Hospital Pharmacy and Errors

[Sparda29]

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What do you guys (pharmacists) do when you catch another pharmacist's error? I feel like I'm the only ****ing person around here who fixes other people's errors quietly without people getting in trouble. Meanwhile, I saw that one pharmacist had caught an error of one of my coworkers (who she didn't like) and started laughing and took the error and went and handed it straight to the director, WTF?????

Maybe it's just me and my ghetto upbringing "snitches get stitches". Just fix the error, tell the person who committed the error that you fixed it quietly, and don't tell administration, jeez.

 

[Carboxide]

...Ghetto upbringing? You? Aren't you from Long Island? Aren't your parents super conservative? Hahahaha

 

[Sparda29]

...Ghetto upbringing? You? Aren't you from Long Island? Aren't your parents super conservative? Hahahaha

Moved to Long Island when I was 16, grew up in downtown Flushing, went to high school in South Side Jamaica, college in Downtown Brooklyn, and pharm school in Harlem.

 

[lisinopril]

What do you guys (pharmacists) do when you catch another pharmacist's error? I feel like I'm the only ****ing person around here who fixes other people's errors quietly without people getting in trouble. Meanwhile, I saw that one pharmacist had caught an error of one of my coworkers (who she didn't like) and started laughing and took the error and went and handed it straight to the director, WTF?????

Maybe it's just me and my ghetto upbringing "snitches get stitches". Just fix the error, tell the person who committed the error that you fixed it quietly, and don't tell administration, jeez.

It's the same no matter where you work...I hate people like this too. If someone does that to me, I would do the same when I find his/her error. Not playing Mr.Nice Guy here.

 

[BidingMyTime]

I guess it depends on the policy and the error. I've worked in places that really had no formal policy for errors, so yes, I just corrected those quietly. I've also worked in places that wanted every error reported, and I generally followed the reporting error in those places (although an error is never a laughing matter, what kind of sociopath laughs about someone's errors.) The exception is, since I've worked in retail, I don't report really dumb stuff like wrong doctor, or wrong office of the correct doctor, or wrong quantity....stuff that in no way could have ever harmed a patient, I've worked with pharmacists who DO report all that stupid ****, yes they seem to get off on the human failings of others.

 

[BidingMyTime]

OK, confession, I have laughed when verifying prescriptions and found a quick code error where the technician made a typo, so the quick code converted to something completely absurd in the prescription---but these were obvious errors, caught before they ever got anywhere near a patient. There is nothing funny about an error that has reached a patient.

 

[PharmDstudent]

What do you guys (pharmacists) do when you catch another pharmacist's error? I feel like I'm the only ****ing person around here who fixes other people's errors quietly without people getting in trouble. Meanwhile, I saw that one pharmacist had caught an error of one of my coworkers (who she didn't like) and started laughing and took the error and went and handed it straight to the director, WTF?????

Maybe it's just me and my ghetto upbringing "snitches get stitches". Just fix the error, tell the person who committed the error that you fixed it quietly, and don't tell administration, jeez.

see "troublemaker"

 

[Sparda29]

see "troublemaker"

Yup, she was a pharmacist who tried to get me on her "side" when I first started there. She was all like, "you don't wanna pick the wrong team as a new guy". I just told her, I'll start my own team, lol. I don't understand the drama of the day shift in hospital pharmacy, we don't have time for that drama **** in the evening shift, lol.

 

[boriqua]

I grew up in the ghetto too. In fact, i'm still in the ghetto(morris heights in the Bronx). I think most pharmacy school kids were spoiled as kids and mommy and daddy gave them everything and would never understand the ramifications of snitching.
It's also a product of less jobs going around so everyone is trying to cut everyone else's throat to get ahead or at least make themselves look indispensable.

 

[rph3664]

I can only think of one pharmacist who would get offended if you pointed out a mistake. And the worst mistake I ever saw that reached a patient was made by (and slipped through) the best tech and best pharmacist we had, and it wouldn't surprise me if the best nurse didn't catch it either. It involved a patient getting 2 1/2 times the morphine they should have, and Narcan as a result. 😱

Catching TECH errors? That's another story. I've worked with techs who accused me of going in and changing it to make them look bad (I went straight to the director when I got accused of that), or they would yell at us and throw things at us, that kind of thing.😡

 

[Sparda29]

I can only think of one pharmacist who would get offended if you pointed out a mistake. And the worst mistake I ever saw that reached a patient was made by (and slipped through) the best tech and best pharmacist we had, and it wouldn't surprise me if the best nurse didn't catch it either. It involved a patient getting 2 1/2 times the morphine they should have, and Narcan as a result. 😱

Catching TECH errors? That's another story. I've worked with techs who accused me of going in and changing it to make them look bad (I went straight to the director when I got accused of that), or they would yell at us and throw things at us, that kind of thing.😡

I don't get offended if you point out a mistake I made. I do get offended if you point it out in front of other people or take it to the director. Do it in a way without an incident form having to be filled out.

 

[rph3664]

So, what do you do when the tech who throws things at you (and is one of the special snowflakes who's immune from disciplinary action) if you point out a mistake does something like hand you an atenolol 50mg tablet when it's supposed to be 100mg? Or you hand her a bag of stat Zofran, and she refuses to tube it because she's "too busy"?

Huh?

Last year, two of her children died in an accident, and I did not see one post ANYWHERE from someone who said they were her friend. Go figure.

When she was growing up, she was always in the ultra-super-mega popularity crowd, and was very upfront that the kids who weren't should be banned from the planet, and then she graduated and nobody cared about that any more, and her life just went downhill from there.

I had another job with a tech who (among other things) referred to black people using the N word, and deliberately filled the cart all wrong when I was working. Her reply whenever I'd ask her to do something? "Make me, (word for female dog)." I still wonder who she had naked pictures of, KWIM?

 

[WVUPharm2007]

What do you guys (pharmacists) do when you catch another pharmacist's error? I feel like I'm the only ****ing person around here who fixes other people's errors quietly without people getting in trouble. Meanwhile, I saw that one pharmacist had caught an error of one of my coworkers (who she didn't like) and started laughing and took the error and went and handed it straight to the director, WTF?????

Maybe it's just me and my ghetto upbringing "snitches get stitches". Just fix the error, tell the person who committed the error that you fixed it quietly, and don't tell administration, jeez.

Some people at my last job were like that. Its the #1 reason I don't mind not doing hospital anymore. I got called into the directors' office once for putting omeprazole into a profile twice. They acted like I ended the universe. Other pharmacists would make serious errors like inputting 110u of insulin rather than 11u. The dose would be given...and nothing. Oops, error. That was it.

 

[pharmalt82]

People think that retail is the only environment where you must be thick-skinned. It's not. Different environment same crap. The only thing that changes is who is giving you crap.

You ain't seen nothing yet. One of my rotations had me basically see the inside-out of 2 hospitals over the course of a month. I saw Doctors, Nurses, Pharmacists, PAs, etc. all acting like children having stupid squabbles about others not letting them finish sentences and what not.
But, that's not the worst thing. The worst thing is seeing this "pass the buck" attitude. I fear becoming an RPh who has to deal with the laziness of other RPhs.

Unprofessional techs are the least of our worries. Techs do most of the physical work for us so we don't have to be bothered while operating the phone, computer, etc.

 

[owlegrad]

People think that retail is the only environment where you must be thick-skinned. It's not. Different environment same crap. The only thing that changes is who is giving you crap.

You ain't seen nothing yet. One of my rotations had me basically see the inside-out of 2 hospitals over the course of a month. I saw Doctors, Nurses, Pharmacists, PAs, etc. all acting like children having stupid squabbles about others not letting them finish sentences and what not.
But, that's not the worst thing. The worst thing is seeing this "pass the buck" attitude. I fear becoming an RPh who has to deal with the laziness of other RPhs.

Unprofessional techs are the least of our worries. Techs do most of the physical work for us so we don't have to be bothered while operating the phone, computer, etc.

I nominate you for post of the day. This is so so true. Personally I am the least bothered when it is the patient giving me crap. That I expect. What I do not expect is when it is the doctor, nurse, or fellow RPh giving me crap.

Today alone I had a doctor call me to tell me that our prices were too high (OH REALLY? And how much do you charge for an office visit?), a fellow RPh give me crap (Well if your perfect pharmacy is hiring please let me know...), in addition to the "normal" level of crap I expect to get from patients.

 

[rph3664]

Some people at my last job were like that. Its the #1 reason I don't mind not doing hospital anymore. I got called into the directors' office once for putting omeprazole into a profile twice. They acted like I ended the universe. Other pharmacists would make serious errors like inputting 110u of insulin rather than 11u. The dose would be given...and nothing. Oops, error. That was it.

I once got in trouble for filing an incident report because a bag of vancomycin was hung, but not administered, for 16 hours! 😕 No, it wasn't a pharmacy error (it was a nursing error), but c'mon, we're all in this together. 🙄

 

[xiphoid2010]

From the management side, I personally would like to see all incidents reported for tracking. I rather have as much info as possible than not enough info.

What to so about an incident is the job of the management, so don't feel bad for catching mistakes. I personally wouldn't think any less of a staff who made an explainable mistakes once in a while. What I care about are repeating patterns, serious errors that can cause significant harm, or involving narcs or policy/regulations.

If the state or joint commission comes in and ask how I'm tracking errors/discrepencies, and I show them an empty folder and say there are no errors even though there were 100,000 orders processed... Lol

 

[KARM12]

Depends on how your managers deal with errors. The ideal system is non-punative where errors can get reported in order to improve the system.

We use the error reporting system to improve patient safety...we don't want to repeat any errors. Sometimes errors are things you wouldn't anticipate, but if someone didn't report it, it could potentially harm someone in the future. I've never seen a pharmacist get in "trouble" for making or reporting an error. Error reporting is an expected part of the job performance for all hospital employees.

 

[Sparda29]

From the management side, I personally would like to see all incidents reported for tracking. I rather have as much info as possible than not enough info.

What to so about an incident is the job of the management, so don't feel bad for catching mistakes. I personally wouldn't think any less of a staff who made an explainable mistakes once in a while. What I care about are repeating patterns, serious errors that can cause significant harm, or involving narcs or policy/regulations.

If the state or joint commission comes in and ask how I'm tracking errors/discrepencies, and I show them an empty folder and say there are no errors even though there were 100,000 orders processed... Lol

Like my main mistakes seem to be going too fast and not catching mg/gm inversions. Like approving a 1 mg Vancomycin order or a 1000 gm carafate order.

 

[PharmDstudent]

Like my main mistakes seem to be going too fast and not catching mg/gm inversions. Like approving a 1 mg Vancomycin order or a 1000 gm carafate order.

There's no "gm" in the metric system - it's just "g". I remember learning that growing up. Pharmacy should have dropped the trailing m too.

So your order entry system doesn't show how many unit cups or dosages you're dispensing? Or are you going too fast to notice?

 

[Sparda29]

There's no "gm" in the metric system - it's just "g". I remember learning that growing up. Pharmacy should have dropped the trailing m too.

So your order entry system doesn't show how many unit cups or dosages you're dispensing? Or are you going too fast to notice?

It does but I'm probably going way too fast to notice.

Reason why I end up going so damn fast is because everyone else is going so slow, and when the unverified orders start piling up, the DOP starts getting pissed off or if its past 5PM he starts verifying from home, not to mention the nurses start calling and asking us to verify orders. It's weird at my hospital, me and my partner come in at 3PM and there are like 50 orders pending verification, and within 15 minutes the queue is empty asides from any suspended/problem orders. I wonder if my DOP can even see that we are doing much more work than the morning crew.

Usually I catch my verification error when I go to check what the tech put in the ziplock bag with the label on top of it. Like for that Carafate error I mentioned before, I caught it when I saw the label asking for 4000 UD cups or something crazy like that when there are only 4 UD cups in the bottle. Another example of a common error would be, I see an order for Nystatin suspension. I see 5 in the dosage field, q6h in the frequency field, and oral thrush in the indication field, but I don't catch that the unit of measure is set to "units" instead of "mLs".

 

[ethyl]

Our system is very punitive. Management has no tolerance towards wrong patient errors and can get you on the fast track to getting fired. There's a fear of reporting errors because of getting called into the director's office, getting "coached" and starting the discipline ladder towards termination.

So as a result the only time errors get turned into management would be severe ones that reach the patient or are so outrageous they can't be ignored. I don't agree with this environment because it's what the ISMP opposes, but there's nothing we can do about it.

 

[Sparda29]

Our system is very punitive. Management has no tolerance towards wrong patient errors and can get you on the fast track to getting fired. There's a fear of reporting errors because of getting called into the director's office, getting "coached" and starting the discipline ladder towards termination.

So as a result the only time errors get turned into management would be severe ones that reach the patient or are so outrageous they can't be ignored. I don't agree with this environment because it's what the ISMP opposes, but there's nothing we can do about it.

Thankfully our system has a non-punitive approach to errors. Hell, even on crazy patient level errors there was no action taken.

MD orders Sodium chloride 3% 80 mL/hr x 3 hours.
Pharmacy policy is to not open the 500 mL bags of Sodium chloride 3%.
Pharmacists prints out correctly typed label and attaches to 500 mL bag of Sodium Chloride 3%, attaches note dose/high alert stickers. Med is sent up.
Nurse calls 15 minutes later saying she ripped the bag and it spilled so she'll need another bag.
Second pharmacist reprints label, attaches label as well as note dose/high alert sticker.
2 hours later, doctor calls asking WTF is going on and asks pharmacist to go investigate what happened.
Pharmacist (me) goes up and discovers the entire 500 mL bag of Sodium chloride 3% has been run, instead of the ordered 240 mL.

Nurse is still around.

 

[rph3664]

Thankfully our system has a non-punitive approach to errors. Hell, even on crazy patient level errors there was no action taken.

MD orders Sodium chloride 3% 80 mL/hr x 3 hours.
Pharmacy policy is to not open the 500 mL bags of Sodium chloride 3%.
Pharmacists prints out correctly typed label and attaches to 500 mL bag of Sodium Chloride 3%, attaches note dose/high alert stickers. Med is sent up.
Nurse calls 15 minutes later saying she ripped the bag and it spilled so she'll need another bag.
Second pharmacist reprints label, attaches label as well as note dose/high alert sticker.
2 hours later, doctor calls asking WTF is going on and asks pharmacist to go investigate what happened.
Pharmacist (me) goes up and discovers the entire 500 mL bag of Sodium chloride 3% has been run, instead of the ordered 240 mL.

Nurse is still around.

Is the patient? Our policy was NEVER to run it at more than 50ml/hr, although one nephrologist DEMANDED 100ml/hr but he finally compromised at 67ml/hr. I'll admit the sodium was beyond critical, but I really didn't want to kill that person either.

 

[Sparda29]

Is the patient?

Yeah, nothing really happened other than sodium returning to normal, but the doc was worried about potential central pontine myelinolysi.s

 

[knight on horse]

Almost all of the hospitals I rotated at had oppressive, drama filled atmospheres

 

[type b pharmD]

Almost all of the hospitals I rotated at had oppressive, drama filled atmospheres

Lol! 👍 this is why I ruled out hospital completely after my first few years of tech/interning. Am so happy to never set foot in one again as an employee.

On the other hand you can see that in retail too but I find mostly a much more cordial, social, and realistic thinking type atmosphere there than in inpt. Although my view is undoubtedly skewed.

 

[Sparda29]

As bad as it can get drama wise in a hospital. I think I have it pretty good with my afternoon-evening shift. After 5PM the directors gone, the clinical pharmacist is gone, so there's no one really telling you what to do during downtime.

Not to mention, one hour breaks and only having to pay $37.50 every 2 weeks for full health coverage.

 

[boriqua]

Lol! 👍 this is why I ruled out hospital completely after my first few years of tech/interning. Am so happy to never set foot in one again as an employee.

On the other hand you can see that in retail too but I find mostly a much more cordial, social, and realistic thinking type atmosphere there than in inpt. Although my view is undoubtedly skewed.

in retail, you and your coworkers have a common enemy to work together to deal with. annoying customers

in the hospital, you only deal with each other.

 

[type b pharmD]

As bad as it can get drama wise in a hospital. I think I have it pretty good with my afternoon-evening shift. After 5PM the directors gone, the clinical pharmacist is gone, so there's no one really telling you what to do during downtime.

Not to mention, one hour breaks and only having to pay $37.50 every 2 weeks for full health coverage.

Yeah.. evening shifts seem to be this sort of magical land . You have it pretty good compared to day shifters!

 

[Sparda29]

Yeah.. evening shifts seem to be this sort of magical land . You have it pretty good compared to day shifters!

It's tough because you only have 2 pharmacists and 1 tech at night but no drama.

 

[owlegrad]

Yeah that's one nice thing about being busy...less time for drama!

We used to have a supertech at my store. I mean wicked fast, extremely low error rate, from a technical perspective just a phenomenal tech. But my goodness, what a drama queen. No one in the district wants her because she is just so toxic to work with. I don't care how "good" you are, it is not worth the trouble if all you do is cause trouble and bring down morale.

 

[Sparda29]

Yeah that's one nice thing about being busy...less time for drama!

We used to have a supertech at my store. I mean wicked fast, extremely low error rate, from a technical perspective just a phenomenal tech. But my goodness, what a drama queen. No one in the district wants her because she is just so toxic to work with. I don't care how "good" you are, it is not worth the trouble if all you do is cause trouble and bring down morale.

Ya. My regular tech for the night shift, most people don't like because he makes mistakes, disappears for cigarette breaks every couple of hours, and catcalls and flirts with all the nurses and females that walk by the pharmacy window. But, he's a fun guy to work with, and for some reason, his flirting with the nurses takes pressure off of us because he manages to keep them at bay, while other techs immediately have us pick up the phone and deal with the nurses. He seems to understand that the only time I wanna be on the phone is when I'm calling a doc, not for missing med bull****.

Another fun part of it is that me and him have a little rivalry especially when it comes to music since he's from Brooklyn and I'm from Queens, so with us it's always Jay-Z Vs Nas.

 

[boriqua]

Another fun part of it is that me and him have a little rivalry especially when it comes to music since he's from Brooklyn and I'm from Queens, so with us it's always Jay-Z Vs Nas.

Nas is the better lyricist and all around rapper, period. Jay is just commercially more successful.
coming from a brooklyn n*gga lol

 

[type b pharmD]

Nas is the better lyricist and all around rapper, period. Jay is just commercially more successful.
coming from a brooklyn n*gga lol

Seconded. Except I'm not black or from Brooklyn . Lol

 

[joetrisman]

As bad as it can get drama wise in a hospital. I think I have it pretty good with my afternoon-evening shift. After 5PM the directors gone, the clinical pharmacist is gone, so there's no one really telling you what to do during downtime.

Yup yup. Night time in the hospital > daytime x infinity

 

[Sparda29]

Nas is the better lyricist and all around rapper, period. Jay is just commercially more successful.
coming from a brooklyn n*gga lol

Try to convince my tech. He gets infuriated every time I play "Ether" by Nas.

Yup yup. Night time in the hospital > daytime x infinity

The only downside I've seen in the evening is that when the **** hits the fan, you're kinda alone. I hate having to emergency borrow meds from other hospitals but I end up having to do it once a week because the morning crew just doesn't seem to anticipate.

Like one time we only had 5 - 50mg vials of Ambisome. Of course, ID doc comes in at 7PM and prescribes 400mg of Ambisome and I end up having to decide whether to order and possibly get yelled at tomorrow for using the emergency service or trying to convince the ID doc to delay starting the med.

Another time we somehow ****ing ran out of Diphenhydramine 50 mg injectables and Haloperidol 5 mg injectables and even ****ing Docusate 100 mg capsules... HOW? I feel like a jackass when I call the hospitals and tell them "uhhh we ran out of Docusate can we borrow 100..."

 

[PharmDstudent]

Try to convince my tech. He gets infuriated every time I play "Ether" by Nas.



The only downside I've seen in the evening is that when the **** hits the fan, you're kinda alone. I hate having to emergency borrow meds from other hospitals but I end up having to do it once a week because the morning crew just doesn't seem to anticipate.

Like one time we only had 5 - 50mg vials of Ambisome. Of course, ID doc comes in at 7PM and prescribes 400mg of Ambisome and I end up having to decide whether to order and possibly get yelled at tomorrow for using the emergency service or trying to convince the ID doc to delay starting the med.

Another time we somehow ****ing ran out of Diphenhydramine 50 mg injectables and Haloperidol 5 mg injectables and even ****ing Docusate 100 mg capsules... HOW? I feel like a jackass when I call the hospitals and tell them "uhhh we ran out of Docusate can we borrow 100..."

Evenings are less dramatic no doubt, but after working with enough attention-seeking, narcissistic troublemakers, I feel like it doesn't matter which shift you work, toxic personality types are bad news - unless you like being thrown under the bus. Why is it sooooooooo hard for some people to just work in peace?
The entire staff where I work is dealing with one right now, and we've all had enough. 🙄

Running out of meds isn't so bad here. We're all pretty friendly in this area and it's the south and all. The only problem I have is running out of narcotics where I work PRN. The LTACH is so small that it's easy to run out if too many patients get started on the same meds.

 

[PharmDstudent]

Yeah that's one nice thing about being busy...less time for drama!

We used to have a supertech at my store. I mean wicked fast, extremely low error rate, from a technical perspective just a phenomenal tech. But my goodness, what a drama queen. No one in the district wants her because she is just so toxic to work with. I don't care how "good" you are, it is not worth the trouble if all you do is cause trouble and bring down morale.

I can definitely relate.

If I ever do the hiring, I'll be screening for whether someone is toxic or not. From what I've been able to associate with troublemakers, they're fake fake fake with an extra sprinkle of fake on top, and thankfully, that's pretty easy to spot.

 

[Sparda29]

Yeah that's the worst part. On the weekends I have to work with this really toxic character (well not anymore since they're switching me to the other weekend), and I have to play the double-agent naive little newbie pharmacist role while she's around just so she doesn't think I know what's up.

Like today.
Her - "Does Jenny talk **** about me while I'm not around?"
Me - Nope, not that I've heard of. (Jenny does talk ****, but so does everyone else in the department since she's a crazy neurotic sex-deprived maniac.


I can't stand these 30 something year old married with kids female pharmacists coming up to me and asking me "do I still have it?" Go away you old hags.

 

[PharmDstudent]

Yeah that's the worst part. On the weekends I have to work with this really toxic character (well not anymore since they're switching me to the other weekend), and I have to play the double-agent role while she's around, lol.

Double agent? I'm gonna have to look that up! 😉

 

[PharmDstudent]

I have to play the double-agent naive little newbie pharmacist role while she's around just so she doesn't think I know what's up.

Lucky to be you. 👍 I wish I could play naive, but I've been around too long, so I've been trying to cope by reading about how to deal with them.

Like today.
Her - "Does Jenny talk **** about me while I'm not around?"
Me - Nope, not that I've heard of. (Jenny does talk ****, but so does everyone else in the department since she's a crazy neurotic sex-deprived maniac.

Everyone talks everyone here too.

I can't stand these 30 something year old married with kids female pharmacists coming up to me and asking me "do I still have it?" Go away you old hags.

Hahahahaha

 

[boriqua]

lol sounds like high school.

 

[rph3664]

I can definitely relate.

If I ever do the hiring, I'll be screening for whether someone is toxic or not. From what I've been able to associate with troublemakers, they're fake fake fake with an extra sprinkle of fake on top, and thankfully, that's pretty easy to spot.

Some places actively look for people like that. My old job found the perfect example of this, and her arrival totally turned a 60-person department upside-down. I also found out recently that she's in the midst of a seriously ugly divorce, and EVERYONE is TOTALLY siding with the husband even though the festivities kicked off with her filing a restraining order against him. 😱

 

[Sparda29]

See the weird thing is, the toxic person in our department told me not to associate with the "troublemakers". From my point of view the "troublemakers" are the good guys (people who are not afraid of the boss(DOP), people who call out the boss when he's in the wrong, people who complain to the boss about nurses and whatnot.

The one thing that freaked me out about her was when she started bitching about one of my friends in the department coming back 10 minutes late from her lunch break. I hate people who watch the clock like that.

Hell, one of my partners took a 2 hour lunch break on me instead of the allowed 1 hour lunch break and I didn't even care about it (even though I was alone for 1 hour of that).