New grad pharmacist... so many errors

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pharm00123

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I am a new grad working for walgreens at our districts busiest 24 hour store. It is so crazy there and I am afraid of making errors while I am trying to work so fast. I come home everyday and cannot sleep because I keep remembering things that happened throughout the day and how I screwed them up! Ahhhh anyone else feel like this and it is normal??

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I'm a grad intern and constantly wish I could jump back in time to handle something differently.
 
I am just a senior tech, but I feel you. THAT FEELING of masking mistakes..
I got 4 stars already in 9 months. Dont worry too much about it, just always try to minimize the error! Focus more on accuracy :)
 
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What the heck are stars?
 
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Apparently in Walgreens when you make a mistake, you get a STAR. It's SO F'N DUMB. The more "stars" you have, the more errors you made. You can get a start for anything dumb like putting the wrong doctor on the prescription label. Or you can get a star for dispensing Coumadin 5mg instead of Clarinex 5mg.
 
I used to feel that way when I was an intern but suddenly stopped caring when I became a pharmacist. It's messed up, I know.
 
I am a new grad working for walgreens at our districts busiest 24 hour store. It is so crazy there and I am afraid of making errors while I am trying to work so fast. I come home everyday and cannot sleep because I keep remembering things that happened throughout the day and how I screwed them up! Ahhhh anyone else feel like this and it is normal??
you sound like my ex - walgreens put her into massive OCD to the point where she couldn't work anymore- oh well, one more reason she is my ex
 
It happens to all new grads, regardless of position. Easiest way is to come up with a system of checking that works for you and stick with it. And if something looks a little off, set it aside and look at it a few times.
 
Apparently in Walgreens when you make a mistake, you get a STAR. It's SO F'N DUMB. The more "stars" you have, the more errors you made. You can get a start for anything dumb like putting the wrong doctor on the prescription label. Or you can get a star for dispensing Coumadin 5mg instead of Clarinex 5mg.

Yes, dispensing errors are really dumb. I don't think I've ever met a pharmacist that created a STARS for the wrong prescriber on the label. And certain ones are weighed less than others. You filled or verified a script that was sold incorrectly? Not really your fault, just your name was attached to the script so you get included in the report. It's just documentation that an error happened.

If you're in a really busy store, you're going to get a lot of STARS reports. It's just too busy to catch EVERY minor detail and sometimes it's not even your fault, you just filled it and it was sold to the wrong person. Unless something significant happens (hospitalization), they won't talk to you about it. The point of STARS is not a punishment, it's to help you and the company to avoid making that same mistake in the future.

I got a STARS report because I was doing data entry for other stores and typed up a Zostavax script (before EHR). The woman lied on the VAR and was on Humira. Of course she called her doctor complaining she felt sick and the doctor screamed at that pharmacist but overall she was fine. But it had to be documented so technically I got a STARS because I entered the prescription for them.
 
I got a STARS report because I was doing data entry for other stores and typed up a Zostavax script (before EHR). The woman lied on the VAR and was on Humira. Of course she called her doctor complaining she felt sick and the doctor screamed at that pharmacist but overall she was fine. But it had to be documented so technically I got a STARS because I entered the prescription for them.

How is that a pharmacy error if the woman lied?
 
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How is that a pharmacy error if the woman lied?


All adverse events to medication are reported too (if it is made known to us). It's partly for the legal aspect too if the woman comes back to sue we have all this documentation.
 
I just started with walgreens too. I trained in a super busy store, but the ones I've floated in so far haven't been as busy.

I just make sure I check things the same way each time. Sometimes when I'm staring at the verification screen for awhile I feel myself getting distracted or taking longer to verify the rx. I always just go do something else for 2 min (ring someone out, fill something, etc) ans then jump back in and my head is clearer.

Most of my post work anxiety is DID I LOCK THE DOORS. Which I know I did it's just paranoia
 
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The way I view it is being able to function under the huge stress and chaos of a retail store, while not making any mistakes, is one of the primary attributes of a good retail pharmacist. Plus, it is survival of the fittest, so you can either learn to deal with it, or you'll have to look for another job.

Some tips... Know your products! Not just top 200 drugs, more like top 1,000+, the more the better, including OTCs, etc. Things to know: brand name, generic name, strengths, dosage forms, indication, usual dosage, bioequivalence, idiosyncrasies.

Knowing these things will make you a lot faster because you it will remove the uncertainty that causes you to second guess yourself, or that keeps you up at night questioning the 'unknown'. You need to be confident and be sure that you dispensed everything correctly.

Now you will eventually memorize these things, but even I find myself having to look things up for the first time, but then I write it down in a notebook and memorize it so I won't have to look it up anymore. For example, I made a note that methylphenidate 30%-70% ER capsule is Metadate CD, while 50%-50% is Ritalin LA.
 
The way I view it is being able to function under the huge stress and chaos of a retail store, while not making any mistakes, is one of the primary attributes of a good retail pharmacist. Plus, it is survival of the fittest, so you can either learn to deal with it, or you'll have to look for another job.

Some tips... Know your products! Not just top 200 drugs, more like top 1,000+, the more the better, including OTCs, etc. Things to know: brand name, generic name, strengths, dosage forms, indication, usual dosage, bioequivalence, idiosyncrasies.

Knowing these things will make you a lot faster because you it will remove the uncertainty that causes you to second guess yourself, or that keeps you up at night questioning the 'unknown'. You need to be confident and be sure that you dispensed everything correctly.

Now you will eventually memorize these things, but even I find myself having to look things up for the first time, but then I write it down in a notebook and memorize it so I won't have to look it up anymore. For example, I made a note that methylphenidate 30%-70% ER capsule is Metadate CD, while 50%-50% is Ritalin LA.
what do you mean 30-70%?
 
what do you mean 30-70%?
It is a bi-phasic release, 30% immediate release, 70% extended release.

Doctors, or in particular, many prescribing programs may only print the generic name on the Rx. Since there are several forms of methylphenidate ER: Ritalin SR, Metadate CD, Ritalin LA, Concerta,... then you need to be able to tell them apart, or call to clarify.

Same with diltiazem, nifedipine, metformin,...
 
Man, making an error in the hospital feels so much worse. You walk in for your shift, settling in, as you're taking a sip of coffee, the secretary tells you the director wants to see you in his office. *gulp* What did I do now...

You walk in and you see the director, the clinical pharmacist, and the pharmacy union delegate there. And then you find out the reason why you were called in for this was because you verified an order the night before for Vancomycin 1 mg q12 when it was supposed to be ordered as 1 gm q12, patient got 1 gm q12 so no harm, but please make sure you're more careful in the future.
 
Man, making an error in the hospital feels so much worse. You walk in for your shift, settling in, as you're taking a sip of coffee, the secretary tells you the director wants to see you in his office. *gulp* What did I do now...

You walk in and you see the director, the clinical pharmacist, and the pharmacy union delegate there. And then you find out the reason why you were called in for this was because you verified an order the night before for Vancomycin 1 mg q12 when it was supposed to be ordered as 1 gm q12, patient got 1 gm q12 so no harm, but please make sure you're more careful in the future.
I agree. In a hospital setting, it definitely feels like you're getting called into the principal's office whenever you're a newbie and make a med error. In retail, the pharmacy supervisor comes into your store to bother you every once in a while but rarely do they bother you about med errors; they mostly fuss at you about quotas or loss prevention issues. So yeah. In retail, occasional med errors are par for the course and to be expected, whereas in hospital, no med errors (no matter how trivial) are the expectation.
 
I just started with walgreens too. I trained in a super busy store, but the ones I've floated in so far haven't been as busy.

I just make sure I check things the same way each time. Sometimes when I'm staring at the verification screen for awhile I feel myself getting distracted or taking longer to verify the rx. I always just go do something else for 2 min (ring someone out, fill something, etc) ans then jump back in and my head is clearer.

Most of my post work anxiety is DID I LOCK THE DOORS. Which I know I did it's just paranoia
I've been finding that I need to step back and pause too, and it happens to me now at least twice a week. If I don't give myself a break, even if it's just by escaping to the bathroom on my own terms, I'll want to push myself harder to the point of cognitive injury.

Corporations think they're being efficient and sly by not staffing effectively and wanting to pump out at lower thresholds, but it doesn't work in their favor if you know how to regulate yourself. Pharmacists are their last frontier, now that labor budgets have been obliterated to nothing, and corporations are trying to find our breaking points.

So my suggestion to everyone is that you need to find your breaking point well before they do if you want to maintain your edge... and let the games begin!

 
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I agree. In a hospital setting, it definitely feels like you're getting called into the principal's office whenever you're a newbie and make a med error. In retail, the pharmacy supervisor comes into your store to bother you every once in a while but rarely do they bother you about med errors; they mostly fuss at you about quotas or loss prevention issues. So yeah. In retail, occasional med errors are par for the course and to be expected, whereas in hospital, no med errors (no matter how trivial) are the expectation.

Yep. The most serious med error I've made was when I was double checking another pharmacist's work without really knowing what I was checking for. I came from a hospital where we didn't make batches of IV solutions, we'd compound whatever we needed on an as needed basis. At this hospital, there was an order for Vancomycin 10 mg/ml, 60 ml IV q8h. I glossed over the 10 mg/ml.

The first pharmacist made the solution at the correct volume but used the 5 mg/ml solution. I didn't catch it since I didn't know a 10 mg/ml solution existed. Error was caught by an eagle-eyed IPPE student who was just reading the labels on the completed products bin before it left the IV room though but they made a huge deal about it. The other pharmacist was panicking, "omg omg i can't believe i messed up, we have to report this on Verge."
 
I agree. In a hospital setting, it definitely feels like you're getting called into the principal's office whenever you're a newbie and make a med error. In retail, the pharmacy supervisor comes into your store to bother you every once in a while but rarely do they bother you about med errors; they mostly fuss at you about quotas or loss prevention issues. So yeah. In retail, occasional med errors are par for the course and to be expected, whereas in hospital, no med errors (no matter how trivial) are the expectation.

I disagree, having worked at several different hospitals & retail, the retail pharmacies seemed to take errors more seriously than did the hospital. I'm guessing this was a difference in the managers and what they chose to focus on. I know when I reported errors of others, in the hospital, that seemed to be the end of it. I can only remember about 2 occasions when the director let me know about an error I made, and it was more of a "letting you know this so you'll know to watch out for it in the future" kind of talk, rather than a "I can't believe you messed this up." talk. Given the years I've worked, I'd be surprised if I only made 2 errors (everybody makes errors.) In contrast, it seemed like in retail every little error (like wrong qty? really?) was being recorded and I had to acknowledge it. I wonder too, maybe in hospitals there are a lower amount of errors, because of the double check of the nurse giving the med that catches a lot of errors, so they aren't recorded as errors since it didn't reach the patient?
 
I disagree, having worked at several different hospitals & retail, the retail pharmacies seemed to take errors more seriously than did the hospital. I'm guessing this was a difference in the managers and what they chose to focus on. I know when I reported errors of others, in the hospital, that seemed to be the end of it. I can only remember about 2 occasions when the director let me know about an error I made, and it was more of a "letting you know this so you'll know to watch out for it in the future" kind of talk, rather than a "I can't believe you messed this up." talk. Given the years I've worked, I'd be surprised if I only made 2 errors (everybody makes errors.) In contrast, it seemed like in retail every little error (like wrong qty? really?) was being recorded and I had to acknowledge it. I wonder too, maybe in hospitals there are a lower amount of errors, because of the double check of the nurse giving the med that catches a lot of errors, so they aren't recorded as errors since it didn't reach the patient?
If it doesn't reach the patient then it isn't a med error. It might be a "near miss", but it's not a med error. I think the heightened sense of alert in the hospital setting is due to the fact that so many systems are in place to prevent med errors yet it still slips through somehow. Between the personnel and the scanners, you have at least six set of eyes that "check" the medication against the patient before it gets taken by the patient: the pharmacy tech fills it, the pharmacist reviews it, the scanner in the dispensing machine verifies it, the nurse looks at it and handles it, the scanner at the bedside verifies it against the order and the patient, and the admitting employee who registers the patient and gives them an armband after verifying the patient.

I mean, it would be great if in retail all of the stock bottles had their own Cubie to scan before we took them off the shelf to dispense them and the customers had to scan their armband before we could sell them their medication! Could you imagine a medication bottle inside a Cubie on the shelf in a retail pharmacy that you had to scan?
 
Man, making an error in the hospital feels so much worse. You walk in for your shift, settling in, as you're taking a sip of coffee, the secretary tells you the director wants to see you in his office. *gulp* What did I do now...

You walk in and you see the director, the clinical pharmacist, and the pharmacy union delegate there. And then you find out the reason why you were called in for this was because you verified an order the night before for Vancomycin 1 mg q12 when it was supposed to be ordered as 1 gm q12, patient got 1 gm q12 so no harm, but please make sure you're more careful in the future.
u have a union rep for a conversation like that?

gosh I hate unions
 
It's for your own good, the union delegate is there to make sure the director/clinical pharmacist don't step out of line.
well, I just hate unions in general, reward mediocrity, everyone gets the same raise regardless of how good they actually are, blah blah blah
 
well, I just hate unions in general, reward mediocrity, everyone gets the same raise regardless of how good they actually are, blah blah blah

Yeah, but they make sure that they actually get raises instead of allowing the hospital to just say we're not giving raises for the next 5 years. Also, health benefits are cheap as ****. Plus they can't fire you unless you do something really malicious. Don't have to worry about getting reprimanded if you come back a few minutes late from lunch or come in late.
 
Yeah, but they make sure that they actually get raises instead of allowing the hospital to just say we're not giving raises for the next 5 years. Also, health benefits are cheap as ****. Plus they can't fire you unless you do something really malicious. Don't have to worry about getting reprimanded if you come back a few minutes late from lunch or come in late.
I guess it all depends on the culture of your place.
1. I pay only $65 a month for good ins - although just because you pay less doesn't mean it is that good - it is all part of the big picture - if they charge you less they just pay less to make up for it
2. I have always gotten good raises, but the idiots who didn't deserve them, didn't get a good raise
3. Never seen anyone get in trouble because they were at lunch a little long shooting crap with someone
 
I got a verbal warning from a lead pharmacist before.

Her: What time did you go to lunch?
Me: 1:20pm
Her: What time is it now?
Me: 135PM, yeah I went to go talk to the ops manager about setting up my insurance plan after lunch.
Her: Do that on your lunch not after.
 
I got a verbal warning from a lead pharmacist before.

Her: What time did you go to lunch?
Me: 1:20pm
Her: What time is it now?
Me: 135PM, yeah I went to go talk to the ops manager about setting up my insurance plan after lunch.
Her: Do that on your lunch not after.

What am I missing, you were given a verbal warning for taking a 15 minute lunch? I thought you got 1 hour lunches (surely at least 30 minutes as is standard in most places?)
 
Yeah, but they make sure that they actually get raises instead of allowing the hospital to just say we're not giving raises for the next 5 years. Also, health benefits are cheap as ****. Plus they can't fire you unless you do something really malicious. Don't have to worry about getting reprimanded if you come back a few minutes late from lunch or come in late.

Seriously? Unions are so stupid. I should be allowed to fire an employee who is chronically late? This must be a joke.
 
Seriously? Unions are so stupid. I should be allowed to fire an employee who is chronically late? This must be a joke.

They can still get fired if they are in a union, it just makes it so that there is a disciplinary process in place.

OK, that makes more sense!

Ya, I took my hour lunch and after I went to go speak to one of the other managers about health insurance, then I came back to the pharmacy. To put it another way, if I'm a sergeant this lady who gave me the warning was the lieutenant and I had gone to speak to one of the captains instead of reporting back to the lieutenant after lunch.
 
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