Mistakes

[owlegrad]

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Just curious, how many mistakes do you catch a day? I felt like all I did today was send stuff back to drop off to be retyped. Even caught an error on a refill. Just wondering what the 'normal' amount is.

 

[owlegrad]

Uhhh... define "mistake". Because if "sending stuff back" constitutes a "mistake" then my answer is 1 out of every 12 prescriptions (because that's what our input accuracy is typically around).

Why would you send something back for anything besides a mistake?

For example today I sent back something typed for QD that should have been BID, something that should have had PRN that was left out, and something that was typed for the wrong patient. Plus some relatively minor stuff like leaving off the DOB or selecting the wrong prescriber. I am not even considering wrong days supply, wrong date written, or anything insurance related.

I am not sure what the % sent back is though. Not even sure if I can run a report that shows it.

 

[Corpseman]

It also depends on how picky you are. I had pharmacists that would send back anything that did not have the numbers spelled out in the sig, while other pharmacists couldn't care less.

I am sure that increases/decreases %'s as well

 

[Jibby321]

The store I work at has a report and we usually have about 1 out of every 35 sent back to drop off.

 

[Old Timer]

An error is NOT an error until it reaches the patient. Up until that time it is a teachable moment. Now when you have to send that many back over and over, you have a person either not trained well enough or not proficient enough to handle drop off at the volume you are filling.

 

[CUpharmD2013]

I'm floating right now, so it really depends on the store and the help. I would say it ranges from about 1% to up to 20%. Since I'm a floater, I tend to just fix it myself unless I've already established a relationship with the techs. As for refills, I find mistakes all the time. The mistakes that I feel that are worth the time to change are those such as instructions, dose, and number of refills.

 

[pezdispenser]

Good techs <1%
Bad techs 20+%
Average 3-5%
I try to encourage techs to ask if unsure, rather than just guess and see if I verify it.

Pharmacists of course should aim for 0 mistakes, but in reality it's about 0.01%.

 

[owlegrad]

It also depends on how picky you are. I had pharmacists that would send back anything that did not have the numbers spelled out in the sig, while other pharmacists couldn't care less.

I am sure that increases/decreases %'s as well

Yes that is true. I was only thinking about things being 'actually' wrong, but some pharmacists are very picky with how they want things typed.

The store I work at has a report and we usually have about 1 out of every 35 sent back to drop off.

That sounds pretty similar to what I am seeing. I just never noticed before how many have to be fixed or realized how much burden it puts on the pharmacist.

 

[BidingMyTime]

I would say anywhere from 2% - 15% depending on the technician working, and what kind of day it was. Today was a bad day, I felt like I was correcting about every other RX (stuff that is obviously wrong, not just being picky),caught an obvious error in an already bagged RX, and even a vial with 2 different tablets mixed together. That # of errors always worries me, I figure the more errors the technicians are making, the more likely that one is to slip by me. Although as Old Timer pointed out, its not statistically an error until it gets to the patient.

 

[owlegrad]

I would say anywhere from 2% - 15% depending on the technician working, and what kind of day it was. Today was a bad day, I felt like I was correcting about every other RX (stuff that is obviously wrong, not just being picky),caught an obvious error in an already bagged RX, and even a vial with 2 different tablets mixed together. That # of errors always worries me, I figure the more errors the technicians are making, the more likely that one is to slip by me. Although as Old Timer pointed out, its not statistically an error until it gets to the patient.

I agree with OldTimer as well.

I have caught so many errors that I never even considered. Like when labeling multiple bottles and using a different patient label on just one of the bottles. Or putting two tablets in one bottle, like you said. Or putting different patients in one basket to be checked.

And then there is weird stuff, like one tech who just will not put the liquid stock bottle in the basket for me to check. How do you deal with something like that? I am talking about a lifer who just keeps "forgetting" (every single time) that I need the bottle when checking. WTF? What's the issue?!

 

[CUpharmD2013]

Had one yesterday where the correct strength of Zestoretic was scanned but a different strength ended up in the bottle. Another situation, that happens a lot, is when labels from the same patient are placed on the wrong bottle of tablets. How do you guys feel about multiple boxes of medication (e.g. albuterol vials) having a label on just one box? Seeing a lot of that lately. Take the extra minute to print up the extra labels, please.

 

[wucool33]

Had one yesterday where the correct strength of Zestoretic was scanned but a different strength ended up in the bottle. Another situation, that happens a lot, is when labels from the same patient are placed on the wrong bottle of tablets. How do you guys feel about multiple boxes of medication (e.g. albuterol vials) having a label on just one box? Seeing a lot of that lately. Take the extra minute to print up the extra labels, please.

I just tape the boxes together 😕

 

[BidingMyTime]

Had one yesterday where the correct strength of Zestoretic was scanned but a different strength ended up in the bottle. Another situation, that happens a lot, is when labels from the same patient are placed on the wrong bottle of tablets. How do you guys feel about multiple boxes of medication (e.g. albuterol vials) having a label on just one box? Seeing a lot of that lately. Take the extra minute to print up the extra labels, please.

I think everything should be labeled and I would send it back if it wasn't. The exception is if its a special ordered item with a high copay, then I tell the techs not to label it until the patient comes in, so we can send it back if they decide not to get it.

 

[PharmDstudent]

I just never noticed before how many have to be fixed or realized how much burden it puts on the pharmacist.

This is just one reason why SDN pharmacists are famous for putting pharmacy students in their place. There's a moment in time whenever a new pharmacist realizes the difference between being a student and being the pharmacist, and I think you've just had that realization. 😎

 

[pezdispenser]

This is just one reason why SDN pharmacists are famous for putting pharmacy students in their place. There's a moment in time whenever a new pharmacist realizes the difference between being a student and being the pharmacist, and I think you've just had that realization. 😎

Too bad SHC1984 was banned. She just became a pharmacist right? Does anyone know how she is doing?

 

[pharmalt82]

The best floater pharmacists that I've seen are the ones who do all the typing and verifying and let the techs do all the basic manual labor like counting, labeling, and ringing people up. This may seem demeaning to some technicians, BUT, a floater can't judge the skill level of a tech instantly and this ensures that a pharmacist has less work to do down the line. Remember, you are there to do the mainly intellectual work. The best techs are the ones who let the pharmacist be the pharmacist.

 

[pharm B]

Too bad SHC1984 was banned. She just became a pharmacist right? Does anyone know how she is doing?

I keep looking for her in the news, but nothing yet. 😉

 

[Jibby321]

Who is this shc1984 everyone is speaking of?

 

[Stilltrying1288]

Had one yesterday where the correct strength of Zestoretic was scanned but a different strength ended up in the bottle. Another situation, that happens a lot, is when labels from the same patient are placed on the wrong bottle of tablets. How do you guys feel about multiple boxes of medication (e.g. albuterol vials) having a label on just one box? Seeing a lot of that lately. Take the extra minute to print up the extra labels, please.

I agree with this and print extra labels at my work place, but I had an IPPE site that ended up giving me a lecture and making me tape multiple boxes instead of printing out the extra labels.

 

[CUpharmD2013]

I just tape the boxes together 😕

Yeah, I've been doing that, but I've also been noting on the sticker the amount of boxes that are there. People always call and say they must not have gotten the full quantity because they end up losing a stray package.

 

[owlegrad]

Personally I am a fan of taping them together. My lead tech puts small boxes in a ziplok bag and labels the bag.

 

[wucool33]

Yeah, I've been doing that, but I've also been noting on the sticker the amount of boxes that are there. People always call and say they must not have gotten the full quantity because they end up losing a stray package.

hmmm... good idea... I'll start doing that too

 

[boriqua]

I tape boxes together too. saves time, saves trees. The environment will thank you for it

 

[rph3664]

It also depends on how picky you are. I had pharmacists that would send back anything that did not have the numbers spelled out in the sig, while other pharmacists couldn't care less.

I am sure that increases/decreases %'s as well

I was taught to always use numerals, because so many people have low literacy and also because it takes up less space on the label.

At my old hospital, we had a tech who would get VERY angry if you rejected anything she filled, even if you could prove she did it wrong. I, and other pharmacists, were screamed at, had things thrown at us, etc. but she was a speshul sneauxflayke who was exempt from disciplinary action, so there wasn't much that could be done about it.

 

[rph3664]

Who is this shc1984 everyone is speaking of?

SHC1984 was initially a dental student who switched to pharmacy, and got banned. Not sure why, and of course the moderators can't tell me anyway. I'm sure there are people here who saw the post, or got the PM, that led to her banning.

She was rather interesting, and flamboyant, or at least her character was.

 

[Jibby321]

SHC1984 was initially a dental student who switched to pharmacy, and got banned. Not sure why, and of course the moderators can't tell me anyway. I'm sure there are people here who saw the post, or got the PM, that led to her banning.

She was rather interesting, and flamboyant, or at least her character was.

I see. Some fourms I have been on (not sdn) in the past will list all banned users with a reason. I guess sdn doesn't do that.

 

[pharmalt82]

What is your opinion of teaspoon/tablespoon vs 5mL/15mL?
I always prefer the arabic numbers. They can get measuring oral syringes or spoons that state the mLs, but they may give the wrong dose if you state teaspoon/tablespoon and they just use kitchen utensils.

 

[Rockinacoustic]

What is your opinion of teaspoon/tablespoon vs 5mL/15mL?
I always prefer the arabic numbers. They can get measuring oral syringes or spoons that state the mLs, but they may give the wrong dose if you state teaspoon/tablespoon and they just use kitchen utensils.

In my experience patients have less of an idea what milliliters are.

If I get a script written in milliliters I'll typically put the corresponding spoonful measurement in the directions in parentheses. i.e. 'Take 5ml (1 teaspoon) by mouth twice a day'

Of course the best solution is just either your or a tech showing them with an oral syringe.

 

[pharmalt82]

In my experience patients have less of an idea what milliliters are.

If I get a script written in milliliters I'll typically put the corresponding spoonful measurement in the directions in parentheses. i.e. 'Take 5ml (1 teaspoon) by mouth twice a day'

Of course the best solution is just either your or a tech showing them with an oral syringe.

Let's suppose you omit the teaspoon/tablespoon business and just write 5mL or 6.25mL or whatever dose is required and the patient declines counseling and the patient doesn't receive a free oral syringe with mL markings. What are the legal ramifications?