The Pharmacy Chick

Flying the coup in retail

RIP Old man

Filed under: Uncategorized — pharmacychick at 6:57 am on Saturday, April 2, 2016

Saying goodbye to your dog is never easy and no matter how many times you have done it, the process sucks just as much.  Old man decided on April Fools, to make no joke about it and said goodbye.  He enjoyed his breakfast, spent the day with his buddies in the yard, and when Mr chick came home from work, he slowly lumbered into the house and laid down…and made it clear it was enough.

A heart can only last so long, especially when its so tired and inefficient.  Mr Chick took him to the same caring loving vet that had performed the miracle spleen surgery on him a few years ago. He remembered him immediately…called him a miracle dog.  I made it after work just in time to hold the boy and say goodbye.

I can hardly see the screen to write..Goodbye Old Man, you were loved

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An old dog, another goodbye on the horizon

Filed under: Uncategorized — pharmacychick at 5:23 pm on Monday, March 28, 2016

The hardest thing I have to do in my current existence is say goodbye to a dog.  It causes my heart to break into hundred pieces and I can feel the cracking starting already.  I have old dogs.  I have written about my favorite girl who died from  Hepatocutaneous syndrome 2 years ago.  It still aches my heart to know she was too young when she died and there wasn’t anything I could do.

My current pack is 3.  Love them all for each of their own special characteristics.  I have a blind dog that I took in as a “temporary” foster…2 years ago. He was tied to a pole outside and left to sleep in a barrel.   I took in an old dog, nearly deaf as a “temporary” foster 4 years ago.   He was dumped at a kill shelter when his owner died.  They are mine now :-) Seems Temporary has a new definition in the Pharmacy Chick household.  My third dog I raised from a pup. She will be 13 later this year, and she is my little old lady.  2 boys and a girl and something tells me that my trio will be a duo or even a single before years end.   My ” old man” as I call him is of unknown age.  When he arrived 4 years ago, we were told he was already 12 or 13.  That was obviously wrong because my breed of dog barely makes it to 13 let along 17 which he might be now.  By his appearance ill guess he is about 13 NOW.   He had a massive tumor removed from his spleen shortly after we got him.He has suffered from a chronic cough from the day we took him in.

Old Man is going to the vet tomorrow again, hopefully not for the last time.  He has been on my mind and heart a lot lately.  He has a myriad of health issues that seemingly defy diagnoses.  But I think we have one…Idiopathic Laryngeal paralysis.  He fits all the criteria and he also has a highly significant heart murmur that impedes his blood flow.  His back legs have atrophied from possible progressive nerve damage and he exhausts himself from the coughing that comes from both the ILP and the murmur. Poor thing, the only time he is at rest is when he sleeps, which is alway in short bursts and for too short of time.   WE have had to sleep with ear plugs in not to be awakened 15 times a night from the coughing. Its tough for us to watch but tougher on him too endure I suppose.   He could have surgery ..again, but his advanced age makes it a challenge for anesthesia. He struggles up and down stairs some days and other days he does well.  The last two days have been hellish on the Old Man.

Decisions decisions….Oh How I hate these days…

The refill box..extinct or not?

Filed under: Uncategorized — pharmacychick at 4:53 pm on Monday, March 28, 2016

ONE , if not THE most frustrating chore of each and every day in the pharmacy is the infamous refill box…that alphabetical list of pages…each of which represents unfinished work….prescriptions with ZERO refills that have been sent to the Dr’s office for approval.  Its always a work in progress.  Every request 1 page goes in….every approval, one page comes back out and into the trash.  Never in 30 years of practicing pharmacy have I ever had an empty box.

Every evening near the end of the day we go thru the box, pulling pages that we may have forgotten to pull earlier and refaxing everything that has been there for 48 hours.  I prefer to refax every 24 hours but I get too many crabby Dr offices sending me nasty notes demanding 72 hours for refill authorizations.  Well ,I don’t get 72 hours to fill a prescription, why do YOU need 72 hours to authorize one?    It takes my techs 30 min or more to comb thru the box, clean it out and fax the remaining content.  Thats a significant amount of time devoted daily….MON-FRI.  Sat and sunday get a pass because we fax on friday night for all things left over on the weekend.

A while back..quite awhile… I had dinner with a pharmacist friend of mine who stated he had dumped his refill box entirely.  He said he decided his and his staff’s time was too valuable to be messing around with the refill box.  One night he tossed the whole thing in the trash.   I asked how he managed to pull that off.  He said ” simple”. “Once its FAXED or E-SCRIPTED, its in the dr.’s office. Im done with it.  I don’t care what happens after that, its THEIR responsibility to ok it or the patients responsibility to ask the dr why its NOT”. He said he made an effort to educate his patients that he no longer took the refill box, and if they wanted to inquire why an rx is not ready, he would verify it went to the office  and refer patients there.  He said it took about 3 months before everyone was aware and on board of the process and with a few bumps and painful moments it has finally managed to take hold.

He said,  “I don’t have 3+ hours a week to devote to the small percentage of  prescriptions I gain by hounding the drs to ok them. I don’t feel its cost effective to use that labor.”

It made sense but I haven’t had the guts to make the dump yet.  It may come sooner than later.  We have been told that we are getting a new computer system.  reading the guidelines and procedure manual I see that the procedures do not include a refill box.  It states. ” Once the refill has been verified as “sent”  it should be discarded.”   WHOA…

There is something I hold on to when I have the knowledge that I have sent a refill– I have the date and time in front of me–and my notes as to 2nd or even 3rd fax. Throwing that to the 4 winds makes me nervous.  No more second faxes..NO more tracking.  Just send and pitch.  Sounds great..until Joe Customer gets pissy when his rx was never okayed…and blames me for not “doing my job and following up” Fact of the matter is I can ASK a dr for an ok, but I cannot demand it.

I think for now Ill keep my box until I get the gut enough to say goodbye to it.

The United States of Oxy

Filed under: Uncategorized — pharmacychick at 4:20 pm on Monday, March 14, 2016

A recent publication in the Wall Street Journal (very timely) illustrates the blog post I wrote about recently about our rampant abuse and misuse of opiates in the United States.  The title of this blog is merely a quote from Senator Edward Markey ” we have become the United States of Oxy”.

Overdose deaths due to Opiates have tripled from 2000 to 2014. The most recent data is 28647 deaths due to opiates.  61% of all overdoses were related to opiates alone.   This factoid however wasn’t the one that concerned ( or shocked) me the most.  This one did:  ( and I am going to Bold face it to emphasize it).  “Americans consume 80% of the global opiate supply despite making up less than 5% of the world’s population” 

Does that shock you?  It should.  It should also sicken you.

We ( Americans) have a drug problem.  We do not have a pain management problem.  We do not have an illness problem. WE HAVE A DRUG PROBLEM  Do you think for that 95 percent of the worlds population do not have back, neck, shoulder, WHATEVER injuries or pain??   What makes us unique to consuming 80% of the  worlds opiates when we are only 5% of the population?

I don’t have the answer.  But I do believe wholeheartedly that we certainly do NOT need to be consuming 80% of all global opiates.  We have too many people wanting opiates to avoid withdrawal, using opiates for inappropriate uses, using opiates in excess and for recreational uses.

Its a bit of an embarrassment to lead the world in this kind of statistic.  The legislation recently passed in the Senate hopes to curb such abuse but its a losing battle when its done on that end.  It needs to start at the Dr’s office.   If you want to read the article you can possibly look online under the Wall street Journal, but most of the time you have to be a subscriber to read it.

http://www.wsj.com/articles/senate-passes-bill-to-fight-u-s-opioid-epidemic-1457633374

 

 

Misuse and Abuse. A growing issue

Filed under: Uncategorized — pharmacychick at 5:29 pm on Tuesday, February 16, 2016

Misuse and Abuse..Dur (drug utilization reviews for the TLA deficient), CMR, Fraud Waste and abuse..All of these are hot terms in pharmacy right now.  Between Boards of Pharmacy, CMS and PBM’s we are attacked on all sides by agencies trying to monitor what we dispense, who we dispense to, how much we dispense and how often we dispense it. More often than not it focuses on controlled substances and expensive drugs…they can levy hefty fines and chargebacks on these.

What that means is that pharmacists now get to don the hat of compliance officer and policeman. It used to be that Overuse was the only thing that we would get harassed about by agencies, but any type of misuse or abuse is monitored  by our overlords.

Misuse is not only over use of a medication. Its any deviation from the directions provided by the prescriber.  This also includes under utilization, or use for any condition for which it wasn’t prescribed.( off label use)

Everyone has misused a drug at some time or another.  I had a bad cough 2 months ago and my doc was being a real pill and wanted an appointment to be seen and it was nearly a week away… IN the mean time Im hacking my guts out.  I had some old vicodin from a shoulder injury so I used it for my cough.  Technically misuse but it worked like a charm.  I occasionally forget to take my cholesterol med, thats technically misuse also.

Recently we received notification that all controlled substances WILL ( not should) but WILL be monitored for misuse and abuse. Days supply will be checked and monitored and days between refills will be reviewed and monitored for accuracy.  What this means is that someone is watching our dispensing of controlled substances.  Opiate abuse is rampant in the United states and the pharmacist is the infantryman trying to do battle from both sides. Customers who need ( or want) their pain meds for genuine need or abuse..and doctors who feel compelled to keep writing scripts despite admonitions from agencies  who ask them to refrain or reduce prescriptions.

Personally, the only reason I care about this subject is a piece of paper on the wall called my license.  I value that license because it pays my bills each and every month.  without it, I cannot come into the pharmacy and make a living.  If I dispense narcotics or any controlled substances  outside proper procedures I can lose that license.   I wrote a piece a long time ago called” Cash is not Carte Blanche” and to this very day I get people ripping me a new a$$hole because they think I am a judgmental whore for not giving narcotics to everyone who claims to need them.   Read the entire post and substitute Zestril for Norco in it and see if you have the same reaction.  All early refills need justification and just because he wanted to pay cash doesn’t mean he gets the refill….and it doesn’t matter the drug except for the fact the 1 is controlled and the other is not. Nevertheless, the actual content of the post got completely lost by commenters getting pissed, all of whom I am guessing take opiates. Why else would you if you didn’t?

let me share some some factoids: cut and pasted from the American Society of Addiction Medicine ASAM.org Opiate addiction 2016 facts and figures

 

Opioid Addiction

  •   Opioids are a class of drugs that include the illicit drug heroin as well as the licit prescription pain relievers oxycodone, hydrocodone, codeine, morphine, fentanyl and others.
  •   Opioids are chemically related and interact with opioid receptors on nerve cells in the brain and nervous system to produce pleasurable effects and relieve pain.
  •   Addiction is a primary, chronic and relapsing brain disease characterized by an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
  •   Of the 21.5 million Americans 12 or older that had a substance use disorder in 2014, 1.9 million had a substance use disorder involving prescription pain relievers and 586,000 had a substance use disorder involving heroin.
  •   It is estimated that 23% of individuals who use heroin develop opioid addictio.4 National Opioid Overdose Epidemic
  •   Drug overdose is the leading cause of accidental death in the US, with 47,055 lethal drug overdoses in 2014. Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to prescription pain relievers, and 10,574 overdose deaths related to heroin in 2014
  •   From 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel. The overdose death rate in 2008 was nearly four times the 1999 rate.  In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills.  Four in five new heroin users started out misusing prescription painkillers. As a consequence,the rate of heroin overdose deaths nearly quadrupled from 2000 to 2013. During this 14-year period, the rate of heroin overdose showed an average increase of 6% per year from 2000 to 2010, followed by a larger average increase of 37% per year from 2010 to 2013.
    •   94% of respondents in a 2014 survey of people in treatment for opioid addiction said they chose to use heroin because prescription opioids were “far more expensive and harder to obtain.”Impact on Special PopulationsAdolescents (12 to 17 years old)
      •   In 2014, 467,000 adolescents were current nonmedical users of pain reliever, with 168,000 having an addiction to prescription pain relievers.
      •   In 2014, an estimated 28,000 adolescents had used heroin in the past year, and an estimated 16,000 were current heroin users. Additionally, an estimated 18,000 adolescents had heroin a heroin use disorder in 2014.
      •   People often share their unused pain relievers, unaware of the dangers of nonmedical opioid use. Most adolescents who misuse prescription pain relievers are given them for free by a friend or relative.
      •   The prescribing rates for prescription opioids among adolescents and young adults nearly doubled from 1994 to 2007

     Women are more likely to have chronic pain, be prescribed prescription pain relievers, be given higher doses, and use them for longer time periods than men. Women may become dependent on prescription pain relievers more quickly than men.

    _______________________________

    Ive come to the realization that most of the people who get hot and bothered over this subject come across as narcissistic  soap boxers who might just as well wear a shirt that says ” narcotic takers lives matter”..since they seem to get all puffed up anytime this subject is broached. They seem to believe that 1) we are the judge and jury in the pharmacy  and 2) we look all day for opportunities to deny people their meds. Of course if the said person were to OD and die as 18893 people did in 2014, I am sure I would be first to be sued by some family  member wanting blood for the death of their “loved” one because I filled their med early/too often/inappropriately.

Lets look at those two assumptions:  Judge and Jury:  In my pharmacy I have 2 rather large documents: the first is the policy and procedure manual of my business…a rotund tome of over 300 pages.  I also have the Federal and State laws governing pharmacy printed in a enormous binder.  It looks somewhat like a printed version of the US TAX CODE in its size and complexity.  THESE two documents are my judge and jury.   They detail what I do, how I do it and the penalties for doing what I am not supposed to do and NOT doing what I am supposed to do.    And tho I do not have physical copies of these in my pharmacy I am also subject to rules of CMS ( center for Medicare/Medicaid Services)  and nearly every insurance company that we do business with.   Deciding ON my own when to refill a prescription is pretty low on this list.   Using ” good judgement” is pretty much pre-decided often by a governing agency, the insurer or the prescriber him/herself.

Assumption 2: we look all day for opportunities to deny meds:  HAHAHAHAHA.  As if I don’t have enough on my plate.  The goal for every rx I have is simple.  Fill it to completion without a hassle and get YOU out of my pharmacy ASAP with all the necessary tools and information required by law.  Discovering a rx is too early is one of those hassles I didn’t need and didn’t ask for.  No pharmacist goes home at night revelling in the joy of rx’s turned away.  We also don’t spend much time mourning over the plight of all our patients any more than YOU as a patient are concerned about the working conditions/mood/heath/life of the pharmacist you handed your rx to. Its a JOB….a Vocation we have to make money and supply a life for our family.  Its not our passion or obsession …at least not for any pharmacist I have met who have practiced for a few years. To think that we have some kind of vested interest or enjoyment in keeping meds OUT of the hands of the people who should have them is another narcissistic tendency.

For anyone who has bothered to read this far I applaud you.  type ” I read it all” in the comments line to prove it LOL

In summary, its rather simple..here are the rules of engagement for  Opiates/benzodiazepines and any other controlled substance we dispense to keep us all on the right size of compliance officers and the law:

  1. WE, the courts and the govt use the hard copy directions as a legal document and we are all are bound to that document. If 90 tabs are given to a patient as a 30 days supply then its  to last 30 days . If a patient comes in 8 days early for a refill or ask for a new rx from the doc then he/she best be able to produce 8 days worth of meds to show the doc if he were to ask or have new directions to support that change.  Ive got several docs in my area now who will refuse to even  issue the next rx till 30 days have passed. Most will put a fill date on these rx’s. They aren’t all idiots just because some behave that way
  2. regulatory agencies are narrowing in on overprescribing and inappropriate prescribing of all controlled drugs.  We have to watch our backs, and if that means telling a patient that we aren’t going to fill a controlled substance early then so be it.
  3. As a patient, do not engage in behavior that would lead your physician /pharmacist/nurse/insurer to assume that you are abusing or misusing a drug.  This includes but not exclusive to: a) taking more medication that is currently prescribed on the label you have on the bottle  b) finding creative ways to get more ” oh I fell last night”  ” I turned my ankle” ” I slipped on the wet floor” excuses have a way of adding up. c) losing meds more than once ” they were stolen on the bus” ” they dropped down the sink” .  Treat your meds like cash.  Would you be careful if you had a handful of 20 dollar bills? and d) going to multiple places and urgent care looking for pain treatments.
  4. if your health deteriorates where you feel you need to increase your doses, you must do it with the permission and cooperation of your prescriber.  You are not autonomous in deciding what is right for your body when it comes to pain management.  Its a team effort and adding more medication may not be the right solution.
  5. Don’t use verbal threats or become argumentative with any of your health care professionals. Thats pretty  much a guarantee that you aren’t going to get any cooperation from any of us.  There are certain red flag behaviors we have been taught to look for and defensive and argumentative behavior is one of those items.
  6. Physicians: use your states Prescription Drug monitoring program if you have one. Any patient presenting “pain” that isn’t obviously quantified with a trauma should be looked up and examined for controlled substances. Any patient who receives regular opiates should also use other modalities to treat and monitor pain. “Just take one more” is not an appropriate modality. Don’t overprescribe opiates.  For instance. Mr Chick received 90 oxycodone for his back surgery and 30 percocet for his appendix removal. Both physicians said ” you shouldnt have too much pain, but here is a prescription.  REALLY was that necessary?  He took 8 oxycodone over first 3 days and that was all he needed.
  7. Pharmacists, its simple math, not an ethics dilemma.  If the patient is supposed to have meds to last 30 days and they are coming in any more than 1-2 days early, then its reasonable to assume that they should have at least 1-2 days left. IF they ask for an  early fill, its more than acceptable to ask the doctor for permission or a reason to document for legal. Leave emotion out of it.  If the patient claims they are out then its really not your problem. Again, its simple math. Now it becomes an issue for the dr and the patient to work out as to why what was given to the patient “ran out”.  90 tabs  at 1 tab 3 times daily will never be anything but 30 days.  its just math. Thats the great thing about math, its not subjective….
  8. lastly, understand that it IS ALL health care professionals “business” to know why patients take their medication.  I get really tired of being insulted by patients and some clinics when I am forced to question a prescription and be told ” This is between me an the patient” or ” Its none of your business”.  Well yes it is…its is very  much my business. And if you question that statement, let me have the DEA , the Board of Pharmacy, your insurer  or the families of the 18,893 people who died of opiate overdose in 2014 explain it to you.

One Wild weekend

Filed under: Uncategorized — pharmacychick at 6:31 pm on Tuesday, January 19, 2016

I wish I could say that my past weekend involved scantily clad ME next to a pool with an umbrella in my drink or 18 holes in a sunny resort.  That would be just too easy. No.  My weekend started with Mr Chick coming home from work and doing his very  normal and usual routine….eating dinner out of the fridge.

Let me start by saying that when we both work, the last thing I want do to is cook so I grab something quick from the fridge and so does he. I had  arrived home before he and I had snacked on something.  He grabbed some leftovers and chowed it down and sat on the couch to watch some TV.  About an hour later his face was all screwed up and he was complaining about having a stomach ache.

“Surely it wasn’t your dinner…it was fresh leftovers”.  “no, I think I ate something NOT so fresh at lunch” When asked WHAT it was, he said he had used a pretty old packet of ranch dressing from his work fridge.  When asked HOW old, he said…”I dunno, 8 months?”.Oh Gawd…  So true to form about 2 hours later he barfed up everything…and then some.   Food poisoning.  Nice. But instead of feeling better after barfing up all the offending food, he continued to puke all night long and into the next am.  Nobody got any sleep..I mean who sleeps when your spouse is dry heaving every 15 min? He emerged the next morning looking worse for wear ( we both did frankly) and  he parked his butt on the couch and watched football, eating nothing but 2 crackers and some water.  He never felt any better so my thoughts moved to NORO virus.  He had just had his first colonoscopy so maybe he had been infected with all that pooping the previous couple of days…But it didn’t get better.

He disappeared up stairs for a while and when he didn’t come down I went to check on him and found him in bed curled up in a fetal position.  “Ive never been in this much pain” ” Well you did barf  hundred times last night, your  muscles are fried”. And I went back down stairs. 15 minutes passed and he hobbled half way down the stairs and said ” I think I need to go to the urgent care”.  Now Mr chick is known for having the “worst colds” and maybe being a little wimpy in the illness department but at no time in our 30 years of marriage has he announced that he wants to go to the hospital. “I think I may have appendicitis”..” all the pain is right here” as he points to is lower right side…

Well Shit damn hell.

If thats the case, we ARENT going to urgent care. We are going to the Emergency Room.  7 pm.

Going to the ED is a bit of a crap shoot.  You can sit there in agony for hours behind every Tom Dick and Harriet or you can be seen right away.  I prayed on the way there that we would get the latter not the former.  We all have heard stories…and I have written stories about people who use the ED as their primary care. Its a fact people so no nasty comments…There is a difference between Emergency care and Urgent care…   Graciously however it was a slow evening, we were taken in  and when they saw his agony they put him on a stretcher and wheeled him into a quiet and dark place.

After an IV was put in and some blood was taken the doc came in, did his initial work up, and thought the same thing Mr Chick did ” Sure looks like that, but we need to scan it to be sure”.   They did, and it was. They admitted him that evening and Mr Chick sent me home. “there isn’t anything you can do here, go take care of the dogs” OH yea, the dogs!  They had been tossed outside before dinner had been fed to them. It was now 9pm. He got a nice dose of Dilaudid and went to sleep.

I started texting people right and left and tried to find someone to work for me, get paperwork going for sick pay, feed the dogs, call Mr Chicks insurance for intake, get gas ( who knew I was on fumes?)AND to complicate things even more, we were going on vacation in a week…would we be able to go?? I mean everything was paid for and technically non refundable…even the golf clubs had already been shipped. So much to think about and deal with. Sleep wasn’t going to happen for me.  Where is  MY Dilaudid LOL.

Im not sure what time I eventually got to sleep but with the texts coming in from everywhere and the fact my brain was on full alert Im sure it was deep into the night. But at 6 am the alarm went off and got ready, fed the dogs and went back to the hospital.  Surgery was scheduled and Mr Chick looked only slightly better than death warmed over but fully set on hydromorphone.  As our friends rallied around me ( “its an appendix..not a cancer diagnosis” I said..but they wouldn’t be stopped..” you aren’t going to be alone”) They prepped and wheeled him away.  I am blessed with pretty awesome friends.

We played word games on our computer and I  dashed into work to check on things–” Good god woman, what are you doing here, we are fine, get back to the hospital”. … and pretty soon, my little restaurant buzzer that they gave me went off ( pretty cool technology) and he was done and in to recovery. He tends to wake up pretty slowly so an hour and a half went by before the buzzer went off a second time telling me he was going back to his room.

By the time we got there he was awake and the first thing he said was ” Wow, I feel so much better, I have no pain at all”

Well I guess that was a sign of a successful surgery. Believe it or not, we were in the car going home by 7 pm that night. We could have stayed an extra night but that was just more money and Mr Chick was in a happy place with that appendix in the trash somewhere..

24 hours from ER to Home.  He’s resting comfortably ( a cliche for sure) and life is getting back to normal, and we are going on vacation saturday  morning!

Override Mania and workflow fails.

Filed under: Uncategorized — pharmacychick at 5:01 pm on Tuesday, January 5, 2016

One of the jobs that we pharmacist s have to do on a minutely basis…is the dreaded override.  As much as I love having my techs at the computer doing the “input” , its actually faster and easier if I am working the input station and they doing the count/pour/label station.  I ll do the check station and they’ll do the sell station.  I have found it works magnificent if I am doing every other station ( funny that they have 6 “stations” in our workflow model and 2 -3 employees… hmmmm. Ive tried to condense it to fewer.  The tech does the intake ( get the basic info and tell them when it will be ready..hint hint…go away for a while)…I do the typing…tech counts…I check and bag…tech sells to patient..I counsel.  Done.Simple huh?

Well PharmacyChick Pharmacy wants to start a new workflow and throw a wrench into what we have proven to work fast and efficient.  They want all the techs to do Intake…typing ( while the patient stands there–and the line grows– to get a paid claim and a price–which I absolutely abhor)……and another tech  counting…and all we do is check and sell…yes they want me to be the checker at the cash register to improve my visibility and my accessibility.  Nice. A 60 dollar an hour cashier.

Now that would be fine and dandy if the computer system that we had actually worked in a fashion that would condone such a system…but it doesn’t.

Imagine a linear ( as most are) pharmacy.  Intake is at one end way down  .hereA…………………………………………..and check and pick up is way down ……………………….here B. Im at I am at B and tech is at A.  without a doubt every single rx we have needs to have an override especially since our system has had an upgrade that requires an override to “alert” us that the patient has had that medication last month.  So if you bring in your refill for Lisinopril 10 and want a refill, the tech inputs the  number and calls me over for an override that says ” Alert: last refill date 12-7-3015 override ____code here..  So important..because no label will come out until that override is done.

So I walk 3o feet 250 times a day to do an override that I could do myself if I was at the station I believe I should be at.  Instead I am at a cash register ringing up a rx standing around whilst Mrs Ethel Frumpkin is fumbling with her checkbook ” Oh I know its in here somewhere” Or Joe “cash is” King is digging out pennies for exact change.

Tech Extraordinare will get sometime 12 windows open with overrides on each one while I am languishing at the cash register while Peter Par is sharing is most recent golf score with me..hole by hole…” and I chipped in from the bunker on 12″

They ( the powers that be that never work in  a pharmacy) say all this in in preparation for the IMPROVED ( read: undertrained and under supported computer system they are installing sometime this year) Ok. I get that.  But what good is it to use a workflow designed for computer 2 if we are using computer 1 and 1 doesn’t work the way that 2 does?

No one seems to want to answer that question.

So I tried it for a few days and decided that it doesn’t work.   Of course the boss man doesn’t like me much for going back to the way I like since he thinks we need to get ready for computer 2 and he already knows I hate to change BUT I will embrace change if it actually works for the better of the department and the patient.  To that end NONE of that is happening yet>

Some comments from customers:

” why is this taking so long? Cant I just drop this off and come back: I have an appointment”

“Ive never had to wait this long to drop off my prescription.”

” Here, ( he tosses bottle over the counter and over the head of the person in front of him), Im leaving” See you later”

And of course the non verbal…eye rolls, huffs, hands on hip, looking at watch or phone..

Yup, going back to what works…

Who ELSE would like to beat up on the pharmacist?

Filed under: Uncategorized — pharmacychick at 5:32 pm on Saturday, December 19, 2015

Its time to head back into posts about pharmacy for a bit.  Pharmacy Chick has certainly had her fill of stupid human tricks and doctor errors the last few days.  And without exception I seem to have to don boxing gloves to fend off the attacks. Am I to be everybody’s babysitter, overseer and keeper?  Shall we commence with some of the stories?

A refill comes in from a patient.(note: Patient orders this med..not me, the doc, or our autofill feature)  It needs a Doctor approval, which we get ON THE SAME DAY. We fill it, patient picks it up, goes home and calls us up and says ” you filled the wrong prescription”.  (note: WE FILLED wrong rx).  I pull hard copy and tell patient that a) patient punched in number with date and time it arrived…b) it was filled correctly by staff and c) dispensed and signed by patient.  ” What exactly did we do wrong Ma’am?”  Thats not the one I wanted.   ” That doesn’t appear to be the pharmacy’s error”.  She complains that we have POOR customer service.  How is filling her prescription exactly as she ordered it POOR CUSTOMER SERVICE?

A doctor sends in an E-script for a patient with the same drug (Prednisone) with 3 ( count them!) 3 different sigs, all slightly different, over a period of 30 minutes.  I call back to determine which pray tell is the RIGHT one? I get a snarky nurse who says ” WELL the LAST ONE ! isn’t that obvious?”  Not exactly. Maybe I should have done all 3.

A clinic sends over a E-script for a patient.  We fill it, the patients wife comes in , picks up her own and her husbands Rx ( with appropriate counseling).   Hubby calls back and says he wasn’t supposed to get this rx.  I( again, pull hard copy , verify it was for this patient) tell him that it was a new order from his doc, and if he has a question about the rx he may want to call the office…which he does and the med assistant says ” we sent no such rx to your pharmacy”…. Mama Bear goes in to full alert and contacts said Med Assistant and ask her ” why would you tell your patient that you sent ” no such rx to the pharmacy?” Because we didn’t…” would you like to see the E script you actually did send?” I produce the document…to which she says “I don’t know why we sent that”  Well it doesn’t matter why, you did. Well he doesn’t need it, you can just refund him.   “(WTF)  and shall you reimburse the pharmacy for refunding the patient for  a medication you ordered unnecessarily …and denied ordering at all?”

A Dr escripted a RX for buproprion HCL 100mg tabs. I filled it correctly.  He meant to order SR 100mg  It went to patient.  What agency should I report a med error to? If this had happened to me I’d have a report 9 pages long to account for this error.

Another Rx came in for Nortrel 0.5/35. It was NOT a refill request, it was a new order.. We filled it, but noted that it was a different dose from the 1/35 that pt had before.  Pt was counseled and I noted the dose change.  ANOTHER error from the doctors office.  Patient elected to leave rx here since she was sure it was wrong. It was. They sent over another rx in about 2 hours. No calls, no explanations, no ” hey thanks for catching that”..

A patient brought in a computer generated script from ER doc for Amoxil 250mg suspension..get this  Dispense 187.5ml give 13.1 ml bid.  WTF?  Really?  first off she is 7 years old and this is essentialy 750mg of amoxil twice daily for a 7 year old. and secondly, doesn’t anyone read these rx anyway?  Dad asked if we had chewables instead of liquid which she hated.  I asked them if they had discussed this before they left and he said  no.. ” Ill call, but it will delay the rx considerably…and the dose is pretty wonky. I need to check on that too”.  Sure enough the doc admitted he hadn’t even looked at the rx, he just signed it and changed it to chewable 25omg 1 bid # 14.   ANOTHER clinic error. At least the doc was  nice about that.. ” I better look better at these computer rxs”

A irate customer fills out a survey…this is what is wrong with OUR pharmacy and why he hates us: a) we are in the back of the store and don’t have a drive thru–well it is a grocery store sir and if you want us to remove the freezers, the  entire back room and the loading dock behind the store then we can manage that drive thru for ya. most pharmacies ARE in the back of the store. b) auto fill “never ” works. well if you call filling your prescriptions and letting them sit til they are re-shelved and ignoring your 2 reminder calls as ” never working” then ya, I guess it never works for you. and c) we are too stupid to figure out his insurance .when ya enroll in medicare, you get new insurance right?  that means you get new coverage and a NEW CARD.. which you really should give to us and not throw away. He transfers to competitor. We aren’t upset.

A man and his girlfriend bring in two rx’s from the urgent care next door. He is new but the girl said ” Ive been here before”  . Great, I collect the rx and HIS insurance info, (both medicaid patients) and I see the prescriptions, one for her and one for him. These rx from urgent care are very complete. All patient info is preprinted on the form, so I find her in the computer at a different address than he is at but verify that they are living in His address now .  I fill his but hers rejects ” coverage terminated”. I page her back but nobody comes.  Eventually they find their way back to the blood pressure machine and I say ” Connie, your insurance is terminated”….and she ignores me. I say louder ” MAAM,  I have Tom’s rx ready but yours rejected “.  She looked at me as if I had grown horns and said ” I didn’t give you a prescription”. I pick up the 2 documents they gave me and I said . “here are the two prescriptions you gave me–one for Tom and one for Connie.”  I am not Connie. and I think we only gave you one prescription.. “No, Tom gave both of these to me”. ANOTHER Dr error… The clinic gave a patient someone else’s prescription.  At the very least its a HIPAA violation and at the worst he may have received someone else’s medication. I called the clinic to tell them of this error and this is their reply” oh dang, I wondered where that went”.

alrighty then..

You know, its hard enough trying to keep my head above water and manage not making my own mistakes. and I have to wade thru everyone else’s muck too. I read the Facebook page ” this is a Pharmacy not a fast food restaurant” most days and I am astonished at the errors coming from  drs offices nation wide.   E-scripts  and Technology haven’t reduced errors, they have magnified them exponentially with ridiculous decimal quantities, redundant and repetitive prescribing, and auto sig population with absurd verbiage that makes no sense whatsoever and patients often walk away with scripts in their hand that were also sent somewhere else electronically and end up with duplications. Doing a DUR becomes a nightmare when I look at a patients profile and see 6 scripts for every drug a patient takes with multiple refills because the office sends a new one every 3o days +6 refills. by the end of 6 months Joe Blow has 6 mirtazapine, metformin, lisinopril, fosamax etc etc etc..  rx’s  with refills on his profile..and all of them filled exactly once. AND because people believe in and trust technology, ( like that doctor did) hard copy rxs aren’t being verified for accuracy before handing off to patients and they aren’t being looked at before being e-sent…

 

Oh the Joy…

and speaking of Joy,  Have a very Merry Christmas to all of my readers who Celebrate the season! Happy Hanukkah ( which just passed) and Kawanza and New Year and  Festivus for the Rest of ya! :-)

 

One book and some old memories

Filed under: Uncategorized — pharmacychick at 3:25 pm on Sunday, December 13, 2015

Reading thru my Facebook feed several months ago I found a story about a man who found a puppy who had been abandoned in a hole in the bottom of a slot canyon in Arizona.  In short some sick human abandoned a puppy in a hole in a place that only a very experienced rappeller would ever be able to find it.  Amazingly enough he was found in the nick of time.  As the story progresses the man who rescues and keeps  the dog works thru some serious issues in his own life, abandonment by his abusive father, a mentally ill mother, intense bullying from schoolmates and finally some kind of resolution. I found an uncomfortable similarity  to his story…his was worse, but the long lasting effects were not.

As I read thru his struggles  thru his youth I began to realize that we have a name for what we both went thru as kids…bullying.  Of course in the 70’s, they didn’t call it that. It was just kids play.  “sticks and stones can break my bones but words will never hurt me”.. WRONG. Words can hurt the most and cause everlasting damage.

When I was a toddler I was abused ( molested)  by a neighbor.  He was an old man who lived across the street. He lived with his sister and her husband. Its too disgusting to write about the details but I was in my twenties before I told my mother about what happened and one detail brought back memories that she knew I was speaking the truth.  On one occasion he almost got caught and he tossed me in the bathroom and told me to get dressed.  I put my panties on backwards.  My mother remembered that day and couldn’t figure out how SHE could have dressed me that day…if she only knew….  She was devastated when I told her the news.

When I was in 2nd grade I got glasses.  I was the only person in my class to have glasses. I was teased mercilessly by some of the boys… FOUR EYES!… my teacher came to my rescue only to make it worse because I was now TEACHERS PET.

I developed a little earlier than some of the girls in my class so by the 5th grade I was starting to bump out in places that used to be flat.  The boys would poke at my chest every day and call me ” STUFFER”  implying that  I stuffed my bra with kleenex.  When I finally started my period  in the 6th grade, I sobbed because I had something else I had to manage and hide at school. I was never among the kids that had money or pretty clothes.  We weren’t destitute but  since my brother and I shared clothes ( he got my hand me downs), it was pretty gender neutral clothing.  I hated going to school.  I spent most recesses alone.

Things got really complicated in junior high.  I was awkward, ugly, sensitive and had very few friends .  One teacher befriended me, told me how pretty I was and would take me home after school….after a diverted trip in his pickup.  It was ” OUR SECRET”…  Ill spare you details, but to this day seeing a red Ford pick up truck creeps me out.  I never told my mother about those molestations because I believed it was an embarrassment.  If you ever think that a 12 year old ” should know better”  doesn’t understand the mind of a 12 year old girl who thinks she is ugly, unloveable and undesired.  By the time I was in college I wanted to say something but I knew I would have my name and my family drawn thru the mud so I kept  my mouth shut. Im 52 years old and the only person who knows what happened is Mr Chick.  There is probably many girls with stories to tell about this man, but it appears nobody ever did.   By junior high,  the circle of friends that would last thru high school were developing.  Cliques had formed and if you were in the “right” group, you were cool, if you were not, then you didnt matter.  Guess which one I was in.  I might as well have been invisible.

By high school,  I was used to my isolated existence. For the most part I was left alone. There was a classmate whose mother made her wear a uniform to school every morning and I always felt sorry for her but looking back we were about the same …isolated and alone.  Looking back I wish I had been more brave to make a friend.  I once asked a boy to a dance..the kind where the girl asks the boy…and I was rejected.  I never made that mistake twice.

I was on the moon when I was asked out by a boy who worked at the same restaurant I worked at after school. I should have known better when he only asked me out because he had been told mistakenly that I “put out”.  We kept dating for a long time but I  was pretty offended by that.  He became as much of a bully as any other kid  in my life when he started pressing me to do things I knew I shouldn’t.  When I finally relented it was the most miserable day of my life to date.  From that time to the day when I finally got strong and courageous to leave him, he would use guilt and  oppression to get his way.

A person can stay that way, they can be and play the victim their entire life.  Some act out and become exactly like their bullies.  Others  do the opposite and champion for the causes.  And yet others do what I did, hide it, suppress it and try to let it die somewhere in their past.  The problem is I have learned is that it never really dies.   It does shape us to some degree.  I certainly have more friends than I did when I was a kid, but the ones I have are platonic and I don’t trust anyone with the intimate details of my life.  Certainly NO one knows about this part of my life.   It even took years of being married before I was actually half accepted that I was acceptable ( and loved) by  my spouse.. to this day I don’t understand why he loves me. I am an introvert and happier listening than speaking. I don’t like to have attention brought to myself and prefer the company of the servants than the masters of the house.

I truly believe that the demons are at rest. They are very much alive. They don’t die, but they seem contented to remain dormant where they cannot do any harm. I am a happy person now.  I am what i am, and I can’t be anyone else.  I don’t even know what possessed me to spill all this out, but I do know that for those people who say ” you cant possibly understand what Ive gone thru…”…I can say..

yes, yes I can.

 

Rush it…or Ru SHIT!

Filed under: Uncategorized — pharmacychick at 5:47 pm on Monday, November 23, 2015

There are few words that Pharmacy Chick gets annoyed over hearing MORE than being asked to RUSH a prescription.  Honestly if you think about it, its a stupid request in the first place.  Who asks a dentist to rush a cleaning..or a dr to rush an exam..or worse yet, ask a surgeon to rush the procedure.  Filling a prescription is a procedure of sorts.  There is a start and a finish and everything in between has to be right.  Since I wrote about an error on my last post, it really drives home that rushing anything is a bit of a foolish venture…rushing driving cars causes accidents.   Rushing a prescription and failing to follow procure by doing all the necessary checks can cause an error and potentially cause harm and the pharmacists job.  I am not saying that I rushed my error in Sept.  I have no recollection of that day in fact other than I clearly transcribed an e-script with the wrong strength.

To ask a pharmacist to rush a script is ludicrous not only because it increases the risk of error but it implies that we are some how slow, and putzing along doing non important things when we should be filling prescriptions.  To be quite honest, I like to have prescriptions filled and on the shelf as quickly and as safely as possible.  I don’t like work sitting around but filling rx is the priority job function.  The daily order, the invoices, the  return to stocks, the cleaning, the report filing, all that admin crap is secondary to getting things filled.  Yet why is it that people think that unless we are asked to RUSH something that we are going to take as much time as we possibly can,  deliberately making such patients sit around while we discuss world politics and what we saw on Facebook?

I dont rush rx.  Sometimes I will move someone to the front of the line.  I certainly have a heart, and can prioritize a person bleeding from  a dentist appointment from someone else who hands me a script for lisinopril at the same time.  Come on, give me a break.  However,  At some point there simply is going to be a wait, and no drama production at the counter is going to change that.   I might add that asking to rush a prescription also implies that their prescription is more important than the Rx’s that have preceded it and that is unfair to the people who have dropped off their rx ahead of the one I am supposed to rush.  Everyone is important. No one is less important than the other.  I know urgent, and I know rude. I also know fair. I am pretty good at balancing all of them to get everyone taken care of in the right order.

The last thing I need to hear is I rushed it so I Ru-SHIT..I made a mistake.  Because I guarantee you that the dude whose rx I rushed will be the least forgiving if there is a mistake made because I cut corners.

Cheers! and Happy Thanksgiving to all reading this.  May you find friends, a warm meal and a comfy place to rest your head on Thanksgiving day!

 

 

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