What Pharmacy Technicians Should Never Forget When Counting Medication
by Bryan Wilson, CPhT
When you think about the title of this blog, one cannot go straight to the endless task of pouring medication onto a pill counter and grabbing a spatula to count pills. But there is more to it than that; you must remember that counting isn't the first step. One of the first things you encounter is a prescription label with a person's name. Do you remember the "5 rights?" The following rights are the right drug, patient, dose, route, and time. Don't be fooled if you think that counting medication is only in a retail pharmacy atmosphere. Counting medications can happen in any facet of pharmacy relations.
When working in an I.V. room or compounding atmosphere, counting medication can consist of bags, syringes, or containers. You must understand that counting can also mean measuring. In a sterile area and dealing with aseptic technique manipulations, your counting could involve measuring a dose as small as 0.2 ml or as large as multiple syringes being added into a TPN (Total Parenteral Nutrition.) In a scenario like this, let's add the five rights. I received a label for Zofran 8 mg IV Q12H, PRN. Now we have a choice, did the doctor allow generic, or must we use the brand name? Does this patient have any known allergies to the drug or its ingredients? Does this patient have an I.V. line present? And is this frequency too much or too often? You might say, "that's the pharmacist's job." Yes, but aren't these examples on the NPTA certification exam? There is a reason we must be conscious of this.
I worked in a compounding pharmacy when there was a shortage of Dextrose 5% I.V. bags. We eventually started making the dextrose flushes from a Dextrose 70% and diluting it with sterile water for injection. I was teaching a new technician about reading a worksheet. I asked her how she knew this was the correct formulation and that the math was right. We proceeded to work out the math on our lunch break. And the formulation answer I came up with was not what we performed. I brought this up to the pharmacist, which was a great idea. He explained that he did the math differently and numbers were rounded. I want to convey that you don't have the time to check the math of every script, but as you learn how to count, measure, and add, you can see if there is something off. Going into the pharmacy technician field with minimum effort and a desire to do what's only expected will make for a long and less desirable career.
I interviewed a fellow pharmacy technician about this topic, and here are our thoughts. He works in a retail setting, and the first thing he mentioned when I asked him about this topic was making sure that there was only one patient label per tote. He suggested not grouping orders by drugs or by route, etc. Each prescription has its bin and existence. His next step was to make sure he had the right drug. Look-alike and sound-alike can be detrimental to your day if you aren't aware of what you are looking for. Be careful when grabbing bottles, and use different methods to ensure you have the correct medication. Safety was another important step he used when counting medications—wearing gloves when counting drugs, such as penicillin and other sulfa medications. This includes properly cleaning the area and handling the tablets to prevent residue from lofting in the air. This helps avoid any possible allergic reactions from the staff. Make sure you are aware of which drugs are alcohol-soluble versus water-soluble. Just because the work area is wiped clean doesn't mean the drug has been removed. Check the package insert to understand how to clean up the drug. Lastly, auxiliary labels are a way to help not only the staff but the patient understand the proper handling and administration of the drug and storage.
As a technician, there are some guidelines you can follow to remember when counting medication. You are not alone; always ask if you are unsure and double-check your work. Speak up if you see something wrong. There is nothing wrong with correcting a coworker respectably and professionally. A team divided is in for a long shift, but communication brings forth ease during stressful times.
1. The Five Rights: A Destination Without A Map | Institute For Safe Medication Practices
2. Policy 100.081 Avoiding "Look-Alike/Sound-Alike" Medication Errors (vchca.org)