Retail pharmacists- what's the normal error rate?

[crossurfingers]

I am a new pharmacist for Walgreens and have only been one for 2 months (been working full time), and I've already had 4 documented errors on my file. I've probably made more that just haven't been caught. Of the ones that were reported one wasn't really my fault (tech sold a prescription that I verified to the wrong patient), two of them were incorrect quantities, and the last one that's been bothering me the most was having another patient's prescription bottle in another patient's bag. I try to be really careful but I seem to make errors despite that. I've been looking at our store reports and it seems like other pharmacists there only have about 5 or 6 reported errors a year. This just makes me feel like I'm doing a crappy job and maybe this just isn't for me. Not to mention the fact that now we get written up for dispensing incorrect packages. I just started and now I'm scared of eventually getting fired because of something like this and having a hard time finding another job as well. Any input on my situation would be great.

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[RxWildcat]

I'll check my notes later, but if I remember correctly, a 99.9% accuracy rate (0.1% error) will directly kill at least 1 patient during your career. A 99.5% rate will kill closer to 10. It gets really ugly after that. Is this your first time working in a pharmacy?

 

[patmcd]

Having tech errors count against you sucks. Where the quanity errors entered wrong or filled wrong?

 

[pharmtastic]

It kinda saddens me that all mistakes are treated the same whether it's wrong quantity or prescriber (less serious) VS wrong direction or frequency (much more serious). Or am I wrong? Are every mistake treated equally?

 

[crossurfingers]

Having tech errors count against you sucks. Where the quanity errors entered wrong or filled wrong?

The quantity errors were entered correctly but filled wrong. I eyeball the amounts of pills in bottles since the techs are supposed to be the ones counting, but apparently that's not enough. A couple of people have come back complaining that we've shorted them.

 

[pion]

We have people complaining constantly about being shorted, especially since they removed the scales. I'm not sure there's much you can do about that except tell the techs to be more careful - obviously you can't recount every script that you verify. But you're definitely not alone there.

 

[patmcd]

The quantity errors were entered correctly but filled wrong. I eyeball the amounts of pills in bottles since the techs are supposed to be the ones counting, but apparently that's not enough. A couple of people have come back complaining that we've shorted them.

Thats exactly what I was afraid you were going to say. Its dumb that you get blamed for that if a bottle is a few off. If it was supposed to be 60 and the tech filled 30, then you should be able to notice that.

 

[Pharmavixen]

When I was first practising, I received a prescription as follows:

Ceclor 500mg stat, then 250mg tid x 10 days.

So I entered it in the computer as Ceclor 250mg take 2 to start, then 1 tid etc, and the tech filled it with the 500mg capsules, and sold it to the customer without me checking it (I was counselling somebody on the phone, and the customer was in a huge hurry, so the tech went ahead and cashed it out.) Stupidly, I signed it later--a mistake I've never repeated in the years since.

The customer got very queasy from taking 1000 mg of cefaclor, and developed some gi upset over the next few days before double-checking with us and realizing the mistake. My boss managed to prevent her from going to the college of pharmacists to launch a formal complaint. In turn, I refused to work with that tech anymore, and the boss accommodated me.

In short, could be you're still finding your feet. Doing this job properly requires an obsessiveness they don't really teach us in school. But it also could be you're working with lousy techs.

If this situation continues, you might consider changing jobs. (I mean pharmacist jobs, not leaving the profession.)

The ISMP website is a good resource for error prevention http://www.ismp.org/

 

[PharmDstudent]

On average, I make an "error" every day. I'll forget my keys somewhere, I bump or trip into things, sometimes I forget to eat or I'll eat too much, and I always forget to empty the dryer. Those are my kinds of "error". I try to follow good habits to prevent those "errors".

Filling scripts is second nature now. I'll double count if I'm talking and filling at the same time.

 

[pharmacology888]

How much retail experience did you have before becoming a pharmacist and have you been with Walgreens before as an intern? Is it the nerves that got to you or this is a superbusy store that just stressed you out?

I am a new pharmacist for Walgreens and have only been one for 2 months (been working full time), and I've already had 4 documented errors on my file. I've probably made more that just haven't been caught. Of the ones that were reported one wasn't really my fault (tech sold a prescription that I verified to the wrong patient), two of them were incorrect quantities, and the last one that's been bothering me the most was having another patient's prescription bottle in another patient's bag. I try to be really careful but I seem to make errors despite that. I've been looking at our store reports and it seems like other pharmacists there only have about 5 or 6 reported errors a year. This just makes me feel like I'm doing a crappy job and maybe this just isn't for me. Not to mention the fact that now we get written up for dispensing incorrect packages. I just started and now I'm scared of eventually getting fired because of something like this and having a hard time finding another job as well. Any input on my situation would be great.

 

[Pharmavixen]

I only double-count benzos and narcotics. It's impossible to double-count everything, and seriously, how many people complain about being shorted hydrochlorothiazide?

I learned this when I was a new grad after a few addicts screamed at me that I was shorting them their Tylenol #3 and Percocet.

Divide the number of teeth by the number of tattoos. As that number approaches zero, you have to count and re-count the Oxycontin that much more carefully.

 

[StallionRx]

Theyre writing you up formally for that?

Ive been practicing since August and have shorted people quanities and made other smaller mistakes here and there, but never formally written up. My partner and I keep a log that we write stuff down to see if were developing trends, but its an in-house log that is never shown to corporate because weve always been able to solve these problems at the store level.

If someone complains Ive shorted them Ill usually review the case, give them the missing pills and theyre usually cool about it.

Dont sweat it. Just make sure your giving the right drug to the right patient with the right directions. Quanities, refills, etc etc is all BS that I wouldnt get upset about. Your going to review thousands of Rxs in a year and your going to mess up - any pharmacist that tells you theyve been perfect their whole career is lying to you. Do the best you can and hope for the best.

 

[PharmDstudent]

Watch the unit-dosed bottles. Cozaar is the worst. The bottle resembles other Merck bottles with quantities of 30 (Singulair), but this bottle has #90 in it. Most likely, if you slap a sticker on the stock bottle, you'll be giving the patient #90 when you meant to give them #30.

The unit-dosed bottles could be open too if a previous patient needed a quantity that was less than the unit-dose quantity. Therefore, you can't put the sticker directly on the bottle, because it's no longer a full bottle.
When you're checking, open the cap of all of the unit-dosed stock bottles to see if the bottle has been opened and if it's missing pills before you send it out.
I open bottles before I slap on the stickers, because a lot of people make this mistake. (I used to have really soft hands before I worked in a pharmacy, but I can't have soft hands if I have to open lots of bottles at work. It's no biggie though. I have a callus from writing notes in class too )

At my store, the Plavix bottle has #30. Most of the time, we give patients a labeled stock bottle. At my IPPE rotation, the stock bottle has #90. They have to count out the pills.

I don't know which pharmacy you work for and how their system is, but I think the F4 thing at Walgreen's is advantageous. At Wags, if you don't agree with what the technician/student has typed, you or the technician can change it before the script is ever filled.

Always check the names on the scripts first before you verify them, because you have to make sure that the basket with script, drug, and label has only one patient's medications in it (unless you want to put members of the same family with the same last name and the same address in the same bag). Otherwise, you might put two unrelated patients' medications in the same bag. Cashiers won't always catch this when it happens, so the patient ends up buying someone else's medication along with theirs.

Hopefully you're stapling the script bag closed after you check the medication so that another patient's medication won't get mixed in later on. This could happen when the cashier shuffles through the pick-up bins. You don't want medication bottles falling out of script bags and then ending up in the wrong bag, because the cashier was in too much of a hurry to put the medication back in it's correct bag.

Patients have to verify their phone number, address, or DOB at pick-up. There's no way around that. If John Smith Jr. wants to pick up his script, then it's wrong if you sell him John Smith Sr.'s script.

I hope this post helps you.
Good luck!

 

[Old Timer]

If you were formally written up for quantity problems, you should find a new job. The only issue you have is wrong persons bottle in the bag. That is a sign you are not organized when you are checking the prescriptions.

You need to evaluate what you do and do it the same way every time.

You need to keep all orders separate.

 

[tussionex]

The quantity errors were entered correctly but filled wrong. I eyeball the amounts of pills in bottles since the techs are supposed to be the ones counting, but apparently that's not enough. A couple of people have come back complaining that we've shorted them.

yeah, but were you "shorting" them vicodin or lipitor?

60 vs 30 i could see as a problem. 1 or 2 tabs....please....tell corporate to find better things to write you up about.

 

[meister]

I'll check my notes later, but if I remember correctly, a 99.9% accuracy rate (0.1% error) will directly kill at least 1 patient during your career. A 99.5% rate will kill closer to 10. It gets really ugly after that. Is this your first time working in a pharmacy?

What is this? Do you have any evidence to support this at all?

 

[confettiflyer]

What is this? Do you have any evidence to support this at all?

I don't have the figures...but I guess if you take the # of Rx's verified annually, divide by the # of retail pharmacists = D. Take the number of death's by Rx error on the fault of the pharmacist (r)...and just do a ratio so that r = 1, for every D scripts verified, on average, r people are killed. Statistically speaking, as a pharmacist, as you approach D, odds are you've killed one person.

NABP says that r = 7,000 (source: washington post, 2000...yeah long time ago).

There are as many as 7,000 deaths annually in the United States from incorrect prescriptions, according to Carmen Catizone of the National Association of Boards of Pharmacy. He told The Washington Post that as many as 5 percent of the 3 billion prescriptions filled each year are incorrect.

So now r = 7000, D = 3,000,000,000. So 428,571:1 is the scripts to death ratio, meaning a pharmacist has to reach 428,000 scripts to kill a pt (statistically speaking).

Say you're a pharmacist from age 25 to 65 (40 years) and verify 200 scripts per day at a decently busy pharmacy...you work 50 weeks out of the year, 5 days a week. Meaning you will have verified roughly 2,000,000 scripts in your lifetime. Statistically speaking, you will average 4.6 deaths...approximately one per decade.

So RxWildcat isn't too far off on what he posted IMO. Of course, this is a whole lot of freakin' voodoo math at 1am based on a lot of assumptions, someone crunch their own numbers or let me know if this doesn't make a lick of sense.

 

[Old Timer]

That's a nice thought. I have been a pharmacist for over 25 years and I have according to your formula verified over 1.2 million prescriptions and I should have killed 2.92 people by now. Thank God, I haven't killed anybody. Just remember the old adage, figures never lie, but liars always figure. You can make numbers up, but they are not real life.

 

[monsterbrain]

I'm a nice tech. To make my pharmacists' lives easier I open all stock bottles to dbl check that they are full and send them down with the bottle and cap separate. That way the pharmacist doesn't even have to open them. Don't you wish I was you tech?

 

[Aggie07]

We were told that if we practiced at 99.9% accuracy over the course of 40 (or so, I can't remember exactly) years we'd kill 6 people.

 

[confettiflyer]

That's a nice thought. I have been a pharmacist for over 25 years and I have according to your formula verified over 1.2 million prescriptions and I should have killed 2.92 people by now. Thank God, I haven't killed anybody. Just remember the old adage, figures never lie, but liars always figure. You can make numbers up, but they are not real life.

Well, it's an average anyway...I mean, just because the avg. life expectancy is 76 or so doesn't mean you'll die by 77 on the dot. Plus, I don't think anyone here will have 2.6 kids either. There's a great number of pharmacists at zero, and I'm sure there are many others that are twice that rate.

And yeah, my calculations are essentially made up, but the 3B and 7,000 figures are hard facts. Some pharmacists have to be responsible for those 7k.

 

[Caverject]

That's a nice thought. I have been a pharmacist for over 25 years and I have according to your formula verified over 1.2 million prescriptions and I should have killed 2.92 people by now. Thank God, I haven't killed anybody. Just remember the old adage, figures never lie, but liars always figure. You can make numbers up, but they are not real life.

How do you know? Do they come out of the grave and tell you a mistake in your pharmacy killed them?

but yeah, it's nice to know over a career of working to have never made a fatal mistake