Dangerous QV2 change 2021

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GP7777

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Technicians will be bagging prescriptions next year as part of workflow. Not sure if some other companies already practice this policy. While I am aware the risk for errors is low, I think it is a fair concern since I'm guessing liability falls back to the pharmacist.

Thoughts? How do we protect ourselves? This is just an error waiting to happen like bagging Warfarin to the wrong person
 
At CVS?

I don't think you can protect yourself. If you follow company policy, your personal liability is low.

How is bagging done at mail order or places with remote verification?
 
Walmart has done this for years. Why are you concerned they will mix up? If everything in the basket or bag belong to 1 customer after you check, the chance for them to mix up is very little unless they are bagging more than 1 patients at a time or stop in the middle of bagging to help a customer. We even have sale associate (cashiers) bagging it.
 
Um I'm sure there is (was?) more than 1 CVS where the pharmacists don't bag anything. They just leave them in the piles of baskets for the pickup people to find and then bag up.

This is how you "protect" yourself. The person doing the bagging error gets a disciplinary action for both wrong drug/wrong person and HIPAA violation. Thus that is a disincentive to **** up. Or at least that is what should happen if you are following the process correctly.
 
I am not 100% how it works yet, but I’m guessing I won’t have the drug in a basket next to me as I verify. I’ll just be looking at a picture and I’ll assume the drug is in a basket somewhere in the pharmacy. It will be bagged minutes to hours after I verify it. I prefer bagging and verifying simultaneously to prevent errors.

I guess people who have been doing this for years at their company are used to the risk. At a place where you bag everything yourself it’s definitely a leap of faith to suddenly have somebody else to do it for you.

Misbagging is a serious concern even if the risk is very small. I’m sure a good number of us have witnessed it even when Rph is verifying and bagging and patient comes back and says ‘this isn’t mine’
 
GP7777 said:
Technicians will be bagging prescriptions next year as part of workflow. Not sure if some other companies already practice this policy. While I am aware the risk for errors is low, I think it is a fair concern since I'm guessing liability falls back to the pharmacist.

Thoughts? How do we protect ourselves? This is just an error waiting to happen like bagging Warfarin to the wrong person
Click to expand...

When I was a pic of a crazy busy pharmacy this is the only way I would allow it to happen in my pharmacy. I would product verify and I would create a huge stack of bottles/info that needed to be bagged. When it would slow down just a bit a technician would slip in and bag behind me.

We did not staple the bag shut: and when the patient picked their stuff up the technician was responsible for matching all bottles with labels/info and if they failed it was “on them” and I would document the incident via the HR process. I had one tech loose her job because she was not checking at point of sale.

It got to the point where a mistake almost never happened at the register, it saved me about an hour a day, and it really worked well.

The “company policy” was in fact that the pharmacist was supposed to bag but my system was so dialed in that no one ever bothered me about it. It was a process which I was very proud of - not sure I will ever have the energy to build a flawless retail pharmacy again.
 
Yes, I understand the tech gets in trouble for the mistake. But the consequences for Rph are way more severe if the patients starts taking the wrong medication and gets hospitalized or something.
 
Do you not scan the bottle? If you scan the bottle, the paper might be for the wrong person but not the drug (hippa violation). No one is gonna die getting the wrong paper.

Many chains stop using the drug info paper as a barcode point of sale. It's placed directly on the product.
 
Yes if you had someone give out warfarin for a 2 year old and the 2 year old actually ingested you would prob be sued along with your employer.

I would say the more common error is therapeutic duplication, for example when something like clopidogrel is dispensed with an overlapping already existing Brilinta, but I haven't come across those types of errors being litigated
 
Sine Cura said:
Yes if you had someone give out warfarin for a 2 year old and the 2 year old actually ingested you would prob be sued along with your employer.

I would say the more common error is therapeutic duplication, for example when something like clopidogrel is dispensed with an overlapping already existing Brilinta, but I haven't come across those types of errors being litigated
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This was my biggest problem with autofills. We do not have enough time to figure out what meds have been dc’Ed and when
 
Momus said:
Do you not scan the bottle? If you scan the bottle, the paper might be for the wrong person but not the drug (hippa violation). No one is gonna die getting the wrong paper.

Many chains stop using the drug info paper as a barcode point of sale. It's placed directly on the product.
Click to expand...
Bottle and label are scanned. Bottle goes in bag, label goes outside bag. Point of sale scans label only. So if I’m not bagging the stuff myself that’s how John Doe (label) gets Mary Jane’s prescription bottle inside the bag.

Yes, it’s low risk. Sure, patient might read the bottle and bring it back. In the end, some of pharmacy’s biggest lawsuits are from these errors slipping through and someone getting hurt.
 
GP7777 said:
Technicians will be bagging prescriptions next year as part of workflow.
Click to expand...
Is this a new policy for CVS?
As a tech, I wouldn't look forward to this. Time on the clock is tight as is, with filling all the scripts. Not sure how this would make the job more efficient.

On a side note, one of our floaters has a tendency to scan scripts into the waiting bin, without actually bagging anything. It can be a pain in the butt to try and find a bag at the register, when it's actually in the QV2 area.
 
They probably classify it as workflow modification or new workflow for techs. At this point, if I was a cvs tech, I would reassess some things. You would be doing part of qv2 (scanning it for rphs I assume, then bagging it) and immunizations.

Btw they are allocating 6.5 hours for techs to do what needs to be done for immunizations plus paid CPR class but time spend is not paid for.

So all in all, your job description is about to change significantly.
 
Everyday someone's bottle is filled with the wrong drug, or patient meds get mixed in the baskets. I would not trust techs to bag at all. How much time would that possibly save anyway? It takes a second to put a bottle in a bag and staple it.
 
Maybe they should eliminate baskets since bottle from another basket may accidentally fall into the wrong basket after pharmacists check them.
Don’t they have some safety measures built in the software to let you know if a particular bottle does not belong to a specific order that you are bagging? At Walmart once an order is visual verified, every bottle that belongs to that order stay in a bag with specific number and bar code. Tech scans the bag’s bar code then scans all bottles in that bag. If one of the bottle doesn’t belong to that order, the scanner would beep to notify them and scan tag won’t print until they scan the right bottle.

Sometime scanner will pick up another bag’s bar code (instead of the one that tech intends to bag since the tech holds it a certain angle and scan the bag while on the rack with other bags’s bar codes) they just need look at the scanner (which shows them which bag # was scaned) and grab the right bag to scan to finish it out then go back to the bag that they grabbed earlier.

We just changed our bagging system recently, now we don’t even bag until customer comes to pick up. Still the same concept, tech scan everything in the bag or bags(if pt has multiple orders.) The system does beep and message pop up said this rx doesn’t belong to this patient (if tech grabs someone else’s bag) and order won’t finalize-no scan tag will be printed. I like this new print-@-pick up since it does save time.

It may save pharmacists only 30 minutes to an hour per day but CVS wants you to use that saved time to visual verify more scripts!
 
Got to wonder if constantly changing workflow/system settings and constantly having to become more efficient due to said workflow changes is actually contributing to more errors overall rather than just keeping the system the same and allowing people to figure out how to be most efficient

A long, long time ago when I was a technician, technicians actually stapled the bags to label for RPh to check off...why does history seem to repeat itself?
CVS IT department twittling their thumbs and need to keep jobs somehow
 
RxAndroid said:
Got to wonder if constantly changing workflow/system settings and constantly having to become more efficient due to said workflow changes is actually contributing to more errors overall rather than just keeping the system the same and allowing people to figure out how to be most efficient

A long, long time ago when I was a technician, technicians actually stapled the bags to label for RPh to check off...why does history seem to repeat itself?
CVS IT department twittling their thumbs and need to keep jobs somehow
Click to expand...
That was policy when I started (at least according to some module) but no one did it. I never saw the point - the RPh still stapled the bag closed so I didn't see any efficiency gain.
 
RxAndroid said:
Why are you assuming that non breeders play video games, watch netflix, and work out during time off? Again just highlights how entitled you are; not everyone gives a **** about having a family. People have different priorities.

Again all high and mighty breeder, your time is not more valuable than us "lowly, peon" non breeders
Click to expand...

owlegrad said:
That was policy when I started (at least according to some module) but no one did it. I never saw the point - the RPh still stapled the bag closed so I didn't see any efficiency gain.
Click to expand...
Even worse, some RPhs didn't staple bag shut....drug would roll out of bag...><...good times (sarcasm)
 
RxAndroid said:
Got to wonder if constantly changing workflow/system settings and constantly having to become more efficient due to said workflow changes is actually contributing to more errors overall rather than just keeping the system the same and allowing people to figure out how to be most efficient

A long, long time ago when I was a technician, technicians actually stapled the bags to label for RPh to check off...why does history seem to repeat itself?
CVS IT department twittling their thumbs and need to keep jobs somehow
Click to expand...

Yup they have the most BS IT dept. They keep rolling out "updates" which always make things worse which require more updates to fix. They have to keep creating work for themselves to keep their jobs secure. I worked there 4 years and the system was just as inefficient in year 4 as year 1, despite the stupid updates every week.
 
This is just an impression...but it seems that big chains rarely allow mistakes to get too far...They turn 'em over to some mouthpiece who pays off or fights as needed...With all the automation...how many actually get out and cause trouble? The boards don't seem to confront the big boyz unless forced..but will nail the little bugs to the cross.. I do see that Wally World just got it for over peddling narcs.. ignoring pharmacist warnings etc. All the usual for the big boyz. You newbies will rue the day you got mixed with this job..
 
Anyone have any new information to share? I'm guessing some stores have probably tried out the new system already in the last few weeks so hopefully someone out there with experience can offer some feedback.

A misbagging would remind me a little bit of the Eric Cropp case in Ohio. His technician prepared an IV bag and he signed off on it. He did not mix any of the meds himself but got charged with manslaughter. Translating to retail, for a misbagging, the pharmacist would not be bagging the med himself, but still be responsible for whatever bagging mishap the technician makes.

Before you comment "train your technician well" yes that is obvious and does not change how I feel about the situation.
 
Personally not a fan. Something about signing off on a Rx I didn't see with my own eyes feels off. No matter how much you try to train a tech they revert to the same mistakes, can't trust them all. They say it's to help pharmacists have more time to consult / vaccinate. I see future significant cuts of Rph hours.

I assume if tech takes correct picture of med, and bags incorrect one... it's on them? Otherwise if I could get fired for that, I would sue for wrongful termination for implementing a crappy system.
 
My store has zero overlap as is. So this is just going to be stupid and pointless from the cutting hours perspective. An RPh has to be there by law.

The real reason they are doing this is so that they can have an "overlap" pharmacist sitting in a chair at home for $40/hour remote verifying scripts.
 
GP7777 said:
Anyone have any new information to share? I'm guessing some stores have probably tried out the new system already in the last few weeks so hopefully someone out there with experience can offer some feedback.
Click to expand...
tech here. the concern never was about mistakes at my store, it was about burdening the techs with extra work, without extra pay (and slowing us down)

our DL has decided our store can keep the new system, as "we are so efficient". :eyebrow:

we are a lower volume store, but virtual verification has slowed us down significantly. it sometimes takes us a couple hours just to clear a single page now
 
the question I have is, is this actually more time efficient?

if I’m understanding correctly, the pharmacist still conducts the product verification, but then hands the med to a tech and they bag the rx? I feel like I can do the entire process quicker than that
 
Some indies do this. I didnt feel comfortable letting clerks bag prescriptions. We had several incidents where they bagged the wrong prescriptions but thankfully patients didnt take the meds and brought them back. In my experience, it would be a big risk and potential for misfills and adverse events.
 
Pronounce Doxazosin said:
the question I have is, is this actually more time efficient?

if I’m understanding correctly, the pharmacist still conducts the product verification, but then hands the med to a tech and they bag the rx? I feel like I can do the entire process quicker than that
Click to expand...

it’s not purely about time rather time value. It definitely can save a pharmacist time. If you save an hour in pharmacist payroll and pay for 2 tech hours you are still saving money.
 
Just unsure how this will pan out in the long run; what incentive is there for keeping technicians more long term? Sure I guess RPh might be in a better position for hands on training, but I mean it's still going to be a never ending struggle of filling technician positions? How is putting more work on those who call out (as a group) regularly going to work out? RPh is always going to be the most reliable work horse; so yeah corporate, cut more RPh hours...><
 
Let‘s refocus the discussion to how pharmacists protect themselves from this. The BOP will say we’re liable for knowing exactly what med is in every single bag that technicians are bagging because they are under our direct supervision.

Aside from having insurance, I don’t see much else I can do.

Surely someone out there who has been working 10-30 years and has a family/mortgage doesn’t want to risk it all on a technician misbagging a warfarin one day?
 
GP7777 said:
Let‘s refocus the discussion to how pharmacists protect themselves from this. The BOP will say we’re liable for knowing exactly what med is in every single bag that technicians are bagging because they are under our direct supervision.

Aside from having insurance, I don’t see much else I can do.

Surely someone out there who has been working 10-30 years and has a family/mortgage doesn’t want to risk it all on a technician misbagging a warfarin one day?
Click to expand...

if you’re following the process that corporate wants you too and you weren’t being completely wreckless and it was indeed a mistake - my guess is that corporates outside counsel will also seek to shield you from liability.

The BOP isn’t going to take everything away from you for a dispensing error, you might get a citation or action against your license but the real action would come from claims on damages suffered by the injured party.

Being honest you can take the wrong pills and not die, hell not even have any tangible negative effects. You need a perfect storm of an error that also turns into harm for the big case to be potentially on deck. From there they don’t typically go after the pharmacist as they know the pockets aren’t deep there, they’ll go after the company and then it’s extremely extremely rare for the case to even make it to trial as the company will do their damndest to settle out and assume no liability for the case to be dropped and family gets paid.

But yea doesn’t hurt to have your own insurance but there’s still some exceptions on coverage in some unique events so read your policy.

if you are still terrified of having any potential risk exposure my advice is leave the medical field because it’s impossible not to have any.
 
GP7777 said:
Let‘s refocus the discussion to how pharmacists protect themselves from this. The BOP will say we’re liable for knowing exactly what med is in every single bag that technicians are bagging because they are under our direct supervision.

Aside from having insurance, I don’t see much else I can do.

Surely someone out there who has been working 10-30 years and has a family/mortgage doesn’t want to risk it all on a technician misbagging a warfarin one day?
Click to expand...

So I actually agree with you that it is inherently unfair to hold someone accountable for something totally outside their control.

But to play devil's advocate, you are already responsible for what your techs/cashiers sell at the register so really you are already liable for a mistake you cannot reasonably expect to be able to prevent.
 
The BoP concerns me as much as bubblegum on my shoe. More annoyance than anything and with the right attorney the most you get is reprimanded and most is dismissed. Just always remember if they come sniffing around then always say "I will check into that and report back to the Board in X days." They want you to panic and say something dumb.

For those of us in chains(pun intended) there are more P&Ps and emails to give to an attorney to help your case such as corporate signing off that techs are prepared for vaccinations.
 
Day 1 here of "virtual verification"...not as bad as I thought. Really hard to screw up when having a neat, clutter free work area (I've always been a huge stickler for this regardless of zone - production, verification, drop off, etc.). Sure still getting accustomed to the new devices and adjusting cameras
 
RxAndroid said:
Day 1 here of "virtual verification"...not as bad as I thought. Really hard to screw up when having a neat, clutter free work area (I've always been a huge stickler for this regardless of zone - production, verification, drop off, etc.). Sure still getting accustomed to the new devices and adjusting cameras
Click to expand...

This is going to be the dumbest thing on the planet for us overnighters. We complained like hell when they took QA away from us. Now we have to do all of these pointless intermediary steps.
 
WVUPharm2007 said:
This is going to be the dumbest thing on the planet for us overnighters. We complained like hell when they took QA away from us. Now we have to do all of these pointless intermediary steps.
Click to expand...
Yeah, I was saying to my technicians yesterday...how the **** can overnights put up with this? It just slows down production way too much; even bypassing just makes the entire process longer (more button mashing just to do the same amount of work)
 
Let me be more direct about this...

If the board views this process as unsafe or inappropriate they will engage CVS not all the individual pharmacists.

The potential penalty/fine/punishment from the board to an individual pharmacist is minimal to zero if you are following policy and procedure. If a significant error happened where you were completely reckless and not acting in accordance to the policy and procedures you may face some consequence from the board. Fines are typically limited and at the extreme you may lose your license or get it suspended. If it was one singular event and mistake it should be 0 penalty.

Now the mega million dollar lawsuits that some of you extreme anxiety pharmacists worry about require a lot of things to happen. First medical negligence is an extremely extremely hard thing to prove and win in actual court so the game is typically seek settlement. Now there’s a lot of state variability on standard of care and liability caps on what a max award a plaintiff could win if it actually goes to trial but one thing is almost universally true if a person or their estate is suing you for an error. There has to be damages, or in this case harm or injury, that occurred for them to make a claim on what is owed to them. This is why I said above an error even with ingestion, possibly even months worth of ingestion depending on the med and patient, might not stand up for a claim made against you as the pharmacist for an error. It’s possible if the patient seeks payment from cvs that they will try to quickly settle for a small amount to make it go away and keep it out of the news, but that’s a PR strategy and lawyer expense strategy. They likely settle wayyyy more claims than could actually win in court.

Now lastly in the event that super harm was done. Wrong thing went out, killed someone. Negligence has to truly be established. If someone or an estate is truly seeking the whale payout, they likely aren’t going to go the route of seeking this against the individual pharmacist. Like I said there’s often caps, judges and juries are more favorable to the little man healthcare worker and less so to the mega evil corporation. The big payout comes in the form of not just winning on personal damages but getting a huge company on punitive damages which would be more of a macro level offense they are found guilty of which is much broader and not applicable to the individual pharmacist.

All in all Joe pharmacist may be looked at as accountable by the board, but potential lawsuits costing him personally millions due to just following a new process his employer put in place. I see extremely extremely low to no possibility of. Again if you are reckless and or not doing what CVS tells you (corporate training not your DL) is the process.. all bets are off but still a better prize for them to go after cvs.
 
PharFromNormal said:
Let me be more direct about this...

If the board views this process as unsafe or inappropriate they will engage CVS not all the individual pharmacists.

The potential penalty/fine/punishment from the board to an individual pharmacist is minimal to zero if you are following policy and procedure. If a significant error happened where you were completely reckless and not acting in accordance to the policy and procedures you may face some consequence from the board. Fines are typically limited and at the extreme you may lose your license or get it suspended. If it was one singular event and mistake it should be 0 penalty.

Now the mega million dollar lawsuits that some of you extreme anxiety pharmacists worry about require a lot of things to happen. First medical negligence is an extremely extremely hard thing to prove and win in actual court so the game is typically seek settlement. Now there’s a lot of state variability on standard of care and liability caps on what a max award a plaintiff could win if it actually goes to trial but one thing is almost universally true if a person or their estate is suing you for an error. There has to be damages, or in this case harm or injury, that occurred for them to make a claim on what is owed to them. This is why I said above an error even with ingestion, possibly even months worth of ingestion depending on the med and patient, might not stand up for a claim made against you as the pharmacist for an error. It’s possible if the patient seeks payment from cvs that they will try to quickly settle for a small amount to make it go away and keep it out of the news, but that’s a PR strategy and lawyer expense strategy. They likely settle wayyyy more claims than could actually win in court.

Now lastly in the event that super harm was done. Wrong thing went out, killed someone. Negligence has to truly be established. If someone or an estate is truly seeking the whale payout, they likely aren’t going to go the route of seeking this against the individual pharmacist. Like I said there’s often caps, judges and juries are more favorable to the little man healthcare worker and less so to the mega evil corporation. The big payout comes in the form of not just winning on personal damages but getting a huge company on punitive damages which would be more of a macro level offense they are found guilty of which is much broader and not applicable to the individual pharmacist.

All in all Joe pharmacist may be looked at as accountable by the board, but potential lawsuits costing him personally millions due to just following a new process his employer put in place. I see extremely extremely low to no possibility of. Again if you are reckless and or not doing what CVS tells you (corporate training not your DL) is the process.. all bets are off but still a better prize for them to go after cvs.
Click to expand...

If board were ever seeing how things are done at CVS, they would have shut down CVS long time ago. Has nothing to do with following processes at all. Process takes time. Time is not available resulting in cutting corners leading to errors as simple as that. Everything else is bull sh**t.

CVS covers it self in the event things go to court by making all these policies and procedures to show that everything is taken care of on paper. Just not practically achievable in real world juggling with 10 things at a time. Imagine clearing 10 pages of queue doing production as per CVS policy.

Who else is excited about writing SOAP notes ? Must be residency graduate failing to get hospital job ended up in corporate CVS convincing bosses its great idea to have pharmacist write SOAP notes at 5pm on Monday evening.
 
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