The Cost of Not Getting It Right
Why Quantity Is as Important as the Right Med and Strength
In this interview, Dave Johnson, vice president at Kirby Lester and a 15-year veteran of the community pharmacy industry, talks about one thing that he still doesn’t understand. Why would a pharmacy ever be okay with losing money, when easy, affordable technology could prevent it?
Dave Johnson: Let’s start off with a string of 13 numbers: 30, 30, 30, 30, 9, 30, 30, 60, 30, 30, 30, 30, 90. These were the pill quantities for a consecutive series of scripts on a Thursday morning at Tuminaro Pharmacy in midstate New York. It’s typical how regularly 30-counts come up – definitely enough to be habit-forming for both technicians filling and pharmacists checking. An “oddball” 9 or 90 can be counted as a 30 in the hectic flow of the day. And that’s a problem that few pharmacy managers are focused on today: using technology to prevent undercounts that disrupt workflow and overcounts that waste money.
ComputerTalk: When you say few pharmacy managers are focusing on quantity errors, what exactly do you mean?
Johnson: There is a focus — and it’s a very healthy focus — on ensuring the right NDC is being filled. Plenty of pharmacies are investing in a workflow module with their pharmacy management system to equip their technicians with a scan-
verification process to make sure they don’t grab the wrong stock bottle. But the computer system cannot prevent a quantity error unless the pharmacy is using a connected counting device that verifies that the prescribed quantity has been counted correctly.
I use the analogy of the cash register. You carefully count the drawer every day because it would be unacceptable to be consistently off. Yet the quantity of pills going out the door is not held to the same scrutiny.
CT: Is it because a wrong drug or strength is so much more serious than a miscount? A wrong med can injure a patient, but an extra pill won’t.
Johnson: That is a logical explanation. But profit protection is just as essential, especially as the business model shifts from just filling scripts to value-based care. And a misconception is that an overcount is only one pill. When you’re hand-counting, you are as likely to miscount by five as you are by one,
like giving 55 or 65 instead of 60. Overcount a medication
like Januvia, at over $10 per tablet, and that just eroded a pharmacy’s already razor-thin dispensing fees. Or you give 30 by accident for a 90-count prescription. In a month, your workflow is going to be derailed when the patient calls for a refill that your system says is not needed.
CT: That last point is a good one. You can cost yourself both money and time later on if you aren’t careful. But the pharmacist check process is supposed to protect against quantity errors, isn’t it?
Certified pharmacy technician
Johnson: Pharmacists and technicians alike are incredibly busy, and they’re creatures of habit. A peek inside a vial may not detect a pill or two difference, especially when the pharmacist is also in the habit of assuming 30.
CT: Automated pill counters obviously offer an answer here.
Johnson: Yes, they do. There are two types of pill-counting devices. First, there’s a simple, noncomputerized counter that is great for accuracy. But it relies on a technician paying close attention to every fill, and humans make mistakes. Then there’s counting technology that’s interfaced to the pharmacy management system and will flag an error if the wrong quantity is counted. Technology like Kirby Lester’s KL1Plus protects against mistakes. Before it counts, the KL1Plus gets data from the pharmacy system and checks for correct NDC, strength, and quantity. It even stores a record of that fill for 10 years — that’s important if you have to defend against an accusing customer, like with narcotics. I like how Jeff Papo, co-owner of Tuminaro Pharmacy, sums up why he uses Kirby Lester counters that connect with his pharmacy management system. He says, “Before we used Kirby, I’m fairly certain we were losing money in a few different ways. Not anymore.” CT