I'm filling prescriptions. Part of this process is scanning the label and then scanning the drug bottle. This causes the scanner equipment to beep with delight if you have the right NDC.
The scanner wants to make sure you're doing it right, so it gives out a loud enough beep so you can hear it. That seems reasonable for a pharmacy.
But not for a guy walking by the other day. He's on his cell phone have a very loud and very personal phone conversation in the middle of the grocery.
He was also very annoyed that my scanner is beeping and apparently interfering with his phone conversation. He let me know he was annoyed by shooting me dirty looks every time the scanner beeped.
I can't believe how rude I was being.
A guy wants to use his HSA (Health Savings Account) card to pay for his medication. For those who don't know, this is a Visa card set up by one's employer with funds to pay for prescriptions and medications.
I scan in his prescriptions and tell him the amount. I tell him to press the <CREDIT> button on the point of sale machine. Instead he ignores me and presses the <DEBIT> button. This causes the point of sale machine to ask for the PIN to complete the transaction.
"I don't have a PIN," he says.
I reply... "Press <CANCEL> then press the <CREDIT> button."
"I don't want to cancel the transaction," he replies.
"This is how we get the machine to accept your card," I say.
"I don't want to be charged twice," he says.
"You won't be. Press <CANCEL> then press the <CREDIT> button to pay."
"But it's not a credit card," he argues.
"This is the only way to get the transaction to work unless you have a PIN for this card."
"I don't have a PIN," he says.
We covered that part already, I'm thinking.
So I give up and decide to just wait. He looks at me, then back again at the point of sale machine. A good fifteen seconds passes then he decides to throw the dice. He presses <CANCEL> then <CREDIT>...
Approved! A receipt prints. Another satisfied customer!
Saying goodbye to the problem patient that transfers all his/her scripts to another pharmacy...
Lady: "I want to fill a prescription."
Me: "Ok, what is your birth date?"
Lady: "August 25, 1971."
Me: "Ok, I have no one with that birth date on my computer. I'll have to add you in..."
Lady: "Oh, it's not for me. It's for my husband..."
You have absolutely NO IDEA how often this happens.
We have an Urgent Care in the same building at Goofmart Grocery. We know their scripts because they are always printed on the same green paper. We also know who the prescriber is based on whether there are two scripts on the paper or three.
If there are two, it is Prescriber 1. Prescriber 1 gives everyone Augment 875 quantity 20 BID plus Prednisone 20mg quantity 5, 1 QAM.
If it has three scripts, it is Prescriber 2. Prescriber 2 gives everyone Amoxicillin 500mg quantity 30 TID, Flonase, and Phenergan with Codeine syrup.
It's amazing how in this neighborhood, everyone that goes to the Urgent Care all have the same condition when they see Prescriber 1, whereas the others that see Prescriber 2 on a different day all have a different condition requiring the other set of exact medications. What an amazing coincidence... or perhaps a little scary? Is it Urgent Care, Urgent Careless, or Urgent Scare?
Recently CBS Boston published an article entitled, I-Team: Report Suggests Trend In Prescription Drug Errors Filled By Pharmacists. Here's the original LINK.
My thoughts are in BLUE.
BOSTON (CBS) — Anyone who has waited in a drug store for a prescription knows a pharmacy counter can be a busy place.
“It’s a high-pace, high-stress environment,” a former CVS pharmacy technician told the I-Team.
She did not want to be identified, but she believes that stress leads to mistakes.
“Somebody gets the wrong strength of medication, somebody gets the wrong number of pills,” she said.
I will tell you that yes, this does happen. What people don't know is that most errors are caught BEFORE they leave the pharmacy. All Boards of Pharmacy want a 0% error rate, and pharmacies are, for the most part, very close to 0%.
The I-Team obtained documents detailing prescription drug errors reported to the State Department of Public Health. Since 2010, pharmacies reported 194 serious drug errors. In one case, an allergy drug was given to a patient instead of a high blood pressure medication. In another case, a patient got something for acid reflux instead of an anti-depressant, and an arthritis drug was given to someone who needed a medicine for seizures.
Like I said, all pharmacists and technicians want a ZERO error rate. When you look at how many prescriptions were filled during this time period, 194... most likely out of millions, results in a statistical zero.
But that doesn't make any pharmacist feel better.
And there is overwhelming pressure from The Authorities to continue to do more and more with less, and it does cause stress and errors:
The pharmacy technician believes a growing trend in pharmacies is behind all that stress and the errors. It is called performance metrics, a system used to measure how many prescriptions a pharmacist fills and how fast. It also counts flu shots and phone calls pharmacists make to patients urging them to fill prescriptions. If the pharmacist falls behind, she says, they’ll hear about it. “You didn’t make all of your 50 phone calls. I want you to write an action plan to tell me how tomorrow you are going to get all of your prescriptions filled, get your phone calls made plus give out x number of flu shots,” she said describing what pharmacists she worked with were told.
CVS would not talk to us on camera, and would not allow our cameras inside their stores, but they did invite the I-Team inside a store to see how the system works. Company representatives told us if metrics contributed to mistakes they would change the system.
HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA
Translation: They'll fire the pharmacist or technician that can't keep up with the metrics and find someone else who can... for awhile.
In a written statement the company said: “The health and safety of our customers is our number one priority and we have comprehensive policies and procedures in place to ensure prescription safety.”
This is really a bunch of crap. Policies and procedures are nothing more than the company protecting itself. When something goes horribly, horribly wrong... the company can say "We're not at fault. It's the pharmacist or tech that didn't follow procedure."
It's IGNORING the real culprit. If the ONE thing that leads to less stress and less errors is MORE help, why isn't the ONE thing to hire MORE help? 'Splain it me, Lucy.
In spite of those assurances, pharmacists are starting to speak out against metrics. Susan Holden is the president of the Massachusetts Association of Pharmacists. She worked under a metrics system at a different drug store chain. “It was very nerve-wracking, very stressful, sometimes tearful,” she recalled. Holden now works as a hospital pharmacist and she says metrics puts too much stress on pharmacists. “Ultimately, I was afraid of harming a patient,” she said.
This is something EVERY pharmacist thinks about every day.
A survey of nearly 700 pharmacists conducted by the institute for safe medication practices found that more than 83 percent believed performance metrics contributed to dispensing errors.
Susan Holden believes if something doesn’t change, the problem could get worse. “The worst case scenario, it could be a very dangerous prescription error. I think anybody could draw a conclusion about what could happen,” she said.
The National Association of Boards of Pharmacy is urging states to restrict the use of metrics that are proven to compromise safety. The Massachusetts Board of Pharmacy has taken no action.
Sounds exactly like my state's Board of Pharmacy.
