New CVS overnight pharmacist questions

[techniques]

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Recently staffed overnight pharmacist here at an unusually busy store that’s within walking distance from the ER. It also has the biggest C2 inventory I’ve ever seen. On busy nights, I can’t even touch the queue until 2 AM usually hit with the bulk of hospice scripts after my system reboots at 3 (I got hit with 26 prescriptions on Black Friday with the driver on his way). So needless to say it’s hard to finish all the expected tasks by 6 AM.

I just have 3 questions.

1. How do you force the system reboot? 3 is literally the worst time for it to go down at this store.

2. Is there a report so that can tell me the top 100 drugs sold at the store so I could optimize the use of the robot? The robot currently fills less than 20% of readyfills and there are drugs in there I’ve never dispensed. I’d be willing to come in on my day off to rearrange things in there. The way it’s set up just doesn’t make sense, gaba 300 and flomax in the small cells, etc.

3. How do I force labels to go to a different printer? Are people literally going to a different terminal and individually printing labels off the queue?

Your insights would be much appreciated. On an unusually slow night, maybe 1 in the 2 months that I’ve worked there, I was able to finish the queue in an hour. On most days, I have to stay after my shift ends to finish everything due before 11:59 and come in early to do RTS.
I have since floated overnights at other stores with significantly more readyfills and finished everything before my shift with no problem.
I don’t feel that the robot helps me at my store, as on average it accounts for less than 2 pages of the queue including the RTS bottles, and filling it is a pain.
The PIC is too busy to figure this stuff out and my counter part won’t. I had to call the help desk just to figure out how to change/add a drug to the robot. I can’t keep staying hours after my shift to finish, it’s killing me. I can literally count the number of days I’ve had 1 interrupted hour overnight so literally every second counts at this store.

 

[SClENCE]

To my knowledge you can't do #1 and #3

 

[RxPreceptor]

20% automation for readyfill/auto scripts is ridiculous; should be around 40-50% at least (unless maybe you have a rather small automation unit?)

Top 100 or even 200 for that matter: M1 -> report ->drug usage (can't recall the exact keys, not at work now, but it's not hard to find). It might take a minute or 2 to generate the top 100 or 200. Keep in mind pkg size when choosing automation drugs (i.e. 30 count pkg sizes are usually not recommended vs. 500 or 1,000 counts pkg sizes).

There is no way to sort production queues, most overnight RPhs will just look at the drug name & cherry pick (production has letters to designate locations, i.e. P for automation, etc.). I believe there is a way to manually run EOD through one of the system functions (M1 likely) but have no use for using it @ my location.

What type of automation unit do you use? Feel free to PM me if you need help (sounds like this store's automation unit has not been updated in a long time)

 

[owlegrad]

Hmmm. You can definitely do number 1 and 2, although I regret that I don't recall the menu options/key strokes to do them. The NDC one is a little annoying because it includes controls, fridge items, prepackaged stuff, etc. Still works though just annoying to manually review it all. So do like a top 200 in order to get the top 100 noncontrolled tablets and capsules.

For number 3, I don't recall a way to select a printer from the computer, I only recall each terminal having a designated printer. You can call the helpdesk and have them change the default printer though, I did that for computers that had nonsensical defaults.

I bet @WVUPharm2007 could help you out though!

EDIT: SilentVampire beat me by seconds and was way more helpful. 🙂

 

[techniques]

We have a small unit maybe 80 cells, but I swear we don’t use most of them and not even all of them are occupied. I’m pretty sure omeprazole 40 should be in there and rosuvastatin. I don’t have the PICs permission to move around fast movers but I’m going to talk to him about Truvada/Isentress. When the hospital calls in for an HIV voucher, they’re there waiting before I’ve finished typing. The detective came in last night before I had checked the voicemail. Based on the other posts, force reboot seems possible. I will call the help desk to ask.

 

[zelman]

To my knowledge you can't do #1 and #3

You can definitely do #1. I haven't worked overnights in years, but I believe is it in the M1 or M2 menu as "Begin EOD" or "End of Day Processing" or something like that. You can do it between midnight and whenever it forcibly runs. I used to print everything and then run it while folding all the labels.

Number 3 would have to be updated by the helpdesk, so having an "overnight configuration" different from daytime would not be practical.

 

[techniques]

20% automation for readyfill/auto scripts is ridiculous; should be around 40-50% at least (unless maybe you have a rather small automation unit?)

Top 100 or even 200 for that matter: M1 -> report ->drug usage (can't recall the exact keys, not at work now, but it's not hard to find). It might take a minute or 2 to generate the top 100 or 200. Keep in mind pkg size when choosing automation drugs (i.e. 30 count pkg sizes are usually not recommended vs. 500 or 1,000 counts pkg sizes).

There is no way to sort production queues, most overnight RPhs will just look at the drug name & cherry pick (production has letters to designate locations, i.e. P for automation, etc.). I believe there is a way to manually run EOD through one of the system functions (M1 likely) but have no use for using it @ my location.

What type of automation unit do you use? Feel free to PM me if you need help (sounds like this store's automation unit has not been updated in a long time)

The PIC works really hard and he’s short tech hours so it’s hard to blame him but updating the NDCs on that thing should have been one of the first things he told me to do. Oh and after QT is resolved, I only have 7 pages of readyfills that I can’t start until after the system reboots at 3 at which point I get slammed with hospice. Last night I printed my first batch of labels at 3:30. Hadn’t done RTS yet, couldn’t have my tech do anything from 9-11 except pick up. The other stores I’ve floated at had 10+ pages I finished and it was my first time at the store. We have unusually high fooot traffic.

 

[owlegrad]

Oh and be careful about not all the cells being occupied - in my experience those are going to be "bad cells" and you may end up regretting trying to utilize them. At the very least test them before you commit to putting something in them you really want to load.

Also be aware that every drug in an automated unit is automatically expired. If you don't understand what that means just ask sosoo.

 

[RxPreceptor]

omeprazole 40mg (sandoz) pkg size #30 might not be a wise choice simply because of how long it takes to cut open the package & remove the dessicants. Rosuvastatin @ my location has been delayed being made automated simply from how many times warehouse NDC has changed & how frequently we have been short on warehouse (we usually have 3+ different MFRs on the shelf for some of the strengths). Agreed, warehouse changes/new NDCs are annoying

You might want to make a list of drugs that need to be removed &/or NDCs that need to be updated, then slowly start updating. If using scriptpro, you can scroll down the list of drugs (& sort by numerous parameters; expiration date is usually a good one to sort by....sosoo...><.....)

 

[techniques]

The PIC works really hard and he’s short tech hours so it’s hard to blame him but updating the NDCs on that thing should have been one of the first things he told me to do. Oh and after QT is resolved, I only have 7 pages of readyfills that I can’t start until after the system reboots at 3 at which point I get slammed with hospice. Last night I printed my first batch of labels at 3:30. Hadn’t done RTS yet, couldn’t have my tech do anything from 9-11 except pick up. The other stores I’ve floated at had 10+ pages I finished and it was my first time at the store. We have unusually high fooot traffic.

Oh and be careful about not all the cells being occupied - in my experience those are going to be "bad cells" and you may end up regretting trying to utilize them. At the very least test them before you commit to putting something in them you really want to load.

Also be aware that every drug in an automated unit is automatically expired. If you don't understand what that means just ask sosoo.

Oh and be careful about not all the cells being occupied - in my experience those are going to be "bad cells" and you may end up regretting trying to utilize them. At the very least test them before you commit to putting something in them you really want to load.

Also be aware that every drug in an automated unit is automatically expired. If you don't understand what that means just ask sosoo.

You

 

[maria1oh]

If it makes you feel better I know a store that still had brand name crestor in the cells a few months ago. There was a way to reboot the system after midnight so it doesn't go down at 3am. I forget how.

 

[FarmD711]

The PIC works really hard and he’s short tech hours so it’s hard to blame him but updating the NDCs on that thing should have been one of the first things he told me to do. Oh and after QT is resolved, I only have 7 pages of readyfills that I can’t start until after the system reboots at 3 at which point I get slammed with hospice. Last night I printed my first batch of labels at 3:30. Hadn’t done RTS yet, couldn’t have my tech do anything from 9-11 except pick up. The other stores I’ve floated at had 10+ pages I finished and it was my first time at the store. We have unusually high fooot traffic.

Wait why can’t you start the readyfills until after the system reboots at 3?

When I work overnights i have QT resolved by 1225-1230. I have all 12 pages of schedules and readyfills produced by 225-230 and have started checking before the system goes down at 3. I usually put drugs away or pull RTS while the system is down and then have all readyfills checked by 445-5.

From my perspective your biggest issue is that you’re not starting the queue until after he system reboots and you’re not maximizing the scriptpro.

You can order new cells if the unused ones are broken. Call them and they will ship to you. Priority number one needs to be getting that robot filled with the right drugs and priority number two needs to be getting the queue out well before 3 am.


Sent from my iPhone using SDN mobile

 

[techniques]

Wait why can’t you start the readyfills until after the system reboots at 3?

When I work overnights i have QT resolved by 1225-1230. I have all 12 pages of schedules and readyfills produced by 225-230 and have started checking before the system goes down at 3. I usually put drugs away or pull RTS while the system is down and then have all readyfills checked by 445-5.

From my perspective your biggest issue is that you’re not starting the queue until after he system reboots and you’re not maximizing the scriptpro.

You can order new cells if the unused ones are broken. Call them and they will ship to you. Priority number one needs to be getting that robot filled with the right drugs and priority number two needs to be getting the queue out well before 3 am.


Sent from my iPhone using SDN mobile

On my one slow night I finished filling and verifying before the system reboot. The usual scenario is that ER waiters stop at around 2 at which point I get slammed with hospice (my counterpart got a hospice compound last night in QT at 2:30).

It’s an unusually busy store at night. But I’ll talk to the PIC about the robot. The right drugs aren’t in there at all and the fast movers aren’t really fast movers.

 

[aznkukuboi]

You can reboot the system but it has to be between a certain time. It's basically after 12 and before 3. Your credentials get bugged through and it's been an issue where you verify a script and it bounces back to qv like 30 min later.

 

[Apotheker2015]

I feel like you are describing the 24 hour CVS I worked at. We had a Script pro. All top 100 drugs would come out of it. The problem was that pharmacists from the day shift would not refill the cells. Thus, I would start my overnight shift with an empty robot. Fun, huh? To make it more fun, they would just fill the order manually and not cancel the script pro order. So as soon as a cell would eventually be filled, sure enough, you'd have a vial come out. And that is why this store had a ridiculous amount of RTS.

You may think otherwise right now because you are new and eager beaver. That's great. However, take a good look around you. Everything that is happening is because your PIC does not care. You have two options: a. go to your supervisor and explain what needs to be happen for you to be successful. b. ask for a transfer to a more organized location.

Sure, we have all heard and experienced CVS horror stories. However, good stores do exist. Transfer elsewhere. Take the path of least resistance. OR do as much as you can during your shift and leave when you are supposed to leave. Trust me when I say this... You will not get fired.