Incorrect OTC refills, do I refuse?

[Curiousone1111]

hey everyone,

I’m a floater and I come across weird fills such as wrong strength of calcium/vit d, or prenatals that require a certain amount of iron or folic acid but a different strength was dispensed, or vitamin d2 instead of d3. Rphs haven’t annotated anything either. If it’s late and doc office doesn’t answer, do you refuse to fill or just dispense it? I know the doc probably doesn’t really care but it just seems sloppy to me.

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[Curiousone1111]

If you think it’s not something harmful (d3 instead of d2 for example) then just fill it. Same thing for prenatals and supplements.

Of course you don’t fill Atenolol 25 if it was written for 50. Use your judgment. You aren’t liable for refills. It’s the responsibility of the rph who verified original prescription.

@Chrish yeah definitely wouldn’t do it for actual rx meds like atenolol. I was afraid we’d still be responsible for refills since we still didn’t “catch” the error.

 

[owlegrad]

Stop looking at refills.

Sage advice.

 

[WorthlessOxygen]

You aren’t.. You would only be responsible if you are checking it for the first time

Depends on how you're system is set up but my chain would consider it an error if I failed to catch a mistake on a refill. They also track whether I viewed the Rx image so they can tell if I "should" have caught an error. I also have a hard time believing that you wouldn't be considered liable for continuing to fill something incorrectly.

That being said, I wouldn't care about anything that OP originally asked.

 

[RxPreceptor]

Agreed with what others have mentioned about refills...just think...how would there be any harm/alteration in therapy in dispensing a lotion vs. a cream (real example Ammonium lactate)? Many of such anal "dispensing errors" boil down to saving the patient $$$ and MD not caring about such nit-picky details that ultimately make no difference in therapeutic outcomes.

 

[footfairy]

Which company do you work for? I have never heard any place that would penalize you for not catching a refill error.

Of course you shouldn’t knowingly fill incorrect rx but if refill prescription is for ointment but originally written for cream I am not gonna bother correcting it. And what proof do they have that I knew about it? I would just pretend like I never saw it.

Until very recently Walgreens had the data reviewed for the first two fills on all prescriptions.

So if you purposely let it go the second time you were just as at fault as the original pharmacist. After that second fill though all the remaining ones would skip data review and only pop up for DUR check.

 

[WorthlessOxygen]

Which company do you work for? I have never heard any place that would penalize you for not catching a refill error.

Of course you shouldn’t knowingly fill incorrect rx but if refill prescription is for ointment but originally written for cream I am not gonna bother correcting it. And what proof do they have that I knew about it? I would just pretend like I never saw it.

Rite Aid. Not all refills have to be checked against the original image. But if you did check a refill against the original and missed an error that was later reported, it would count as your error. The original fill would also be an error that counts against the pharmacist who filled it.

The proof would be you dispensing something that doesn't match the Rx

 

[WorthlessOxygen]

But is there any way to track it though that you checked a refill against original image if system doesn’t prompt you to check it and you just did it out of curiosity?

Yes. The system generates an RX note saying that you viewed the image with a timestamp and you are responsible for checking the prescription again. Supposedly not the case if you don't view the image on scripts where you're not prompted to do so.

 

[wagrxm2000]

What is wrong with this place?

No you don't intentionally fill a medication wrong. Fix it.

Yes it goes on you if it's later caught. It goes on everyone who let it go through wrong.

 

[Curiousone1111]

What is wrong with this place?

No you don't intentionally fill a medication wrong. Fix it.

Yes it goes on you if it's later caught. It goes on everyone who let it go through wrong.

@wagrxm2000 I’m surprised at the number of people saying not to care about refills at all and that it’s just going to be the original rph’s fault… just thought maybe I’m a noob.

I guess the right thing to do is refuse to fill til I can get the office on the phone to let them know what’s been filled thus far… even if it means all the techs will think I’m anal for not just dispensing. Seems most rphs just let these things go.

 

[Sine Cura]

"prescriber authorized switch to so-and-so for dispensing"

Guess pharmacists can't be arsed to type that much

 

[Curiousone1111]

"prescriber authorized switch to so-and-so for dispensing"

Guess pharmacists can't be arsed to type that much

@Sine Cura yeah, I expect the rph who changed it to annotate. I just don’t feel comfortable annotating it myself unless I speak to someone, esp if I don’t usually work there and I’m just filling in for the day.

 

[Curiousone1111]

Keep in mind my response applies to refills only. If rx was written for d2 but original rx was typed and dispensed one time for d3 and I happen to perform visual verification on the refill for the same rx pt is filling.

Of course if it was an original rx being verified for the first time, you should never let it go and correct it right away regardless of how minor it is. OP specifically asked about refills on supplements and prenatals and that’s what I was addressing. At the company I work for, rph isn’t required/ liable to verify original rx image for any refill. So if I happen to catch any error this way, depending on error I would correct it right away (metformin ER vs regular) or wouldn’t worry about it (examples in op’s post).

Best practice in any case is not to look at refills if not required.

@Chrish so at your workplace, for refills, you just have to make sure the pill is correct in the bottle/matches the label?

 

[Curiousone1111]

Yes. I thought that was the norm. What’s the point of it being a refill otherwise?

@Chrish well rx may have refills but the first rph may have made a mistake and I was under the impression that each rph has a responsibility to ensure that what they’re filling is accurate, even if a refill.

 

[M0df]

I remember someone catching an error on refill 5+. Days of handwritten prescriptions though. K citrate vs K chloride.... Just saying that it does happen.

If your employer doesn't want you checking hardcopies of any refills, just means they intentionally don't want to find any mistakes.

 

[Dreamer716]

For original examples, I could care less. Especially if its put in for a different strength (ie. iron supplement in a prenatal) because that's what insurance would cover. Never for any RX meds.

On the topic of refills, do yourself a favor and check all refills. Especially on the second fill. How would you know if something was wrong on the original script if you don't check the second.

I check data entry twice now for everything (drug, directions, quantity). Gives me peace of mind since I'm going 110 miles per hour and doing a lot of drop off since that's the way workflow is set up at my chain.

 

[Curiousone1111]

For original examples, I could care less. Especially if its put in for a different strength (ie. iron supplement in a prenatal) because that's what insurance would cover. Never for any RX meds.

On the topic of refills, do yourself a favor and check all refills. Especially on the second fill. How would you know if something was wrong on the original script if you don't check the second.

I check data entry twice now for everything (drug, directions, quantity). Gives me peace of mind since I'm going 110 miles per hour and doing a lot of drop off since that's the way workflow is set up at my chain.

@Dreamer716 sounds good. I’ve seen higher doses than the recommended on refills and didn’t see any notes. Didn’t feel comfortable refilling without speaking to the office to at least bring it to their attention then see if they still want it or not… but got eyerolls from the techs because “all the other rphs do it.” Idk why they even care lol

 

[Sparda29]

Are we talking about stupid **** like vitamins and calcium? I'm just gonna bill whatever is covered and fill what we have in stock. I don't need the headache of matching NDCs on calcium/vitamin D. Half the time they don't cover the NDC my wholesaler has in stock. Major, Rugby, Windmill, Sunrise, all the same ****.

Prenatal vitamins, again whatever is covered. No one cares.

Obviously you should fix mistakes that are on actual prescription drugs that can cause harm if it was filled wrong.