The phrase “when will I ever use this in real life” often finds itself proven wrong in healthcare, as numerous components of long-lost thoughts creep back into the typical workflows. Calculations is one of those most wish they could still forget, but are very important in every day processes in pharmacy. This section will go over the most common of these that typically occur on a daily basis, with Week 4 working on more complex scenarios.
At the foremost aspect of nearly every action operated in the pharmacy is one of ultimate patient safety — calculations are of no exception to this rule. If medication doses are incorrectly calculated through any component of prescription preparation and/or processing, patients could experience severe complications – potentially even death. At the easiest, patients do not receive enough medication for the action, and an uncomfortable scenario is not completely covered (like a low dose of a medication to treat a headache doesn’t alleviate the headache). However, providing 10 or 100 times the dose of more severe medications (like blood thinning agents, opiate-based pain medications, blood pressure medications, etc.) can lead to one or more failures of essential systems, causing organ failure and likely death.
Calculations are also important to third-party payer systems to ensure proper billing procedures are performed for fair and proper financial calculations. For instance, calculating a medication that should last for 3 months as a 1 month prescription, the patient may pay a lesser coinsurance payment than contractually due for the 3 month’s worth of medication, and the third-party payer system ends up paying excess for the medication than was contractually required. Some payers see this as an abuse or fraudulent scenario, and will demand financial payment in return to correct their overpayment, and potentially fine the pharmacy for the error.
Another third-party payer system error involving calculations could be appropriate dosing guidelines set forth by payer systems. For instance, if a medication is said to not be taken more than twice a day, and the prescription is processed for an equivalent dose of three units daily, the payer may create a rejection stating the medication is beyond their established proper dosing formulary guideline. This may create excess and unnecessary work on behalf of the pharmacy personnel, third-party payer personnel, and potentially even prescriber’s office personnel unnecessarily working on prior authorizations or attempting to determine what is the appropriate formulary restriction to be corrected. Besides this component, if it is improperly calculated for an extended period of time, the patient may go unnecessarily without treatment – which could cause more issues and concerns depending on the length of time and original diagnosis.
Financial systems are also in place to gain the pharmacy’s most appropriate and top profit per unit of medication. If improper calculations are made and inventory levels are affected (improper counting, improper dispensing versus processing, etc.) could lead to incorrect inventory values for medications. These will not only affect financial ability of the pharmacy depending on the potential loss of medication not properly billed and paid, but can also lead to patients suffering from last-minute needs not being able to be processed due to expected inventory not available for dispensing. If more is billed than dispensed, then there has been a case of abuse and fraud created, which could be found as a guilty component of violating one or more state and federal laws.
All in all, patient safety is of utmost concern and can depend upon proper calculations at various steps of prescription processing and preparation. The main key to keep in mind is that if you are not 100% certain of your calculations, ask around as there is somebody who can assist with those, even if that is only the pharmacist on duty that day. This section will dive deeper into the common calculations, and next week’s section even more complex, but there will be additional components not covered here that arise due to unique scenarios, new therapies, and even more complex aspects of healthcare calculations that will not be covered here.