 whose almost completed all rotations. You SHOULD know this by now. Let's say you get a prescription for Restoril with 9 refills and you fill it that way. The board calls you on it, what are you going to say? "Oh I haven't studied law in like 3 years, my bad!" Yeah, all states have different laws but there is one underlying law that will always be there. By law you have to counsel and keep record of it, as BMBiology pointed out in his post.
 
BMBiology said:
You can disagree with me regarding who should enforce this policy but I think we agree that the policy is being abused. Therefore, it's up to the Board of Pharmacy, as a regulatory agency, to enforce its own policy meant to ensure patient's safety.
Click to expand...

That will never happen. Not enough inspectors to go around and no state has the budget to fund something like that. They could theoretically "make" the funds but it would have to be okayed and signed by the state governor, which I doubt would happen in most states.
 
Caverject said:
That will never happen. Not enough inspectors to go around and no state has the budget to fund something like that. They could theoretically "make" the funds but it would have to be okayed and signed by the state governor, which I doubt would happen in most states.
Click to expand...

If you are making that argument, then technically we shouldn't have any laws because it's not possible to enforce it every time. I think common sense dictates. The Board of Pharmacy does not have to check every pharmacy. They only have to hand out a few major fines not only to the corporation but also to the pharmacy managers. If they do this, I don't think they will need much additional fund because they can use the fines to pay for the extra inspectors. That should send the messenge. If you don't enforce it, then of course people are going to break it.
 
BMBiology said:
If you are making that argument, then technically we shouldn't have any laws because it's not possible to enforce it every time. I think common sense dictates. The Board of Pharmacy does not have to check every pharmacy. They only have to hand out a few major fines not only to the corporation but also to the pharmacy managers. If they do this, I don't think they will need much additional fund because they can use the fines to pay for the extra inspectors. That should send the messenge. If you don't enforce it, then of course people are going to break it.
Click to expand...

Are you a CA pharmacist???

If so...you would know we have about 15 inspectors for the WHOLE D*MN STATE. If you get the State Board Bulletin, you'll know they're always looking for people to hire as inspectors. There are really, really bigger fish to fry pharmacy wise than this. Likewise...all the laws we have to protect pharmacists in this state were won by pharmacists only. Take a look at the make-up of the State Board of CA - the President of the Board is the Northern California Director of Pharmacy Operations for Safeway.......duh!

This infraction wouldn't even get a fine - it would get a "correction" notice. A4D mentioned Walgreens - well-guess what - Walgreen's is not allowed to staff more than what is allowed in CA no matter what they do in Kentucky.

But - please, get real - if this pharmacist, who may or may not be the PIC is routinely overstaffing, all he/she needs to do is say that person is a clerk - not a tech - done! If this is a floater - or YOU are the floater.....your job is easy - send one person home. If you are the staff pharmacist who is being put in this position, just say I won't do it anymore.. It IS YOUR JOB to know the laws & comply with the laws, no matter your position. I've done all of these - its not hard & you are respected for what you know & doing the best job within the staffing levels allowed.

The point here is - THAT pharmacist is allowing & promoting a poor work environment. WHY??????? For a few extra points on a silly computer which says you're doing a good job? Oh my gosh.......this is what is wrong with pharmacists being pumped out now. Your good job is doing it well & knowing you are doing it well & in the mindset, framework, employment setting which promotes good work for everyone - you, mostly! Your self worth should not be tied to what Coco referred to as an artifical reinforcement of being overworked.

Let me make it very, very clear - in CA - no employer can FORCE YOU TO BREAK THE LAW!!!! But - you must know the law. Its easy - its online. There is also an anynomous (sp?) line to report infractions - you can use this too.
 
If you guys spend more time thinking about work and how you can improve your perfromance rather than posting all these comments... we would probably make less mistakes!!!!:meanie:
 
ZpackSux said:
If you guys spend more time thinking about work and how you can improve your perfromance rather than posting all these comments... we would probably make less mistakes!!!!:meanie:
Click to expand...

Where did you just drive in from??? 😛

I think you've got axel grease on your jumpsuit - and are you sure those dung beetles are still alive????🙄

Now you're not a dop & responsible for all this *** you just want to make everyone work,work, work:meanie:😡 - oh wait....that's what you wanted them to do when you were the dop🙄 !
 
I've only seen the little snippet on ABC's website, but from what I saw, it appeared to blame the entire thing on a poor 16 year old who typed in the script. It wasn't here fault, there, numbnut, sensationalist media. It was the registered pharmacists fault. The asshats have the lack of ethics to display this poor girl's photo all over national TV as a maimist (is that a word?) and infer that it was all her fault.

That's just wrong.
 
SDN1977: Why are you so angry? Just calm down. I am making the point that it is silly to have a policy that supposedly to protect patient's safety when it's not being enforced. I think that's a legitimate point. What's the point of creating a policy when it's not enforced? I don't think this responsibility should fall upon the pharmacist. That doesn't make much sense. It's the duty of the Board of Pharmacy to enforce its own policies.

You made the point that no one is forcing you to break the law but what's being done when the law is broken? What's the Board of Pharmacy doing to prevent people from breaking its policy? Apparently, it has not done much because no one seems to be following it. If the pharmacist is at fault as you claimed, then the Board of Pharmacy is also at fault for not enforcing its policy. I find it ironic that you first said I shouldn't blame it on the Board of Pharmacy but then later, you made excuses as to why the the board is not enforcing its policy (e.g. operational director of safeway is the board president). You cannot have it both ways.
 
BMBiology said:
SDN1977: Why are you so angry? Just calm down. I am making the point that it is silly to have a policy that supposedly to protect patient's safety when it's not being enforced. I think that's a legitmant point. What's the point of creating a policy when it's not enforced? I don't think this responsibility should fall upon the pharmacist. That doesn't make much sense. It's the duty of the Board of Pharmacy to enforce its own policies.
Click to expand...

Oh...SDN isn't mad....
 
sdn1977 said:
Where did you just drive in from??? 😛

I think you've got axel grease on your jumpsuit - and are you sure those dung beetles are still alive????🙄

Now you're not a dop & responsible for all this *** you just want to make everyone work,work, work:meanie:😡 - oh wait....that's what you wanted them to do when you were the dop🙄 !
Click to expand...

I've been on the interstates looking and studying Truck Washes...😀
 
I think that 20/20 show was meant to bash pharmacy.. else it would have never got aired.

it is pretty stupid, they expect a pharmacist to talk to every single patient at the register and monitor what they buy OTC!! stupid...
so, what if someone buys aspirin.. are you suppose to ask them to list all their meds to see if they are on coumadin/plavix/ibu?? +, patients on coumadin are allowed to be on low-dose aspirin qd

the lady representing our field should have defended us better. There is no LAW stating that there has to be a pharmacist at the counters ringing ppl up... and pharm techs are not trained to spot drug interactions.

I feel so bad for that high school girl... they were blaming her for her typing error... and it should have been the pharmacist's fault. They weren't suppose to tape her and show her on national TV.. simply ruins her career...

I'm simply glad i'm not working for CVS/walgreens where they time you for every single rx!!
 
BMBiology said:
SDN1977: Why are you so angry? Just calm down. I am making the point that it is silly to have a policy that supposedly to protect patient's safety when it's not being enforced. I think that's a legitimate point. What's the point of creating a policy when it's not enforced? I don't think this responsibility should fall upon the pharmacist. That doesn't make much sense. It's the duty of the Board of Pharmacy to enforce its own policies.

You made the point that no one is forcing you to break the law but what's being done when the law is broken? What's the Board of Pharmacy doing to prevent people from breaking its policy? Apparently, it has not done much because no one seems to be following it. If the pharmacist is at fault as you claimed, then the Board of Pharmacy is also at fault for not enforcing its policy. I find it ironic that you first said I shouldn't blame it on the Board of Pharmacy but then later, you made excuses as to why the the board is not enforcing its policy (e.g. operational director of safeway is the board president). You cannot have it both ways.
Click to expand...

I'm not angry & would have said so last night if not for the maintenance.

I am saddened that someone new to the profession, particularly within my state such as yourself, does not realize that the responsibility of the pharmacy & all its rules and regulations fall on the shoulders of the pharmacist on duty at the time. In fact, it is stated clearly in section 4007 of the B&P:

"..However, rules and regulations may require that the function be performed only under the effective supervision of a pharmacist who shall have the overall responsibility for supervising all activities that take place in the pharmacy."

Sure, I could ask the Board to come in for something this small, but what purpose would that serve when I could do it myself. I also make sure my technicians & clerical staff don't help themselves to controlled drugs & my non-pharmacy staff does not have access to HIPAA controlled information or the pharmacy at all. When you take on the role of pharmacist, you take on all the functions & are responsible for them all. This 16 yo young woman was taken advantage of in many ways & one was, perhaps, performing a function beyond that which she should have been doing. The responsibility for that lies with her supervising pharmacist - which could be you at any time.

My point is - why can't you (assuming you are a pharmacist)?

You ask, what happens when the rules are broken? If it occurs on my shift, I say "there are too many people here for just me - one person needs to go home. You can choose & if no one chooses, I get to choose. Then I call my dm & say one person is going home because I'm the only one here - do you want them somewhere else? otherwise, one is going home". See - its not a question can I send someone home - I just do. I don't have it both ways - I have it one way - the way the law is written & I get to decide since on my shift, I'm the supervising pharmacist (aka, the only pharmacist).

What did you learn in pharmacy school that made you & Coco think you should be pulled along by forces over which you have no control? I don't know which state Coco is in, but in CA - you did not learn that in your law course and you had terrible rotations if you learned that on those.

The State Boards function is not to "catch" criminals.....because they assume we are not criminals. They are to provide a framework under which we function & as responsibile professionals, it is assumed we will function as we are taught. This should make you empowered, but somehow, you seem frustrated at your lack of control....perhaps I'm misreading.

My point is - some choose not to function the way they were taught then blame a corporate or regulatory body when the blame lies on themselves. That doesn't make me angry, it makes me sad.
 
I was disgusted with this program. That tech who made the typing error was not at fault. The pharmacist on duty was at fault as we all know the Rph on duty does the final verification. I am appalled and in the future will try to shy away from these programs. Hopefully the general public is not swayed by these *****ic journalistic stories. We are not perfect and never will be. As long as these chains continue to measure time and sevice, some of us will be rushed and mistakes will happen. Stay safe!

Dr. M
 
sdn1977- Your assumptions about me are not only wrong but they are also so many that I am not going to correct you. It's sadden me that you need to make personal attacks to express your points. I applaude you for your professionalism.
 
BMBiology said:
sdn1977- Your assumptions about me are not only wrong but they are also so many that I am not going to correct you. It's sadden me that you need to make personal attacks to express your points. I applaude you for your professionalism.
Click to expand...
She never once personally attacked you. She disagrees with you and makes a strong case as to why you are wrong in your points. For someone that loves to debate and make strong statements like you, this post is sort of surprising to see.
 
sdn1977 said:
....someone new to the profession, particularly within my state such as yourself, does not realize that the responsibility of the pharmacy & all its rules and regulations fall on the shoulders of the pharmacist on duty at the time.

What did you learn in pharmacy school that made you & Coco think you should be pulled along by forces over which you have no control? I don't know which state Coco is in, but in CA - you did not learn that in your law course and you had terrible rotations if you learned that on those.
Click to expand...
.

I understand the law and abide by it. Not only that, I questioned why the law is not being enforced by the Board of Pharmacy since so many pharmacists do not think they need to abide by its policy. Like I said before, the law is being broken. If the Board of Pharmacy depends on pharmacists to enforce its policy and it doesn't seem like they are, then shouldn't the Board of Pharmacy do something about it?

I have learned not to make personal attacks to make my point. I think the bolded words speak for themselves. I hope she will one day learn the same.
 
I don't know if it's company wide or not, but the Walgreens that I work at did not show their KPI's this morning when the pharmacist tried to print them out. The boxes were grayed out and no numbers were visible. For people who don't know, KPI's are the numbers which show how many scripts we did, time < 15 mintues, etc. I hope Wag's gets rid of those things and let's us do our work in the way that it's suppose to be: correct and effective.

Almost everyone who works in a pharmacy, or in a health related field for that matter, has had a prescription filled at one point in their life, and thus the pharmacy personnel knows that the person standing across the counter from them wants their medicine (generally) filled as soon as possible. It's not like we're purposefully trying to be slow about it because we all know what it's like to wait. The under fifteen minute times are pretty ludacris, and I'm hopeful they (have) are getting rid of them.
 
BMBiology said:
.

I understand the law and abide by it. Not only that, I questioned why the law is not being enforced by the Board of Pharmacy since so many pharmacists do not think they need to abide by its policy. Like I said before, the law is being broken. If the Board of Pharmacy depends on pharmacists to enforce its policy and it doesn't seem like they are, then shouldn't the Board of Pharmacy do something about it?

I have learned not to make personal attacks to make my point. I think the bolded words speak for themselves. I hope she will one day learn the same.
Click to expand...

BM - let me apologize. I in no way was attempting to make a personal attack on you, which could be conveyed as well to Coco for that matter.

Let us speak clearly, though. You are new to the profession - am I correct on that? Apparently newer than Coco who found herself in this situation & chose to leave it rather than put up with an unworkable & untenable situation which was one way to deal with it.

You say you know the law & know that the responsibility lies with the supervising pharmacist. So, you know that in that the board expects that supervisor to end the illegal activity - just as you would if you caught one of your technicans or other ancillary personnel taking controlled drugs or working under the influence. You would not expect the board to come & find that - am I correct on that?

You did not mention that this was occuring during your shift as the supervising pharmacist, but I assumed that. Forgive me if I assumed incorrectly.

However, you made the comment that "so many pharmacists do not think they need to abide by this policy". I am not aware that this occurs & I've been in the business a very, very long time. I've worked in many retail situations and have actually floated as well - never once have I been placed in an illegal situation, but if I had, I would have handled it exactly as I said.

This program was not about a CA pharmacy, but you and I were speaking of CA pharmacists and since CA is often a leader in this profession (not excluding many other areas which are much, much farther along than we in other aspects of the profession), just what situation are you speaking about?

We are tremendously proactive in this state with regard to our working conditions. In fact, we are farther ahead than any other state, I'd venture.

I am hoping to empower you, Coco and all those others to not tolerate the situation which a faceless entity has placed you. However, you, personally, do not need empowering since in your law class & your rotations you learned how to be assertive and not be placed in an unlawful situation. I will caution you, however, that there is no one at the CA state board office - you must contact an inspector by email & again....it is just not on their radar. I appreciate you don't agree, but there really are much bigger issues for inspectors and not only the board, but your employer would want this handled within your internal corporate structure rather than bring them in.

We will have to disagree the board is necessary for the maintenance of this law (since it is a moot point within at least 18 months anyway).

Again....I will apologize if you took my comments as a personal attack. They were not intended as such.
 
All4MyDaughter said:
This seems like a strange policy. I understand that it is a supervision issue but our store always runs better with more techs. Someone to answer the phone, get the drive-thru, etc. We have 8 technician work-stations (never have that many techs) so there are lots of areas to cover. I hate it when I have to work by myself with the pharmacist. It's so hectic.
Click to expand...

There is no limit on the amount of employees doing non-tech duties such as answering phones, working the cashier, etc. There is only a limit on the amount of techs doing tech duties, such as filling. If there is only one pharmacist working, there can only be one tech filling.
 
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