u/Busynotes2

With less than 2 years of experience, and I work a lot of solo coverage, so this situation has honestly been weighing on me a bit. I feel pretty dumb for not catching it immediately, but this is the first time I’ve run into something like this and I’m trying to learn from it.

One of my technicians received a call from a prescriber’s office stating that their e-prescribing system was down. My technician told them to send a facsimile transmission of the prescription over to us.

We later received a facsimile transmission of a prescription for a Schedule II controlled substance (Vyvanse). It had a prescriber signature and initially looked valid, so it was verified in the system. Before any actual filling/processing started, I realized facsimile transmissions for Schedule II prescriptions generally aren’t valid in outpatient retail unless specific exceptions apply (LTC, hospice, etc.). I stopped the process before anything was filled or dispensed.

My questions: If a Schedule II prescription is verified but stopped before filling even begins, is that considered any type of violation? Is this typically treated as a near-miss / workflow interception since no medication was prepared or dispensed?

And a related question: If this had been inadvertently filled and dispensed to the patient before the issue was caught, what would the consequences usually look like? For the pharmacist involved? And how serious is a one-time incident like this versus a repeated pattern? Just trying to understand where the regulatory line is in real-world practice between verification, filling, and actual dispensing, and what the risk level looks like if something slips through. Appreciate any insight from people who’ve dealt with similar situations.

Last Friday, the hazardous waste vendor arrived approximately an hour and a half before closing. They completed the initial documentation on their laptop before 6:20 PM but did not return after 7:00 PM with the finalized paperwork.

During the visit, one of the vendor representatives asked me to confirm the quantity for a controlled substance solution spill—specifically whether it should be recorded as 1 oz, 102 mL, or 1 mL. On the waste log, I documented 1 oz and verbally confirmed that this was the correct amount. This was my first experience handling a controlled substance solution spill situation, and I viewed it as a learning opportunity.

At the end of the day, I was in a bit of a rush and quickly signed off on the paperwork after verifying the NDC.

Today, I noticed that the entry was recorded as 1 mL for the controlled substance solution, despite my confirmation that it should be 1 oz.

I would appreciate any guidance on how best to handle or correct this situation moving forward, as I want to ensure accuracy and follow proper procedures.

Adderall 20 mg IR was originally dispensed on 4/10/2026 as 1 tablet BID, #60 for 30 days. On 4/29/2026, the prescriber increased the dose to Adderall 20 mg IR 1 tablet TID, #90 for 30 days.

My calculation: Time between fills: 4/10 → 4/29= 19 days Previous regimen: 2 capsules/day → estimated use = 19 × 2 = 38 capsules used Remaining from original fill: 60 − 38 = 22 capsules left New regimen: 3 capsules/day 22 capsules ÷ 3/day = ~7 days remaining

Based on this, I documented that the earliest fill date should be 5/4/2026. However, the prescription was processed and filled on 4/30/2026 by my manager. Subsequently, today the provider changed therapy to Adderall XR 20 mg, 1 capsule once daily.

When there is a change in frequency of the same controlled substance (e.g., BID → TID), do you typically perform a remaining-supply calculation like this to assess early refill timing? Or do you generally dispense if the prescription is updated and appears clinically appropriate without doing a full overlap/supply reconciliation?

At my current store, my manager requires the pharmacist to perform a triple count on all controlled substance prescriptions after they are filled. In contrast, my previous manager was comfortable with technicians double-counting CIII–CV medications, while CII prescriptions were double-counted by technicians and then verified by the pharmacist with a third count and a back count of the stock bottle.

I find the current expectation somewhat frustrating at times, especially when it involves hazardous controlled substances like clonazepam.

In another pharmacy I’ve worked in, the process was different and more streamlined: technicians were responsible for back-counting the stock bottle and documenting the remaining quantity directly on the bottle after completing their double count. The pharmacist’s role was then primarily to verify that the physical inventory matched the system count in the computer CIII-CV.

What is the standard practice at your pharmacy for controlled substance verification and counts?

A couple situations at work recently have me second-guessing things, and I’m curious how other pharmacists would’ve handled them. A few days ago, I was counseling a father on nexium 10 mg packets for his 2-month-old baby. The directions were to mix 1 packet once daily. During counseling, I asked for the baby’s weight and he told me 3.7 kg. I then checked the prescription again and noticed the weight was also listed on the script that had already been verified by my manager.

The dose immediately seemed off to me. Since the prescriber’s office was already closed, I told the father to hold off on giving it and that I would contact the office first thing the next morning. I called the next day, recommended adjusting it to nexium 2.5 mg, and the office sent over a new prescription. Thankfully, the parents were very understanding.

In another situation, I was verifying two Focalin prescriptions for a 15-year-old patient. She had been on 40 mg ER daily for almost a year. Last month, her provider increased her to 60 mg ER daily, which my manager had previously verified and dispensed. When I checked dosing references, I saw that the typical max pediatric dose is 30 mg/day, and in some cases with close monitoring, it can go up to 50 mg/day.

I called the provider to discuss my concerns and recommended considering an alternative plan, but he kept asking why we had dispensed the same dose last month without issue. I explained that I was not comfortable verifying the prescription as written. He ultimately said he would send the prescriptions to a different pharmacy.

As a pharmacist with almost 2 years of experience, situations like these make me second-guess things. Sometimes I worry my manager may not be consistently catching dosing issues, which puts extra pressure on me.

If I hadn’t caught the nexium dose issue and the baby had been harmed, who would typically be held responsible in a situation like this? What would you have done differently in either of these scenarios? The verifying pharmacist or the pharmacist who provided the counseling?

What would you have done differently in either of these scenarios?