CVS Verification Tray

[RxPreceptor]

State laws here require only RPh can do RTS and verification of cell replenishments.

A few cases of mixed SPC meds I've come across include the following:
1) technician unknowingly drops tab/capsule landing in uncapped script pro vial that has been sitting on the conveyer belt (has happened only once)
2) RPh returns incorrectly labeled RTS vial (involves a white tablet & being the same drug just off by strength).

3) Script pro vials build up on conveyer belt & some get tilted over sideways only to be tilted back upright by the conveyer (caps/tabs get pulled along the conveyer belt with potential to be dragged into the wrong vial). This has happened numerous times & is most likely incidence (the vial getting knocked over is problematic for "light weight" scripts)

4) Cell directly above a cell that is filling a script drops some loose tablets remaining at the bottom of the chute

Both machines and humans are far from perfect

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[Rouelle]

State laws here require only RPh can do RTS and verification of cell replenishments.

A few cases of mixed SPC meds I've come across include the following:
1) technician unknowingly drops tab/capsule landing in uncapped script pro vial that has been sitting on the conveyer belt (has happened only once)
2) RPh returns incorrectly labeled RTS vial (involves a white tablet & being the same drug just off by strength).

3) Script pro vials build up on conveyer belt & some get tilted over sideways only to be tilted back upright by the conveyer (caps/tabs get pulled along the conveyer belt with potential to be dragged into the wrong vial). This has happened numerous times & is most likely incidence (the vial getting knocked over is problematic for "light weight" scripts)

4) Cell directly above a cell that is filling a script drops some loose tablets remaining at the bottom of the chute

But still there is potential variability in interpretation of “verification of cell replenishment.” At my hospital gig, a tech pulls meds for the Pyxis restock. I verify the correct meds are pulled, sign off on it, then the tech goes and loads it. I don’t usually actually load the bins myself, nor do I see him/her do it. There is always a possibility (probably not, but possible) that the tech screws something up in the actual loading process, in which case the error would obviously be mine.

Does your state require the RPh physically do it start to finish, or is it possible that s/he verifies the drug itself, then the tech takes it from there?

 

[RxPreceptor]

Tech can pull cell, bring & scan stock bottles, then waits for RPh to inspect empty bottles used, verify qty, update lot#s, expiration dates, then does final sign off/credentials. Doesn't necessarily need to be done start to finish, just finish (although I prefer doing the whole process myself if possible).

Clarification: tech can physically load the cell, but RPh needs to inspect

 

[Corpseman]

Does CVS not have a bar code scanner to make sure you are dispensing the correct medication? Besides the occasional incorrect RTS label (which would make the entire bottle (usually) wrong during verification) there should be extremely few times the wrong med is dispensed.

 

[maria1oh]

Cvs does have bar code scanning but work bench is cluttered and constant interruption (phone calls and customers). I would say at least once or twice a year I caught a tech scanning multiple orders and somehow the labeled vial for metronidazlole would contain ciprofloxaxin. Then cipro bottle would contain metronidazlole.

The old school idea was don't bother to inspect the tablets because you could count on bar code scanning but unfortunately one time carbamazepine and prednisone got mixed up and rph got license suspended for it at cvs.

So yes extremely few times it happens but these few times can be extremely dangerous.

 

[MV777]

Cvs does have bar code scanning but work bench is cluttered and constant interruption (phone calls and customers). I would say at least once or twice a year I caught a tech scanning multiple orders and somehow the labeled vial for metronidazlole would contain ciprofloxaxin. Then cipro bottle would contain metronidazlole.

The old school idea was don't bother to inspect the tablets because you could count on bar code scanning but unfortunately one time carbamazepine and prednisone got mixed up and rph got license suspended for it at cvs.

So yes extremely few times it happens but these few times can be extremely dangerous.

Agree not to rely on bar code scanning when verifying. I think you are referring to cells but ... I have caught a few times when things have happened like protonix was in Plavix bottle and Plavix in protonix bottle for the same patient. Right drug was scanned out but when put into the bottle, distractions and moving quickly causes mistakes

 

[zelman]

Agree not to rely on bar code scanning when verifying. I think you are referring to cells but ... I have caught a few times when things have happened like protonix was in Plavix bottle and Plavix in protonix bottle for the same patient. Right drug was scanned out but when put into the bottle, distractions and moving quickly causes mistakes

USE THE MAT!

 

[chickfoot]

I was initially resistant to the VVT because of slowdown, but I understand how its use for patient safety - like let's not give them a bunch of different drugs they weren't looking for! So I like it for safety, and, it let's me easily take a guess if the tech actually gave me 90 or 30 tablets - do you enjoy having pts come back or call you a month later trying to fill their rx or complain? I'll turn to my tech and ask, "Can I have more?" (like a little Oliver Twist!)

SOOO despite VVT and a pharmacy manager that seems to be immune to error (I've caught a couple near misses, she was defensive when I expressed concern that the last dispensed rx may have gone out #40 instead of the #30 that got logged... I was trying to figure out why I was 10 short on vyvanse...) a patient came back saying they received the wrong med - fortunately they were easy-going! My pharmacy manager gave metoprolol er 50mg (a WHITE ROUND tablet) instead of glipizide (another WHITE ROUND tablet). She did a bit of sleuthing about the shelt and the RTS bottle had the wrong drug in it! Which my name was on the RTS label - which I couldn't/didn't figure out THAT origin... but still BLAME IT ON THE RTS.........aka I guess blame it on me......... BUT THE VERIFYING RPH OF THE -- GLIPIZIDE RX -- could have looked at the tablet before she verified it???????

I'm probably going to work for Rite Aid... I kinda hope they have something similar.