question on dispensing practice of large qty of control meds

[lorain]

---

Members don't see this ad.

say if the rx is written for a percocet that comes in bottles of 100, and the rx is for 120: do you double count the new bottle of the 100? or do you double count the 20 from one bottle and add that to a vial with the new bottle of 100?


lately, Ive been just slapping on a label on the manufacturer bottle (sealed of course), and then just putting the 20 in a vial and double counting that

in a busy store, whats the best practice to dispense these large qyt of pain meds without taking up soo much time?

 

[Kirbypuff]

I double count the 20.

MotherfreakinA, I once had to double count #720 Alprazolams. I just counted #280 out of a new 1000 bottle and then I weighed the 720 on the scale just in case.

 

[Vitamin K]

I never label stock bottles, and especially not on C2s. What if there are broken pills? And why would you want them to have 2 bottles that look different for the same prescription? That just causes confusion. I usually double count the 20, then count the 100 ct bottle once (since they counted it to put it in the bottle), and combine them into a larger vial. I still count the qty in the stock bottle because I've had stock bottles of C2s come to me short a few tabs/caps before.

 

[lorain]

well i forgot to add, most of these people wait for their rx, so i show them that im gonna give them a stock bottle and the remaining in a vial

im just trying to see the best way to do it w/out taking up so much time

 

[Old Timer]

say if the rx is written for a percocet that comes in bottles of 100, and the rx is for 120: do you double count the new bottle of the 100? or do you double count the 20 from one bottle and add that to a vial with the new bottle of 100?


lately, Ive been just slapping on a label on the manufacturer bottle (sealed of course), and then just putting the 20 in a vial and double counting that

in a busy store, whats the best practice to dispense these large qyt of pain meds without taking up soo much time?

Double count the 20 and place them all in a vial.

I never label stock bottles, and especially not on C2s. What if there are broken pills? And why would you want them to have 2 bottles that look different for the same prescription? That just causes confusion. I usually double count the 20, then count the 100 ct bottle once (since they counted it to put it in the bottle), and combine them into a larger vial. I still count the qty in the stock bottle because I've had stock bottles of C2s come to me short a few tabs/caps before.

This is silly. You are assuming responsibility from the manufacturer for any shortage that occurs. Unless you open the bottle when you receive it from the wholesaler, you have accepted 100 pills into inventory. You have no wiggle room.

I use sealed manufacturers packages whenever possible. The lot # and exp date are on the packages and problems are clearly the fault of the manufacturer if there is a problem.

 

[johnep34]

In UK virtually all CDs packed in blisters in 28s or 56s. We just check no empty blisters for addicts, done in few seconds.
johnep

 

[Vitamin K]

Double count the 20 and place them all in a vial.



This is silly. You are assuming responsibility from the manufacturer for any shortage that occurs. Unless you open the bottle when you receive it from the wholesaler, you have accepted 100 pills into inventory. You have no wiggle room.

I use sealed manufacturers packages whenever possible. The lot # and exp date are on the packages and problems are clearly the fault of the manufacturer if there is a problem.

It's not silly at all...it's personal opinion. I absolutely hate using sealed stock bottles. How many times do you see broken tablets in a stock bottle? Quite a bit. Now imagine that the broken pill is an XR or ER version of that medication. I'd be concerned that the patient would "just take both halves" instead of calling about the broken pill. I just like to know what's going out the door at my pharmacy, that's all.

 

[lorain]

Double count the 20 and place them all in a vial.



This is silly. You are assuming responsibility from the manufacturer for any shortage that occurs. Unless you open the bottle when you receive it from the wholesaler, you have accepted 100 pills into inventory. You have no wiggle room.

I use sealed manufacturers packages whenever possible. The lot # and exp date are on the packages and problems are clearly the fault of the manufacturer if there is a problem.

2 questions:

1) what happens if there is a broken pill in there, what do you tell the customer?

and

2) do you label the stock bottle even if it doesnt have that safety cap? (like the methadone 100 bottles do, but the generic percocets dont)

for example the other day i got rx for 450 methadone, i just labeled for sealed bottles, opened the new one double counted 50 and put them in the vial and showed the pt when i rung em out...should i not do this in the future?

 

[Praziquantel86]

I don't use the stock bottles for dispensing either. I trust that the count is accurate, but I double-check to make sure nothing inside is broken. I'll double-count anything additional to the stock bottle.

 

[Old Timer]

It's not silly at all...it's personal opinion. I absolutely hate using sealed stock bottles. How many times do you see broken tablets in a stock bottle? Quite a bit. Now imagine that the broken pill is an XR or ER version of that medication. I'd be concerned that the patient would "just take both halves" instead of calling about the broken pill. I just like to know what's going out the door at my pharmacy, that's all.

It's not silly to not use stock bottles. It's silly to double count them. You are free to do what you want. The number of XR tablets that can't be split is so minuscule as to incalculable. Of the pills that can't be split that show up split in stock bottle would require a report to the FDA. See Paxil CR. How would that lot of tablets fare bouncing around in a plastic vial? The XR argument has nothing to do with the original question about counting sealed bottles of pills. There is a bazillion times more likely to be a recall and the patient having the lot number is a greater protection to the patient than the odd chance they got a split XR tablet that would harm them being split.

 

[Old Timer]

2 questions:

1) what happens if there is a broken pill in there, what do you tell the customer?

Depends on the drug the patient and the situation. I would tell them to report it to the company. They take patient's complaint's much more seriously than they take our complaints. I might just swap them out and report it to the company.

and

2) do you label the stock bottle even if it doesnt have that safety cap? (like the methadone 100 bottles do, but the generic percocets dont)

I either put them in a vial or swap lids with another bottle on the shelf somewhere that has the same size lid.

 

[Old Timer]

It's all a matter of perspective. None of you were probably even alive let alone practicing in 1982 when the Tylenol tampering took place. You take for granted sealed bottles and glued box tops. There are still people, me among them, who prefer a sealed manufacturers package.

 

[lorain]

Depends on the drug the patient and the situation. I would tell them to report it to the company. They take patient's complaint's much more seriously than they take our complaints. I might just swap them out and report it to the company.

and


I either put them in a vial or swap lids with another bottle on the shelf somewhere that has the same size lid.

ok so say you need 120 oxycodones that come in bottles of 100....would just open a new bottle, put those in a vial...then open a 2nd one, double count 20 and toss those in the vial...is that how you do it?

 

[Old Timer]

ok so say you need 120 oxycodones that come in bottles of 100....would just open a new bottle, put those in a vial...then open a 2nd one, double count 20 and toss those in the vial...is that how you do it?

Yes, I would never dispense a manufacturers bottle unless it was a sealed package? Except I would double count the 20.

 

[Carboxide]

I always opened the box of 100, counted them ONCE (taking the manufacturer's count as the first count), put them in a vial and double counted 20 and added them to the vial.

 

[Old Timer]

I always opened the box of 100, counted them ONCE (taking the manufacturer's count as the first count), put them in a vial and double counted 20 and added them to the vial.

Please tell what you would do if you were short 2 Oxycontin?

 

[Carboxide]

Please tell what you would do if you were short 2 Oxycontin?

In the box of 100? I would re-count the 100. If I still got 98, I would probably just toss on some more and double count out 120 as a whole.

If you meant a patient came back and said they only got 118...well, I can't really say as I'm not a pharmacist and don't have the experience to tell you what to do. This is the way my pharmacist taught me to do it, so I do it that way 🙂

 

[Smilescali]

Yes, I would never dispense a manufacturers bottle unless it was a sealed package? Except I would double count the 20.

I know people who just add pills to the new bottle and then cross out the quantity on the bottle to indicate the new quantity.

 

[Thoughtfulsinner]

I have the techs count them. I'm too busy to count pills.

 

[MountainPharmD]

I have the techs count them. I'm too busy to count pills.

Lucky dog....

 

[samuricool]

Actually, I did count a manufacturer sealed bottle of 100 oxy's and it had a surplus of one. I counted again just to be sure and then told my manager. Im not sure what she did, but from now on I dont put it in a vial unless I count it. Im sure that it would be very rare to ever see again, but just to be safe.

 

[Old Timer]

In the box of 100? I would re-count the 100. If I still got 98, I would probably just toss on some more and double count out 120 as a whole.

If you meant a patient came back and said they only got 118...well, I can't really say as I'm not a pharmacist and don't have the experience to tell you what to do. This is the way my pharmacist taught me to do it, so I do it that way 🙂

'

You would then be 2 pills short and subject to a civil fine of $25,000.00. Great idea... keep it up....

 

[Carboxide]

'

You would then be 2 pills short and subject to a civil fine of $25,000.00. Great idea... keep it up....

How would I be 2 pills short?

Again, I do it the way I was told. If the pharmacist was concerned about how I was doing it, then he would not have told me to do it that way. If I go to another pharmacy and they ask me to do it differently, I'll do it their way. I was just saying what I do.

 

[Old Timer]

How would I be 2 pills short?

Again, I do it the way I was told. If the pharmacist was concerned about how I was doing it, then he would not have told me to do it that way. If I go to another pharmacy and they ask me to do it differently, I'll do it their way. I was just saying what I do.

You would be 2 pills short because you accepted a DEA 222 form that says you received 100 pills. Those 100 pills would be counted as received in your inventory.

 

[Carboxide]

You would be 2 pills short because you accepted a DEA 222 form that says you received 100 pills. Those 100 pills would be counted as received in your inventory.

I see. What about broken pills or pills that accidentally fall on the ground and are thrown away? Again, the owner and pharmacist has told me to do that as well.

 

[Old Timer]

I see. What about broken pills or pills that accidentally fall on the ground and are thrown away? Again, the owner and pharmacist has told me to do that as well.

Schedule II drugs are never thrown away...

 

[Carboxide]

Schedule II drugs are never thrown away...

Well, your experience is showing 😉 As I said, I am not a pharmacist and therefore don't know all the rules. I just did what the pharmacist I volunteered with told me to.

 

[MountainPharmD]

I see. What about broken pills or pills that accidentally fall on the ground and are thrown away? Again, the owner and pharmacist has told me to do that as well.

All C-II medications must be tracked from the date they were made to the date they were dispensed or destroyed. You do not throw away C-II's that fall on the ground or are broken. Hell, I don't throw away any pill I drop on the floor. 10-second rule.

The policies and procedures vary by company. With my last company if a discrepancy was less then three pills you only needed to make a notation in the perpetual log. So if you were shorted, dropped a Concerta pill and it rolled into the black hole behind the counter you could log what happened in the perpetual inventory and move on.

My current company does not allow even a one-pill discrepancy. Any shortage must be documented on a DEA form 106 and sent to the Director of Pharmacy at the corporate office. They determine if it was a significant loss and will decide if the 106 needs to be sent to the DEA.

 

[Carboxide]

All C-II medications must be tracked from the date they were made to the date they were dispensed or destroyed. You do not throw away C-II's that fall on the ground or are broken. Hell, I don't throw away any pill I drop on the floor. 10-second rule.

The policies and procedures vary by company. With my last company if a discrepancy was less then three pills you only needed to make a notation in the perpetual log. So if you were shorted, dropped a Concerta pill and it rolled into the black hole behind the counter you could log what happened in the perpetual inventory and move on.

My current company does not allow even a one-pill discrepancy. Any shortage must be documented on a DEA form 106 and sent to the Director of Pharmacy at the corporate office. They determine if it was a significant loss and will decide if the 106 needs to be sent to the DEA.

The place I worked was a small independent, which is probably why it had looser rules. I understand why CIIs shouldn't be tossed - you don't want addicts scouting out pharmacy trash locations and digging through them. I always asked someone what I should do if I dropped some and went by that. Unfortunately, winter in Michigan means that the ground (even inside) is wet and muddy, so dropped pills aren't always salvageable.

 

[Aznfarmerboi]

The place I worked was a small independent, which is probably why it had looser rules. I understand why CIIs shouldn't be tossed - you don't want addicts scouting out pharmacy trash locations and digging through them. I always asked someone what I should do if I dropped some and went by that. Unfortunately, winter in Michigan means that the ground (even inside) is wet and muddy, so dropped pills aren't always salvageable.

No, c2s should never be thrown away because its the law. You have to keep everything in perspective. If it is to be destroyed, you fill out a DEA form 41. Every narcotic is tracked down to the last pill.

I heard of a rph missing one pill from original bottle. What can I say? I doubt there will be civil penalities like Oldtimer mentioned but tough luck. For me, I never dispense in manufacter bottle. This goes for regular prescriptions too. Its just good practice and to cover my ass.