Where do old pills go to die?

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GrapePropel

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When I was working in a pharmacy for APPEs I asked the preceptor what happens with expired pills. He told me they sell them to a third party for pennies on the dollar. Sure enough one day a man came with a bag and truck and picked up a bunch of pills. But there there was also a jar full of expired pills that one of the women used for her kitty litter. So i didn't understand why they had two systems for disposal of pills.

Can someone please explain in depth how expired medications are dealt with at chains and independents? thanks

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You were seriously working at a place within the last century that gave or sold expired pills to random people off the street?

Um, no, that is not what is legally done. Expired meds are either destroyed on-site (and thoroughly documented with witnesses) & this is rarely done these days due to pollution concerns..... or they sent to a disposal site where they are burned or otherwise environmentally safely disposed of (and again, this all has to be thoroughly documented by the sending pharmacy.)

Expired meds should NEVER be given out by a pharmacy for any reason. (and if SoSo tells you different, it's not true.)
 
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You were seriously working at a place within the last century that gave or sold expired pills to random people off the street?

Um, no, that is not what is legally done. Expired meds are either destroyed on-site (and thoroughly documented with witnesses) & this is rarely done these days due to pollution concerns..... or they sent to a disposal site where they are burned or otherwise environmentally safely disposed of (and again, this all has to be thoroughly documented by the sending pharmacy.)

Expired meds should NEVER be given out by a pharmacy for any reason. (and if SoSo tells you different, it's not true.)

no not off the street. I mean the people that came to get the pills were like official pill disposers or government affiliated company? i think. They had like uniforms and were part of a company so i think they were "sent to a disposal site"

but i think he said the pharmacy gets paid (small %) for the old pills bc the company sells the pills to other country where expired pills are allowed to be used.
 
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What's the reimbursement for expired flu shots?
The Merck rep said something like we can get paid back like 90% on expired zostavax. So more than pennies on dollar.
 
She used expired pills as kitty litter? Lol
 
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no not off the street. I mean the people that came to get the pills were like official pill disposers or government affiliated company? i think. They had like uniforms and were part of a company so i think they were "sent to a disposal site"

but i think he said the pharmacy gets paid (small %) for the old pills bc the company sells the pills to other country where expired pills are allowed to be used.

The term for that sort of company is usually triple-R (reverse distributor, returns, and removal) or "reverse distributor" which really only pertains to CS destruction but is generalized to all cases since you need it to operate This is quite a legal business, and does make money, but they can get involved in some shady business.

You're actually not paid by the reverse distributor for meds that go elsewhere. Oftentimes, the manufacturer will pay the reverse distributor a bounty for keeping track of what gets expired out of which pharmacy, so that they can plan batch production alongside getting the invoices from a normal distributor which you get some pittance. In the case of dangerous or street-value ones, sometimes this really is more a return where the company takes from you and then sends back to the manufacturer for disposal or destruction.

Also destruction is like laptop destruction, where they will find some place somewhere that doesn't have the environmental regulations in state to prevent dumping. That's why many of them operate destruction sites in West Virginia and New Jersey (or work with them as third party).

There's this grey market for drugs that have been expired but still would pass stability tests. There's provisions within FDA that allow for expired meds to be donated but not sold outside the country, but specifically have to go to a traceable group. This is a change because of the reimport problem where we would sell expired drugs then have some jerk smuggle them back in and sell as counterfeit through 3rd party distributors.

You might want to check with your state practice acts, but inspectors get pretty annoyed/angry about having big "pill collections" at home even if no CS is present as they would cite you for the need for a prescription to have meds outside the pharmacy. Kitty litter isn't exactly an acceptable use.

There's also DoD's universe, where I see them routinely use expired meds on active duty. Only the best for them, right? (In fairness, most expired solid meds aren't immediately bad after expiration, but the DoD openly ignores disposal rules most of the time.)
 
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Expired meds should NEVER be given out by a pharmacy for any reason. (and if SoSo tells you different, it's not true.)

sometimes they keep expired meds in scriptpro machine like in this picture. warfarin has been there since 2010.
 

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She used expired pills as kitty litter? Lol
Yeah one of the owners had this big glass jar full of expired or defective pills. And I asked her: what do you do when it gets filled? she said she uses it for kittylitter at her home for her pets
 
sometimes they keep expired meds in scriptpro machine like in this picture. warfarin has been there since 2010.
that seems like very poor and risky practice. What if they accidentally get dispensed?
 
The term for that sort of company is usually triple-R (reverse distributor, returns, and removal) or "reverse distributor" which really only pertains to CS destruction but is generalized to all cases since you need it to operate This is quite a legal business, and does make money, but they can get involved in some shady business.

You're actually not paid by the reverse distributor for meds that go elsewhere. Oftentimes, the manufacturer will pay the reverse distributor a bounty for keeping track of what gets expired out of which pharmacy, so that they can plan batch production alongside getting the invoices from a normal distributor which you get some pittance. In the case of dangerous or street-value ones, sometimes this really is more a return where the company takes from you and then sends back to the manufacturer for disposal or destruction.

Also destruction is like laptop destruction, where they will find some place somewhere that doesn't have the environmental regulations in state to prevent dumping. That's why many of them operate destruction sites in West Virginia and New Jersey (or work with them as third party).

There's this grey market for drugs that have been expired but still would pass stability tests. There's provisions within FDA that allow for expired meds to be donated but not sold outside the country, but specifically have to go to a traceable group. This is a change because of the reimport problem where we would sell expired drugs then have some jerk smuggle them back in and sell as counterfeit through 3rd party distributors.

You might want to check with your state practice acts, but inspectors get pretty annoyed/angry about having big "pill collections" at home even if no CS is present as they would cite you for the need for a prescription to have meds outside the pharmacy. Kitty litter isn't exactly an acceptable use.

There's also DoD's universe, where I see them routinely use expired meds on active duty. Only the best for them, right? (In fairness, most expired solid meds aren't immediately bad after expiration, but the DoD openly ignores disposal rules most of the time.)

Thanks for all this information. I'm still kinda confused on the State/federal laws regarding the destruction of medications both controlled and non-controlled. Are there any laws at all? Can the pharmacist just take his expired meds out back and burn them assume he or she is not violating any environmental laws?

I thought there would at least be a law that makes sure controlled 2 medications are destroyed. Like maybe a federal auditor comes by and verifies the addictive drugs are properly destroyed. Otherwise what is stopping shady independent pharmacy from just saying they destroyed all their expired oxycodone and hydrocodone when they really just took it home and are selling it on the street for cash profit?

My cousin works as a CRNA and she says when they empty fent bags there has to be another witness to sign off that you dumped the whole bag and did not take any opiates home with you.
 
Most of the time the exp date and lot numbers do not get updated when adding meds to script pro. Most of the meds are fast movers so highly unlikely to be expired.
 
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Most of the time the exp date and lot numbers do not get updated when adding meds to script pro. Most of the meds are fast movers so highly unlikely to be expired.
Still seems like the hospital would be putting itself at risk if they were audited and they found the wrong dates on the drug. Lot identification could be important if there was a recall with a certain medication lot.
 
sometimes they keep expired meds in scriptpro machine like in this picture. warfarin has been there since 2010.

Ever bother to look at the actual data when you pull up a cell (you know the electronic data, not some old sticker that is photo aged)? Odds are whoever replaces the cell just doesn't put an updated sticker on the front. SPC will block expired scripts from being dispensed....given someone can actually input the correct data
 
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sometimes they keep expired meds in scriptpro machine like in this picture. warfarin has been there since 2010.

1) When was this picture taken? For all I know, it was taken in 2011. If you took it last week, then that is obvious pharmacy law violation--I would not work in a place that allowed such flagrant violation of law, contrary to what you think, you are just as guilty as everyone else in that pharmacy.

that seems like very poor and risky practice. What if they accidentally get dispensed?

I really don't get how expired meds work as cat litter. Real cat litter has nice baking soda or febreze in it to keep down odor control. And it pretty fine, most cats would turn up their nose at digging in a pile of pills. Not to mention, what if the cat decided to lick it or eat it for whatever reason (hey, cat's lick their butts, so how is that different from licking something in their litter box?)--expired meds could still have enough potency to potentially be lethal to cat. Not only is it illegal, what the owner is doing, it makes no logical sense, and it's potentially dangerous to the cat.

Thanks for all this information. I'm still kinda confused on the State/federal laws regarding the destruction of medications both controlled and non-controlled. Are there any laws at all? Can the pharmacist just take his expired meds out back and burn them assume he or she is not violating any environmental laws?

Yes, there is a law. (OK, I guess I don't know for sure that there is a law in your state....but I would be extremely surprised if there wasn't.) Generally speaking, it's not legal for to just do "whatever" with expired meds. They need to be destroyed or given to a destruction company, and there must be documentation of all of this. Now, I could see the owner "documenting" that she is destroying the meds, and getting the co-owner to sign off that he witnessed the destruction of the meds.....but obviously falsifying documents is illegal.

My cousin works as a CRNA and she says when they empty fent bags there has to be another witness to sign off that you dumped the whole bag and did not take any opiates home with you.

Exactly. This is how it is supposed to be done. Just because the pharmacy owner you work for doesn't do this, that doesn't mean that she shouldn't be doing this.

Still seems like the hospital would be putting itself at risk if they were audited and they found the wrong dates on the drug. Lot identification could be important if there was a recall with a certain medication lot.

Oh yeah, definitely major Jcaho violation or whatever accrediting body the hospital uses.
 
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Yeah one of the owners had this big glass jar full of expired or defective pills. And I asked her: what do you do when it gets filled? she said she uses it for kittylitter at her home for her pets
Gotta assume she meant mixing them with the cat litter and disposing of them afterwards, not actually using the pills themselves as cat litter. Same concept as mixing with coffee grounds.
 
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that seems like very poor and risky practice. What if they accidentally get dispensed?

Don't worry, once you put the computer-generated label on the bottle, it magically extends the shelf life by a year from the date dispensed. At least that's what I've heard around here.
 
1) When was this picture taken? For all I know, it was taken in 2011. If you took it last week, then that is obvious pharmacy law violation--I would not work in a place that allowed such flagrant violation of law, contrary to what you think, you are just as guilty as everyone else in that pharmacy.
this is why i don't call the ethics hotline or upper management to report these issues. they would just place the blame on me. someone who doesn't even work there. Lol. Oh and i have more photo dumps to upload but u have so much sh;t already.
 
1) When was this picture taken? For all I know, it was taken in 2011. If you took it last week, then that is obvious pharmacy law violation--I would not work in a place that allowed such flagrant violation of law, contrary to what you think, you are just as guilty as everyone else in that pharmacy.
I really don't get how expired meds work as cat litter. Real cat litter has nice baking soda or febreze in it to keep down odor control. And it pretty fine, most cats would turn up their nose at digging in a pile of pills. Not to mention, what if the cat decided to lick it or eat it for whatever reason (hey, cat's lick their butts, so how is that different from licking something in their litter box?)--expired meds could still have enough potency to potentially be lethal to cat. Not only is it illegal, what the owner is doing, it makes no logical sense, and it's potentially dangerous to the cat.
Yes, there is a law. (OK, I guess I don't know for sure that there is a law in your state....but I would be extremely surprised if there wasn't.) Generally speaking, it's not legal for to just do "whatever" with expired meds. They need to be destroyed or given to a destruction company, and there must be documentation of all of this. Now, I could see the owner "documenting" that she is destroying the meds, and getting the co-owner to sign off that he witnessed the destruction of the meds.....but obviously falsifying documents is illegal.
Exactly. This is how it is supposed to be done. Just because the pharmacy owner you work for doesn't do this, that doesn't mean that she shouldn't be doing this.
Oh yeah, definitely major Jcaho violation or whatever accrediting body the hospital uses.
Okay, I don't want it to seem like I'm just hounding sosoo, but I'm going to apply some critical thinking here.

A couple of things stink about that photo.

1.) In order for a CVS pharmacy to have a Script Pro, their volume needs to be around 4,000 prescriptions per week or more.

2.) My store is relatively slow, doing around 1,500 rx per week.
We used 344 tablets of Warfarin 5mg in the month of July.

3.) A single script pro cell like the one in the photo holds 676cc.

I happen to have Teva 5mg in stock, and checked. About 180 tablets fit into a 16 dram vial.
That's roughly 3 tabs per mL.

So, if that Script Pro cell were filled to the brim, we could expect it to hold a maximum of 2,100 tablets if we're being generous.

So, if a person posts a picture of a Script Pro cell in a CVS with a date from 2010, they're asking you to believe that a 4,000 prescription per week pharmacy can't use #2,100 tablets of Warfarin 5mg in 7 years?

They're asking you to believe that those tablets would still be there after the pharmacy filled a minimum of 1,344,000 prescriptions.

Does that seem reasonable to you?

I think she is just demonstrating, once again, that she believes labels on containers have magical time warping properties.
 
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Sosoo obviously does not know how to operate a script pro & is using pictures out of context. Machine will not dispense expired script meds unless someone purposely uses expired drug and overrides the hell out of everything using wrong data inputs. Please stop posting your tinfoil hat conspiracy nonsense
 
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Sosoo obviously does not know how to operate a script pro & is using pictures out of context. Machine will not dispense expired script meds unless someone purposely uses expired drug and overrides the hell out of everything using wrong data inputs. Please stop posting your tinfoil hat conspiracy nonsense
Ohhhhh I totally forgot about that aspect of it.

MYTH BUSTED
 
I happen to have Teva 5mg in stock, and checked. About 180 tablets fit into a 16 dram vial.
That's roughly 3 tabs per mL.

So, if that Script Pro cell were filled to the brim, we could expect it to hold a maximum of 2,100 tablets if we're being generous.

So, if a person posts a picture of a Script Pro cell in a CVS with a date from 2010, they're asking you to believe that a 4,000 prescription per week pharmacy can't use #2,100 tablets of Warfarin 5mg in 7 years?

They're asking you to believe that those tablets would still be there after the pharmacy filled a minimum of 1,344,000 prescriptions.

Does that seem reasonable to you?

I think she is just demonstrating, once again, that she believes labels on containers have magical time warping properties.

base on your assumption alone, your calculation is way off... scriptpro cells dispense in 13 dram vials, 20, and 40. and so i don't know where you get the 16dram from. and again, in pharmacy practice, are we to base drug expiration on assumptions? if there is a product recall, are we to make guesses on the lot number? if 7 years is not long enough to update the labeling, how long should this continue further? 14 years? 21 years? theres actually a requirement to update the labeling after so and so months. a real audit by a non-lazy auditor will detect noncompliance with each yearly visit. the past 7 years have been audited by an ignorant, noncompliant fool. 7 years is enough to define as "gross negligence." // anyone making excuses for mislabeling is clearly noncompliant with regulatory.
 
base on your assumption alone, your calculation is way off... scriptpro cells dispense in 13 dram vials, 20, and 40. and so i don't know where you get the 16dram from. and again, in pharmacy practice, are we to base drug expiration on assumptions? if there is a product recall, are we to make guesses on the lot number? if 7 years is not long enough to update the labeling, how long should this continue further? 14 years? 21 years? theres actually a requirement to update the labeling after so and so months. a real audit by a non-lazy auditor will detect noncompliance with each yearly visit. the past 7 years have been audited by an ignorant, noncompliant fool. 7 years is enough to define as "gross negligence." // anyone making excuses for mislabeling is clearly noncompliant with regulatory.
I don't think you are even understanding what I did there.

Basically, I wanted to solve for X, where X = the volume occupied by 1 tablet of Teva Warfarin 5mg.
There were a few known variables, and I was able to get a rough estimate on quantity by filling a 16 dram vial with tablets.
Then, because the volume of a script pro is a known constant, we can solve for Y, where Y = the maximum number of tablets in a script pro cell.

I did this to point out that an intelligent, competent individual could not reasonably assume that a high volume store could keep ~2,000 tablets in stock for 7 years.

No, you're not basing drug expiration on assumptions.
As RxVampire pointed out, Script Pro does not allow expired meds to be dispensed.
There's a bar code reader on the robot for a reason.

Also, you're attempting to move your goalposts and assert that your problem with the photo is that the label on the cell is the problem.
You clearly stated that you believed the problem was expired tablets inside the cell, and you were attempting to use the photo as proof of the tablet being expired.

Furthermore, there is no Texas law concerning cell labeling in Script Pro or any other robotic filling system.
As long as the vial label has the correct expiry date, it is compliant. Unlike the normal Production vials, Script Pro does this automatically. Barcodes n stuff.

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I don't think you are even understanding what I did there.

Basically, I wanted to solve for X, where X = the volume occupied by 1 tablet of Teva Warfarin 5mg.
There were a few known variables, and I was able to get a rough estimate on quantity by filling a 16 dram vial with tablets.
Then, because the volume of a script pro is a known constant, we can solve for Y, where Y = the maximum number of tablets in a script pro cell.

I did this to point out that an intelligent, competent individual could not reasonably assume that a high volume store could keep ~2,000 tablets in stock for 7 years.

No, you're not basing drug expiration on assumptions.
As RxVampire pointed out, Script Pro does not allow expired meds to be dispensed.
There's a bar code reader on the robot for a reason.

Also, you're attempting to move your goalposts and assert that your problem with the photo is that the label on the cell is the problem.
You clearly stated that you believed the problem was expired tablets inside the cell, and you were attempting to use the photo as proof of the tablet being expired.

Furthermore, there is no Texas law concerning cell labeling in Script Pro or any other robotic filling system.
As long as the vial label has the correct expiry date, it is compliant. Unlike the normal Production vials, Script Pro does this automatically. Barcodes n stuff.

Nba GIFs - Find & Share on GIPHY

again, you're making assumptions. you're assuming scriptpro utilize 16dram vials. you're also assuming i claimed there are expired tablets in the cells. nowhere in this thread did i say the tablets are expired. in past threads n this u keep making false assumptions and went on n on like a broken record. tell me at which point did i say there are expired meds in the scriptpro?? the issue is mislabeling.. i did mention that. are u telling me the FDA does not have laws on mislabeling?? that this is what u call compliant?
 
again, you're making assumptions. you're assuming scriptpro utilize 16dram vials. you're also assuming i claimed there are expired tablets in the cells. nowhere in this thread did i say the tablets are expired. in past threads n this u keep making false assumptions and went on n on like a broken record. tell me at which point did i say there are expired meds in the scriptpro?? the issue is mislabeling.. i did mention that. are u telling me the FDA does not have laws on mislabeling?? that this is what u call compliant?

Three things:

1.Do you know what a dram is?
It doesn't matter what size vials the robot uses. Re read my post until you understand why I mentioned 16 dram vials.
2. Where do old pills go to die?
3. The FDA is a regulatory body that has no jurisdiction over the practice of pharmacy.
Even if it did, that's not how that law works.
 
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Three things:

1.Do you know what a dram is?
It doesn't matter what size vials the robot uses. Re read my post until you understand why I mentioned 16 dram vials.
2. Where do old pills go to die?
3. The FDA is a regulatory body that has no jurisdiction over the practice of pharmacy.
Even if it did, that's not how that law works.

1) this is very lengthy. i'll read it when the vial size is according to scriptpro. 13, 20, or 40.
2) my mistake. i wrote it in contrast to what i was thinking.
3) mislabeling is part of pharmacy laws. if u are noncompliant, you're just like the ppl who are "gross negligent."
 
1) this is very lengthy. i'll read it when the vial size is according to scriptpro. 13, 20, or 40.
2) my mistake. i wrote it in contrast to what i was thinking.
3) mislabeling is part of pharmacy laws. if u are noncompliant, you're just like the ppl who are "gross negligent."
You are truly amazing.
We could catch you wrist deep in a cookie jar, and you'd say you were measuring it to prevent cookie thieves from getting in.

1 dram = 3.7mL

3.7mL/1 dram = 16 drams / XmL -> X= ~60mL

Then

~180 tablets / 60mL = X tablets / 1mL
It has nothing to do with the vials actually used in Script Pro.

I'm not even going to address the other two.
God help your pic.
When I was working in a pharmacy for APPEs I asked the preceptor what happens with expired pills. He told me they sell them to a third party for pennies on the dollar. Sure enough one day a man came with a bag and truck and picked up a bunch of pills. But there there was also a jar full of expired pills that one of the women used for her kitty litter. So i didn't understand why they had two systems for disposal of pills.
Can someone please explain in depth how expired medications are dealt with at chains and independents? thanks
One interesting thing is that most expired return companies only give you a credit once you hit a certain quantity threshold for a given NDC.

I.e. they're not going to give you $0.0007 if you return a 1,000 count bottle of Warfarin 1mg with 2 tablets inside.

In reality, Independents have no idea what happens to the meds once they're boxed up and leave.

Notably, they even do C2s.
They issue a 222 and everything.
 
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sometimes they keep expired meds in scriptpro machine like in this picture. warfarin has been there since 2010.

I'm curious, what happens to these cvs stores when the board comes in for their annual check? They don't announce when they are coming.
 
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I'm curious, what happens to these cvs stores when the board comes in for their annual check? They don't announce when they are coming.

depends on who the board members are thats coming in to audit. i'm guessing here in this state they don't look thoroughly. its safe to say they are clueless. lets say there's a recall alert, how are u to know for sure what lot # is in there. u can only "guess" that the lot # from the cell is the same as what's on the shelf. but that's still guessing. technically, as in other states, you're suppose to update the cell label with new lot# and expiration each time you add in new bottles. that is best practice, and in case there's recall alerts you're right on with the lot#. but no one does that. at best they update the label every 2 months. which is fair enough. but 7 years? holy smoke.
 
depends on who the board members are thats coming in to audit. i'm guessing here in this state they don't look thoroughly. its safe to say they are clueless. lets say there's a recall alert, how are u to know for sure what lot # is in there. u can only "guess" that the lot # from the cell is the same as what's on the shelf. but that's still guessing. technically, as in other states, you're suppose to update the cell label with new lot# and expiration each time you add in new bottles. that is best practice, and in case there's recall alerts you're right on with the lot#. but no one does that. at best they update the label every 2 months. which is fair enough. but 7 years? holy smoke.

No one believes that picture. Also if many stores are doing this, at some point they would get caught by a different person doing an audit. I had a different person one year who was extremely picky. She looked at an entire aisle to make sure everything was good

So what are you waiting for?
 
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So what are you waiting for?

last year was a big waste of time b/c i end up not having concrete proofs. so it was tossed out. im now back to the drawing board. ^^
 
We use an automated machine at work and we do update the lot # and expiration every time we replenish the machine. It's not hard, the machine prompts us to enter in that info with every replenishment. The pharmacist checks it when they check the replenishment and if the tech messed up the pharmacist corrects it.

We never update the label on the canister though...why would we? It's totally pointless. The machine records the lot # and exp date much easier than reprinting stickers every time we replenish the machine. I am not aware of any law, regulation, or policy that requires that information be printed on a sticker since the machine is keeping all that information stored electronically.
 
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We use an automated machine at work and we do update the lot # and expiration every time we replenish the machine. It's not hard, the machine prompts us to enter in that info with every replenishment. The pharmacist checks it when they check the replenishment and if the tech messed up the pharmacist corrects it.

We never update the label on the canister though...why would we? It's totally pointless. The machine records the lot # and exp date much easier than reprinting stickers every time we replenish the machine. I am not aware of any law, regulation, or policy that requires that information be printed on a sticker since the machine is keeping all that information stored electronically.

Barcode technoreggae is amazing

^^^ that's auto corrected, but I'm gonna leave it that way.
 
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Gotta assume she meant mixing them with the cat litter and disposing of them afterwards, not actually using the pills themselves as cat litter. Same concept as mixing with coffee grounds.
:rofl:It's funny that you had to explain this.
 
1) this is very lengthy. i'll read it when the vial size is according to scriptpro. 13, 20, or 40.
2) my mistake. i wrote it in contrast to what i was thinking.
3) mislabeling is part of pharmacy laws. if u are noncompliant, you're just like the ppl who are "gross negligent."

Didn't realize you thought.;)

No one believes that picture. Also if many stores are doing this, at some point they would get caught by a different person doing an audit. I had a different person one year who was extremely picky. She looked at an entire aisle to make sure everything was good

So what are you waiting for?

And you're right. Actually even the vendor would yank the equipment in minutes if they saw it being used that way from a liability perspective (and almost all of them mandate at least annual checks as part of a service contract). You specifically have to falsify the control mechanisms when you load and prime the cartridge/cassette if it's from a model newer than 2003 (automated dispensers are medical devices and they don't get 510k approval from FDA if they lack that technology after the HIPAA passage). I don't recall with the ScriptPros that you have to relabel with the current lot and expiration date every time, but I do know you have to enter it somewhere for the cartridge/cassette to prime.
 
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