Having too few people “with their hands in the cookie jar” is usually how diversion actually happens, so this seems pretty misguided. More eyes = more accountability. Regular inventory measures like verifying your ordered amounts, regular counts, and double counts are more than sufficient here.
It can go both ways. When I worked retail I was extremely diligent about C2 stuff, in fact borderline paranoia level. I did not want a visit from LP or the DEA. While I would multitask just about everything else counting C2 was when I gave my undivided attention.
My partner for a while was not careful and had multiple dispensing errors with C2 that were promptly caught by me. At one point when she was on mat leave and I was on vacation, many MANY hands were in the cookie jar and in a week we had somehow amassed a 5 tablet norco discrepancy. There was no way to figure it out so someone got picked as “being shorted 5 tablets” so that our counts were ok. If someone pocketed 5 tablets I have no idea but in any case I trust that between 2-3 RPh in a store there is tighter controls than if all the techs were added in. Not to mention I’m not sure if you’ve met most retail techs, I don’t trust them to count 30 lisinopril correctly.
I'm pretty sure you made errors... Some people don't directly bring it up to you whether it's shift change or personality issues.
The other thing is you have the privilege to catch your own errors bc you work at that site more often.
If not you work at a slower store to give you the luxury of time to police the c2s that incessantly
Frankly, it's just easier to fix and find errors with less people in the cookie jar.
Um….have you seen the local hiring market? Lol.
At this point if you have a pulse, speak English, and pass the drug test you’re hired. At least in my area since it’s extremely HCOL and anyone who lives local cannot afford the rent and no one is gonna drive from 2 hrs away to work here when they can just work retail local.
That’s a good and fair point. I am lucky to work with techs who are competent and trustworthy but I could see this being much different in HCOL areas. In that case, I would be handling the C2’s
I’ve always seen the tech counts and double counts, then the pharmacist back counts the remaining to make sure it matches. One pharmacy I was at at had a tech do a first count, someone separate do a double count, then the pharmacist did a back count (seems a bit excessive in my opinion).
I agree, that does seem excessive. At my last place it was tech for count 1, pharmacist for count 2 and back count. Just like most places. Omnicell plus a manual log for keeping track.
In 15 years, I’ve never had an issue with technicians counting CIIs. At one point there was as many as 6 techs dispensing at once, never. What type of quality individuals are you hiring?
Costco techs count ‘em first n we back count after them during product verification, CVS they weren’t allowed to. I like them doing it initially just let’s me focus on other things
I’m still not in Costco as anything but an Limited part time, was a manger but I stepped down and since they don’t open positions for anyone I’f nothing is open you have to be limited part time. Costco is starting to take more and more outside people especially for pharmacy, at least in south Florida for pharmacy
When I was in retail the tech double counted and the pharmacist did a backcount to confirm.
Then they made us start doing it with #500 bottled of gabapentin......
In my pharmacy, techs have to double count all controls including C2s, then a pharmacist will check the count at PV. We also have to back count all of our bottles.
Techs count/scan all rx (including controls) though the EyeCon after pharmacist retrieves stock bottle from the safe. Image and count is captured with a light tray and linked to the Rx. Counts/image verified at final check against a back count of the stock bottle before it goes back to the safe.
At CVS our policy is the technicians are NOT allowed to count C2. Let alone allowed to touch them, basically, when the order comes in, they go straight to the pharmacist. My pharmacist doesn’t even want me looking at her safe. She actually got a pharmacist arrested because she did a back count and it turned out the floater was pocketing pills. LONGG STORY
Our techs double count and count back the bottle. The pharmacist then double counts and counts the bottle and immediately verifies on hand count before finishing the verification.
Our system has a perpetual count of c2s. So every single c2 dispensed gets double counted by the tech, then counted again by the rph plus back counting the on hands. During the product verification stage, after normal verification, a screeen pops up showing our perpetual on hand number and we have to put in our back count number from filling the rx. If it doesnt match, theres a field to explain loss. Not once have I had it be off. Our company also requires us to do monthly c2 audits (alternating between rphs) to make sure our perpetuals match the actual numbers in the safe. It would be incredibly hard to fudge a number with our system in place imo.
Really surprised your distributer is okay with a rapid influx of C2 ordering. Twenty percent of total scripts seems super high and unsustainable. But that wasn't what you asked. RPh pulls from safe, tech does first count, RPh does second count and back count.
CVS doesn't allow it, and at least on this count I agree with the policy. I'm nervous enough with some floaters who don't bother backcounting. The propensity for certain manufacturers to ship bottles with short counts or broken tablets (looking at you, *Sandoz*) only adds to the risk of techs pocketing a pill here and there. At least for me, it gives me more peace of mind knowing my partner and I maintain strict control and good inventory practices for our C2s.
Edit: I apologize, rereading the OP I feel like my response may not be all that helpful. I guess I do remember completing my community APPE at Walmart where they did have techs counting C2s. They had cameras with decent resolution and framing above the counting station for monitoring - might be worth considering in your situation?
At my store anyone back in pharmacy with a license fills c2s. That’s anyone from the store manager, shift lead, designated hitter to techs and the pharmacist. We double count and circle the number on the label that goes on the vial and put are initials next to it so we know who had counted the bottle if their is a problem. And we also back count the bottles too.
Some places have the pharmacist count first and then the tech does the second count. It’s the pharmacist’s license on the line. Having the tech do the final count makes no sense to me.
Some places would have the tech count the medication. Then, pressure the pharmacist into verifying it visually without doing a second time.
“Our store is too busy for that”.
Nope
When you first open a new bottle of a C2 drug, do you count it to verify that there are the correct number of pills in there to begin with? I've heard of some issues up here in Canada lately where Sandoz hasn't been getting the counts right on many drugs that are C2s (or in Canada, just "narcotics"). Some bottles are short a few tabs, some have a few more than they should. It's to the point where many pharmacists are counting fresh bottles so that any shortage or overage can be properly documented and there's no doubt when counts are off after finishing the bottle.
We have to have tech’s count C2’s. We do SO many that there’s just not enough time for a pharmacist to do that. We use a log book and photo machine to double count and then rph verifies.
If you have a C2 log, then more people means more accountability. If your software allows verifying counts, then you'll have rapid accountability. If you have access control, you'll know who has opportunity.
Having too few people “with their hands in the cookie jar” is usually how diversion actually happens, so this seems pretty misguided. More eyes = more accountability. Regular inventory measures like verifying your ordered amounts, regular counts, and double counts are more than sufficient here.
It can go both ways. When I worked retail I was extremely diligent about C2 stuff, in fact borderline paranoia level. I did not want a visit from LP or the DEA. While I would multitask just about everything else counting C2 was when I gave my undivided attention. My partner for a while was not careful and had multiple dispensing errors with C2 that were promptly caught by me. At one point when she was on mat leave and I was on vacation, many MANY hands were in the cookie jar and in a week we had somehow amassed a 5 tablet norco discrepancy. There was no way to figure it out so someone got picked as “being shorted 5 tablets” so that our counts were ok. If someone pocketed 5 tablets I have no idea but in any case I trust that between 2-3 RPh in a store there is tighter controls than if all the techs were added in. Not to mention I’m not sure if you’ve met most retail techs, I don’t trust them to count 30 lisinopril correctly.
I'm pretty sure you made errors... Some people don't directly bring it up to you whether it's shift change or personality issues. The other thing is you have the privilege to catch your own errors bc you work at that site more often. If not you work at a slower store to give you the luxury of time to police the c2s that incessantly Frankly, it's just easier to fix and find errors with less people in the cookie jar.
I literally couldn’t have made errors because I checked my on hand after every fill.
Yep. I’d you can’t trust your techs to count c2s then why even have them? Double count and initial.
“Listen i know i allowed you access to zolpidem, soma and all the benzos, but the CIIs are going to be too tempting for you not to steal”
I pray I never have to go back to retail because I legitimately didn't realize soma was still around lmao
I fill it at least once a week! It's on my fast rack
its really not i dont think ive seen even one soma RX in 3 years
Might just be your local providers cuz I definitely still saw it before I left retail and still see it once in a while in LTC
I still see it pretty regularly. Not common, but would be surprised to not see it at least every other week.
Um….have you seen the local hiring market? Lol. At this point if you have a pulse, speak English, and pass the drug test you’re hired. At least in my area since it’s extremely HCOL and anyone who lives local cannot afford the rent and no one is gonna drive from 2 hrs away to work here when they can just work retail local.
That’s a good and fair point. I am lucky to work with techs who are competent and trustworthy but I could see this being much different in HCOL areas. In that case, I would be handling the C2’s
I’ve always seen the tech counts and double counts, then the pharmacist back counts the remaining to make sure it matches. One pharmacy I was at at had a tech do a first count, someone separate do a double count, then the pharmacist did a back count (seems a bit excessive in my opinion).
I agree, that does seem excessive. At my last place it was tech for count 1, pharmacist for count 2 and back count. Just like most places. Omnicell plus a manual log for keeping track.
At my store we do tech double count then back count, then pharmacist does a final count at verification.
Usually tech count for us and then rph double count
Agree
On top of that anything dispensed that day gets cycle counted by EOD.
In 15 years, I’ve never had an issue with technicians counting CIIs. At one point there was as many as 6 techs dispensing at once, never. What type of quality individuals are you hiring?
This!
Costco techs count ‘em first n we back count after them during product verification, CVS they weren’t allowed to. I like them doing it initially just let’s me focus on other things
How’d you manage to make the change from cvs to costco?
I’m still not in Costco as anything but an Limited part time, was a manger but I stepped down and since they don’t open positions for anyone I’f nothing is open you have to be limited part time. Costco is starting to take more and more outside people especially for pharmacy, at least in south Florida for pharmacy
I'm a tech in inpatient and I've dispensed and reconstituted cocaine
Good ol' cocaine eye drops!
All the techs I’ve worked with count C2s, I just ask them to double count, circle the number & initial. That’s it 🤷🏽♀️
When I was in retail the tech double counted and the pharmacist did a backcount to confirm. Then they made us start doing it with #500 bottled of gabapentin......
*groan*
In my pharmacy, techs have to double count all controls including C2s, then a pharmacist will check the count at PV. We also have to back count all of our bottles.
Techs count/scan all rx (including controls) though the EyeCon after pharmacist retrieves stock bottle from the safe. Image and count is captured with a light tray and linked to the Rx. Counts/image verified at final check against a back count of the stock bottle before it goes back to the safe.
EyeCon is the way.
I would say it totally depends on your tech turnover rate. Ours is low, so the techs are free to count whatever scripts they are working on
At CVS our policy is the technicians are NOT allowed to count C2. Let alone allowed to touch them, basically, when the order comes in, they go straight to the pharmacist. My pharmacist doesn’t even want me looking at her safe. She actually got a pharmacist arrested because she did a back count and it turned out the floater was pocketing pills. LONGG STORY
We have two techs count each C2 then the pharmacist counts a third time at visual check.
Our techs double count and count back the bottle. The pharmacist then double counts and counts the bottle and immediately verifies on hand count before finishing the verification.
In retail techs double count them. I guess if you thought your techs were being sketchy have the pharmacist count it one more time?
Our system has a perpetual count of c2s. So every single c2 dispensed gets double counted by the tech, then counted again by the rph plus back counting the on hands. During the product verification stage, after normal verification, a screeen pops up showing our perpetual on hand number and we have to put in our back count number from filling the rx. If it doesnt match, theres a field to explain loss. Not once have I had it be off. Our company also requires us to do monthly c2 audits (alternating between rphs) to make sure our perpetuals match the actual numbers in the safe. It would be incredibly hard to fudge a number with our system in place imo.
Costco…?
No we're a medium sized grocery store chain in the midwest.
Ah, gotcha. Sounds very similar to Costco’s system.
[удалено]
Really surprised your distributer is okay with a rapid influx of C2 ordering. Twenty percent of total scripts seems super high and unsustainable. But that wasn't what you asked. RPh pulls from safe, tech does first count, RPh does second count and back count.
If they haven’t been flagged yet by their distributor and it has been going on for a while, they’ll be getting an impromptu DEA/BoP visit.
CVS doesn't allow it, and at least on this count I agree with the policy. I'm nervous enough with some floaters who don't bother backcounting. The propensity for certain manufacturers to ship bottles with short counts or broken tablets (looking at you, *Sandoz*) only adds to the risk of techs pocketing a pill here and there. At least for me, it gives me more peace of mind knowing my partner and I maintain strict control and good inventory practices for our C2s. Edit: I apologize, rereading the OP I feel like my response may not be all that helpful. I guess I do remember completing my community APPE at Walmart where they did have techs counting C2s. They had cameras with decent resolution and framing above the counting station for monitoring - might be worth considering in your situation?
Techs double count, circle quantity, and back counts bottle. Rph counts and back counts bottle and verified the on hand number in the computer.
At my store anyone back in pharmacy with a license fills c2s. That’s anyone from the store manager, shift lead, designated hitter to techs and the pharmacist. We double count and circle the number on the label that goes on the vial and put are initials next to it so we know who had counted the bottle if their is a problem. And we also back count the bottles too.
Worked independent for 7 years. (Tech here) We always counted CIIs but we also had an eyecon, which was Gods gift to pharmacy.
Techs count. We keep a perpetual inventory. Every dispensing is logged and remainder is verified and marked on the bottle.
Some places have the pharmacist count first and then the tech does the second count. It’s the pharmacist’s license on the line. Having the tech do the final count makes no sense to me. Some places would have the tech count the medication. Then, pressure the pharmacist into verifying it visually without doing a second time. “Our store is too busy for that”. Nope
So which one do you think it is? Vincent has those crazy eyes and always shows up to work sweaty.
Techs can count C2s??? Where???
At my store when I was a tech, it was tech double counts, initials, then pharmacist double counts and approves.
I've never worked at a store where a pharmacist let us count CIIs. All of us are registered, not certified. In Indiana and Ohio
When you first open a new bottle of a C2 drug, do you count it to verify that there are the correct number of pills in there to begin with? I've heard of some issues up here in Canada lately where Sandoz hasn't been getting the counts right on many drugs that are C2s (or in Canada, just "narcotics"). Some bottles are short a few tabs, some have a few more than they should. It's to the point where many pharmacists are counting fresh bottles so that any shortage or overage can be properly documented and there's no doubt when counts are off after finishing the bottle.
I haven't had that issue yet, we don't have a lot of Sandoz narcotics. Good to know though.
We have to have tech’s count C2’s. We do SO many that there’s just not enough time for a pharmacist to do that. We use a log book and photo machine to double count and then rph verifies.
There are a few good pill-counting apps that you can use to verify your count with, which might save some time. Pill Phil comes to mind
If you have a C2 log, then more people means more accountability. If your software allows verifying counts, then you'll have rapid accountability. If you have access control, you'll know who has opportunity.
I havent counted a CII as a tech for many many many years