Do you need a Pharmacy Technician???

Re: Do you need a Pharmacy Technician???

Tracy Windler RVN — Fri, 13 Nov 2009 04:39:09 GMT

I've worked in quite a few different practices and have only just come across a practice that checks their prescriptions! I know of vets and nurses who have made silly, but major mistakes, including myself-I dispensed, to a Papillon, a 100ml bottle of metacam,meant for a retriever! (I'll never work when taking piriton again) luckily I noticed when I couldn't find the next patient's metacam! But it does scare the hell out of you. I've heard of cats being given 50mg Norocarp (carprofen) instead of Noroclav -potentially deadly. And our opthalmologist was referred a case where a cat had been given the wrong dose of baytril and went blind-the owner's sued the practice.

I do think its unacceptable to have untrained receptionists and inexperienced student nurses dispensing medications, as I think this is where most of the mistakes are made or missed merely due to lack of knowledge, but checks really don't take a lot of man-hours, do they, as already mentioned, we should enforce the 24 hr rule and make sure we have time.

But to say that animals are less important than humans because these things are not done is ridiculous, you could say that about any aspect of Animal care. You can't compare them!

Re: Do you need a Pharmacy Technician???

Vicky RVN — Thu, 12 Nov 2009 23:33:33 GMT

For meds that are dispensed during a consult the vet will get them themselves. For repeat prescriptions we ask for 24 hours notice so that vet can prescribe drug and print label, qualified/student nurse will dispense the drug, then a second qualified/student nurse will check the dispensing. Initials are put on the label of the nurses and a note made on the computer as to who dispensed/checked the drugs.

My mum was on HRT tablets, she got her prescription from the chemist. She had thought the box looked different, but thought it was just new packaging/different manufacturer. She took the tablets...and started bleeding, like she was having a period, with stomach cramps and all! She then checked the tablets against her prescription, and they had a slightly different name! She told the doctors surgery and they said they'd had problems with that chemist before...funnily enough she doesn't use that one anymore It's disgusting that there is obviously something going on at the chemist, sounds like an incompetent member of staff, for my mum it didn't do any harm, but for someone else it could...

Re: Do you need a Pharmacy Technician???

Emma Clark — Wed, 11 Nov 2009 13:44:39 GMT

Our policy is that a vet checks history and puts up the prescription if the animal is allowed it, the label then gets put into a box which the nurses then deal with. We count/collect the drugs, put the label on, recheck the history to make sure the vet hasn;t missed anything/got the dosages wrong, intial the label then put them for the client to collect. Works for us, haven't had any major issues as the double check by the nurse tends to pick up any problems (which are mainly the vets charging 1 tablet instead of 1 box lol)

Re: Do you need a Pharmacy Technician???

Snowb — Wed, 11 Nov 2009 00:41:08 GMT

the place i trained at and occasionally still locum with have a checking procedure, vet puts up drugs, and if a SVN dispenses then the qualified on pharmacy double ch and initials are placed on the computer system so a errors can be traced back.

And when I was training I thought this was standard in all practices, since locuming I have come to realize that this is not always possible especially where there is a lack of staff however I do have a problem when receptionists (very new students) are allowed to dispense drugs as I feel this is not (yet) in their job description or training, we spend years learning drugs, what they do etc and so can easily spot a calculation error the vets have made not just if they have been given the wrong amount of tablets to complete the course. However when locuming you can not change how a practice is run but you can if you are their long term and it is always good to maybe put a SOP in place. I still double ch myself everytime I dispense as mistakes can happen. And as nick said clients should be made to wait 24hrs for repeat prescriptions so they can be checked with the vet.

Re: Do you need a Pharmacy Technician???

Sal the 1st — Tue, 10 Nov 2009 23:30:29 GMT

I think it is a good idea to have a 2nd person checking dispensed meds - but in practice I have only come across it in two places I have worked. As the majority of practices out there have problems recognising a qualified nurse I doubt they would spend too much on a pharmacy tech somehow - but is a good idea

Re: Do you need a Pharmacy Technician???

Kim Buckley — Tue, 10 Nov 2009 21:40:21 GMT

I think in an ideal situation then yes dispensed drugs should be checked but for most practices that just isn't possible. I know that when we are really busy there just isn't the staff and it's not like the vet can check it after the nurse has put the medication out because it is often sent from one of our branches. I know I am really careful at dispensing and have picked up mistakes from the vets on quite a few occasions.

Re: Do you need a Pharmacy Technician???

StephSVN — Tue, 10 Nov 2009 21:35:35 GMT

In the practice where I work it is whoever is working on reception that dispenses drugs, this is normally receptionists, sometimes ANA, SVN or occasionally QVN. Never any checks made. My mums dog had to go on steroids for very itchy skin, should have been 5mg but was given 25mg - I wasn't involved with giving the medication so never occured to me to check the tablets - dog had bad reaction, incredibly lethargic and got clear discharge from both nostrils - reduced tablets quicker than originally planned and was fine. Got more tablets at a check up which was when mistake was realised as the new tablets were very different to old ones so mum phoned me (I was back in uni by that stage). Next time I went back I told the head nurse and practice manager and suggested checks were put in place, but nothing has changed.

I have also heard of a rabbit being given fuciderm instead of fucithalmic - poor bunny lost its eye. Can't remember if this mistake was due to the prescribing vet or person that dispensed it though...

Re: Do you need a Pharmacy Technician???

Katy — Tue, 10 Nov 2009 21:05:04 GMT

Having heard of the things that can go wrong in human pharmacy, even with the checks in place, it definately makes me more aware when I am dispensing drugs.

Vets make mistakes too, and I think that someone's prescribing and dispensing should be checked.

I have to admit I was pretty mad when I found out my kitten had been given the wrong dose of wormer. So what if she was just ataxic? Scared the cr@p out of me.

I'll admit I make dispensing errors occasionally, but at least I know I have someone more qualified than me there to check what i'm doing.

Re: Do you need a Pharmacy Technician???

Kim Buckley — Tue, 10 Nov 2009 21:00:37 GMT

We don't have a second person check our dispensing but then it's only QVN who are put on the dispensing role. Everyone makes mistakes and I think once you've done it once it soon teaches you to be a lot more careful! I've never seen any serious problems where the wrong medication has been given as it's either been picked up or obviously not affected the animal.

Re: Do you need a Pharmacy Technician???

Nick Shackleton — Tue, 10 Nov 2009 19:19:00 GMT

I agree with you on this one Katy

Back when I was in general practice we used to have a nurse on consult/dispensary every day.

He/she would be there to help the vets with their consults as well as work thru the list of repeat prescriptions that reception handed thru to us. A vet would check whether the patient could have a repeat or not, or if the needed a check before the next one and so on. the vet would also check the dosage etc....

The nurse would then dispense the prescription. A vet would then double check that the correct drugs and dosage had been dispensed and initial. We used to ask clients to give us 48hrs notice to arrange prescriptions

This nurse would also dispense any medications prescribed by the consulting vets.

One of the practices better ideas!

At most other practices its normally receptionists who do the dispensing etc....

Where I am now it's us nurses who do the dispensing or the vets, but no drugs are double checked prior to the clients being handed to the medications.

Re: Do you need a Pharmacy Technician???

Caro Laithwaite VN — Tue, 10 Nov 2009 19:01:48 GMT

Have to say l have never been in a practice that had checks l did work in one where we filled in paperwork = exp date, client name patient name drugs dose/amt but not all thats been discussed hence my answer earlier.

Re: Do you need a Pharmacy Technician???

Maisy — Tue, 10 Nov 2009 18:46:18 GMT

With the exception of one practice, there has always been procedures put in place to check medication that is being dispensed and all drugs are signed off by 2 members of staff.

Re: Do you need a Pharmacy Technician???

hissycat — Tue, 10 Nov 2009 18:42:27 GMT

The practice where I work has recently made it policy that only nurses count and hand out meds.. however not necessarily an RVN, could be a student on their first day! I started out as a receptionist and used to count meds then. Certainly not ideal. When I first started my nurse training the 'practice manager' (over confident sole receptionist) used to authorise repeats and put them up!! I agree that there should be checks in place, even if its just another vet/nurse double checking things, however who has the staff available?...I have seen many mistakes made (usually wrong strength of antibiotic or simialr) and have made them myself. It is easily done and i'm sure many have done it, from experienced vets to lay staff. When you are extremely busy and tired it is going to happen. I have never seen a mistake cause major harm to a patient though, things are often picked up by an eagle eyed receptionist or the owner themselves. Mistakes also happen in human pharmacies, wasn't there a case not long ago where a baby was accidently given methadone? Not sure what the answer is, not may practices have the staff to put double check safeguards in place. Does anybody know if disciplinary action has ever been taken against anyone because of this?

Re: Do you need a Pharmacy Technician???

loobylou — Tue, 10 Nov 2009 18:36:47 GMT

All medication that leaves our practice has initials of 2 members of staff, pref one being an QVN or vet.
We check the drug and strength matches the label and that a cat hasnt been given dog sized drugs.
It seems to work well for us, on one occasion when a wormer wasnt double checked a kitten got a lge cat milbemax, kitten was fine after 24 hrs supportive nursing.
A few times we have picked up discrepancies, sometimes the vet clicking on the wrong strength drug, sometimes the dispenser picking up the wrong pot.

Re: Do you need a Pharmacy Technician???

Caro Laithwaite VN — Tue, 10 Nov 2009 18:19:01 GMT

There is probably a lot more staff on the pharmacy jobs you mention. Generally vets are not run with enough staff to have all sorts of checks. So it is a case of make do and live with the problems.

Re: Do you need a Pharmacy Technician???

danielle83 — Tue, 10 Nov 2009 18:18:55 GMT

Hi Katy,

In the practice I am employed within, we have many checks in place to guard against dispensing errors.

The vet prescribes the medication prints label in pharmacy. Then comes out of consulting room in to pharmacy (all consulting rooms open out into pharmacy), they then pick up the pot of meds they have prescribed, nurses then count meds (we have a nurse rota'd on a pharmacy shift all day every day) and vet checks pills in pot are correct and initails label. Dispensing log is then filled out with initials of prescriber/checker and person who put pills in pot. Works well for us. This is the procedure we undertake for all POM-V and CD's.

Sorry to hear about the incident with your cat, but I can assure you there are many failsafes in most practices to guard against dispensing errors. I have never known any errors that have led to patient harm.

Hope this answers your question.