Some good responses! Interesting to see how it differes a little bit how people perceive what we do back there. In most pharmacies, and the one where I work, it goes like this:
1. Patient drops of prescription. Tech has to collect allergies and DOB of patient from person dropping off. Yes, even if they are already in the system. Yes, even if they are already printed on the script. What if they have changed or the doctor printed it wrong?
2. Technician checks to make sure we have medication and gives estimate of time to fill medication. If it is a controlled medication, such as Oxycontin or Adderall, we check not only if we have it, but also the patient’s profile to see when they last got this medication. If it was too soon, we refuse to fill it. Sometimes we run drug reports on people. We can see every pharmacy you ever filled a controlled prescription at, what you got, and when.
3. Prescription is given to data entry tech at computer. Tech places barcode and scans the image into the computer, then has to type through all the information. This includes selecting correct patient with correct DOB, verifying allergies, DAW selection (brand or generic ok?), date written, medication name, strength and quantity, number of refills, doctor who wrote it, directions, days supply and how the prescription was received (written, phoned, transfer, etc.). There are more steps involved for transfers and e-faxed Rxs.
We do real-time online billing, so we adjudicate it through the insurance. Assuming everything goes well, that takes a few seconds. Everything almost NEVER goes well. 9/10 times we have to input some sort of override code because insurance is stupid. Medco/Express Scripts is especially bad. Eventually we figure it out, or we have to call the patient. Half the time patient is like “Oh, I have new insurance!” Whoops.
If we don’t have the medication or must order it, the data entry person must take time to call the patient and let them know.
4. Label, backtag, auxiliary labels and bag label print. Get placed in a bucket along with hardcopy of prescription with backtag affixed and stock bottle of desired medication. Next person at “fill” station has to scan their individual barcode, scan RX label, then scan the stock bottle barcode to ensure it’s the correct medication (National Drug Code, or NDC, must match). Sometimes there are issues here and it must be done manually, the fill changed for a partial fill, etc.
Tech then counts out number of pills necessary from the stock bottle. If it’s a control, it must be counted twice and signed by the person who counted it. Narcotics are stored in the safe, so we must wait for the pharmacist to get them. The person doing fill is also the “counter” person; if they have to run to the counter to help a customer in the middle of counting, they usually have to start over in some fashion. This sucks when you have to count 200+ of a pill. Counting capsules is a pain as well.
The thing that annoys patients the most are boxed products, like birth control, insulin, eye drops, creams, etcs. They must still be scanned and everything verified by the pharmacist. You cannot just “slap a label on it”. What if the tech grabbed the wrong drug? What if the medication had expired? What if a new medication the patient was taking interacts with their old birth control refill? So, even though it doesn’t have to be necessarily “counted”, it must still be checked like everything else.
When they have counted and scanned everything, they put it in the amber vial you all know and love, make sure the lid is the correct type (safety or non-safety according to patient preferences) and apply the label.
5. Places bucket in the stack next to the pharmacist. Pharmacist must check prescription, including everything that was entered at data entry, against the hard copy. Must make sure doctor knows what they are doing. Checks for interactions, appropriateness of therapy and duration of therapy. Re-counts controlls and must back-count and log all narcotics before they go back in the safe. Files hardcopy prescription, affixes appropriate mix, fridge, or counselling stickers to back and sends it to be filed in the drawers for pickup. If there is a problem, pharmacist must “send back” prescription to data entry to fix it. Repeat process…
This is all assuming the doctor didn’t a) write completely illegibly, or b) write for something stupid (can’t tell you the number of times doctors have completely forgotten to put required things on a prescription, or even when they leave prescription messages!).
If there is any problem at all with the prescription, then we have to call the doctor. Even if the most stupid, tiny stuff. We cannot assume anything. It must be crystal clear. This takes time as well.
If there is an interaction, we have to call the doctor on that too to see if they are okay with it if it is minor, and document it. OR if it’s a major interaction, we have to call and try to get the rx changed to something different. Again, this takes time.
So yeah…it’s a very intricate process to make sure that what goes out to the patient is 100% correct. Mistakes do happen. But I will tell you that mistakes happen more often when people try to rush us, get irate, stand at the counter/hover staring at us, show up early (if we tell you 30 minutes, don’t show back up in 10, please!) or overall just put more pressure on us than usual. We don’t WANT you to wait any longer than you have to for your prescription, really. But trying to rush us or getting angry isn’t good for anybody. I think sometimes people need to stop and think that this is medication they are putting in their or a loved one’s bodies, not just standing in the checkout line buying a new pair of pants.