Thursday, February 19, 2009

Betty, Betty, Betty.....

Dear Betty,

Perhaps you'd like to explain to me why you don't take the initiative to figure out what's wrong when the physical count in a CII bottle does not match the quantity in our CII book.

You see, today we filled a Ritalin prescription for someone and upon back counting the bottle (standard procedure as you know), we realized that the quantity left in the bottle did not match that in our CII book. It was off by a whopping 60 tablets. The last one to fill a prescription for that particular strength of Ritalin was you. You back counted the bottle and wrote it down on the bottle. Then you went back and recorded the script in the CII book, but instead of using the actual inventory, you simply subtracted from the previous quantity listed and came off with an entirely different number.

I would think that any normal person would look at the number on the bottle and the number in the book and realize something wasn't quite right. Maybe a script hadn't been entered into the book. Maybe there was another open bottle in the safe that you didn't notice. There are any number of reasons why the two counts wouldn't match. However, you took no initiative at all to figure it out. You simply left it for the next lucky pharmacist to figure out.

Well, that next lucky pharmacist was me. Know what I figured out? You fucked up. There were 60 less tablets than listed of one strength of Ritalin and 60 more tablets than listed for another strength. Someone had given someone the wrong strength of Ritalin recently, and upon checking the book, I found out it was you.

Do you realize that the counts were off for both of those strengths, and you never bothered to question it? On both strengths you back counted the bottle and recorded the prescriptions in the CII book. You knew both counts were off and did nothing about it.

You see... This is why we back count the bottles. This is why we keep a running inventory in the CII book. It's not just company policy being rammed down our throats. We do it so that in the event we are ever off, we can figure out why and possibly catch a mistake before it leaves the pharmacy.

Now I realize you have a far smaller mental capacity than your average human being. However, I think even you could look at two numbers and realize if they match or not. It's not like one is written in roman numerals or something. Just plain old regular numbers both on the bottle and in the book. Who am I kidding though? Of course you realized the numbers were different. You were just too lazy to care. Well, an error occurred because of your laziness.

But you don't really give a shit about that either, do you?


Go fuck yourself,

Pharmacy Mike

12 comments:

Anonymous said...

Document all these things and take them to your DM. Evil prevails when good men do nothing...
For patient safety and improving the image of pharmacists everywhere, do your best to make sure Betty gets fired or sued.
Would you want Betty preparing prescriptions for your parents, grandparents, children and then counseling them?

new marvel said...

Just based on the past 3 entries, I'm starting to understand why you're "frustrated about almost every detail of [your] life."

At least your blog is interesting & well written. :)

Anonymous said...

uh oh. can she get fired for this?

Pharmacy Mike said...

We're working on getting rid of her. She has 2 documented strikes against her already. Three strikes and she's out? Hopefully???

Anonymous said...

Good to hear man, I hope it works out and you get a new, great pharmacist to join your team!

The Ole' Apothecary said...

Hey, Mike, if I were returning to retail, I'd be honored to have you as the guy re-showing me the ropes. You obviously care very much about the practice of pharmacy. I'm sorry you had to get stuck with this lady (of whom I've been reading for at least a year now!), and I hope you are able to justify her removal soon.

Sandra Dee said...

Wow, passive-aggressive much? Why not deal with the problem like a grown-up instead of being such a petulant baby?

Pharmacy Mike said...

We are dealing with the problem. Thank you for your concern.

pharmacy chick said...

The count back has saved many a bacon. its also the easiest way to keep track of inventory. How many times has the count back been wrong (and hence the count in the prescription bottle wrong) and the filler said "but I counted it twice!"..well then count it 3 times then !

Pharmacy Mike said...

In my first few months as a pharmacist, I got burned by not back counting and immediately logging the script in the CII book once. At the time, we generally filled all the CII's and then logged them at the end of the day when we had time. We were very busy, and we figured we didn't have the time to stop and record it every time we filled a CII.

One time, I dispensed Avinza 60mg to someone instead of Avinza 30mg. I caught the mistake several hours after dispensing it, and the patient had already picked it up.

It ended up being no big deal. I was able to contact the patient and correct the mistake with no harm done. However, from that day forward, I vowed that I will NEVER put off back counting and logging a CII script. I always do it immediately after I fill it, and I usually wait until it's logged until I put it in the bin to be picked up. I learned my lesson.

It's such an easy thing to do, and it saves a lot of mistakes. There's really no excuse not to.

Anonymous said...

When I first worked in a hospital, first thing in the morning we pharmacists would inventory each locked patient nurse-server (next to the patient room) on our unit to note how many doses of narcotic were used, and then refill to a certain par quantity based on the individual patient usage. It was so time-consuming (meanwhile orders were being requested, nurses were asking questions, patients were needing their pre-ops, etc.) that by the time we arrive back at the pharmacy vault for restocking, we'd nearly done a day's work in the first 45 min. One of the benefits of this on-the-spot inventory, to keep track of trends and possible diversions was NOT realized because of the endless confusion of counting, and distractions. The matter was solved quite efficiently by stocking several central nurse units, use of perpetual inventory for pharmacy vault.

CII count-back in retail/hospital/clinic settings is most helpful with reconciliation of whole pharmacy amounts at the time the drug is dispensed and potentially is 'going, going, gone'.

Anonymous said...

Counting the inventory is not just about patient safety, I have never had a controlled error yet (reaches for every peice of wood i can find) but it has helped me avoid being scammed by addicts. Isnt it funny how it is only ever the controls that have a few tablets missing from the bottles?

Got freaked out recently though, thought i had a sticky handed staff memeber as we were missing 2 strips of morphine tablets, luckily my keen eyed tech spoted them behind our safe as they had fallen down the back.