Reducing Pharmacy Errors

[clarkbar]

What's the best way to reduce pharmacy errors? It seems that it's hard to not glaze over hour after hour of DUR, checking bottles, blister packs, etc. Also, if there is an error, how does one deal with it, even if under the table? There is no way that pharmacists are doing less errors than a computer. My windows 10 fails or crashes about 0.5 percent of the time.

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[Rukn]

honestly I would say getting away from verification every couple of hours

 

[6GodPharm]

honestly I would say getting away from verification every couple of hours

And how do you think you can get away from verification for 2 hours? Hell i'm usually doing QP and QV at the same time so I can just have people at drop off, in the front and drive thru

 

[Rukn]

And how do you think you can get away from verification for 2 hours? Hell i'm usually doing QP and QV at the same time so I can just have people at drop off, in the front and drive thru

Nothing is going to happen if you take a quick break or take a quick walk around the pharmacy after every couple of hours

Trust me

 

[owlegrad]

Two things help me:

One is always following the same process when filling. I always scan my drugs immediately before counting, never in batches. I hate when I find techs scanning in batches, the whole point of scanning is to match the label to the drug and if you don't immediately prepare the script after scanning you introduce a chance for the label and drug to become separated/mismatched. Train your techs to use the system to prevent errors. Obviously if your work place doesn't use scanning this won't apply.

When checking I try to remain vigilant. If I find my attention waining I take a short break. I usually play music so I can filter out other distractions. I don't think there is any trick to it, just know your limits and work within them. Focus focus focus and don't go faster than is safe.

As for what you do when you discover an error, just apologize to the patient and fix it. The worst thing you can do is try to cover it up. Just be honest, most people are shockingly forgiving about errors. More forgiving about errors than about taking 15 minutes longer than expected to fill it, lol. Follow your companies policy with regard to reporting the error.

 

[BidingMyTime]

I was pm'd this question in a slightly different form, but I will copy my answer here:

I think a lot of it is just experience. The more experience you get with common errors will help you to know what to be especially careful about. Also keeping up with new drugs/dosage forms/etc.--unfamilar products are more likely to lead to errors. Experience with the doctors in your area, for the ones who insist on handwriting, or for when the electronic system is down, unfamiliarity with a doctor's writing can lead to errors. The ISMP http://ismp.org/ has a lot of good information on errors and a regular newsletter (not sure if they charge for it or not, I get it at work.) Many times, there is no real reason why an error occurred, but certainly many errors are commonly reported, so those are ones to pay special attention to. Sometimes its possible to help prevent common errors by storing drugs separately from each other instead of next to each other (if the packaging looks very similar or the names are very similar.) Also high risk drugs, those are always worth triple checking. Make sure you have good lighting in the pharmacy, poor lighting will make people prone to drift and make it harder to catch errors.

To add on to the specifics in this question, dealing with errors should not be done "under the table." If you find an error, explain the error to the patient, do what you can to correct it (replace the medicine if incorrect, replace the label if the label had incorrect information, if pt is having adverse effects or has taken a substantial amount of the medication (like its caught on refill) then call the prescriber to see how they want to procede, follow your organizations policies for reporting the error--pretty sure every pharmacy whether hospital or retail is required to have such a policy.)

As for computers making less errors....yes and no. Yes, computers are more likely to catch certain types of misfill errors, but they can't catch knowledge errors. They can't catch when the DUR errors, they can't catch illogical dosing errors, they can't catch "just plain wrong" errors....well, sure they can, you see that with all the DUR overrides you do, but that's the issue the computer has no way of looking at DUR's and seeing which ones should be overriden, and which ones need to be followed up on, they can't catch dosing errors or differentiate between the wide range of dosing based on diagnosis (I had one pop up yesterday about high dosage for an amoxicillin 250mg in an 8 year old....seriously????) So yes, technology and computers have definitely reduced errors, by scanning bar codes, by data entry eliminating handwriting reading errors, by filling/dispensing machines (Omnicel, Pyxis, Script Pro, Yuyama, etc.) And certainly by popping up DUR warnings and alerts....but computers aren't at the level of being able to interpret those warnings & alerts, humans have to do that.

 

[CountBy5s]

I was pm'd this question in a slightly different form, but I will copy my answer here:

I think a lot of it is just experience. The more experience you get with common errors will help you to know what to be especially careful about. Also keeping up with new drugs/dosage forms/etc.--unfamilar products are more likely to lead to errors. Experience with the doctors in your area, for the ones who insist on handwriting, or for when the electronic system is down, unfamiliarity with a doctor's writing can lead to errors. The ISMP http://ismp.org/ has a lot of good information on errors and a regular newsletter (not sure if they charge for it or not, I get it at work.) Many times, there is no real reason why an error occurred, but certainly many errors are commonly reported, so those are ones to pay special attention to. Sometimes its possible to help prevent common errors by storing drugs separately from each other instead of next to each other (if the packaging looks very similar or the names are very similar.) Also high risk drugs, those are always worth triple checking. Make sure you have good lighting in the pharmacy, poor lighting will make people prone to drift and make it harder to catch errors.

To add on to the specifics in this question, dealing with errors should not be done "under the table." If you find an error, explain the error to the patient, do what you can to correct it (replace the medicine if incorrect, replace the label if the label had incorrect information, if pt is having adverse effects or has taken a substantial amount of the medication (like its caught on refill) then call the prescriber to see how they want to procede, follow your organizations policies for reporting the error--pretty sure every pharmacy whether hospital or retail is required to have such a policy.)

I was pm'd this question in a slightly different form, but I will copy my answer here:

I think a lot of it is just experience. The more experience you get with common errors will help you to know what to be especially careful about. Also keeping up with new drugs/dosage forms/etc.--unfamilar products are more likely to lead to errors. Experience with the doctors in your area, for the ones who insist on handwriting, or for when the electronic system is down, unfamiliarity with a doctor's writing can lead to errors. The ISMP http://ismp.org/ has a lot of good information on errors and a regular newsletter (not sure if they charge for it or not, I get it at work.) Many times, there is no real reason why an error occurred, but certainly many errors are commonly reported, so those are ones to pay special attention to. Sometimes its possible to help prevent common errors by storing drugs separately from each other instead of next to each other (if the packaging looks very similar or the names are very similar.) Also high risk drugs, those are always worth triple checking. Make sure you have good lighting in the pharmacy, poor lighting will make people prone to drift and make it harder to catch errors.

To add on to the specifics in this question, dealing with errors should not be done "under the table." If you find an error, explain the error to the patient, do what you can to correct it (replace the medicine if incorrect, replace the label if the label had incorrect information, if pt is having adverse effects or has taken a substantial amount of the medication (like its caught on refill) then call the prescriber to see how they want to procede, follow your organizations policies for reporting the error--pretty sure every pharmacy whether hospital or retail is required to have such a policy.)

As for computers making less errors....yes and no. Yes, computers are more likely to catch certain types of misfill errors, but they can't catch knowledge errors. They can't catch when the DUR errors, they can't catch illogical dosing errors, they can't catch "just plain wrong" errors....well, sure they can, you see that with all the DUR overrides you do, but that's the issue the computer has no way of looking at DUR's and seeing which ones should be overriden, and which ones need to be followed up on, they can't catch dosing errors or differentiate between the wide range of dosing based on diagnosis (I had one pop up yesterday about high dosage for an amoxicillin 250mg in an 8 year old....seriously????) So yes, technology and computers have definitely reduced errors, by scanning bar codes, by data entry eliminating handwriting reading errors, by filling/dispensing machines (Omnicel, Pyxis, Script Pro, Yuyama, etc.) And certainly by popping up DUR warnings and alerts....but computers aren't at the level of being able to interpret those warnings & alerts, humans have to do that.

I work in high volume stores. Sometimes it feels like a rat race. totes/baskets stacked 10 high.. drive thru ,phone ringing constantly and waiters make it impossible sometimes to make a dent in the workload..

I am trying to come up with a good process. All I have is double ck, triple ck. and ck again.

My question as a new pharnacist is, how do you handle those late night panick attacks that you did something wrong, but you cant remember what. You reviewed/verified over 500 Rx that day.

: /

 

[owlegrad]

I have heard that from other new pharmacist but personally when I go home I am done. Maybe I'm a sociopath, I don't know, lol. Errors happen, just do your best. Losing sleep over it certainly isn't going to help.

Sent from my SAMSUNG-SM-G920A using SDN mobile

 

[Sine Cura]

It is a rat race and a lot of times you are just rearranging deck chairs on the Titanic.

Verifying efficiently is a skill. Too slow and you get distracted by complaints. Too fast and you get distracted by complaints and waste time with an error report.

I don't even spend as much time on input accuracy as I make sure I avoid pointless rebills and duplicate fills or other things like "this patient won't pay for a 90 day supply of X drug so let's redo it." If you are stuck on input accuracy and don't solve other problems that have nothing to do with verifying input accuracy you will just be an average retail pharmacist at best (not that being a retail pharmacist is anything to take pride in)

 

[catalyzt]

Caffeine and breaks to get out of the pharmacy every two hours. Lots of caffeine, though. And not doing the same thing, e.g. verification, for hours at a time.

 

[VA77]

Does anyone have any numbers on input and verification for a pharmacist that they consider safe. It seems everyone has a different opinion of the word "safe". I know that NC has a law that a pharmacist can only verify 150 Rx per shift but most far exceed that number and it only becomes a concern to the BOP if there is an error involved. It kind of reminds me of the highway law in Montana for the speed limit being "safe and prudent" meaning you can do 120mph but if you crash then your in trouble. I know some pharmacist do not want a limit and would verify 1000+ Rx's a day but I'm worried about the legality of it and being sued. If for instance, the average Rx filled in your state is 350 and you are doing 600+ and a patient is injured would they consider the amount of Rxs reckless or ill considered? I know the bottom line is only do what you feel safe doing but management has a different perspective and a clean license is something you never get back plus a clean conscience.