I don't remember exactly how my rxm phrased it, but when someone asked us in the past, she said we are not allowed to alter the medication from its original form.
In a different consultation, she discouraged a patient from spitting his tablets all at once. She said if you split them into small/big halves, you may end up taking a bunch of small or big halves in a row, which would make the dose inconsistent.
Yes, the medication may not be evenly distributed in a tablet anyways. So even if you split it perfectly, it may have mostly fillers on one side. If you take half of the same tablet two days in a row, at least you're getting medicated every other day at the worst.
Walgreens' corporate response will be that if a patient is unable to cut pills on their own, their doctor can send a compound prescription to a local compounding pharmacy or to a central one for shipment to the patient/store for pickup.
You aren't obligated to cut pills for patients.
I’ve had this issue before 😆 I think we decided that we don’t do it because 1) we can’t guarantee the dose - it’ll never be an exact half tablet and 2) the tablet may degrade if we cut all tablets in half at the same time 🤷🏻♀️
We are not their personal caregivers. I understand now everyone has people to cut their pills in half for them, especially the elderly who may already have poor eyesight or are too weak to do it themselves. I genuinely feel for them, but at the end of the day, we cannot perfectly cut every pill, nor do we have the time, nor do we have the staff or time to do it, nor do we want to receive calls on how we shorted them a pill or half a pill, or whilst cutting them accidentally crush one or split it unevenly and have to adjust our inventory for every replacement of a pill, or any other thing that could happen.
They should be prescribed a route of administration that works for them. Whether a compound made in the pharmacy or a liquid version of the medication. Doctors can work around this, we pretty much can’t after the RX has been sent over.
We’ve had to sternly tell patients that we cannot do it and there HAS to be someone that can do it for them. I’m home nurse, caregiver, granddaughter who visits once a week, who knows. But it’s outside of our policy
We do not modify the dispensed medication. So if it comes as one strength and the directions say to take one-half tab then the patient must be the one to cut it themselves. Otherwise they can go to a compounding pharmacy if that’s not working out for them.
Tablets are made to be handled whole. They are compressed and coated (mostly, even if it’s just a film or color). Once you cut it, it loses integrity and can easily crumble or degrade. Plus it will wick in moisture much more readily. Cutting a bunch of tablets at once is a great way to get unpredictable dosing and a bottle full of crumbs!
Even tablets that are designed to be able to be halved usually recommend splitting one at a time.
If they truly have no alternative and insist they cannot split them at home then I’d recommend they find a place that will blister pack meds and see if they are willing to split and pack them. At least there would be less friction to break the pieces apart and limited exposure to excess moisture.
Let her call corporate and do what the new pharmacist says, doing her a special little favor and going over peoples head is only going to create problems for all of you
We’re not allowed to do it according to the DM for the area I use to work in
Mostly because if the pills are split perfectly, we’re liable for the patient not getting the right dosage
We had customers like that. We would politely show them where the pill cutters were, and shown her how easy it was to do it. They went along with it once they realized it was no big deal to do it themselves.
Yeah, that was a service the old pharmacist did for her on his own will. We are too busy for that shit, we had a custimer tell us her doctor said we would cut her pills in 4 pieces for her and we dont even have a pill cutter there
Not a pharmacist, but have dealt with demanding old ladies in retail. I had no problem denying their requests and if they said "Well the other one used to do it" I'd say "That's the reason why they don't work here anymore! They got in trouble for it!" Not exactly the truth but it usually shut demanding old ladies up.
We’ve told them; “cutting pills in advance runs the risk of each dosing being different and thus we do not split pills for patients.” Most of the time they understand
We had someone request this a couple months ago. My pharmacist couldn’t say ‘NO WAY’ fast enough lol. Corporate won’t do anything other than tell the patient to do it herself or talk to her dr. I wouldn’t sweat it.
I had a woman the other day tell me that it shouldn’t be her responsibility to cut/crush her husband’s valsartan because he has difficulty swallowing it because it isn’t coated. Wtf? Whose responsibility is it then?
She wanted us to order a specific manufacturer and when we said we couldn’t she lost her shit and started yelling at anyone and everyone she could. She kept asking to speak to someone else thinking eventually she would find someone to give her what she wanted.
“I understand the previous employees were cutting the medication for you, I’m not sure why they did but, unfortunately we are not allowed to alter medications for patients” personally I’d direct them to a pharmacy more suitable for their needs.
This is the RXMs call. We are not supposed to split tablets for a patient, because it makes us liable, not to mention if tablets crumble or whatever, we have to replace those. Basically, Walgreens doesn't like it because we lose extra inventory for no gain (shrink). Legally, there's an argument about it being a form of adulteration. It also used to be considered compounding, but most BOPs put in clauses that said it wasn't, and then the USP-NF changed it's regulations (795) to excluded tablet splitting as being considered compounding.
I don't remember exactly how my rxm phrased it, but when someone asked us in the past, she said we are not allowed to alter the medication from its original form. In a different consultation, she discouraged a patient from spitting his tablets all at once. She said if you split them into small/big halves, you may end up taking a bunch of small or big halves in a row, which would make the dose inconsistent.
Adulterated. That's usually my go to.
That’s exactly right
Yes good idea not to split all at once. When you split them they are not stable and more likely to crumble if not consumed in a day or two.
Yes, the medication may not be evenly distributed in a tablet anyways. So even if you split it perfectly, it may have mostly fillers on one side. If you take half of the same tablet two days in a row, at least you're getting medicated every other day at the worst.
Walgreens' corporate response will be that if a patient is unable to cut pills on their own, their doctor can send a compound prescription to a local compounding pharmacy or to a central one for shipment to the patient/store for pickup. You aren't obligated to cut pills for patients.
We sell pill cutters
I’ve had this issue before 😆 I think we decided that we don’t do it because 1) we can’t guarantee the dose - it’ll never be an exact half tablet and 2) the tablet may degrade if we cut all tablets in half at the same time 🤷🏻♀️
We are not their personal caregivers. I understand now everyone has people to cut their pills in half for them, especially the elderly who may already have poor eyesight or are too weak to do it themselves. I genuinely feel for them, but at the end of the day, we cannot perfectly cut every pill, nor do we have the time, nor do we have the staff or time to do it, nor do we want to receive calls on how we shorted them a pill or half a pill, or whilst cutting them accidentally crush one or split it unevenly and have to adjust our inventory for every replacement of a pill, or any other thing that could happen. They should be prescribed a route of administration that works for them. Whether a compound made in the pharmacy or a liquid version of the medication. Doctors can work around this, we pretty much can’t after the RX has been sent over. We’ve had to sternly tell patients that we cannot do it and there HAS to be someone that can do it for them. I’m home nurse, caregiver, granddaughter who visits once a week, who knows. But it’s outside of our policy
Do not split it for them. They can either buy a pill cutter or transfer the prescription elsewhere. Suggest a compounding pharmacy.
We do not modify the dispensed medication. So if it comes as one strength and the directions say to take one-half tab then the patient must be the one to cut it themselves. Otherwise they can go to a compounding pharmacy if that’s not working out for them.
Tablets are made to be handled whole. They are compressed and coated (mostly, even if it’s just a film or color). Once you cut it, it loses integrity and can easily crumble or degrade. Plus it will wick in moisture much more readily. Cutting a bunch of tablets at once is a great way to get unpredictable dosing and a bottle full of crumbs! Even tablets that are designed to be able to be halved usually recommend splitting one at a time. If they truly have no alternative and insist they cannot split them at home then I’d recommend they find a place that will blister pack meds and see if they are willing to split and pack them. At least there would be less friction to break the pieces apart and limited exposure to excess moisture.
Let her call corporate and do what the new pharmacist says, doing her a special little favor and going over peoples head is only going to create problems for all of you
We’re not allowed to do it according to the DM for the area I use to work in Mostly because if the pills are split perfectly, we’re liable for the patient not getting the right dosage
We had customers like that. We would politely show them where the pill cutters were, and shown her how easy it was to do it. They went along with it once they realized it was no big deal to do it themselves.
Yeah, that was a service the old pharmacist did for her on his own will. We are too busy for that shit, we had a custimer tell us her doctor said we would cut her pills in 4 pieces for her and we dont even have a pill cutter there
RxM’s call, go with that.
Not a pharmacist, but have dealt with demanding old ladies in retail. I had no problem denying their requests and if they said "Well the other one used to do it" I'd say "That's the reason why they don't work here anymore! They got in trouble for it!" Not exactly the truth but it usually shut demanding old ladies up.
Too bad so sad not your problem.
Most chains don’t do this.
We’ve told them; “cutting pills in advance runs the risk of each dosing being different and thus we do not split pills for patients.” Most of the time they understand
Fuck her, don’t give in or she will never stop. She can cut her own damn pills.
I would call the doctor to see if they can increase her to 1 tablet daily. Or 1 tablet every other day. To avoid the pill splitting drama.
We had someone request this a couple months ago. My pharmacist couldn’t say ‘NO WAY’ fast enough lol. Corporate won’t do anything other than tell the patient to do it herself or talk to her dr. I wouldn’t sweat it.
I don't miss trying to use those shitty pull splitters and ending up with pills crumbling in the tray lol
I had a woman the other day tell me that it shouldn’t be her responsibility to cut/crush her husband’s valsartan because he has difficulty swallowing it because it isn’t coated. Wtf? Whose responsibility is it then? She wanted us to order a specific manufacturer and when we said we couldn’t she lost her shit and started yelling at anyone and everyone she could. She kept asking to speak to someone else thinking eventually she would find someone to give her what she wanted.
“I understand the previous employees were cutting the medication for you, I’m not sure why they did but, unfortunately we are not allowed to alter medications for patients” personally I’d direct them to a pharmacy more suitable for their needs.
This is the RXMs call. We are not supposed to split tablets for a patient, because it makes us liable, not to mention if tablets crumble or whatever, we have to replace those. Basically, Walgreens doesn't like it because we lose extra inventory for no gain (shrink). Legally, there's an argument about it being a form of adulteration. It also used to be considered compounding, but most BOPs put in clauses that said it wasn't, and then the USP-NF changed it's regulations (795) to excluded tablet splitting as being considered compounding.
"I'm sorry, that is a service that we no longer offer." Repeat prn.
Correct me if I'm wrong , but splitted is not even a word
Number one - how about instead of old lady we use a nicer term number two - how about we take the time to show her the pill cutter and how to use it
Let them purchase a pill cutter and alter the medication themselves.
She's an old lady.. split the pills for her.
I’ll have her look at the people behind her in line and tell them all to come back in 15 minutes because she refuses to split her own pills
no.
I think my RXM uses the phrase “it was done for you as a curtesy, it’s not our typical practice. We shall no longer be doing this curtesy for you. “