Labeled Directions

[Scruples]

Just wondering how everyone feels about labeling directions. I was taught and have practiced
that what is on the prescription is what should be on the label. However, with all the KPMs, I have
techs who now take short cuts. If the label states take "i bid pc b & s" then I put " one two times a day after breakfast and supper" as the doctor ordered and the techs are putting "one two times a day after meals".
Or, "every day" if the MD specifically puts " 1 tab one time per day".

Just would like your input/perspectives on this.

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[owlegrad]

I don't see what this has to do with KMPs.

I am a little flexible with what goes on the label, though over time I do train the staff on what I expect to see on the labels. In your example the first one I would want it to say something like "Take 1 tablet twice a day after breakfast and dinner" but I wouldn't send it back for saying after meals, I would just let them know next time if the doc specifies the meals I want it on the label. In the second example I would want something like "Take 1 tablet daily" and if the label literally just said "every day" I would send it back and let the tech know that is completely unacceptable.

 

[maria1oh]

It is annoying. I check to see if it has refills. If yes then I might be more picky about the label since other pharmacists will be checking the refills in the future ...but if there are no refills then I'm more relaxed.
I knew a pharmacist who rejected prescriptions because they did not include "by mouth" - just said "take 1 tablet daily"

Also cvs defaults to today's date on prescriptions so I have seen a lot of wrong dates. If it's a non control and the date is off by a day do you let it slide sometimes?

I think it is just a matter of time before cvs updates their system so verification is in two steps. First verify the data entry (since this is where most errors happen) and then let it go to production and then final verification. This is the way they do it at Walgreens, krogers and walmart.

 

[owlegrad]

It is annoying. I check to see if it has refills. If yes then I might be more picky about the label since other pharmacists will be checking the refills in the future ...but if there are no refills then I'm more relaxed.
I knew a pharmacist who rejected prescriptions because they did not include "by mouth" - just said "take 1 tablet daily"

Also cvs defaults to today's date on prescriptions so I have seen a lot of wrong dates. If it's a non control and the date is off by a day do you let it slide sometimes?

I think it is just a matter of time before cvs updates their system so verification is in two steps. First verify the data entry (since this is where most errors happen) and then let it go to production and then final verification. This is the way they do it at Walgreens, krogers and walmart.

Haha, I do the refill thing too. Much more picky if refills are present.

I pretty much always let the date slide, unless it is crazy like weeks or months off. I used to try to send back all the wrong dates but after a little while I just gave up.

I would love a two step system. I hate all the hassle involved with sending back a script that has made it all the way to verification. Although I guess you would be chained to the computer in that scenario since production would shut down every-time you step away? How would you even do a waiter during flu season? What a nightmare.

 

[Scruples]

I don't see what this has to do with KMPs.

I am a little flexible with what goes on the label, though over time I do train the staff on what I expect to see on the labels. In your example the first one I would want it to say something like "Take 1 tablet twice a day after breakfast and dinner" but I wouldn't send it back for saying after meals, I would just let them know next time if the doc specifies the meals I want it on the label. In the second example I would want something like "Take 1 tablet daily" and if the label literally just said "every day" I would send it back and let the tech know that is completely unacceptable.

The techs are racing against the clocks and trying to only use pre-set sigs. When the data entry is not done in a certain time it counts against them
as well as if the RPh rejects their work, it counts against their efficiency percentage.

 

[owlegrad]

The techs are racing against the clocks and trying to only use pre-set sigs. When the data entry is not done in a certain time it counts against them as well as if the RPh rejects their work, it counts against their efficiency percentage.

I mean this constructively, not in a mean way at all. That is a poor excuse for bad typing IMO. The extra five seconds to type the odd ball sig is not going to make the difference between going in the red or not. In the example of "every day" all they have to type is "1t;qd" how much time are they saving by leaving out "1t" or "1c"? None. It has nothing to do with saving time and everything to do with seeing how much they can get away with. They may be saving two or three seconds on the breakfast/dinner example but really come one. Anyone who types should be able to handle the 30 extra or so keystrokes to type it all out.

 

[trailerpark]

I thought it was dumb when all the pharmacists made me write "unwrap" on suppositories because of the N=1 patient who obliterated her butt hole with a sharp foil suppository.

 

[maria1oh]

When I ask certain techs to change something I learned that they won't. They tell me they have done it that way before (using default today's date, poor label directions, etc.) I have to change it myself if I want it to get done.

Also it can be tricky when checking refills because you can not edit the directions. Would you check out a refill that had directions of "qd" ="every day" instead of the proper 1t;po;qd or would you file an incident report and fill it as 1t;po;qd

 

[owlegrad]

When I ask certain techs to change something I learned that they won't. They tell me they have done it that way before (using default today's date, poor label directions, etc.) I have to change it myself if I want it to get done.

Also it can be tricky when checking refills because you can not edit the directions. Would you check out a refill that had directions of "qd" ="every day" instead of the proper 1t;po;qd or would you file an incident report and fill it as 1t;po;qd

If a tech won't change a label, send them home. I am not even kidding. No way do you let that fly.

I personally do not file incident reports on other pharmacists very often. In fact, I have filled exactly two of them. One of them had the directions "Right ear" for birth control, the other one was Vyvanse 60mg capsules in a bottle labeled for Vyvanse 50mg. I do report my own mistakes because that it is my choice to do so. I do <usually> correct the label on refills by printing the hardcopy, inactivating the script, and retyping it correctly. I just note on the hardcopy that it is a minor sig correction and mark the remaining amount of refills. In fact, I don't usually do this myself, I ask the drop off tech to do it. Obviously she doesn't love doing it, but there are parts of my job I don't love too.

The level of stupidity I will let slip by me on a refill is directly proportional to how busy I am at the moment I am verifying the offending script. If it is a ready fill or due the next day, I just set it aside to fix later. I have let things like "Every day" go when it is the 11th refill and for some reason the person wants to wait on it.

 

[trailerpark]

Do techs really tell a pharmacist no, they wont do something that's asked of them? I don't think I've ever refused to do anything at any job I've had.

 

[PolarPop]

Do techs really tell a pharmacist no, they wont do something that's asked of them? I don't think I've ever refused to do anything at any job I've had.

Anything??

 

[Sparda29]

I have this one tech at the independent pharmacy who types incomplete sigs. So the rule when I'm working there is that the only people allowed to type scripts are me and the super-tech. Everyone else is only allowed to count or be a cashier.

 

[RxMonkey]

I thought it was dumb when all he pharmacists made me write "unwrap" on suppositories because of the N=1 patient who obliterated her butt hole with a sharp foil suppository.

Every pharmacist I've worked with >45 ish years old has told me about their n=1 who did not remove the label. Although, not one has insisted that I include that part in the sig.

 

[BidingMyTime]

Do techs really tell a pharmacist no, they wont do something that's asked of them? I don't think I've ever refused to do anything at any job I've had.

Yeah, I've never had a tech out and out refuse me when I asked them to do their job (although they might have scowled at me the rest of the day & complain to management that I was mean for making them do their job.)

 

[trailerpark]

Yeah, I've never had a tech out and out refuse me when I asked them to do their job (although they might have scowled at me the rest of the day & complain to management that I was mean for making them do their job.)

What was the scenario?

 

[Wheresmyaricept]

Just wondering how everyone feels about labeling directions. I was taught and have practiced
that what is on the prescription is what should be on the label. However, with all the KPMs, I have
techs who now take short cuts. If the label states take "i bid pc b & s" then I put " one two times a day after breakfast and supper" as the doctor ordered and the techs are putting "one two times a day after meals".
Or, "every day" if the MD specifically puts " 1 tab one time per day".

Just would like your input/perspectives on this.

I fill it exactly as it's written. "One topically twice daily rectally as directed once a day by mouth" for eye drops...but some of the techs just roll their eyes at me.

 

[RealityRx]

This is one of the many reasons I have always preferred overnights. I type it the way I like it.

I'd rather be chronically exhausted than try to convince another human being to care about what I care about. And when I get ones who do, I am never allowed to pay them more money. They always leave for better jobs. Usually with a letter of recommendation from me.

 

[owlegrad]

I had one the other day called in...

"Valtrex 1g UD #1 tube 0RF". Hmmm....

It was supposed to be 2 scripts, one for the topical and one for tablets. I guess they wanted to save time and combine them.