Pharmacist QA Verification ?

[MIRPh]

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As an intern, my learning experience in the retail store was quite limited. This happened bcoz our store had very few tech hours and so there wasn't much time for the preceptor to actually teach me everything that a RPh needs to do. I was basically doing tech duties.
But, of course, over a period of time, I was able to work in drop off, production and pick -up .So, that helped.
However, I never even saw the pharmacist verification QA screen. No idea at all !!! Now, is that the norm ? As a result, now as a RPh looking for jobs, I'm freaked out and questioning my ability to do it all with such few tech hours these days.

I know that on the QA screen, the RPh compares and verifies all details of the scanned prescription with the data entered at drop-off. But what else?

For eg. how does the RPh make sure the dose/ strength prescribed is ok for the patient? Does the screen provide dose recommendations or is the RPh just expected to know that ?
Also what checks ,if any, does the screen provide for any potential interactions?
Is there anything else? Can I expect any sort of training from my potential retail employer that will put me at ease?
I'd really appreciate the help. When I say, I'm freaking out....I really am..
Thanks and best wishes..

 

[pezdispenser]

I only know the Walgreens system so some things may be a little different. I'm pretty good at these because I review thousands of scripts per day at my job (yes, really!).

I know that on the QA screen, the RPh compares and verifies all details of the scanned prescription with the data entered at drop-off. But what else?

Also make sure it is scanned under the correct patient profile.

You will get faster once you are familiar with:
- every single brand name (including discontinued brands)
- generic name (some generics have their own 'brand' names like birth control)
- strength
- dosage form
- package size
- usual directions (this will also clue you in if it's an over/underdose).

For eg. how does the RPh make sure the dose/ strength prescribed is ok for the patient? Does the screen provide dose recommendations or is the RPh just expected to know that ?

Walgreens has a separate Drug Utilization Review screen. The computer will automatically check the script dosage based on the days supply (#120 tabs for 30DS, it thinks you're taking 4 tabs per day) and determine if it's within an appropriate range for the patient's age. It's not perfect however, like if you run an Augmentin #125mL bottle with sig 5mL q12h x 10 days, with 10DS, it thinks you're taking 12.5mL per day.

So you still need to check yourself. You need to eventually be familiar with:
- the estimated weight of a child based on the age
- mg/kg dosage of liquid medications
- most tablets are 1 qd so know which ones are NOT 1 qd, such as those which are qw, qid, qam, qhs, etc.
- other dosage forms like, for example, patches could be biw, q72h, qw

Also what checks ,if any, does the screen provide for any potential interactions?

Yes, the computer will check for interactions against the patient's profile and the insurance may give you some information as well. The Walgreens system presents you with a list and you need to decide whether to override them or not. When you become familiar with them, determine ahead of time which ones you will always override and which ones you will consult with the patient or prescriber. For example, I will override warfarin with most maintenance medications, but not with an acute medication like an antibiotic.

Is there anything else? Can I expect any sort of training from my potential retail employer that will put me at ease?

Probably not. They will train you how to use their computer system, but they deliberately stay away from anything that is within your professional judgement as a pharmacist. That's the weird thing, particularly for retail. You're expected to know everything about pharmacy practice but IMHO pharmacy schools in the US focus more on clinical/hospital practice, and do not teach community pharmacy practice very well, if at all.

A couple of areas to develop would be:
- OTCs
- Conflict resolution. Do not go in thinking that you're the best and always right, and things are going to be done your way, because the customers and managers will destroy you real fast, or you will get so angry that you will destroy yourself. Keep an open mind. Know your options and what you can (be inventive) and can't do (legally) and hopefully you will find an amicable solution.

Once again, there are certain situations that arise with customers repeatedly. Become familiar with them and determine a solution beforehand, or even ways to prevent them entirely.

I'd really appreciate the help. When I say, I'm freaking out....I really am..
Thanks and best wishes..

Just stay calm, think clearly, and don't be afraid to ask for help when you need it. Good luck!

 

[MIRPh]

Thanks a million. I was keeping my fingers crossed and waiting for a response.
Your reply helped a lot. Thanks for taking the time to send such a detailed mail. At least now I know what decisions will be based 100 % on my knowledge and on what things I can expect some support from the computer system at the pharmacy.
Best wishes.