Monday, August 26, 2013

Why it takes TIME to get your Rx Filled

We're completely aware of your situation. You went to the doctor. Your appointment was at 9 am. You were there at 8:50 am. You waited until 9:15 before they called your name, weighed you, took your temperature and blood pressure, then sat you in an examination room to wait another 20 minutes before being seen by the practitioner. 

We go to doctors too. We know the procedure. We don't like it any more than you do.

By the time you've left the doctor's office with prescriptions in hand, you've had enough. All you want to do is go home, curl up in your Snuggie and watch The Walking Dead. BUT you have to stop by the pharmacy first. And by the time you get to the DROP OFF window (or in some cases, the PICK UP window because the logic of the two terms escapes you entirely) you're sick of the world. We can see it on your face. You want your prescription filled IMMEDIATELY and you expect us to slap a label on something and hand it back to you over the counter.

Unfortunately, it just doesn't work that way. No matter how long you had to wait at the doctor's office, you're going to have to wait a little longer. I'm sorry, but YOUR health is too important to us at the pharmacy to risk hurrying just because you want to go home.

When you drop off a prescription, this is what happens:

1. We verify who you are with what is in our database. If you're new to our pharmacy, we have to put in all your information. We need to add you into the system, build a computer profile, add any allergies to medications, and add your insurance information.

2. We type in your prescription, translating what the doctor has written using Latin abbreviations into English. We need to make sure we're putting in the right medication, strength, dosage, and instructions. You might think this is simple, but this is by far where most mistakes occur. 

Doctors and prescribers, for some reason, think anyone can read their scribble. We're good at it, but not perfect. There are just going to be times where we have to call the prescriber to clarify what was written, and this takes time. If the prescriber had just taken 30 seconds longer to make sure what they wrote was easy to read it would save 10-20 minutes at the pharmacy.

Consider for example the following, taken from an actual prescription:

Yeah, I know... almost completely unreadable. This doctor CONTINUALLY writes like this and no matter how many times we've called the office, they act like we're NUTS for not being able to decipher his crazy writing.

You would think that the medical review board or someone, somewhere would be all over this kind of crap to stop it, but no, they aren't. Pharmacists get hit with this nonsense every single day. If we can't read it, we have to call the doctor's office, and that takes time. MOST of the time we have to wait until someone calls us back, and that makes YOU, the patient, WAIT.
(By the way, the above Rx translates to: Percocet 10/325mg, Take one tablet by mouth every three hours as needed)

Other times we can read the prescription but it doesn't make sense. Here's another example:

This is a prescription for Ambien, 5mg, Take one tablet by mouth as needed every twelve hours. BUT YOU DON'T TAKE AMBIEN THAT WAY. I have no idea what the doctor was thinking, but if the patient actually took it the way it was prescribed it could be dangerous and/or deadly. You'd be surprised how often we get prescriptions with simple stupid mistakes like this... unfortunately most pharmacists do not have the capacity to "fix" the situation without calling the doctor... and that takes time.

3. So we FINALLY know what it is the doctor wants you to take. Now we run a check on the computer. MOST of the time, we get what's called a DUR (drug utilization review). This is where the computer stops the process and the pharmacist comes over to check everything out. The computer may have detected a drug interaction with something else you're taking, or it could just be something easily fixed like a days supply issue. The point is that IT TAKES TIME TO FIX THIS AND GO ON.

Now we can send off the information electronically to your insurance company. We're billing them in your behalf. Most of the time this is a smooth operation and we get a paid claim telling us how much to charge you for the co-pay. Like I said, MOST of the TIME it is a smooth operation... but sometimes it isn't. There's a whole business of ferrets why it doesn't work... sometimes your insurance info has changed, or the insurance wants a "Prior Authorization" or they just don't want to pay for it, period. So at that point we have to communicate with you about the issue. This takes time.

4. Depending on the outcome of number 3 above, the next step is to fill your prescription. Unfortunately for you, you're not our only customer. We're doing the same thing with other clients who have dropped of their prescription before you, and your prescription will go into a queue until we can get to it. 

Most of the time this isn't long (because we work fast) but it still takes time. Remember, other people are dropping off prescriptions too. And the phone... that damn thing, it never stops ringing. People call all the time and ask to talk to the pharmacist just to have the pharmacist put in their Rx number into the computer and process it. The technicians can handle this. The automated system can handle it -- in fact, that's the first thing it asks you when you call. But these people need the extra special attention of the pharmacist. This takes time!

5. Finally, we have a chance to start working on your prescription. We need to pull the correct drug and match the NDC (national drug code) with the label we've printed. We count, pour, lick and stick the label. Then it goes on to the pharmacist.

6. The pharmacist checks to make sure everything is correct, clarified, appropriate, and above all safe for the patient. We once again match the written prescription with what has been printed and filled. We check drug interactions AGAIN. We check to make sure you're getting what was prescribed AGAIN, and make sure it is appropriate for you and your condition. By the time the pharmacist puts his/her initials on the filled prescription, it has been checked and double-checked and re-checked and checked one more time just to make sure. THIS ALL TAKES TIME. We're the LAST link in the chain of safety and we know that. BEFORE the medication leaves the pharmacist we HAVE to make sure it is correct. And that takes time.


Anonymous said...

Your problem is that your pharmacy looks like a shop. It should look like an office.


Anonymous said...

Your problem is that the general public does not care about reality.

Anonymous said...

My hat's off to pharmacists, technicians and clerks! Every work day you strive to do the right thing in the face of people that consider you the equivalent of the high school kid from whom they ordered a Big Mac that day at McDonalds (might be why they're waiting for their Lipitor prescription). Your blog is hilarious to anyone that's ever worked in a pharmacy, and everyone knows that laughter is the best medicine for workplace frustration. Hang in there, and keep doing the right thing, CrazyRxMan!

guitarrgirl said...

Last year I was sick and between the doctor and the pharmacy it took three times before I wasn't handed a medicine a wasn't allergic to! This is after all that checking. Last month it took my pharmacist (same company for 20 years, same location/pharmacist for 3 years) and it took four tries before they got my med count right (shorted me again). Last week it took my daughter 4 tries for them to get it right. Incompetence is rampant in this business.

Anonymous said...

This doctor who prescribed the Percocet is careless, he forgot to write the quantity in letters !!!!!