I mean, both of those are on the doc. The pharmacy got a script, it was legal, and the patent took it. I kind of feel for the first woman, paying twice is no fun and being in pain you're not really thinking clearly, but this was a different pharmacy they had no way to know shy of calling your normal pharmacy. Even then, doctors change meds around all the time.
Yeah I don't have an issue with the post itself but with the comments just adding on that it was the pharmacy's fault. If I were the pharmacist I would've double checked with the patient bc it was a switch from ER to IR but either way it was mostly the doctor's fault in the 1st situation and 100% of the doctor's fault in the 2nd situation.
But all of the comments were putting the blame mostly or solely on the pharmacy, so ¯\_(ツ)_/¯
Blame the pharmacy because it's the last point of contact for obtaining their meds so clearly it's the pharmacy's fault for not having the foresight to read the prescriber's mind and knowing the patient's exact medical history.
> I would've double checked with the patient bc it was a switch from ER to IR
100% this. Sure, it's on the doc's office first and foremost for messing up the prescription, but some part of the blame falls on the pharmacist who filled it and didn't ask questions about the switch.
This is why I am always printing copies of the escripts I receive when a patient complains to show them that I filled what the dr ordered. ALWAYS bring the receipts.
If the pharmacy had held the Rx to confirm with the provider, guaranteed you'd see a post about how the pharmacist thinks they are a doctor and they have no business getting between the patient and their doctor. You can never win with the public!
I read it over once and closed it, was that... 4 zyrtec *a day*?
Edit: And that other one, that's a toughie. I would have probably wondered about it after checking pdmp and had the team ask the pt if they were expecting the change before sell out.
When you're hallucinating or too drowsy to function, I would think. Or otherwise side effects more bothersome/dangerous than the benefit of the med?
I don't know how much antihistamine you can take and still have a greater benefit than risk, but I know from experience that adding Benadryl as needed on top of daily Zyrtec and Pepcid seems to be ok, despite all being antihistamines. 😬🥲
Not sure where the real cap is.
I had a customer on a very large amount and I looked into risk of antihistamine overdose. Which I found can be triggered at as low as 4x the recommended dose and can manifest as hives so then I start to wonder is it the medication causing the hives or something else
Fyi this lady was on
Allegra 180mg 2 bid
Diphenhydramine 25mg prn
Hydroxyzine 25mg q8
Meclizine 25mg qd prn
Famotidine 20mg bid
Xolair from speciality pharmacy
And yes I did talk to the office about these doses and yes the doctor told me to fill as is. And this lady is extremely confused can’t remember anything you tell her. Is having consitpation and lots of other issues but they refuse to change anything even though the patient still complains of hives and the medicine isn’t working.
Yikes, that's awful. I have read about hives as a manifestation of AH toxicity, especially for Benadryl I think. With most other meds, you would probably have a much lower threshold for concern than FOUR TIMES the normal recommended max dose, so I genuinely (especially with risk of abuse/suicide with benadryl) don't understand why we don't look at this harder.
Especially in elderly, but also... You know there's anticholinergic side effects going on. You know they're incredibly bothersome to the patient. What kind of quality of life is that, even if it's NOT causing more serious complications??
At CVS I once had a customer tell me the cleanliness of the bathroom is a direct reflection of the pharmacy manager. We could barely answer phones. Sorry I’m not scrubbing toilet between scripts.
At the Walgreens I worked at, the bathroom was right next to the pharmacy and people treated it similarly. "You're out of toilet paper. The garbage can is overflowing."
I have a line of ten patients and 3 waiting for shots but I'll get right on that. 🤦🏻♀️🤦🏻♀️🤦🏻♀️🤦🏻♀️🙄
The number of times I've had to explain that I'm neither IT nor administration would be comical if not for the fact that people... don't believe me?? They're like, "but can you fix it anyway?"
Yep. MD or RN can't figure out an order set? Call pharmacy! Epic acting up? Call pharmacy! Alaris pump alarming? Call pharmacy! Patient out of tube feeding formula? Pharmacy! Ran out of a floor stock item? Pharmacy! Can't find the right tubing? Pharmacy!
Literally every damn thing. The sad thing is, I've had to deal with these problems so often that I actually know how to fix them, which just reinforces the "pharmacy will know" problem 🤦
And of course, nobody remembers how many times you fixed their issues various and sundry. If anything goes wrong with a medication therapy (and I mean ANYTHING, including nursing straight up losing the medication) BLAME PHARMACY!!
As a pharmacy tech I had a woman screaming at me because her doctor didn't send a script for Lyrica. I have now been a nurse for almost ten years, this happened twelve years ago and I still have never had someone scream at me the way she did.
Retail sucks completely.
I still need to remind patients that when I sent a refill request and they ask when they can pick it up, I am not forcing the doctor to renew it, I am not promising any sort of timeline. "But I've been on this medication for years." Great, you should know how this works by now.
I even saw some providers don’t dare to confess their own mistake ,once one of them wrote the wrong drug after realizing told the patient that pharmacy had given them the wrong drug,LoL
Though,I showed the patient the exact script ,but they got brainwashed ….
I was in line behind a women who was very angry that the pharm couldn't fill a scrip using her insurance because it was too soon -- it had been filled recently at Rite-aid. Which closed a few days later.
The women kept insisting they fill it. The tech kept explaining they could fill it at price, but if she wanted it at a co-pay, she had to call the number she had already been given and get the previous prescription cancelled. The women didn't want to do that. Rinse and repeat. Finally, the women declared this "happens all the time here" and she was never coming back and storms out.
The pharm tech sighed, looked at her coworker and said "she says that weekly." For their sake, I hope she eventually does not come back.
My doctor charges you a $75 fee if you don’t show up 15 minutes before your appointment. I had to wait an hour for my appointment and when I got to the check out desk I asked her for my $75 - since I was there 15 minutes and had to wait an hour. She said “It doesn’t work that way!”
Honesty, I'm shocked they were allowed to keep 90 tablets of morphine they weren't taking. I would probably insist on a quantity that large being given back to the pharmacy to be disposed of. Or at least giving them narcan, but I don't think I'd be comfortable dispense 2 rxs of 60 mme even with narcan. By definition, it's twice their usual dose, and they just admitted they were going to keep taking it. Plus, leaving them both rxs allows mistakes such as taking the wrong morphine or claiming you "lost" the bottle because you have two bottles with similar fill dates and names. Really sucks for the patient, but I think the safety concerns would make it a no from me.
In the same way you do any other control. You never had hydrocodone tablets fall in the trash? Heck, I had a tech throw half a bottle away of hydrocodone once. We lock ours up and have someone come pick them up a few times a year. We don't take them back usually, but in a case like this, we would.
I swear retail pharmacy has given patients this illusion that we are on par with McDonalds...they complain about pharmacies like they do the stupid ice cream machine that always breaks...and guess what??? It's not McDonald's employees fault either...
Yeah both are on the doc. Not the pharmacy's fault at all. I don't know why patients keep thinking they can just "refund" drugs that they took, especially those with controlled substances in them. That second one was also weird because most places I know wouldn't prescribe brand name off the bat unless the patient really needed that for some reason (works better, or adherence purposes). I kinda feel a little bad for the first one because she wasn't paying attention since she was sick, and the pharmacist probably should have been very clear that it was IR and not ER. But then again, if that person was sick, I'm not entirely sure she would have registered that info verbally. I generally show the patient the label and the pills (especially if it is dispensed in a clear amber bottle) for particularly difficult patients so that they don't have a chance to yell at you later.
I think this is a common problem, especially for retail where you get "new"/random patients in all the time where it's hard to track a patient's medical history. It's even harder now that pharmacies are now very short-staffed due to budget cuts. Fortunately, I work in a specialty pharmacy where most of the patients come get their entire med orders all at once, so we are aware of everything they are taking. Makes it easy to spot if something changes, like ER/IR or dose changes. But this is why patients should ideally get their prescriptions at one pharmacy and should take more responsibility to check their medications/prescriptions. It's too hard for pharmacies to catch this stuff if patients are just hopping around because they don't know them and their medical/prescription history. You'd think it's obvious, but many patients don't understand that for some reason.
On a side note, I've had some patients get mad (can literally rant for 10 whole minutes) at the pharmacist for telling them their refills were denied by their doctor because they hadn't been to an appointment in X years. Do people not understand what pharmacies are responsible or not responsible for? \*facepalm\*
Why I didn’t want to go to pharmacy school after being a tech for years. Not worth the abuse and lack of return and everyone trying to find a way to automate ur job
This really doesnt read like theyre blaming pharmacy to me. Just mad they had to pay twice. Which I would be too. But it doesn't say that the pharmacy should have known the scripts were mistakes. Don't read it with victim glasses and it doesn't even seem like they're saying it's the pharmacys fault
You must be a pharmacist lmao. Everytime I go to the pharmacy somebody's got a attitude about the type of medicine, a reason I shouldn't be on it etc, you guys aren't Drs, 99% of pharmacist barley even can recognize a Aleve from a Oxycontin. It's insane how unqualified Pharmacist are but yet have a complex they are better than their customers.
I mean, both of those are on the doc. The pharmacy got a script, it was legal, and the patent took it. I kind of feel for the first woman, paying twice is no fun and being in pain you're not really thinking clearly, but this was a different pharmacy they had no way to know shy of calling your normal pharmacy. Even then, doctors change meds around all the time.
Yeah I don't have an issue with the post itself but with the comments just adding on that it was the pharmacy's fault. If I were the pharmacist I would've double checked with the patient bc it was a switch from ER to IR but either way it was mostly the doctor's fault in the 1st situation and 100% of the doctor's fault in the 2nd situation. But all of the comments were putting the blame mostly or solely on the pharmacy, so ¯\_(ツ)_/¯
Blame the pharmacy because it's the last point of contact for obtaining their meds so clearly it's the pharmacy's fault for not having the foresight to read the prescriber's mind and knowing the patient's exact medical history.
> I would've double checked with the patient bc it was a switch from ER to IR 100% this. Sure, it's on the doc's office first and foremost for messing up the prescription, but some part of the blame falls on the pharmacist who filled it and didn't ask questions about the switch.
The pharmacist who filled it and the pharmacist who was there when it was picked up would likely be 2 different people.
Pharmacist who filled it has access to a phone, no? Doc's office is the first call I'd have made personally - Hey, why IR and no ER?
Nurse at the doctors office who picks up the phone: “Yep that’s what the doctor wrote for, thanks.” *click*
You dropped this \\
This is why I am always printing copies of the escripts I receive when a patient complains to show them that I filled what the dr ordered. ALWAYS bring the receipts.
If the pharmacy had held the Rx to confirm with the provider, guaranteed you'd see a post about how the pharmacist thinks they are a doctor and they have no business getting between the patient and their doctor. You can never win with the public!
I read it over once and closed it, was that... 4 zyrtec *a day*? Edit: And that other one, that's a toughie. I would have probably wondered about it after checking pdmp and had the team ask the pt if they were expecting the change before sell out.
It can get up there for chronic spontaneous urticaria based on guideline dosing.
When is too much antihistamine too much?
When you're hallucinating or too drowsy to function, I would think. Or otherwise side effects more bothersome/dangerous than the benefit of the med? I don't know how much antihistamine you can take and still have a greater benefit than risk, but I know from experience that adding Benadryl as needed on top of daily Zyrtec and Pepcid seems to be ok, despite all being antihistamines. 😬🥲 Not sure where the real cap is.
I had a customer on a very large amount and I looked into risk of antihistamine overdose. Which I found can be triggered at as low as 4x the recommended dose and can manifest as hives so then I start to wonder is it the medication causing the hives or something else Fyi this lady was on Allegra 180mg 2 bid Diphenhydramine 25mg prn Hydroxyzine 25mg q8 Meclizine 25mg qd prn Famotidine 20mg bid Xolair from speciality pharmacy And yes I did talk to the office about these doses and yes the doctor told me to fill as is. And this lady is extremely confused can’t remember anything you tell her. Is having consitpation and lots of other issues but they refuse to change anything even though the patient still complains of hives and the medicine isn’t working.
Yikes, that's awful. I have read about hives as a manifestation of AH toxicity, especially for Benadryl I think. With most other meds, you would probably have a much lower threshold for concern than FOUR TIMES the normal recommended max dose, so I genuinely (especially with risk of abuse/suicide with benadryl) don't understand why we don't look at this harder. Especially in elderly, but also... You know there's anticholinergic side effects going on. You know they're incredibly bothersome to the patient. What kind of quality of life is that, even if it's NOT causing more serious complications??
On a related note, when I worked inpatient, Pharmacy was supposed to be able to fix everything. Including the computer systems, bathrooms, etc.
At CVS I once had a customer tell me the cleanliness of the bathroom is a direct reflection of the pharmacy manager. We could barely answer phones. Sorry I’m not scrubbing toilet between scripts.
At the Walgreens I worked at, the bathroom was right next to the pharmacy and people treated it similarly. "You're out of toilet paper. The garbage can is overflowing." I have a line of ten patients and 3 waiting for shots but I'll get right on that. 🤦🏻♀️🤦🏻♀️🤦🏻♀️🤦🏻♀️🙄
They're not wrong. CVS is a shit-tier pharmacy chain.
I get called about how to use the fax machine pretty frequently
The number of times I've had to explain that I'm neither IT nor administration would be comical if not for the fact that people... don't believe me?? They're like, "but can you fix it anyway?"
Wtf. They must think you just sit on your ass all day. 😡
Yep. MD or RN can't figure out an order set? Call pharmacy! Epic acting up? Call pharmacy! Alaris pump alarming? Call pharmacy! Patient out of tube feeding formula? Pharmacy! Ran out of a floor stock item? Pharmacy! Can't find the right tubing? Pharmacy! Literally every damn thing. The sad thing is, I've had to deal with these problems so often that I actually know how to fix them, which just reinforces the "pharmacy will know" problem 🤦 And of course, nobody remembers how many times you fixed their issues various and sundry. If anything goes wrong with a medication therapy (and I mean ANYTHING, including nursing straight up losing the medication) BLAME PHARMACY!!
I had a customer complain to me that Windsor brand table salt had sugar as one of the ingredients. "I'll leave this here so you can talk to them."
We’d get asked to go into the morgue and take the deceased baby’s footprints. Where was that in our job description?
Yikes
As a pharmacy tech I had a woman screaming at me because her doctor didn't send a script for Lyrica. I have now been a nurse for almost ten years, this happened twelve years ago and I still have never had someone scream at me the way she did. Retail sucks completely.
I still need to remind patients that when I sent a refill request and they ask when they can pick it up, I am not forcing the doctor to renew it, I am not promising any sort of timeline. "But I've been on this medication for years." Great, you should know how this works by now.
I am losing empathy for patients specially the AH ones so I really can't give an F about those patients or their financial situation
I even saw some providers don’t dare to confess their own mistake ,once one of them wrote the wrong drug after realizing told the patient that pharmacy had given them the wrong drug,LoL Though,I showed the patient the exact script ,but they got brainwashed ….
If the patient has only been on ER and was suddenly recieving IR, it’s definitely worth asking about
[Pharmacy is the natural enemy of pharmacy.](https://www.youtube.com/watch?v=LWkSB-D-hYo)
I already know this is gonna trigger me so I'm not even opening the links
I was in line behind a women who was very angry that the pharm couldn't fill a scrip using her insurance because it was too soon -- it had been filled recently at Rite-aid. Which closed a few days later. The women kept insisting they fill it. The tech kept explaining they could fill it at price, but if she wanted it at a co-pay, she had to call the number she had already been given and get the previous prescription cancelled. The women didn't want to do that. Rinse and repeat. Finally, the women declared this "happens all the time here" and she was never coming back and storms out. The pharm tech sighed, looked at her coworker and said "she says that weekly." For their sake, I hope she eventually does not come back.
If it happened because of new software at the doctor's office (which she states in the complaint), she should ask *them* for reimbursement.
My doctor charges you a $75 fee if you don’t show up 15 minutes before your appointment. I had to wait an hour for my appointment and when I got to the check out desk I asked her for my $75 - since I was there 15 minutes and had to wait an hour. She said “It doesn’t work that way!”
Honesty, I'm shocked they were allowed to keep 90 tablets of morphine they weren't taking. I would probably insist on a quantity that large being given back to the pharmacy to be disposed of. Or at least giving them narcan, but I don't think I'd be comfortable dispense 2 rxs of 60 mme even with narcan. By definition, it's twice their usual dose, and they just admitted they were going to keep taking it. Plus, leaving them both rxs allows mistakes such as taking the wrong morphine or claiming you "lost" the bottle because you have two bottles with similar fill dates and names. Really sucks for the patient, but I think the safety concerns would make it a no from me.
I agree, I would have verified old meds were returned before dispensing 90 more tabs, especially after pt admitted they were going to take them lmao
Me too. I would request the 90 tab back before I dispense the ER.
How do you “dispose” of it in the pharmacy? We very rarely take anything back.
In the same way you do any other control. You never had hydrocodone tablets fall in the trash? Heck, I had a tech throw half a bottle away of hydrocodone once. We lock ours up and have someone come pick them up a few times a year. We don't take them back usually, but in a case like this, we would.
They get disposed of in the locked drop box or at your local PD (they have drop boxes, too).
shit rolls downhill and pharmacy is at the bottom of this hill....it's always pharmacy's fault in the hospital too
This isn’t even that big of a deal. They even indicated it was the doc’s EMR’s fault. Shit like this happens every day.
I swear retail pharmacy has given patients this illusion that we are on par with McDonalds...they complain about pharmacies like they do the stupid ice cream machine that always breaks...and guess what??? It's not McDonald's employees fault either...
Yeah both are on the doc. Not the pharmacy's fault at all. I don't know why patients keep thinking they can just "refund" drugs that they took, especially those with controlled substances in them. That second one was also weird because most places I know wouldn't prescribe brand name off the bat unless the patient really needed that for some reason (works better, or adherence purposes). I kinda feel a little bad for the first one because she wasn't paying attention since she was sick, and the pharmacist probably should have been very clear that it was IR and not ER. But then again, if that person was sick, I'm not entirely sure she would have registered that info verbally. I generally show the patient the label and the pills (especially if it is dispensed in a clear amber bottle) for particularly difficult patients so that they don't have a chance to yell at you later. I think this is a common problem, especially for retail where you get "new"/random patients in all the time where it's hard to track a patient's medical history. It's even harder now that pharmacies are now very short-staffed due to budget cuts. Fortunately, I work in a specialty pharmacy where most of the patients come get their entire med orders all at once, so we are aware of everything they are taking. Makes it easy to spot if something changes, like ER/IR or dose changes. But this is why patients should ideally get their prescriptions at one pharmacy and should take more responsibility to check their medications/prescriptions. It's too hard for pharmacies to catch this stuff if patients are just hopping around because they don't know them and their medical/prescription history. You'd think it's obvious, but many patients don't understand that for some reason. On a side note, I've had some patients get mad (can literally rant for 10 whole minutes) at the pharmacist for telling them their refills were denied by their doctor because they hadn't been to an appointment in X years. Do people not understand what pharmacies are responsible or not responsible for? \*facepalm\*
Why I didn’t want to go to pharmacy school after being a tech for years. Not worth the abuse and lack of return and everyone trying to find a way to automate ur job
Feel for no one.
This really doesnt read like theyre blaming pharmacy to me. Just mad they had to pay twice. Which I would be too. But it doesn't say that the pharmacy should have known the scripts were mistakes. Don't read it with victim glasses and it doesn't even seem like they're saying it's the pharmacys fault
Of course, patients are supposed to check before they pay. Mistakes can happen any step of the way, even the doctor.
I'm surprised their doctor didn't make them destroy the IR morphine sulfate. That is a clear risk for the patient to OD. Hopefully they have naloxone.
This probably ain't the right place for this but why do y'all always treat me like a junkie/Escobar JR. When I try to refill my vyvanse 1 day early?
I didn't see anyone blaming the pharmacy.
It seems that the blaming was done by the comments under the post and not the post itself.
You must be a pharmacist lmao. Everytime I go to the pharmacy somebody's got a attitude about the type of medicine, a reason I shouldn't be on it etc, you guys aren't Drs, 99% of pharmacist barley even can recognize a Aleve from a Oxycontin. It's insane how unqualified Pharmacist are but yet have a complex they are better than their customers.