Virtual Verification: Asset or Danger?

[amm338]

hi I'm a pharmacist in PA and I wanted to get a message out about virtual verification in retail pharmacies. I want to survey pharmacists, techs, interns on it. If VV gets overwhelmingly negative responses, I want to bring it up to a legislator or to the state board. Please take just a minute or two to fill it out! It's super fast but I need a lot of responses to make a real impact. I only have 290 responses. I need to get into the thousands for the board to take it seriously.

If you don't know what it is, virtual verification is a somewhat new way of checking prescriptions at CVS and Walgreen's. At CVS for example, a tech will count pills on a tray and scan an image of the pills under a scanner or an image of a sealed bottle with it's NDC in view and then bag it and staple it and file it in the waiting bin ready for the patient. The pharmacist never touches the pills or bags unless there is an issue with the process like a blurry image. The pharmacist verifies the prescription by looking at the images virtually that the tech took. They can take multiple pics, can include images of the expiration, seal of the bottle, can place number of bottles side by side in one image, whatever else. The pharmacist can zoom in and out and send it back to the tech to retake images if needed. Ask me questions if you want before taking the survey! Please share with other pharmacists and techs and interns you know. Thank you for your time 🙂

Virtual Verification in the Retail Pharmacy Setting

Is virtual verification an improvement from manual verification in terms of productivity and safety?, Does virtual verification save pharmacy employees' time compared to manual verification?, Is virtual verification safer than manual verification?

www.survey-maker.com

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[RxPreceptor]

Damn, seems to be heavily favored/bias for those who prefer manual verification. I will admit, it will be harder on new hire techs

A system like virtual verification is nothing new to me (seen this about a decade ago during rotations). Sure it has its flaws and disadvantages (mainly being at the mercy of how well a store's techs are trained...and their willingness to actually show up). Virtual verification cuts down on clutter and makes prioritizing waaaay easier vs manual verification (I rather enjoy not having to play "eagle eyes" seeing who can be the first to find a waiter amongst 100+ baskets of scripts covering the entire counter and floor).

 

[Sine Cura]

and their willingness to actually show up

Big if

 

[RxPreceptor]

No one else care to join the discussion? As always the glass can be half full or half empty. I maintain a fairly neutral stance (I'm not pro-virtual verification despite my last post). I'm genuinely curious about others' perspectives on this matter of workflow (I'm sure there are more factors to consider)

Plenty of tedious cons...mostly in failure to coordinate all technicians to uniformly capture all required data elements in pictures taken collectively as a team. Uncertainty/room for contamination (NIOSH drugs, PCNS/Sulfonamides, etc. - use designated tray or take picture afterwards showing cleaning done with alcohol bottle).

Biggest con being having workflow depend more heavily on employees with significantly less incentive, accountability, and training (RPh burdened with management and being glued to the computer screen). Most new techs/new hires are intimidated to help with triage...let alone some of these so called trained ones will fail to lift a finger in helping triage (worse yet, he/she creates more problems when trying to help). Let's just say some techs just flat out can't multitask/sequence task

 

[owlegrad]

Personally I have never worked with it but it sounds like another way to screw the pharmacist when someone doesn’t follow SOP and makes it easier for the tech to mess up in a way that would be impossible to catch.

 

[PharFromNormal]

The issue to me likely isn’t the concept rather the implementation. Seems like techs have more responsibility doubt that comes with any more coming their way.

The act of taking a picture and ensuring it’s a good picture and then verifying the picture all seems like it takes more time overall which is fine. But it’s not fine if it’s done with the justification to remove time (tech/rph hours).

Something makes my spidey sense go off that this wasn’t implemented for altruistic purposes as who wants to increase cost to fill in this environment. This model has more time demand on the tech and you still need a rph in the four walls during operating hours... that is until you don’t.

Where do I place my bets that this is a means to start moving verification out of the store entirely?

I mean this isn’t a real job post is it...

Telepharmacy Technician in Chicago, Illinois | Ebony Career Center

Apply today for the CVS Health's Telepharmacy Technician position in Chicago, Illinois

www.ebonycareercenter.com

 

[WVUPharm2007]

Can't wait until I can get that at home QV2 verification job.

 

[PharFromNormal]

Can't wait until I can get that at home QV2 verification job.

You think they are going to want to pay for those setups in your house needed to virtually counsel someone?

Nah your gonna be on the bench in one store expected to do all your work there and oversee another store. No way they letting you work from home.

 

[WVUPharm2007]

You think they are going to want to pay for those setups in your house needed to virtually counsel someone?

Nah your gonna be on the bench in one store expected to do all your work there and oversee another store. No way they letting you work from home.

Ha ha ha. Counsel?

They are gong to eliminate all pharmacist overlap and instead have someone at home doing QV1/2 for multiple stores.

 

[RxPreceptor]

Already cut RPh hours where I am at...virtually no overlap compared to previous schedule (terrible pun definitely intended)

 

[radio frequency]

I don't think I could have caught a bottle with mixed T2s and T3s with virtual verification unless the photo had been just right. Don't even ask how they got mixed up...basically a big, total system failure. Sometimes having the pills in front of you is very helpful though.

 

[PharFromNormal]

Ha ha ha. Counsel?

They are gong to eliminate all pharmacist overlap and instead have someone at home doing QV1/2 for multiple stores.

ive looked into some state regs on this... there are many states that have strict guidance on the remote pharmacist. Some states it’s a direct one to one relationship. Some it must be done from the confines of another pharmacy etc.

And yes... counsel. It’s one thing to have pharmacists simply not execute their legally required duty (state mandatory). It’s an entirely different for the company to not even have a way to be compliant. Since I imagine it will catch a lot of eyes, compliance will need to be high or the board will have a cash cow.

Read that job description it literally talks about A&V equipment

 

[WVUPharm2007]

ive looked into some state regs on this... there are many states that have strict guidance on the remote pharmacist. Some states it’s a direct one to one relationship. Some it must be done from the confines of another pharmacy etc.

And yes... counsel. It’s one thing to have pharmacists simply not execute their legally required duty (state mandatory). It’s an entirely different for the company to not even have a way to be compliant. Since I imagine it will catch a lot of eyes, compliance will need to be high or the board will have a cash cow.

Read that job description it literally talks about A&V equipment

There is another pharmacist there in the building at all times by law. Why would the remote pharmacist be the one counseling?

I don't think we are talking about the same thing.

 

[PharFromNormal]

There is another pharmacist there in the building at all times by law. Why would the remote pharmacist be the one counseling?

I don't think we are talking about the same thing.

Did you read this?

Telepharmacy Technician in Chicago, Illinois | Ebony Career Center

Apply today for the CVS Health's Telepharmacy Technician position in Chicago, Illinois

www.ebonycareercenter.com

it’s a technician all alone in a pharmacy. There is no pharmacist on site. The supervising pharmacist is completely remote therefore counseling is done via A/V equipment referenced in that job posting.

 

[PharFromNormal]

There is another pharmacist there in the building at all times by law. Why would the remote pharmacist be the one counseling?

I don't think we are talking about the same thing.

“The Telepharmacy Technician is responsible for all operations of a remote Telepharmacy location, where the Pharmacist oversight occurs from a separate Supervising Pharmacy location.”

 

[Rukn]

This will probably lead to the end of this joke of a "profession"

They will eliminate overlap, cut hours further, commence lay offs, reduce tech hours

 

[RxPreceptor]

Did you read this?

Telepharmacy Technician in Chicago, Illinois | Ebony Career Center

Apply today for the CVS Health's Telepharmacy Technician position in Chicago, Illinois

www.ebonycareercenter.com

it’s a technician all alone in a pharmacy. There is no pharmacist on site. The supervising pharmacist is completely remote therefore counseling is done via A/V equipment referenced in that job posting.

Uh huh...over 1 page of size 12 font, block text, single line spacing description of responsibilities (including manager role) for a high school education requirement job. How appealing does this sound to anyone/what do you think the pay offer is? This is turning into a joke. How would such a setting handle narcotics with an RPh being remote?

1 RPh overseeing a dozen stores run by/managed high school educated techs who don't know what he/she is getting themselves into (the best equipment and time management skills in the world are unable to offset the shear lack of resources, never ending list of expanding metrics, & lack of understanding about practicality from a workflow perspective by a bunch of corporate @$$ hats)

 

[PharFromNormal]

Uh huh...over 1 page of size 12 font, block text, single line spacing description of responsibilities (including manager role) for a high school education requirement job. How appealing does this sound to anyone/what do you think the pay offer is? This is turning into a joke. How would such a setting handle narcotics with an RPh being remote?

1 RPh overseeing a dozen stores run by/managed high school educated techs who don't know what he/she is getting themselves into (the best equipment and time management skills in the world are unable to offset the shear lack of resources, never ending list of expanding metrics, & lack of understanding about practicality from a workflow perspective by a bunch of corporate @$$ hats)

maybe this is a better formatted one and on their official site (also open position)

https://jobs.cvshealth.com/ShowJob/JobId/1131568/PharmacyTechnician–Telepharmacy105SWabashAveChicagoIL

 

[Rainbowdash]

The camera thingy is very glitchy. It takes forever to capture an image. Nothing stops the tech from putting an extra bottle/taking out a bottle by accident. I already caught some unlabeled meds going out (the tech scanned all the labels, but forgot to affix the label on the med).


If it would allow me to vv from home, even for 50% decrease in salary, I would be all for it. Maybe that is the ultimate goal--we'll vv at home, and an extra tech will be hired at the store (?). . . Ohh well, one can only dream.

 

[WVUPharm2007]

Did you read this?

Telepharmacy Technician in Chicago, Illinois | Ebony Career Center

Apply today for the CVS Health's Telepharmacy Technician position in Chicago, Illinois

www.ebonycareercenter.com

it’s a technician all alone in a pharmacy. There is no pharmacist on site. The supervising pharmacist is completely remote therefore counseling is done via A/V equipment referenced in that job posting.

That isn't legal in any state I'm licensed in. Lol, good luck, with that CVS.

 

[RxPreceptor]

maybe this is a better formatted one and on their official site (also open position)

https://jobs.cvshealth.com/ShowJob/JobId/1131568/PharmacyTechnician–Telepharmacy105SWabashAveChicagoIL

Main point - it's asking quite a lot/entails far more than any high school degree applicant to be accountable for with questionable pay.

 

[Sine Cura]

Part of the telepharmacy technician job description from above.

Performs the functions of the Supervisor on Duty for the pharmacy department by maintaining all standards set by Asset Protection. This includes all policies and procedures regarding personal belongings in the pharmacy/Telepharmacy department, employee purchases, personnel access to the pharmacy/telepharmacy department, check-in process and documentation for controlled substances, returns processes and documentation for controlled substances, asset protection-initiated audits, cycle counts, and any other policies and procedures regarding asset protection.

You can't even get PharmDs to meet this expectation seriously, much less marginal high school grads.

Good luck with that.

This + no-accountability culture => total disaster

I personally shake containers to suss out obvious undercounts/overcounts, and having to touch things physically is not an un-trivial part of product verification. Are they gonna scan expiration dates on the source bottle?

Good luck~

 

[RxPreceptor]

Part of the telepharmacy technician job description from above.



You can't even get PharmDs to meet this expectation seriously, much less marginal high school grads.

Good luck with that.

This + no-accountability culture => total disaster

I personally shake containers to suss out obvious undercounts/overcounts, and having to touch things physically is not an un-trivial part of product verification. Are they gonna scan expiration dates on the source bottle?

Good luck~

Yeah especially on that no food and cell phones in the pharmacy...I try to enforce that and I get reported to by HR by said technician in question. Sure there's more to the story of course, but the point is you can't win on all expectations even when one puts forth the intentional effort. Everything else is just fine, LMFAO

I don't think anyone went to pharmacy school to learn how to babysit grown adults with authority issues
Ok, sorry for the tangent...back to discussing Virtual Verification

 

[Sine Cura]

Unfortunately PICs aren't running a pharmacy these days when it comes to chain retail. They are running a preschool except the "grownups" acting like children include not just the customers but also the direct reports

Indulgent babies who need to pound 3x Monsters a day just to cope in retail. JFL

If accuracy scans include the Data Matrix code on source bottles at least that can capture actual exp date info from the GTIN. Doubt anyone at these sclerotic chains ever considered utilizing that data for telepharmacy.

 

[meltyblend]

My store started the new VV system a couple weeks ago and it's been a disaster. Wecare has dropped to an all time low and all pharmacist overlapped was removed. When they took away the overlap, they said the new 4:1 ratio would allow more tech hours. Well, tech hours were cut as well. Big help that was.

The new system has made production a rate limiting step in getting things done. It's a bottle neck effect. No matter how fast you are at any other stations, the picture capture system is just too slow to keep up. You essentially need 2 techs at production at all time and they can't be diverted to do anything but production. In my store, we tend to have everything print and pulled but by 1pm everything is going red.

The system seems ok in theory. But it puts the work burden on the techs doing production and there's no quality control to the pictures that are being taken. The techs basically take the picture however they want and you hope they're doing it right. Unless the pharmacist wants to physically go hunt down the bagged script to manually verify a bad picture, there's going to be a lot of bad verification that slides by. The liability still falls on the verifying pharmacist but the tech has to do all the heavy lifting. Yet there's no compensation to the tech despite the increase work load.

Now let's talk about going back to look at images of previous verified scripts. It takes several steps to even do that. To actually look at the image, you need to go onto radar/spark, click on the first tab, and select production image retrieval. Besides the fact that logging into radar takes time (CVS systems lags like crazy), it's unnecessary work when they could have just allow you to look at the image using the RV function.

Tl;dr: the new system sucks and relies too much on tech proficiency and efficiency

 

[M0df]

It is an asset for CVS.

Is it danger for you? Would you be liable? Possibly but they are really going after CVS if anything happens. This is just adding more variables and while I prefer to do it the old fashioned way, I bet there are pharmacists who don't always open the bottle. So all in all, just don't do 1 second final check.
That will look suspicious in court.

 

[amm338]

No one else care to join the discussion? As always the glass can be half full or half empty. I maintain a fairly neutral stance (I'm not pro-virtual verification despite my last post). I'm genuinely curious about others' perspectives on this matter of workflow (I'm sure there are more factors to consider)

Plenty of tedious cons...mostly in failure to coordinate all technicians to uniformly capture all required data elements in pictures taken collectively as a team. Uncertainty/room for contamination (NIOSH drugs, PCNS/Sulfonamides, etc. - use designated tray or take picture afterwards showing cleaning done with alcohol bottle).

Biggest con being having workflow depend more heavily on employees with significantly less incentive, accountability, and training (RPh burdened with management and being glued to the computer screen). Most new techs/new hires are intimidated to help with triage...let alone some of these so called trained ones will fail to lift a finger in helping triage (worse yet, he/she creates more problems when trying to help). Let's just say some techs just flat out can't multitask/sequence task

my problem with it is that if we can't see it physically, then we can't really be responsible for what is in that bag. How can our licenses depend on something we can't ensure is safely filled for the patient?

 

[PharFromNormal]

my problem with it is that if we can't see it physically, then we can't really be responsible for what is in that bag. How can our licenses depend on something we can't ensure is safely filled for the patient?

The responsibilities that come with your license are not the same as the responsibilities that your employer says is your job. What your employer tells you not to worry about does not remove any expectations a board may have.

you are the pharmacist you are responsible full stop.

 

[RxPreceptor]

my problem with it is that if we can't see it physically, then we can't really be responsible for what is in that bag. How can our licenses depend on something we can't ensure is safely filled for the patient?

Yeah, I feel you on this one...why I am a huge advocate of production zone (one Rx at a time in designated area...really boils down to cleanliness and organization) & consistently letting techs finish a task first when having to run to pick up.

 

[firework]

In my state, and many others, pharmacists can work remotely, but wherever they work from, has to be a pharmacy establishment registered with board and subject to board inspections. But this is before COVID. Since COVID, all boards allow pharmacists work from home and this probably won't change back again.

 

[quickpic007]

Damn, seems to be heavily favored/bias for those who prefer manual verification. I will admit, it will be harder on new hire techs

A system like virtual verification is nothing new to me (seen this about a decade ago during rotations). Sure it has its flaws and disadvantages (mainly being at the mercy of how well a store's techs are trained...and their willingness to actually show up). Virtual verification cuts down on clutter and makes prioritizing waaaay easier vs manual verification (I rather enjoy not having to play "eagle eyes" seeing who can be the first to find a waiter amongst 100+ baskets of scripts covering the entire counter and floor).

Are yellow waiter baskets not a thing at your store? At my old cvs any waiter goes in a yellow basket. Too easy! Not into trusting a technician who has been at my store for 2 hours to know how to use a stapler and read. No way.

The camera thingy is very glitchy. It takes forever to capture an image. Nothing stops the tech from putting an extra bottle/taking out a bottle by accident. I already caught some unlabeled meds going out (the tech scanned all the labels, but forgot to affix the label on the med).


If it would allow me to vv from home, even for 50% decrease in salary, I would be all for it. Maybe that is the ultimate goal--we'll vv at home, and an extra tech will be hired at the store (?). . . Ohh well, one can only dream.

You must be kidding. How many vv do you think they will expect per minute? per shift? I would think 360 per hour minimum if only vv. 2880 for an 8 hour day! For half rate?! Good luck keeping that work license with today's retail tech talent.

 

[Sine Cura]

Until techs are held to a higher standard, which may/should include higher pay and an actual accountability regime to discourage diversion and reinforce minimum job performance standards, gl

Also a controlled environment like central fill vs a ****-show fish bowl environment visible to the public matters too as far as distraction level

Quantity errors cannot be easily sussed out either. How realistic is it to "flag" such Rx if you are expected to blast through them

 

[RxPreceptor]

Are yellow waiter baskets not a thing at your store? At my old cvs any waiter goes in a yellow basket. Too easy! Not into trusting a technician who has been at my store for 2 hours to know how to use a stapler and read. No way.

You must be kidding. How many vv do you think they will expect per minute? per shift? I would think 360 per hour minimum if only vv. 2880 for an 8 hour day! For half rate?! Good luck keeping that work license with today's retail tech talent.

With this system, there is a HUGE (p>>>0.05) drop in basket use vs. old system (RIP label sticking out of baskets not being placed properly...eyeballs)

 

[wagrxm2000]

We did this awhile ago when they put us out front.

It flopped and we're back in the pharmacy.

 

[VA77]

Anyone's state have any laws on the time-frame for counseling? I'm afraid the chains will just say call this 1800 number and now your caller number 18 with an estimated wait time of 32 minutes.

This is what you are going to get if you don't have counseling on-site with a pharmacist. Of course, we could just let the tech do counseling since we have already 'let' them do IMZs and in some states final verification. Might as well designate a TIC....Tech in Charge.

 

[PharFromNormal]

My store started the new VV system a couple weeks ago and it's been a disaster. Wecare has dropped to an all time low and all pharmacist overlapped was removed. When they took away the overlap, they said the new 4:1 ratio would allow more tech hours. Well, tech hours were cut as well. Big help that was.

The new system has made production a rate limiting step in getting things done. It's a bottle neck effect. No matter how fast you are at any other stations, the picture capture system is just too slow to keep up. You essentially need 2 techs at production at all time and they can't be diverted to do anything but production. In my store, we tend to have everything print and pulled but by 1pm everything is going red.

The system seems ok in theory. But it puts the work burden on the techs doing production and there's no quality control to the pictures that are being taken. The techs basically take the picture however they want and you hope they're doing it right. Unless the pharmacist wants to physically go hunt down the bagged script to manually verify a bad picture, there's going to be a lot of bad verification that slides by. The liability still falls on the verifying pharmacist but the tech has to do all the heavy lifting. Yet there's no compensation to the tech despite the increase work load.

Now let's talk about going back to look at images of previous verified scripts. It takes several steps to even do that. To actually look at the image, you need to go onto radar/spark, click on the first tab, and select production image retrieval. Besides the fact that logging into radar takes time (CVS systems lags like crazy), it's unnecessary work when they could have just allow you to look at the image using the RV function.

Tl;dr: the new system sucks and relies too much on tech proficiency and efficiency

this is what I was trying to say originally - the concept probably seems fine. The implementation im sure leaves much to be desired.

 

[APN-59 rph]

I was passing thru a mid-sized clinic today,.......they run about 20 pharmacies in the clinics....three of them are remote staffed by techs....It's the wave of the future.