The Pharmacy Chick

Flying the coup in retail

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!

 

 

Two Errors, two different reactions.

Filed under: Uncategorized — pharmacychick at 6:26 pm on Wednesday, November 18, 2015

On Friday  night Pharmacy Chick was driving home from work.  It was dark, raining and I was very tired. Yet, as I approached this intersection, habit took over and I looked right and left before I entered it….and doing so spared me the impact of a young lady running a red light at high speed.  I slammed on my brakes and she missed me but she hit the car coming from my opposite direction.  By the grace of God, ( no comments please, its MY blog after all) she only clipped the front end of the car instead of T-boning her head on, which would have surely caused injury to both.  In the aftermath, I pulled over, went to the closest car ( the HittER) and told her to IMMEDIATELY call 911 and said ” You do realize you ran a red light right??” She assumed all responsibility for what she did.  I then ran to the other car ( The HitEE) where another driver had stopped to assist her.  She was startled and a bit disoriented but physically unharmed. All parties met at the side of the road.  I could hear the sirens so the police were nearby.This girl had made a grievous error by running a red light.

For all intents and purposes HitEE had every right to be angry and indignant. She could have been killed at the most, and harmed at the very least with a direct hit. What did she say to the HittER?  ” ARE YOU OK?” .   It was a twenty-something girl who hit the other car.  I can’t begin to assume what she was doing ( or not doing) when she sped thru the intersection..and “didn’t see” the red light.  Was she playing with her phone?  Fiddling with the radio?   It doesn’t matter at that moment, and it wasn’t my business.  As a witness on a dark night I only saw HittER run the light and hit HitEE.  What I also saw was GRACE.  She said ” Im ok it was an accident.. we are all alive”. HittER was apologetic and upset at what she had done.    HitEE wasn’t angry. She wasn’t indignant. And, to be honest, I am not sure how I would have reacted if I had been struck.  I might have asked what she was doing  and if her phone was involved.Im do not tend to be an over-reactor but I haven’t been nearly killed in a car accident either…. But…this wasn’t my story or my error to react to. It was hers to own and she chose a forgiving and accepting response.

In Sept I made a filling error on a prescription.  I transcribed Atenolol 50mg instead of 25 on a prescription that had been e-sent to us.  This patient was a long timer.  15 years or so.  We had a (what I believed) to be a great pharmacy patient relationship.  She had been on 25mg for a long time.  She took the 50s for a month or so before discovering the error.  She had felt ” a little more tired and my resting pulse was low” –her reports when I asked her about any ramifications.  She had reported the error to my other pharmacist who contacted me. I called her immediately, made sincere apologies…asked if she had any harm ( no), and asked if there was anything I could do for her at this time ( No)  This error had my initials on it so I owned the error.  She also owned the error.  I made it and she controls whatever response she wants to it.  Its hers and her right to have any response to having a pharmacy error she wants.  I can’t make that decision but i have to live with it and respect it.   She chose to be angry, unforgiving and indignant.  I was surprised simply because this wasn’t the kind of person she had showed us to be over the last 15 years but then again,  everything had gone well and perfect for 15 years.   My apologies went un-accepted and nearly un-acknowledged.  She at least said ” I know we are all human and make mistakes….( but then we got the butt-sandwich)  BUT I dont think I can trust you again. I may have to transfer out”.

All I could say to that is ” I understand. This is a decision only you can make and I will support what ever you need to do, again I am most sorry”.

Clinically this is a pretty mild error. It wouldn’t have had any long term impact on her health or well being.  But its an error and no error is the fault of the patient. But to her it was as big a deal as if I attempted to kill her…

Any error upsets me. I try to be careful and accurate every rx every day.. But I am more upset that I am un-forgiven. If she does decide to stay, I am sure I will get to be her punching bag for a while as she vents this out.

 

 

 

And more on price gouging

Filed under: Uncategorized — pharmacychick at 6:23 pm on Wednesday, November 11, 2015

I wrote a piece recently about the ridiculous price increase of Glumetza. I haven’t received as many comments on a post since my oxycontin/oxycodone error rx of a couple of years ago.  I am glad that people are angry about this and I hope it trickles into a flood of inquiries as to the reason for this abomination.

What isn’t so noted is the other price increases that we have experienced in recent years.  Lets go over a few.  1. Tetracycline.  So this is a drug that was so cheap at one time, that I think I bought it for about 2 bucks/100.   Used almost exclusively for acne, it was a cheap drug for teens to take for their faces.  It disappeared for awhile only to reappear about a year or so later at a cost of nearly 1000.00 a bottle of 100.  Did anything change? no.  Just the cost.

2.  Doxycycline Hyclate: Same story different drug.  Thankfully monohydrate is less expensive and we have used it as an auto sub with permission from most doctors once they got wind that hyclate went thru the roof.

3. Digoxin.  Another drug that was under $10 per hundred is nearly 250.00 COST for same amount.  Its an abomination and nearly impossible to explain away.

4. Epi-Pen.  Several years ago my church wanted an epipen for their emergency kit.  The doctor bought on at the normal rate (at the time) for about 72.00 for the twin pack.  Today that same twin pack is rounding out at over 500.00.  Seriously?  When a person gets a copay back for over 150.00 they have a serious decision to make. Take it and be 150.00 more in the poorhouse or take the risk and leave it behind.  I always send them to the mfr website to get some loyalty coupon.  Might as well stiff the company.  they are ripping us off. Its a travesty to charge so much money for an item that 99% of the time outdates and is thrown away.  Its one of the few medical items that is made for the sole purpose of hoping to never use!

5. Clobetasol.  What used to be about 7 bucks for 15grams is now rounding out at bout 150.00 per 15 grams.  I quit making a compound a while back when the ingredient  copay to the pt was over 120.00 because the clobetasol was being included at current market value. They looked at me as if I was the person ripping them off.

Its not right. Its not fair..its the American way apparently.

Random thoughts for Monday

Filed under: Uncategorized — pharmacychick at 6:42 pm on Monday, November 9, 2015

Pharmacy Chick is sick.  She has a cold but because she is a retail pharmacist she went to work because thats what we do.  The most glaring symptom that I have is the distinct lack of voice.  I sound like someone went over my vocal cards with a lawn mower…a gravelly squeaky kind of sound comes out now where a mere 48 hours ago, a melodic voice of a woman used to be.   For the most part people ignored me other than stating the obvious: “Geez you got a cold?’  no I always sound like this…really?   But not one person asked why I didn’t stay home until nearly 3 pm when it was the time for my shift to end.  This very high maintenance lady was taken aback by my rather horrific voice. “Why aren’t you  home?” she said.  I responded with the truth we all know to be evident ” because if I stayed home this pharmacy wouldn’t open today and you wouldn’t have received your prescription and I’d probably be out of a job”.” we in retail have to come to work because there is nobody to cover us when we are sick”.

An awful truth but its the truth none the less.

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Another plane crash recently and subsequent retrieval of the flight voice recorder proved to me once and for all that if I ever fly again, I am going to be asked to be strapped to the flight voice recorder. At least my corpse will be recovered.  perhaps they should make planes out of whatever that recorder is stored in. it always survives.

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I made a new recipe today.  Mac and Cheese.  It cost me over 20 bucks in cheese.  Mac and cheese shouldn’t cost 20 bucks.  It should cost 2.  Ill let you know if it was worth the trouble.

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Regarding my cold.  I called my own doctor today and asked if perhaps( as I grovel) he might prescribe for me some Hycodan or Tussionex for the cough that rages after I go to bed. WE all know DM is crap, even the makers know its crap.  He didn’t return my call.  Thanks for that one Doc.  I found some outdated Benzonatate in the cupboard.  Down the hatch!

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This welfare guy wanted a 3 month rx for all his stuff as he was traveling to Turkey for an extended trip. I told him truthfully that welfare doesn’t pay for  drugs for vacations. If you have money to travel you can buy your own meds.  He called the welfare office and they caved.  Tell me again why we do this for these pseudo poor immigrants?

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I see that more and more places are closing for Thanksgiving day, and even a few are closed Black Friday.  I can see being closed thanksgiving day, but I really see no point in closing Black friday. To those who have to work TG day…I am sorry.  You should be home with your family.

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I hate the clocks changing .  Its 430 pm and its dark.  This sucks no matter what.  Mr Chick seems immune to the time change, but I pad my way upstairs by 830 now days because it feels like freakin midnight.  perhaps I should live at the equator.

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Starbucks is getting crap because its “antiChristian” cups .  1- Starbucks has never come out as a Christian company and near as I can tell  and 2- snowflakes ( or the lack thereof) have no christian significance to the birth of Jesus.   Are Christians over persecuted when we are slighted? YES  Everyone seems to be tolerant of everybody BUT Christians lately but this isn’t something to be heated over. Its a dang paper cup.  Im going to tell you Merry Christmas and if you don’t celebrate it fine.  I do.  Feel free to wish me a Happy Hanukkah , Kwanza or any other winter holiday.  Ill be civil and greet you back.  I don’t tell you to piss off and I won’t report you to your Superiors for offending my sensitive nature.

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I just bought my plane tickets for my first vacation in 2016.  It makes my aching body feel a tiny bit better. Now Im going to take that same body and tuck it under my recently purchased Pendleton wool blanket and watch Football…

Cheers!

 

 

Lets Talk Stupid Stuff

Filed under: Uncategorized — pharmacychick at 6:50 pm on Monday, October 26, 2015

WE all have annoyances in our lives. Either by people or processes we deal with, there are things that are annoying, or irritating or darn infuriating. Recently I have been working at some different stores while their personnel issues have been worked out.  We also had a recent set of meetings with management ( I e. non pharmacists bosses)  Its time to have some fun.  Start a list of the most stupid things we see, do, or endure in the pharmacy. They are in no particular order:

Here are some of my favorites:

1. Our computer tells us constantly when we have an electronic script coming in.  And it makes us answer every time we clear the screen whether we want to look at it.  Do you think I need to answer yes or no 150 times? Why does our software imply that escripts are the more dire thing I have that I have to acknowledge it with a Y or N every time I clear the screen?

2. Our software was recently updated so we have to put our initials in every time we fill a script or clear a screen.  Quite possibly the most annoying thing I deal with all day and I have to do it 300 times a day.

3. passwords:  not only do I have at least 12 different kinds of passwords for the pharmacy but they require I change them every 90 days and each has its own special format.  If I could pick one to last me forever it would be this IHCMPEFND.  Anyone quess what it says?

4. Changing insurance :  Same insurance? new BIN… why oh why do you do this to us? Recently a major player sent all new cards to their insured that looked IDENTICAL save for the BIN.  Wanna venture how many bothered to carry the new card?  5% maybe… {plan terminated}

5. Unit of use bottles.  Why might you say I hate unit of use bottles??  I hate only those bottles where its impossible to put a label on it.  What is the point of unit of use bottles if you cannot label them? Any bottle that is smaller than a pharmacy label is useless to me and a waste to the plastic bottle it came in.

6.  Impossible to read Font… Do you hear me Aurobindo?   Good god, the font on Aurobindo bottles have to be a 6 or smaller.  so small that I may need a microscope soon to read them.

7. Childproof caps on large bottles:  Ok, who might ever dispense a 500ct bottle of temazepam?  Well if you do you have your safety cap already for you.  But honestly, who needs a safety cap on a 1000ct metformin?

8. Useless Reports.   my company is stellar at making me generate and keep useless reports.   everything dated and initialed of course..I really have no input on the profitability of the company so why do I need to keep all the financials IN the pharmacy?

9.  Voice over Internet phones.  Have you ever had these?  If you are considering putting them into your pharmacy or your home….DONT.  They suck.. really…they do. Everybody sounds like they are talking thru a paper towel tube with a wad of paper towels in their mouth  Toss in a non native english speaker and its a recipe for disaster.

10. Round pills..need I say more?

11. Irrelevant and inaccurate ads:  WE have voice over ads running in between the songs over the store.  When its time for the pharmacy ad to come on, its usually some stupid request to have the patient visit our pharmacy and have 1) us help them select a new insurance …WTF  2) determine if we are preferred or non preferred …and I know this how?  3) find out if all of their meds are covered …crystal ball broken, call insurance. 

12. package inserts.  In todays information age,  why do we need a package insert?  really….think about it.  Every pharmacy has access to  every  resource available on the planet including some very useful ones on our phones.  I have 3 alone on my phone…why do I need a package insert.  Put a web address on the side of the bottle and move on.

13.  Synthroid?  do you really need a  nanometer sized opening for your tablets?

14. Counting trays without the little thumb helper.  Yea, I know its pretty small, but I can’t open the tablet cover without the thumb helper…

15. Surveys.  I thought secret shopping was an annoyance..but surveys are almost as bad.  Do we need all that back-patting?  Begging for affirmation that we are doing a good job? I had asking for them and I hate filling them out.

16. Flu shots: I dont hate flu shots in and of them selves.  I hate fact that some ( not all) people ( and some at the corporate office)  have equated a flu shot to getting a big mac at McDonalds.  They aren’t and never will be instant.  When somebody asks me if they “can get a flu shot now”. I ask them  ” if NOW means somewhere in the next 20 min yes…if you cannot commit to 20 min then come back when that time frame works for you ”

17. explaining our job to a non pharmacist boss.  might as well be talking Swahili.

This is by no means a comprehensive list.  How about  some of your own stupid stuff?  This isn’t patient bashing…This is situational stupid stuff we deal with in our processes every day

lets go!

 

 

Does one’s income determine worth? Importance?

Filed under: Uncategorized — pharmacychick at 8:32 pm on Wednesday, September 23, 2015

Recently I was walking down the 18th fairway at a golf course. Recently this course had hosted an event in which TV coverage was provided, along with it, all the grandeur of a VENUE: including everything from tents, stands,  electronic scoreboards and porta-potties.  Since this event was over ( as I wouldn’t be playing in any event ON TV, I was watching a large group of men disassembling one of the massive temporary structures they had built only a few weeks ago.  You’ve no doubt seen them if you have ever watched golf on TV.  They can be a simple as rows of seats on scaffolding or as complicated as  a house with rooms, roofs, electricity, and hot/cold water.

If you have ever been privy to seeing these structures go up and down, its rather amazing.  They are all just metal poles, nuts and bolts and plywood…all wrapped in green or white fabric with a hundred million zip ties.

Most of these guys where shouting to each other in Spanish so I imagine they were all hispanic laborers, either hired for the job, or they travel from venue to venue setting these tent cities up and down all over.  The thing that struck me was that I imagine most of them make little more than laborer wages but when you consider what they are building, its pretty important that they do it right.  These scaffolds hold thousands of people..at one time. Take the plastic skin off these structures and they aren’t much underneath but a skeleton of poles. No wonder they cover them up.

My point in describing this to you is that I thought about the work these men do for under 20 bucks an hour likely is going to support the lives of several thousand people and absolutely none of them will give a thought to who built this structure they are standing on.  They assume it will hold them safely and not collapse.  These laborers built a structure thats going to hold CEO’s in a corporate tent, people who make a zillion times more money than they do.  Generally, society puts value on the CEO.    I think we need to put some value on the laborer who spend hours in the sun building something that he is going to stand on and not fall thru 30 feet to the ground.

So I pose the question.  Does our value or worth come from our income?  No, of course not.  IN fact I propose that some of our most important people aren’t the ones who are sitting in a leather chair in a corner office shuffling papers and barking orders,  but the guy who is doing most of the work unnoticed and unrewarded. Put aside the laborers who built the scaffolding for a minute.  Who are you surrounded by that probably goes rather unnoticed that probably you couldn’t do without?

I look at my staff in the pharmacy.  I make good money and I know it.  I earned my wages by obtaining my degree in Pharmacy.  My techs did not.  They don’t make good money, but you know what? they work so unbelievably hard to help my patients that if I could pay them my wages I would.  They put in a supreme effort to make the pharmacy that I manage look “easy”.  Without them I am nothing.  With them I am successful .  We make a team.  Sometimes my customers look down on “just” a tech, but if they realized how much I depended on their efforts, they might look at them differently. 75% of the work in the pharmacy is done by the techs.  There is 1 of me and 3 of them.  They are so valuable to me that I routinely let them know.  I never want them to feel unappreciated or undervalued. Each year I treat them to a bonus that is probably majorly frowned upon by corporate.  I don’t care.  The company never rewards their labors…so I do.

The next time you see a man in a thousand dollar suit, remember the man who sewed it.  Or when you pull out of your driveway , remember the tech who adjusted your brakes,  or when you sit before that plate of food at a restaurant, think about the cook who made it. The next time I watch a golf tournament on TV Ill certainly think about the guys who spent a month or more getting it ready for the guy in the thousand dollar suit… who drives to the course… to sit and eat that plate of food he didn’t make…

Value..and worth…

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