CVS Incident Reporting

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josh6718

josh6718

Pharmacist
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Does CVS have a disciplinary policy regarding dispensing errors? For example, would a pharmacist be terminated or put on probation after a certain number of incident reports had been filed?
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josh6718 said:
Does CVS have a disciplinary policy regarding dispensing errors? For example, would a pharmacist be terminated or put on probation after a certain number of incident reports had been filed?
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Yes. But it's either subjective or confidential.

When I was an intern, my pharmacist had to either make no errors for 3 months to get off some sort of double-secret-probation list or make one and get disciplined (fired, I think). However, I don't think the way to get into that situation is explicitly known.
 
zelman said:
Yes. But it's either subjective or confidential.

When I was an intern, my pharmacist had to either make no errors for 3 months to get off some sort of double-secret-probation list or make one and get disciplined (fired, I think). However, I don't think the way to get into that situation is explicitly known.
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I was told it is based on a bell-curve where if you are on the wrong side of the curve you get disciplined. I have never known any pharmacists to get fired for errors though. My partner said he was on the double-secret probation once though. He fixed it by not reporting his errors anymore. Fixed!
 
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Work for a different large chain but I believe the number for termination is incredibly high like 8-10 within a rolling 12 month period. Any known errors that go unreported can result termination as per the handbook however that may have some leniency depending on the situation/pharmacist-PDM relationship.
 
It really depends on the error. It it's a no harm no foul error don't worry about it. If you do something really stupid like:

  • Dispense 20 Tramadol per day to an 11 y/o blasting through the DUR.
  • Give the wrong drug and send someone to the hospital.
  • Give Penicillin to a known Penicillin allergic patient again blasting through the DUR
These kinds of things will get you in trouble.

What will get you fired is failing to report an error no matter how trivial. Also, disregarding company policy that leads to an error....
 
I recently caught an error at QV when I noticed the vial weight was off. Looks like the tech put in the wrong drug into the correctly labeled vial. Does cvs discipline the techs in these situations or would it be entirely the rphs fault for not catching it?
 
Wouldn't you open the vial to look at the drug inside anyway?
 
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maria1oh said:
I recently caught an error at QV when I noticed the vial weight was off. Looks like the tech put in the wrong drug into the correctly labeled vial. Does cvs discipline the techs in these situations or would it be entirely the rphs fault for not catching it?
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If the drug goes out, the pharmacist is responsible. I tell my techs all the time. They don't make mistakes, only pharmacists make mistakes. For this to happen, they would have to violate CVS policy for which they should be counseled. Verbally at first and then written up and dismissed if it continues. They have to get the right pills in the right bottle. Your job is to make sure they do.
 
No I don't always open the vial unless it says accuracy scan bypassed or the weight is off. Not to mention the tablets/capsules/liquids sometimes look the same. Not always possible to try and read the imprint on the tablets/capsules. The liquids are easy to mix up if a patient was prescribed both liquid benadryl and liquid Zantac.
 
Lol wow. That is a terrible way to verify. TERRIBLE. I blast through DUR's like OT said, but I would never in a million years not check contents In the bottle.

You would be surprised as to what I've found over the years. Check the bottle EVERY TIME. Even if it's vitamin d2.
 
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maria1oh said:
No I don't always open the vial unless it says accuracy scan bypassed or the weight is off. Not to mention the tablets/capsules/liquids sometimes look the same. Not always possible to try and read the imprint on the tablets/capsules. The liquids are easy to mix up if a patient was prescribed both liquid benadryl and liquid Zantac.
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...
 
maria1oh said:
No I don't always open the vial unless it says accuracy scan bypassed or the weight is off. Not to mention the tablets/capsules/liquids sometimes look the same. Not always possible to try and read the imprint on the tablets/capsules. The liquids are easy to mix up if a patient was prescribed both liquid benadryl and liquid Zantac.
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This is shocking to me that a pharmacist would not open the bottle and look inside..,

It's like asking to make an error.
 
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maria1oh said:
No I don't always open the vial unless it says accuracy scan bypassed or the weight is off. Not to mention the tablets/capsules/liquids sometimes look the same. Not always possible to try and read the imprint on the tablets/capsules. The liquids are easy to mix up if a patient was prescribed both liquid benadryl and liquid Zantac.
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wow you can't be serious? horrifying
 
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I can understand an honest mistake, but routinely not checking the pill because 'why bother'?! I hope you trolling. Otherwise, terrifying.
 
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maria1oh said:
No I don't always open the vial unless it says accuracy scan bypassed or the weight is off. Not to mention the tablets/capsules/liquids sometimes look the same. Not always possible to try and read the imprint on the tablets/capsules. The liquids are easy to mix up if a patient was prescribed both liquid benadryl and liquid Zantac.
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On behalf of every other pharmacist in the world, we do not agree with your procedure. You are the outlier until someone else posts otherwise.
 
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maria1oh said:
No I don't always open the vial unless it says accuracy scan bypassed or the weight is off. Not to mention the tablets/capsules/liquids sometimes look the same. Not always possible to try and read the imprint on the tablets/capsules. The liquids are easy to mix up if a patient was prescribed both liquid benadryl and liquid Zantac.
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Look, it's your license. Do what you want. In my professional opinion after verifying prescriptions for 33 years this August what you are doing is unprofessional. You are there for two reasons and two reasons only, to make sure the drug is right for patient based on a DUR before you dispense ( right dose for the patient, not allergic, etc) and to make sure the correct pill is in the bottle. Based on what you do, you could be replaced by a scale with good software.

I can tell you, you are violating company policy and if you make an error and they look at the tape, you WILL be fired. You will probably also lose your license. You have an obligation to the patient to make sure they get the right drug. You have failed to comply with company policy, you have failed legally to protect the patient and you have filed morally.

I would like to meet the pharmacist that trained you. I get to train just about every new graduate pharmacist in our district and every single one of them is taught to look at every pill. Either pour them in your hand or pour them in a counting tray, I don't care. But you check the entire bottle.

You are derelict in your duties and a disgrace to the profession if this the way your practice.
 
maria1oh said:
No I don't always open the vial unless it says accuracy scan bypassed or the weight is off. Not to mention the tablets/capsules/liquids sometimes look the same. Not always possible to try and read the imprint on the tablets/capsules. The liquids are easy to mix up if a patient was prescribed both liquid benadryl and liquid Zantac.
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maria1oh said:
No I don't always open the vial unless it says accuracy scan bypassed or the weight is off. Not to mention the tablets/capsules/liquids sometimes look the same. Not always possible to try and read the imprint on the tablets/capsules. The liquids are easy to mix up if a patient was prescribed both liquid benadryl and liquid Zantac.
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wow.. don't trust your technician too much.

one cvs rph got sued recently because ambien was dispensed instead of azithromycin. and what the article said was.. how come the pharmacist got mixed between white pill (ambien) and pink pill (azithromycin)?!
This can happen anytime when you don't open the bottle.
 
I'v worked with 3 staff pharms, 2 PIC's, and 3-4 floaters and I'v only known one of them to check what's in every vial.
 
How scary, I have never know a pharmacist who didn't check what was in the vial/bottle. Then again, I don't normally watch other pharmacists checking. But I am shocked that a pharmacist wouldn't. I guess this explains a couple of the bizarre incident reports I saw this past month, where the drug dispensed didn't look anything like the drug that should have been dispensed. I can understand when there are a couple of wrong pills mixed together with the right pills, when they both look alike, it would be very easy to miss this. But a whole bottle of clearly different looking pills? It never occurred to me that the pharmacist wouldn't have been checking at all.

To Maria1Oh, you truly are neglecting your professional duty. If you can't read the tablets, then you need to get better glasses, or a magnifying glass, or whatever it takes. As for liquids, I require the technicians to put the bottle I'm checking with the bottle they filled from. Yes, I suppose its possible they could fill the RX wrong, but then put maliciously put the right bottle with the RX, but I do not find this very likely. I hope you have never worked in a hospital, I shudder at the thought of your signing off on IV's without checking them, since you think they all look the same.
 
At CVS and other chains, it's company policy that you open the vials to check contents and match imprints. Not only do you have to worry about wrong drug totally, but also commingled drugs (which happens often if you use Kirby).
 
SClENCE said:
I'v worked with 3 staff pharms, 2 PIC's, and 3-4 floaters and I'v only known one of them to check what's in every vial.
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Even if the accuracy scan is right, I've seen many times where the techs switch the labels on the bottles by mistake. Scary that any pharmacist doesn't take the time to open up a vial. It take 2 seconds and it is your professional RESPONSIBILITY to ensure what's in the bottle is correct. If you can't be counted on to do that, then you should be replaced by a robot that will gladly do so.
 
I wonder if we can get long term disability or worker's comp for repetitive stress injuries from opening 400-500 vials per day.
 
npage148 said:
What about looking into the bottom of the bottle? Opening all those bottles is a quick way to an overuse injury
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You won't catch co-mingling. You need to look at the pills.
 
how is this even a controversy? it's a black and white issue. I can't believe I call some of you guys my peers
 
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I always check the pills even when I fill it, out of habit. I also smell the liquids each time , there have been several times where the tech didn't put the bottle with the liquid and I have been able to identify it by smell.
 
So you guys literally dump the whole vial out to make sure another pill didn't get in somehow? I'v never seen anyone do this before.

I'v had one pharmacist (floater) ask me to put the stock bottle for liquids with the filled prescription to verify.
 
I pour some of it in my hand and eye the rest. If it's metformin 500 mg #180 with one gemfibrozil stuck in the middle of a 60 dram vial, I think im screwed
 
SpartanLaser said:
I pour some of it in my hand and eye the rest. If it's metformin 500 mg #180 with one gemfibrozil stuck in the middle of a 60 dram vial, I think im screwed
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You should be checking the numbers on every pill. You are putting your patients at risk.
 
This thread is a great example of why the state boards should be tracking errors. I can't believe some of the stuff I'm reading here on both sides.
 
The people saying they check the imprint on every pill in a vial are just trolling right? That seems absolutely absurd. How would you have time to do anything else in the day but flip pills over to check for imprints.
 
TheGoatBoyy said:
The people saying they check the imprint on every pill in a vial are just trolling right? That seems absolutely absurd. How would you have time to do anything else in the day but flip pills over to check for imprints.
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No, I'm not trolling. I pour out every bottle. You don't check the imprint on each pill, but you pour them, check the imprint and look for something out of place....
 
I always opened the bottle, matched the imprints and then looked for oddballs. I rarely poured out the bottle, though I occasionally did. Usually there were few enough pills (30 HCTZ in a 13 dram vial) that I could look down into the bottle and make sure there weren't any weird ones. I do think not looking at all is putting a lot of faith in your technicians. Unless they are only pulling one med at a time from the shelf, there is always the possibility they will scan one bottle and count another.
 
I usually pour the pills on the counting tray, or if they are small pills I use the cap of the vial to pour some of the pills and check the imprint on the pill then I match it to the info on the QV screen.
 
Pouring the pills in your hands as some of the previous posters have mentioned is pretty unhygienic, you are constantly touching things that has germs on it, eg the keyboard, phones etc. It is better to use the tray. Think about it, would you like someone's hand all over your pills. I sure wouldn't.....
 
brianna05 said:
Pouring the pills in your hands as some of the previous posters have mentioned is pretty unhygienic, you are constantly touching things that has germs on it, eg the keyboard, phones etc. It is better to use the tray. Think about it, would you like someone's hand all over your pills. I sure wouldn't.....
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I feel the same way, it is gross to make it a point to touch all those pills. Think of someone handling all your food before you it eat. Yuck.
 
brianna05 said:
Pouring the pills in your hands as some of the previous posters have mentioned is pretty unhygienic, you are constantly touching things that has germs on it, eg the keyboard, phones etc. It is better to use the tray. Think about it, would you like someone's hand all over your pills. I sure wouldn't.....
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I wash my hands multiple times per day. haven't killed anyone yet.....
 
You should not be pouring pills in your dirty hand. Either use the cap or counting tray.
 
Touching all of the pills in unprofessional and uncalled for in my opinion.
 
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