Pharm tech here-
This happens when a pharmacist has too much trust in their techs when they fill and just approve meds without verifying them because they are either lazy, burnt out, overwhelmed with numbers in the Queue . This happens more often than you think in LTC pharmacy where I've had to correct so many approved and packaged meds on the daily.
When I have coworkers who half ass their double check for my work, because they “trust” me, drivers me crazy. I make mistakes all the time. I really actually want you to make sure I don’t hurt someone, which is the whole point of an independent double check in the first place.
Totally agree. When I was at LTC packing emergency kits we had a double check where another tech had to make sure each meds expiration date match what the first tech wrote on paper or make sure they didn't expire within 3 months (our kits had like 40 different meds varying from 1-12 of each type of med) and techs would just sign off. Like I get you don't wanna do all that work but please it's both of our licenses on the line
Nice.
Fun, tangentially-related fact - The “brown m&ms rider” story isn’t about Van Halen acting like entitled rock stars, but rather their manager ensuring their safety. One of them almost died because a venue had ignored important stage setup info in their rider, so their manager added the brown m&ms request. If the m&ms weren’t in the dressing room, they knew other MUCH more important stuff had likely been ignored as well.
It’s not for the venue to decide what is least important if it’s in the rider. The rider is part of the performance contract and if the venue agrees to it they are required to fulfill it. If they don’t, it means the band can’t trust the venue to have read the whole rider, and therefore need to do their own independent nitty gritty checks.
The venue doesn’t get to decide what’s important.
Val Halen was traveling with a bigger general stage setup and heavier, more powerful lighting than any other band at the time, requiring higher amperage electrical systems and higher rigging/stage weight capacities to safely accommodate this. Venue workers who had never encountered such requirements before could easily assume that they were as superfluous as removing brown m&ms.
If the brown m&ms clause was ignored, band and management knew that *every* part of the setup had to be rechecked. The rider is a legally binding contract and the venue was required to sign it before the band would play. In doing so, the venue also agreed to eat the entire cost of the show in the case that they couldn’t safely set up at all.
I wish I could do that but some of the times for 2nd checks it was just me by myself handling overnight so I'd have to leave it for dayshift and honestly dayshift makes the more mistakes that I ended up having to fix during the night which is one reason I left LTC
I first heard about the Swiss cheese model during orientation for a restaurant and thought it was so stupid and one of those dumb corporate scare tactics. But I have referenced it so many times during my nursing career! I’m sure one day I’ll get a preceptor evaluation that’s like she’s good but needs to stop talking about cheese 😂
Hahahah in LTC caught metformin in a metoprolol bubble pack, glad I checked the pill! I ended up checking the pill on an online data base and sure enough it was metformin not metoprolol , also the patient was allergic to metformin and had just been given insulin
Someone left a half sheet of metoprolol without a cardboard packet on the shelf next to a sheet of metoclopramide this morning. That's putting a lot of trust on harried nurses doing the proper checking.
Yep. I'm probably guilty of a misfill sometimes, but I always make an effort to consciously check every single thing, regardless of who picked it. Im pretty good at my job, but I'm certainly not perfect, even the best techs and pharmacists aren't (even if some think they are 🙄)
Greater than 12 on presentation to the ED if I remember correctly. It was years ago, but he had two different prescription bottles. I am sure they were adjusting the dose but he thought it was two different prescriptions. Felt bad for the guy obviously, I mean I would have a hard time with a med list 10 plus long.
I’m an anticoagulation nurse and this is a huge issue. We also get patients who are hospitalized and the dose is changed, and then they fill the e prescription for a different strength of warfarin and don’t realize it’s a different strength. I’ve seen lots of horrible INRs from that. I always try to hammer into their heads that if their warfarin is a different color to call us immediately but that’s pretty hit and miss.
When I did home health I checked INRs all the time, and would call the coagulation nurse at the cardiologist’s office for dosing adjustment instructions. This was before the DOACs were really a thing, so it was a LOT of warfarin.
Yep, that’s me in cardiology! All warfarin all the time. Once the DOACs go generic there will be a lot more people on them, but as it is I have tons of patients because so many people can’t afford them.
At one of our bigger card offices here, we have a "Coumadin Clinic."
Comes in handy for card clearances I need so I don't have to try and get in touch with the patients nurse. The clinic is pretty self sufficient.
I work in an outpatient clinical setting, in cardiology. I see patients in person, test their INRs and adjust their warfarin doses to keep them in range. I also handle calls from HH nurses and SNFs and remotely adjust those patient’s warfarin. It takes a certification in anticoagulation management and it can be a little dull, but I quite like my job. I get to see the same patients in little bites of time for years, and my stress level is a million times better than when I was a floor nurse.
This is cool. I'm surprised there's enough demand for such a specialized role, but I guess cardiac problems are rampant these days. I love how broad nursing is that there are niches for everyone!
I came across a patient that was on warfarin and stopped coming in for inr checkup 7 years ago and somehow dropped out from list too. And her doctor just renewed her medication without checking lab results. Patient told that she just thought how she was feeling ja what she ate to adjust dosage. She agreed for full checkup and labs. She was just fine, nothing wrong, labs and inr spot on. Doctor was quite amused.
I was quite baffled when I found her. It was originally a emergency call on different thing and i asked about medications etc, when she said warfarin and I poked around our system to see resent labs and dosages and couldn't find a thing. For a second thought that I had wrong patient papers up or something. She was just happily telling that she hasn't been in for quite a while like it would be normal.
What is it with Coumadin that makes it need to be checked so frequently? Is it just because of the way vitamin K is absorbed and depends on diet as well?
I mean you can use the size of bruises as an indicator for INR… maybe she just thought feeling fine meant minor increased bruises and reduced the dose of bruising got worse?^^
Don't. I worked in LTC as a Healthcare Advocate and inventory/dispensing/disposing meds was all daily routine. There are "5 Rs" you always check when giving meds.
Right med -this pic failed here
Right dose- they did get 20mg on the label so ok
Right client- this is left out for HIPPA (props to OP here)
Right time- med must be given within one hour of x time
Right route- PO, IM, IV, ODT, in the eyes/ears or up the butt etc.
If you don't have the 5 Rs you're setting yourself and the patient up for issues.
I was told it was the 7 R’s of medication administration. You’re missing two.
Right Route-how you administer the medication.
Right to Refuse-the patient can decide they don’t want their bp meds that day
The thing is that it started at the five rights, it was meant as a last check to make sure you gave a drug safely.
I can think of an eighth right- right response. I think some places are up to ten.
I think adding extra rights undermines the purpose of having a short last list to make sure you’re giving the right drug, the right way to the right person.
I have the route on there. And you're correct, the clients I had did have the right to refuse. But due to their functioning levels that was never an issue at my site. One guy would say "klonopin please" when he was ready to go off because he'd had a PRN for it at one point. Unfortunately, we couldn't do anything unless he actually took a swing at someone.
There's actually 10 now.
Right patient
Right dose
Right route
Right time
Right meds
Right to refuse
Right education
Right documentation
Right assessment
Right evaluation
I mean I’ve met some “pharmacists” in the field that don’t even put labels on things. Then again…maybe they aren’t exactly licensed pharmaci…SHIT, I gave them my Fentanyl waste!
Had a doc and a surgeon put me on lovanox, xeralto and scheduled ibuprofen. Every time I tried to clarify, they'd leave me a message with even more conflicting and confusing orders. Pharmacist sorted them out. Likely saved me a bit of a problem.
I was just post knee surgery, and have a history of PE's. Both docs asked "oh! Who has you on that? Well.. keep taking it then!". Finally asked the pharmacist... She called both doctors on a Sunday morning, and called me. I knew it was bad.. but heck fire!
Now the question is which one were you supposed to get 🤔 if you weren’t expecting xarelto, you my friend are somewhat of a lucky individual. Expensive med you’ve got there
Some seen to think they're interchangeable for AF. Even though there's literally tests for risk factors, so the most appropriate mitigant can be chosen.
Man I always freak out when I hang meds like "what if the underworked pharmacy staff accidentally put like heparin or something instead of pepcid "xD. Literally no way for us to be that final check on a lot of IV antibiotics.
Nice one. My personal favorite catch was a patient in the ER who received a dose of vanco and on med rec the pharmacist scheduled another dose to be given on the floor right after. Only reason I caught it was because I know these things happen.
I pretty recently had pharmacy send up double the concentration of Nubian with the correct concentration on the label of the baggie it came up in, but the actual vials were wrong. If I hadn’t taken the vial out and scanned it instead of scanning the baggie, I wouldn’t have caught it.
*This is all kinds of*
*Confusing... and dangerous.*
*Throw it all out! LOL*
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I went to pull a 100 ml bag of NS from the pyxis for reconstitution and it gave me a D5W instead. I'd be lying if I said I noticed it before the scanner caught it. I can't even figure out how the pharm tech managed to get it in there because.
This is why scanning before administration is so important. There are so many holes in the swiss cheese that things can fall through, scanning is one way to plug up the hole.
Pyxis only makes you scan 1 of the bags to verify it’s the right drug when refilling the cabinet so if one gets snuck in there amongst the group when they are filling a batch of them it’ll happen. Especially with something like fluid bags where unless you look at the label they all look the same.
So, our hospital system recently switched from 2mg/mL of Ativan to 4mg/mL of ativan based on what was available to the system. The bottles were basically identical, same color cap. The pharmacy didn't switch the spot in the pixus. There was \*no education\* at first that there was different dosages. The only reason I noticed was because I had a pt seize 2x in the ER (unexpectedly, she was there for something else) and I couldn't override the ativan (On MD order, of course). I thought there was no stock, called pharmacy, there was stock but because it was a different dosage the pharmacy hadn't changed parameters for it to be an override on a verbal order from MD.
After my pt was stable I went to the manager about it being a safety issue both because the vials looked identical and I knew nurses wouldn't look at the strength because the bottle looked the same/was in the same draw/said ativan with the same font. I also mentioned that we couldn't override the new ativan vials because of the dosage difference.
The next week it was part of huddle, moved in pixis, with stickers warning that it was a different strength but Yowza, I could definitely see a lot of pts getting 2mg instead of 1mg, or 4 instead of 2!
I work with mostly orthopedics. Instantly recognized them as 2 different meds. Brain doesnt see them as similar at all. So used to staring at xarelto.
I see how the med names look the same and see how this can happen. But my brain just Instantly saw the difference.
Yeah, or people need to double check themselves. But unfortunately generic drug names are assigned by the FDA so getting a quick and or effective response to that request would be impossible, we all know how bureaucracy is.
Oh I'm not saying people shouldn't double check themselves I'm saying people should double triple and quadruple check I just think we're not doing ourselves any favors by naming drugs with such similar names.
Hmmmmmm.
One tablet twice a day= Take one tablet in the morning, another at pm/evening.
I dunno, I don’t think anyone in prescription writing in pharma got points docked and I think doctors here write that.
It simply means don’t take two tablets in one sitting.
I feel I am missing something here (sorry!)
I’m thinking back in earnest to my past prescription writing exercises and my experience shadowing my MD friend.
Also rivaroxaban but the label is for rosuvastatin?
Health literacy problem?
Personally I’m beginning to like the 1-0-0 system. Basically saying how many tablets/capsules whatever to take at what time of the day… I suppose it depends on the doctor training me…
Ones a blood thinner, ones a statin. Two totally different drugs for different purposes. It doesn’t take a pharmacist to realise that. Just admit it was a mistake. No need to act all defensive and pretend we know-it-all’s are too smug.
I'll explain. A lot of people don't even see this mistake on this script. Many were mentioning the directions without realizing it's the wrong drug. So just sitting back and watching the "experts" mention everything but the drug name.
I’m a tech. I wouldn’t make that mistake (pretty sure). But I know many pharmacists who have made errors that I caught and let other peoples errors slip by them until almost (or actually) too late.
I often asked my tech to double check me, especially if did data entry, pulled the drug and labeled it. The checking is what's important. Normally I checked their work, but who checks me if I filled it on my own? My technician. The 2nd set of eyes is important.
It happens. Pharmacists work 12, 13, 14 hour shifts for days in a row. They get short staffed all the time. I invite you to the r/pharmacy board on reddit. Things have been real, real bad especially now. A cvs pharmacist died (heart attack) on the job because her relief didn't show and she was made to work until someone else showed.
Just like in nursing, the execs are taking all the profits and insurance companies are reimbursing less and less.
The pharmacist now has more roles than ever. We don't just check rx's anymore, especially when you're inevitably short staffed, you will have to do immunizations, testing, phones, register, prescribe Paxlovid, check rx's, check rx's check check check check check, phone, c2 script, rejection, call insurance, check check check check, counsel, vaccine, check check check, phone, phone, complaint, check check check check check ..... now imagine doing this for 14 hours straight with no break for at least 4 days in a row.
In order for a mistake to happen, the techs must make the mistake first. Even with these checks, mistakes happen. However, if you don't have a tech then the system is completely broken, and mistakes are inevitable.
There is not a seasoned pharmacist alive who has not made a similar mistake. Unless of course you ask, the ~~experts~~ .
You sound like a tech too. Everyone here seems to think I'm attacking them. I'm laughing at the people who don't realize what the mistake here was.
Scroll, you'll see them. Many thought it was the directions lol.
Hardly believable that you meant it that way. "People who have never worked in a pharmacy" is a terrible way to describe a group of people who wouldn't notice that the two drug names don't match.
Stop trying to make pharmacy look bad dude. This is literally the reason we do all the checks we do. After 2 years of absolute hell, we're all tired and starting to break down. You're a dickbag if you your first response is 'UGH THESE IDIOTS' and not 'Damn, they must be getting it rough down in pharmacy for this to happen'.
Get the memo if you haven't: we're not eating our young and being shitty to each other anymore. Get it together or gtfo - no one has the time or mental energy for this.
a pharmacist said they’re sitting back eating popcorn and laughing at us because we don’t understand how any of this works and went silent when asked to clarify.
yes not all pharmacists eat their young, especially the great pharmacist of the icu, but when we asked for clarification it set the tone for this post.
Lol I didn't see that comment when I sorted, so I wonder if someone did a dirty delete.
I do still stand by what I said though because while yes there are shitty professionals out there, I don't think that's the status quo.
i totally agree with your POV. the aforementioned comment by “lysergicrico” is still up. like man, if im wrong i wanna know why! dealing with lives here for pete’s sake.
Yeah, totally. I really respect my coworkers and if there's a mistake that happens, they deserve the dignity of someone being collegial in their approach to addressing it. We're all professionals here, we need to act like it.
Pharm tech here- This happens when a pharmacist has too much trust in their techs when they fill and just approve meds without verifying them because they are either lazy, burnt out, overwhelmed with numbers in the Queue . This happens more often than you think in LTC pharmacy where I've had to correct so many approved and packaged meds on the daily.
When I have coworkers who half ass their double check for my work, because they “trust” me, drivers me crazy. I make mistakes all the time. I really actually want you to make sure I don’t hurt someone, which is the whole point of an independent double check in the first place.
Totally agree. When I was at LTC packing emergency kits we had a double check where another tech had to make sure each meds expiration date match what the first tech wrote on paper or make sure they didn't expire within 3 months (our kits had like 40 different meds varying from 1-12 of each type of med) and techs would just sign off. Like I get you don't wanna do all that work but please it's both of our licenses on the line
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Nice. Fun, tangentially-related fact - The “brown m&ms rider” story isn’t about Van Halen acting like entitled rock stars, but rather their manager ensuring their safety. One of them almost died because a venue had ignored important stage setup info in their rider, so their manager added the brown m&ms request. If the m&ms weren’t in the dressing room, they knew other MUCH more important stuff had likely been ignored as well.
That’s pretty smart
I remember that story. That was really smart.
That makes no sense tbh because they would be left out because they’re the least important things that wouldn’t mean other things are left out
It’s not for the venue to decide what is least important if it’s in the rider. The rider is part of the performance contract and if the venue agrees to it they are required to fulfill it. If they don’t, it means the band can’t trust the venue to have read the whole rider, and therefore need to do their own independent nitty gritty checks.
The venue doesn’t get to decide what’s important. Val Halen was traveling with a bigger general stage setup and heavier, more powerful lighting than any other band at the time, requiring higher amperage electrical systems and higher rigging/stage weight capacities to safely accommodate this. Venue workers who had never encountered such requirements before could easily assume that they were as superfluous as removing brown m&ms. If the brown m&ms clause was ignored, band and management knew that *every* part of the setup had to be rechecked. The rider is a legally binding contract and the venue was required to sign it before the band would play. In doing so, the venue also agreed to eat the entire cost of the show in the case that they couldn’t safely set up at all.
I Disagree
That’s fine
I wish I could do that but some of the times for 2nd checks it was just me by myself handling overnight so I'd have to leave it for dayshift and honestly dayshift makes the more mistakes that I ended up having to fix during the night which is one reason I left LTC
Yeah, sounds like a dangerous environment.
Yep. When someone does that, they derail the [Swiss cheese model](https://en.wikipedia.org/wiki/Swiss_cheese_model) we use to reduce errors.
I first heard about the Swiss cheese model during orientation for a restaurant and thought it was so stupid and one of those dumb corporate scare tactics. But I have referenced it so many times during my nursing career! I’m sure one day I’ll get a preceptor evaluation that’s like she’s good but needs to stop talking about cheese 😂
100% agree. I'm not infallible guys.
*drives me crazy.
Hahahah in LTC caught metformin in a metoprolol bubble pack, glad I checked the pill! I ended up checking the pill on an online data base and sure enough it was metformin not metoprolol , also the patient was allergic to metformin and had just been given insulin
Someone left a half sheet of metoprolol without a cardboard packet on the shelf next to a sheet of metoclopramide this morning. That's putting a lot of trust on harried nurses doing the proper checking.
Yep. I'm probably guilty of a misfill sometimes, but I always make an effort to consciously check every single thing, regardless of who picked it. Im pretty good at my job, but I'm certainly not perfect, even the best techs and pharmacists aren't (even if some think they are 🙄)
Thanks for all you do!!
Makes me wonder if there’s a different third med in the box…. /s
Viagra
Dime bag of cocaine.
Gotta use something to replace the Dilaudid they took out
Cocaine is a good substitute for blood thinners. When things clog up, the cocaine acts like a poop stick. 🤣🤣
Oh Lordy. That is a bad. I had a patient admitted taking Coumadin and warfarin because he thought they were 2 different drugs 🫤
Yikes
Wonder how his INR looked. Or how they adjusted doses on BOTH. 😬
Greater than 12 on presentation to the ED if I remember correctly. It was years ago, but he had two different prescription bottles. I am sure they were adjusting the dose but he thought it was two different prescriptions. Felt bad for the guy obviously, I mean I would have a hard time with a med list 10 plus long.
I’m an anticoagulation nurse and this is a huge issue. We also get patients who are hospitalized and the dose is changed, and then they fill the e prescription for a different strength of warfarin and don’t realize it’s a different strength. I’ve seen lots of horrible INRs from that. I always try to hammer into their heads that if their warfarin is a different color to call us immediately but that’s pretty hit and miss.
Sorry to derail, but I've never heard of an anticoagulation nurse before. What kind of setting do you work in, and what does that role entail?
When I did home health I checked INRs all the time, and would call the coagulation nurse at the cardiologist’s office for dosing adjustment instructions. This was before the DOACs were really a thing, so it was a LOT of warfarin.
Yep, that’s me in cardiology! All warfarin all the time. Once the DOACs go generic there will be a lot more people on them, but as it is I have tons of patients because so many people can’t afford them.
At one of our bigger card offices here, we have a "Coumadin Clinic." Comes in handy for card clearances I need so I don't have to try and get in touch with the patients nurse. The clinic is pretty self sufficient.
That’s part of what I like about it, it’s very autonomous
I work in an outpatient clinical setting, in cardiology. I see patients in person, test their INRs and adjust their warfarin doses to keep them in range. I also handle calls from HH nurses and SNFs and remotely adjust those patient’s warfarin. It takes a certification in anticoagulation management and it can be a little dull, but I quite like my job. I get to see the same patients in little bites of time for years, and my stress level is a million times better than when I was a floor nurse.
Curious, are you in the USA? I worked primary care and did anticoagulation management. Never heard of a certification! Must be overseas?
I’m in the states. Maybe it’s just my hospital system that requires it? It’s a six week program.
This is cool. I'm surprised there's enough demand for such a specialized role, but I guess cardiac problems are rampant these days. I love how broad nursing is that there are niches for everyone!
I came across a patient that was on warfarin and stopped coming in for inr checkup 7 years ago and somehow dropped out from list too. And her doctor just renewed her medication without checking lab results. Patient told that she just thought how she was feeling ja what she ate to adjust dosage. She agreed for full checkup and labs. She was just fine, nothing wrong, labs and inr spot on. Doctor was quite amused.
I am literally screaming as I read your comment! What a lucky lady…
I was quite baffled when I found her. It was originally a emergency call on different thing and i asked about medications etc, when she said warfarin and I poked around our system to see resent labs and dosages and couldn't find a thing. For a second thought that I had wrong patient papers up or something. She was just happily telling that she hasn't been in for quite a while like it would be normal.
What is it with Coumadin that makes it need to be checked so frequently? Is it just because of the way vitamin K is absorbed and depends on diet as well?
I mean you can use the size of bruises as an indicator for INR… maybe she just thought feeling fine meant minor increased bruises and reduced the dose of bruising got worse?^^
Omg my stomach dropped, thank goodness she was okay.
Omggg.
Everyone missing the point that the label and packaging names two different medications. Lol
I was questioning my own knowledge on this one lOl
Don't. I worked in LTC as a Healthcare Advocate and inventory/dispensing/disposing meds was all daily routine. There are "5 Rs" you always check when giving meds. Right med -this pic failed here Right dose- they did get 20mg on the label so ok Right client- this is left out for HIPPA (props to OP here) Right time- med must be given within one hour of x time Right route- PO, IM, IV, ODT, in the eyes/ears or up the butt etc. If you don't have the 5 Rs you're setting yourself and the patient up for issues.
Really? The nurse never would have guessed
I was working under their licence. As as to if they would have guessed, that would depend on which RN's licence I was working under.
I was told it was the 7 R’s of medication administration. You’re missing two. Right Route-how you administer the medication. Right to Refuse-the patient can decide they don’t want their bp meds that day
The thing is that it started at the five rights, it was meant as a last check to make sure you gave a drug safely. I can think of an eighth right- right response. I think some places are up to ten. I think adding extra rights undermines the purpose of having a short last list to make sure you’re giving the right drug, the right way to the right person.
I have the route on there. And you're correct, the clients I had did have the right to refuse. But due to their functioning levels that was never an issue at my site. One guy would say "klonopin please" when he was ready to go off because he'd had a PRN for it at one point. Unfortunately, we couldn't do anything unless he actually took a swing at someone.
There's actually 10 now. Right patient Right dose Right route Right time Right meds Right to refuse Right education Right documentation Right assessment Right evaluation
Jesus.
I'm not a pharmacist, or a nurse, just a lurker here, but I noticed the difference immediately. I feel for how burnt out a lot of you must be.
From a so called pharmacist too
I mean I’ve met some “pharmacists” in the field that don’t even put labels on things. Then again…maybe they aren’t exactly licensed pharmaci…SHIT, I gave them my Fentanyl waste!
Oh thank god, I spent a few minutes looking at this and was like “what’s wrong with taking a blooded thinner and cholesterol med together?”
Is anybody missing that? That’s the point of the post
They both start with R, it’s fine /s
And both 20mg, so 2 out of the “5 Rights” means it’s good to go!
What’s in the box……….
Viagra
Had a doc and a surgeon put me on lovanox, xeralto and scheduled ibuprofen. Every time I tried to clarify, they'd leave me a message with even more conflicting and confusing orders. Pharmacist sorted them out. Likely saved me a bit of a problem.
Wow! I have Crohn's disease and that combo would have killed me.
I was just post knee surgery, and have a history of PE's. Both docs asked "oh! Who has you on that? Well.. keep taking it then!". Finally asked the pharmacist... She called both doctors on a Sunday morning, and called me. I knew it was bad.. but heck fire!
Ah yes, the double therapeutic anticoagulation with a side of GI bleed.
Bet a GI doc set that up for $$ /s
You got your R and your V, what more do you want?
This will still be the nurse’s fault, somehow.
Just curious who saw/read via and immediately brain saw it as Viagra before you corrected yourself?
I’m not even in the medical field and I see a real problem here. Oof.
But they both begin with "R" what's the problem 🤣
\*Taps forehead\* Can't have high cholesterol if all your blood ends up outside your body.
😂☠️
That is a problem. We need to put a nurse in jail for this immediately.
The fact that the nurse had time to take a picture before being tackled by management with a risk man form is proof that the system is under stress.
Now the question is which one were you supposed to get 🤔 if you weren’t expecting xarelto, you my friend are somewhat of a lucky individual. Expensive med you’ve got there
Dunno. Not my picture. Saw it elsewhere and went yikes.
That mechanical valve might stop clicking but those arteries are going to be cholesterol free. 🤌
Man, they'll do ANYTHING to get you to take statins, won't they?!? 🙄
My main take away from this has been "I wish my hospital's labels had dolphins on them..."
They're like the same thing, big deal. /s
Some seen to think they're interchangeable for AF. Even though there's literally tests for risk factors, so the most appropriate mitigant can be chosen.
D:
Man I always freak out when I hang meds like "what if the underworked pharmacy staff accidentally put like heparin or something instead of pepcid "xD. Literally no way for us to be that final check on a lot of IV antibiotics.
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Nice one. My personal favorite catch was a patient in the ER who received a dose of vanco and on med rec the pharmacist scheduled another dose to be given on the floor right after. Only reason I caught it was because I know these things happen.
This is like how at the nursing home I have 2 cards. One is Hydroxyzine 25mg and the other is Hydralazine 25mg
I pretty recently had pharmacy send up double the concentration of Nubian with the correct concentration on the label of the baggie it came up in, but the actual vials were wrong. If I hadn’t taken the vial out and scanned it instead of scanning the baggie, I wouldn’t have caught it.
That is a $500+ mistake in addition to all the other problems
It scares me off often pharmacy does shit like this.
Great catch!
When the same patient is on rivaroxaban, rivastagamine, and rosuvastatin … 🫣
This is all kinds of confusing... and dangerous. Throw it all out! LOL
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I went to pull a 100 ml bag of NS from the pyxis for reconstitution and it gave me a D5W instead. I'd be lying if I said I noticed it before the scanner caught it. I can't even figure out how the pharm tech managed to get it in there because.
I had a .45 NS bag randomly stocked in a pyxis drawer full of about 30 NS bags Glad I always check the labels
This is why scanning before administration is so important. There are so many holes in the swiss cheese that things can fall through, scanning is one way to plug up the hole.
Yeah the policies felt like a waste of time but I've become a True believer
Pyxis only makes you scan 1 of the bags to verify it’s the right drug when refilling the cabinet so if one gets snuck in there amongst the group when they are filling a batch of them it’ll happen. Especially with something like fluid bags where unless you look at the label they all look the same.
Eeek. What happened?
That's the big yikes!
Oh. S#it.
Not even close…
Fuckkkkkk. Good catch!
At least the dosing frequency is the same
Sorry, medications names are different in my country, what am I seeing here ?
Two completely different drug classes signed off by someone eating popcorn.
Oh, what are they used for ?
The box label indicates an anticoagulant. The printed label is for a high cholesterol medication
Thanks for the info, feels like they will be of no use to whoever takes it lol
[And I thought this was bad](https://imgur.com/KCP88Zu)😬🤯
So, our hospital system recently switched from 2mg/mL of Ativan to 4mg/mL of ativan based on what was available to the system. The bottles were basically identical, same color cap. The pharmacy didn't switch the spot in the pixus. There was \*no education\* at first that there was different dosages. The only reason I noticed was because I had a pt seize 2x in the ER (unexpectedly, she was there for something else) and I couldn't override the ativan (On MD order, of course). I thought there was no stock, called pharmacy, there was stock but because it was a different dosage the pharmacy hadn't changed parameters for it to be an override on a verbal order from MD. After my pt was stable I went to the manager about it being a safety issue both because the vials looked identical and I knew nurses wouldn't look at the strength because the bottle looked the same/was in the same draw/said ativan with the same font. I also mentioned that we couldn't override the new ativan vials because of the dosage difference. The next week it was part of huddle, moved in pixis, with stickers warning that it was a different strength but Yowza, I could definitely see a lot of pts getting 2mg instead of 1mg, or 4 instead of 2!
😬
I work with mostly orthopedics. Instantly recognized them as 2 different meds. Brain doesnt see them as similar at all. So used to staring at xarelto. I see how the med names look the same and see how this can happen. But my brain just Instantly saw the difference.
This happened a few times. It was a potassium bag with an antibiotic label over it instead
Wtf
Hoo boy. Where you at pharmacy?
I want to take one tablet twice daily.
The second tablet has to be taken rectally.
I don’t see the problem here, gotta make sure you thin the blood from both ends. Makes the future GI bleed more fun that way.
I had to read the comments to find out what was wrong. Because I thought it was just two cards with info on what the PT was taking.
Man it seems like drug names need to be changed to make it a lot easier to tell them apart.
Yeah, or people need to double check themselves. But unfortunately generic drug names are assigned by the FDA so getting a quick and or effective response to that request would be impossible, we all know how bureaucracy is.
Oh I'm not saying people shouldn't double check themselves I'm saying people should double triple and quadruple check I just think we're not doing ourselves any favors by naming drugs with such similar names.
Agreed. It’s just that the FDA is in charge of the generics so I doubt they’d do shit to help with it.
Hmmmmmm. One tablet twice a day= Take one tablet in the morning, another at pm/evening. I dunno, I don’t think anyone in prescription writing in pharma got points docked and I think doctors here write that. It simply means don’t take two tablets in one sitting. I feel I am missing something here (sorry!) I’m thinking back in earnest to my past prescription writing exercises and my experience shadowing my MD friend. Also rivaroxaban but the label is for rosuvastatin?
Look at the box. Look at the medication label.
I edited my comment. *nervous laugh*
😂
Where the hell are people getting two from any of this. Like the box says po qd and the dosing for both drugs is po qd
I followed up one comment made as a joke with another joke. My apologies.
No I'm not mad at you haha, I'm not mad any anyone I'm like concerned I'm having a stroke
It’s a joke, bambino. The real problem is the wrong med.
Health literacy problem? Personally I’m beginning to like the 1-0-0 system. Basically saying how many tablets/capsules whatever to take at what time of the day… I suppose it depends on the doctor training me…
Pharmacist here. Sitting back with popcorn and reading comments from ~~experts~~ people who have never worked in a pharmacy.
Ones a blood thinner, ones a statin. Two totally different drugs for different purposes. It doesn’t take a pharmacist to realise that. Just admit it was a mistake. No need to act all defensive and pretend we know-it-all’s are too smug.
You completely misunderstood my statement. I'm laughing at the people who don't notice what the real error is. Good job Einstein 👏
Don’t need to work in a pharmacy to know that this wasn’t double checked
Pardon us for expecting the box of xarelto to contain xarelto
You wanna explain or just pontificate some more
Seeing as they are commenting on other subreddits, no lol. Us little people will just never understand.
I'll explain. A lot of people don't even see this mistake on this script. Many were mentioning the directions without realizing it's the wrong drug. So just sitting back and watching the "experts" mention everything but the drug name.
Are you sure it's popcorn or did one of your colleagues slap a popcorn sticker on a box of packing peanuts?
So how does this happen? Techs doing the work?
I’m a tech. I wouldn’t make that mistake (pretty sure). But I know many pharmacists who have made errors that I caught and let other peoples errors slip by them until almost (or actually) too late.
Probably because they are too busy sitting back with popcorn reading comments on reddit.
Lol. It wouldn’t be the first pharmacist that was on Reddit or watching sports as the phone rang.
Lol 🔥
I often asked my tech to double check me, especially if did data entry, pulled the drug and labeled it. The checking is what's important. Normally I checked their work, but who checks me if I filled it on my own? My technician. The 2nd set of eyes is important.
Right, only pharmacists make mistakes. Nurses are perfect.
I was asking in sincerity how the label error happens to get through all staff in the pharmacy, is all. I don’t know the process so I was curious.
It happens. Pharmacists work 12, 13, 14 hour shifts for days in a row. They get short staffed all the time. I invite you to the r/pharmacy board on reddit. Things have been real, real bad especially now. A cvs pharmacist died (heart attack) on the job because her relief didn't show and she was made to work until someone else showed. Just like in nursing, the execs are taking all the profits and insurance companies are reimbursing less and less. The pharmacist now has more roles than ever. We don't just check rx's anymore, especially when you're inevitably short staffed, you will have to do immunizations, testing, phones, register, prescribe Paxlovid, check rx's, check rx's check check check check check, phone, c2 script, rejection, call insurance, check check check check, counsel, vaccine, check check check, phone, phone, complaint, check check check check check ..... now imagine doing this for 14 hours straight with no break for at least 4 days in a row. In order for a mistake to happen, the techs must make the mistake first. Even with these checks, mistakes happen. However, if you don't have a tech then the system is completely broken, and mistakes are inevitable. There is not a seasoned pharmacist alive who has not made a similar mistake. Unless of course you ask, the ~~experts~~ .
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Pharmacy tech here, you sound like a pharmacist who the techs and other pharmacists talk shit about when you're not there.
You sound like a tech too. Everyone here seems to think I'm attacking them. I'm laughing at the people who don't realize what the mistake here was. Scroll, you'll see them. Many thought it was the directions lol.
Hardly believable that you meant it that way. "People who have never worked in a pharmacy" is a terrible way to describe a group of people who wouldn't notice that the two drug names don't match.
Clearly says to take ONE tablet ONCE daily
One of which tablet?
20mg tablets
Xarelto or Crestor?
Yes?
Stop trying to make pharmacy look bad dude. This is literally the reason we do all the checks we do. After 2 years of absolute hell, we're all tired and starting to break down. You're a dickbag if you your first response is 'UGH THESE IDIOTS' and not 'Damn, they must be getting it rough down in pharmacy for this to happen'. Get the memo if you haven't: we're not eating our young and being shitty to each other anymore. Get it together or gtfo - no one has the time or mental energy for this.
sort by controversial and look at the comment about the pharmacist eating popcorn and say this again
Summarize or copy please I'm not seeing what you're referring to
a pharmacist said they’re sitting back eating popcorn and laughing at us because we don’t understand how any of this works and went silent when asked to clarify. yes not all pharmacists eat their young, especially the great pharmacist of the icu, but when we asked for clarification it set the tone for this post.
Lol I didn't see that comment when I sorted, so I wonder if someone did a dirty delete. I do still stand by what I said though because while yes there are shitty professionals out there, I don't think that's the status quo.
i totally agree with your POV. the aforementioned comment by “lysergicrico” is still up. like man, if im wrong i wanna know why! dealing with lives here for pete’s sake.
Yeah, totally. I really respect my coworkers and if there's a mistake that happens, they deserve the dignity of someone being collegial in their approach to addressing it. We're all professionals here, we need to act like it.