The Pharmacy Chick

Flying the coup in retail

Best tech story heard yet….2. and I wish I had my camera.

Filed under: Uncategorized — pharmacychick at 10:01 pm on Wednesday, April 29, 2009

I wish I could take the credit for this story, but I only get to tell it second hand.  I have a tech who used to work elsewhere and still has friends at her previous pharmacy.  She came back from lunch chuckling under her breath, and relayed this story from a tech at her old pharmacy locale.

This little old lady was on the first aid aisle, looking up and down at a package of Q-tips. After watching this lady scrutinize the package the tech asked if there was a problem or if she needed help with the product. 

The lady replied “I want to see the ingredients”.  On a box of Q-tips.  She apparently spent several minutes trying to convince this lady that a box of Q-tips will not have a list of “ingredients”.

She was too kind.  Pharmacy chick would have had a hey-day with it.  I’d have probably said ” A paper stick and some cotton”….

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Some things just scream “photo op”.  Too bad not all photo ops come with cameras in attendance.  I was at the grocery store and I had just turned down the frozen food aisle.  The left side is all vegetables and the right side is all ice cream and frozen desserts.   As I looked down the aisle I had to laugh….there were 5 people all bent over, with their butts sticking as they perused the ice cream section.  Nobody was together, it was a “coincidence of anatomy” that everybody had assumed the same position…I just ambled by the cheek parade wondering where the camera was when I really needed it!

The victim nobody will write about.

Filed under: Uncategorized — pharmacychick at 10:09 pm on Monday, April 27, 2009

Twenty one horses dead.  Wow.  For the business of polo, it might as well be 21 people.  I  know a lot of people whose earning power wouldn’t be a fraction of what those horses were worth.  I only know what  I have read in the paper and on the internet, but this much is clear:  A mistake was made in compounding some kind of “supplement” injection to boost the energy of the horses and this mistake killed every horse who got it.  Before I knew what was in the supplement, my first thought was “hmmmm. I wonder if they injected too much potassium, causing caridac arrest”.  Well I still don’t know the answer but I do understand that potassium was an ingredient in this compounded mess.

My heart goes out to the team, and to those poor horses.   But I also feel a lot of pain for that pharmacy, and whoever compounded it.  There is some pharmacist in Florida whose initials were on that bottle and who probably hasn’t had a 2 continuous hours of sleep since the tragedy.  He or she is probably working this thing over in his/her head a thousand times wishing they could rewind the clock and undo this disaster.  Nobody will every write anything nice about it.  Soon writers who know nothing about the business will start skewering all things compounded.  “Sound the alarm! Stop all compounding”.  They will interview somebody who had a filling error in a pharmacy and soon we all will be looked at with the hairy eyeball.

This pharmacist made a horrific mistake, but its not the first mistake in a pharmacy.  We all have had them. Thankfully none of mine have been serious (knock on wood).  This florida pharmacist wasn’t so lucky.

This person is a victim too.   It was an accident.  A terrible terrible horrific accident.  This person’s life will never be the same.

Pointless email

Filed under: Uncategorized — pharmacychick at 12:12 pm on Monday, April 27, 2009

Promised to simplify life, the computer has moved from “life saver” to “time consumer”.  Yes I will admit that having a computer to process prescriptions has made the drug-filling part of my job easier, especially when customers lose or otherwise do not have their prescription numbers.  The downside of having computers is that bean counters and managers want to have “reports” printed and filed for everything they can dream up.

The idea that we could go “paperless” was nonsense because every regulatory agency wants hard copies of everything, printed and filed for 2,3,7, or10 years.  My storage room overfloweth with not only boxes of prescription hardcopies, but now we have boxes of RX reports,  Third party reports, Immunization reports, Stats/sales reports, controlled substance reports….you know what I mean.

Rarely does a day go by that I don’t get a question from a customer “Hey Chick, do you have email?” implying they want to email something to me at the store.  My answer is always the same “No.I.Dont”.  I just cannot imagine have to wade thru consumer email AND corporate email sent to me during the course of a day.  My corporate IN-Box is too much as it is.  Once, as I was wading thru my Inbox, I replied to an email sent to me. I had a question about an application on our computer.  I accidentally hit reply-all instead of reply.  That wouldn’t have been an issue if he hadn’t sent the original email as a global one ( one that goes to the entire company). Whups.  I got a stern reply for that one.  I am sure nobody had ever done it before. Its not like I was sending spam or insulting the president.

I just don’t need (or want) to have consumer email sent to Chick pharmacy.  Thankfully, that idea hasn’t taken root anywhere corporately.  My home email is another issue.  I keep a private email box and a “public” one, for junk mail.  Once a week or so I go in there, highlight everything and delete it.  Seems that no matter how many times one Unsubscribes, the mail still comes. 

Still, one thing bugs the heck out of me in my private email box.  Personally, I call them pointless emails.  Here’s some examples: 

1.  I got a “happy face” sent to me.  Thats it.  some friend of mine sent me a smiley face and told me to have a nice day….AND to send it to 10 of my friends and back to her so that by the end of the day I’d have X number of happy faces in my in box.  WHY in the world would I want my inbox populated with 70 happy faces?

2. Warnings and threats:  I have a couple of relatives who think I should be scared to death or threatened a couple of days each week.  “Dont wear a pony tail in the parking lot at night–somebody could grab it and pull you away.”  ” Look under your car, somebody can grab your ankles…”  Beware of this, beware of that” At this rate, I’ll be a raving agoraphobic and will never leave my house again!  They also send me the kind that tells me that something horrible will happen to me if I dont forward it to 10 more people.  Maybe I should forward it back to them 10 times in a row.  Perhaps they will get the message.

3. Political agendas:  I have one “friend” whose political views border on the sublime.  We maintain our friendship by not discussing politics.  She does however feel its ok to send me “forwards” of  politically charged emails that (insert some famous politician) is (insert some heinous act) or is introducing some bill in congress and “we must stop it”.   “WE” aren’t going to do anything but delete the email.  During the election she sent  smear emails against any candidate she didnt’ like. None of it was true but she apparently hasn’t heard of Snopes.

4. Urban legends.  I have customers who bring me questions about health related urban legends, and they usually populate my inbox at about the same time.  The darn things are viral.  Good thing that communicable diseases do not spread like email.  We’d all be dead.  Come on people,  check your  material before you send it on. Coca Cola is not going to kill people,  if it is, I’d be dead a long time ago. 

5. Dirty Jokes:  Ok, who among all my contacts does NOT know that I am an evangelical Christian? I do not like sex jokes, racial jokes or sexy racial jokes.

Can you imagine the inbox we’d have if we took consumer email from every Tom, Dick and Harry on the street?  We’d need a pharmacist just to answer email and an IT guy to keep the viruses out.

Send this post to 10 of your friends or all of your hair will fall out tomorrow, fleas will infest your bed and your hard drive will melt like warm butter!

Peace!

A punk is a punk is a punk…and the Y chromosome.

Filed under: Uncategorized — pharmacychick at 11:02 pm on Friday, April 24, 2009

For a Friday, it was pretty calm.  I think the nice weather had a significant impact on the desires of people to visit the pharmacy when there were much more inviting things to do, like hang out in the sun.  Nevertheless, we had just enough stuff going on to keep the day interesting.

This gal comes in with a prescription for her boyfriend. She hands me an Aetna card, which I can tell from the beginning is the wrong card.  Every Aetna card has “rx” on its face if its the drug card.  This one didn’t but I tried it anyway just to be sure. It rejected.  I filled the rx for cash and told her that she had the wrong card.  She paid the roughly $12 for the rx and went on her way.  A couple of hours later the boyfriend shows up with one major chip on his shoulder, demanding to know why we didn’t take his card.  “Its the wrong one.” “Bring me the correct card and I’ll bill it for you .This is the one you show your dr’s office”.   (you bring me attitude, I’ll give it right back at you, punk).  He kept arguing that his Aetna was his right card and I kept telling him that it wasn’t.  After determining that he trades at Big Box up the street, I decided to call BB and find out what plan they had Punk on.  MEDCO.  I told the pharmacist in near earshot to Punk that “well, Medco isn’t Aetna is it? I guess he lost his card after he gave it to you”.  He just kept arguing that his Aetna card was “all I needed”. I did a print screen of the new insurance and handed it to Mr Punk and said “Heres your REAL pharmacy information. Take care of it or ask for a new card. Your next pharmacy will need it, or you’ll be paying cash there also”. 

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A few hours later I am laboring over a bunch of discharge prescriptions and this guy comes up with 2 bottles in his hand. “What’s the difference betweent these two?”  In his hands is a bottle marked TUMS 750 and TUMS-1000. (you ARE kidding me aren’t you?)  “The 1000’s have 250mg more of Calcium Carbonate”, I replied.  To which he replied and I kid you not “Oh, so I can take 1 of these 1000’s and get the same as 2 of the 750’s?” I guess that depends on which math you use, I suppose….

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Diazepam and Cyclobenzaprine for muscle relaxation.  A quick counsel and their appropriate usage and the inevitable “do not use alcohol while on these medications”.  You’d think I had just taken away his birthday or something.  “REALLY?” “So what happens if I do drink?”  I replied simply “well, we hope you’d still wake up the next morning, but there’s no guarantee. Its not a good combination, OK?”

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The phone rings…I hate late evening calls.  There is never anything good in them..What time do you close?  “9pm”. (its about 8:45 pm now.) Oh, do you go home then? No, I just spread out the sleeping bag and make a night of it… “Yes, right at 9 pm” I am leaving no room for negotiations. Can I drop off a prescription at 9? “yes, and you can pick it up the next day, we are preparing to close now”.  He apparently chooses to do something else.

And with that, another week closes at Pharmacy Chick pharmacy.  My weekend off.  No thoughts of the store til Monday morning.

Peace!

Your emergency is not my emergency.

Filed under: Uncategorized — pharmacychick at 8:17 am on Tuesday, April 21, 2009

I love the weekends.  The phone rarely rings, no e-scripts interrupt my work and the paperwork that has built up all week has a chance to be tackled and wrestled into submission.  Nevertheless, there are occassions….

This guy walks in with a script that he has had for a few days.  It says Adderall XR 20mg #30, 1qd.  Its signed, dated and all looks well EXCEPT that the “XR” has been marked out with a black sharpie pen.

I tell the guy that I cannot fill it, as it has been altered.  Whether by intent or malice, it is an altered script and must be verified or re-issued. That in itself is not a problem but it was Saturday.  I told the guy about the problem and explained that we would need to verify and make the changes on Monday.

He acted horrifed. “Can’t you just call the Dr?” (as if I had his home phone on my speed dial). “Sorry, we don’t page physicians on the weekend.”  “Its not a medical emergency”.

He left with his prescription in hand, convinced that I was wrong and was going to try the competitor up the street. Good luck with that one buddy.

I wish I could impress with prescribers not to alter their prescriptions, C-2 or otherwise. Do it right, leave no guesswork. Date it, sign it, read it again before you hand it to the patient and mentally ask yourself “is there any reason this rx might be a problem?”  and, if the answer is no, give it to the patient

Then, everybody is happy…on Saturdays also.

The followup on the Medicare audit post.

Filed under: Uncategorized — pharmacychick at 7:58 am on Saturday, April 18, 2009

Well, we got official denial from Medicare on that strip claim I spent so much time researching.  The patient brought in HER explaination of benefits.  REJT- due to insufficient information submitted. 

What part of the 70 pages I sent was “insufficient”?  We had already told the patient it would be denied because the patient’s testing log was not supportive of the amount dispensed even tho the sig supported the amount.  Bring me my badge, I have to be strip usage policeman now.

Again, more nonsense! So much for being honest.  I probably should have handed the lady her log books back with a pencil and said “Here, fill in some more…we need more entries!”. 

At least the office let me know they would appeal.  It would appear they got September’s paid finally.  Maybe they will pay December’s also.

What a pain in the rump.  What’s next?  Tablet by tablet documentation of amount consumed?  Ya know what confuses me?  Mail orders that deal with diabetic supplies and the like will AUTO ship you boxes and boxes of strips, all billed to medicare.  If your rx says test TID, then you will get 3 boxes of strips every 90 days until you are swimming in strips.

Sigh.  Which brings me back to this story:  Many moons ago this guy (who I had never seen before) came up to my counter holding a grocery bag.  He handed it to me and asked me if I could this stuff. I looked inside and it contained about a dozen boxes of test strips.  He explained that his mail order company sent him boxes every 3 months, and he didn’t use that many.  He claimed he called to stop the deliveries but they kept coming,and now he was over wrought with strips.  Not liking the idea of just throwing them away, he brought them to me.  Not wanting to run afoul with any regulatory agency, I told him that I couldn’t accept them but I gave him the phone number for a charitable org who would likely jump at the chance to use that stuff.

God help that pharmacy if THEY ever needed to prove usage.

Nonsensical Realities.

Filed under: Uncategorized — pharmacychick at 9:30 am on Friday, April 17, 2009

Rational thought is one of the Chick’s strong suits.  I like to think things through and made sound decisions based on all the available information.  Too bad not everybody thinks that way.  I made a few observations in the pharmacy the other day.

1.  It makes no sense to make a bottle so-called “unit of use” if the bottle is too small for a pharmacy label.

2. Conversely, it makes no sense to put a childproof cap on a 500ct bottle of anything. When’s the last time YOU slapped a label on a 500 ct bottle of Hydrocod/Apap 5-500 and sent it on its way?  Do us a favor Big Pharma, give us a simple screw cap.

3.  HIPAA doesn’t make a lot of sense in the pharmacy when everybody including the paper boy can pick up prescriptions for everybody else.  Its not like we are tossing around PHI for everybody to see and use, but if you are going to send your spouse/friends/kids/ or whatever to pick up your Valtrex prescription, I am gonna have to counsel somebody…guess who its gonna be?

4. Likewise, that little stop sign that says “stand here for patient privacy” is a joke, unless someone is mostly deaf. Clearly, if I can hear their conversations, they can hear mine. So, if they are gonna take privacy seriously, they need to perform a major remodel or bring our standards the same as mail order: written counsel is acceptable.

5. I am required to look at the NDC number of everything when I check it.  Does it have to be the item with the smallest font on the label? It makes no sense to need a magnifier to see the most important thing on the label.

6. It makes no sense to tell ME it will take your office 72 hours to authorize a refill, tell your patients. As far as I am concerned, before you stick the key in the lock at night, you should do your refills and call them in, ya lazy bum! 

7. Likewise I am not your message service, if you want to see a patient, call him yourself. I’ll try to pass on the “make appointment”  or “needs lab work” message, but it makes no sense to expect the pharmacy to do it. I dont ask YOU to call my patients and tell them they are over due for a refill do I?

8. It makes no sense to put me in charge of a half-million dollars worth of drugs and then tell me I have to pack my lunch in a clear plastic bag for “security”.  If someone wants to steal drugs, they will. In fact, we could practice pharmacy buck naked and STILL steal drugs if somebody wanted them bad enough.

9. It makes no sense to have a prescription written for 30+11 refills and NOT be able to give 90+3  on insurance. If I were a Dr, I’d write “365 days- dispense per patient/insurance requirements”.

10.  It makes no sense that a Doctor can charge a patient for a missed appointment but I can’t recoup MY expenses for prescriptions not picked up. It costs me money to fill a prescription AND more money in labor to return it.

11. It makes no sense that non pharmacists build and run pharmacies, then wonder why we revolt.

12.  Medication guides every time:  enough said.  One is enough thank you. Either print it with the counseling materials on the receipt or forget it.  Its getting out of hand.

13. It is nonsense to expect much joy from employees who dont get lunch, breaks and endure 12+ hour shifts. Likewise, what patient would want their prescriptions filled from tired, hungry and irritable staff?

14. APhA is the biggest oxymoron on the planet. 

Yours truly.

Meanderings in the day.

Filed under: Uncategorized — pharmacychick at 10:05 pm on Tuesday, April 14, 2009

Now thats a switch…And so begins another day in the pharmacy when the phone rings “Hi, this is (Big PBM Mail Order Back East), do you have a prescription on your shelf for Mary Mayhem?  we are getting a refill too soon on her order.”

Whoa, a mail order calling a retail store for a refill too soon issue?  I thought they had all-power-given-by the gods of processing to fill everything and anything with impunity.  Cool.

We have a winner: Guy brings in a new prescription. It has a $30 copay.  He pays for it with a $30 gift card he got yesterday. He hands me a coupon for $30 more.  (restrain yourself Chick…)

Gotta love those E-scripts:  “Hi, this is Lori Loopy,  My Dr said he emailed you a prescription, did you get it yet?  (nope)  This repeats itself several times until Ms Loopy finally gives up 30 minutes before we close. The script never arrives.

Gotta love those E-scripts II :  Script comes in for Millie Miller, Biaxin 500mg  #28  Sig:  1 tab by mouth. (ok, so what shall I do with the other 27?)  Me thinks there is something missing in the sig but the office is closed at 4 pm.  Sheesh, I want those hours. (looking at clock, realizing I have 5 hours to go).

Gotta love those E-scripts III:  We get an e-script for Rich Richards for one vial of albuterol nebulizer solution to be nebulized one time.  We aren’t going to break a box for one single vial.  We spend f.o.r.e.v.e.r on the phone weaving thru a masterpiece of voicemail confusion before we give up and leave a message.  We are assuming they want 1 box, but that sig indicated otherwise.  Hours later the call arrives: “oh, you weren’t supposed to get that, it was an order to get one treatment here…”.

He must have got his degree from the cereal box:  Lady was scanning the cough/cold dept. We asked if she needed assistance. “My dr told me to get Singulair for my allergies”  She was not going to be convinced it was a prescription only because HER DR TOLD HER.  “I’ll just go to (nearby competitor) and get it there!”  Yea, good luck with that.

Just another day in the world of Pharmacy Chick.

Dick and Jane (Pharmacy Version)

Filed under: Uncategorized — pharmacychick at 9:30 pm on Tuesday, April 14, 2009

See Dick fall and go boo boo.

See Jane take Dick to the doctor.

Dick broke his arm.

Dick needs some medicine.

See the Doctor write Dick a prescription.

See Jane Drive Dick to the Pharmacy.

See Dick give the prescription to the pharmacist.

Dick forgot his insurance card.  UH OH, Bad Dick!

Jane didn’t bring her purse.  UH OH, Poor Jane.

See the pharmacist tell Dick how much money he needs to buy his medicine.

See Dick frown at the Pharmacist: But I have insurance Ms.Pharmacist!

See Pharmacist ask Dick for card….again.

See Dick tell pharmacist again he doesn’t have it.

See the pharmacist tell Dick how much money he needs to buy his medicine…again.

And so it goes.

Be Prepared.  DON”T BE A DICK. 

(Blatantly stolen from every Dick and Jane story I ever read)

What’s Fair on the airplane?

Filed under: Uncategorized — pharmacychick at 1:54 pm on Sunday, April 12, 2009

As you know the Chick went on vacation a few weeks ago.  It was a wonderful time, but since then I decided to write about an event that occurred on the flight back.  If I were to have all the money in the world, which of course I will never have, I’d charter a plane.  After this flight I am sure “Window lady” would also.

We flew down and back on the same kind of plane:  2 seats on each side, about 20 rows deep.  They can stuff you in there pretty tight now days and this plane had no first class (which I have been blessed with exactly once in my life), so all passeners were among the great unwashed.  Because I always fly with Mr Chick, I always know my seat mate.  This is signficant because its a crapshoot for single fliers.  I feel really sorry for the lady across the aisle from us on that night.

We took our seats and she was directly accross the aisle, in the window seat.  Boarding last (or close to last) was this ENORMOUS woman who took the aisle seat next to this poor lady.  To say she was obese was an understatement.  She struggled mightily to get the seat belt buckled, but she managed to achieve it by tucking it under a huge layer of adipose tissue, known as her abdomen.   She couldn’t fit into the seat with the arm rest down so she pushed it up and essentially took up her own seat and half of the seat next to hers, occupied by the lady I now felt greatly for.  Window lady paid for her seat…all of it…every square foot of it and got half of it. Aisle lady took up all of the seat she paid for and then some.  She couldn’t even move the tray table 2 inches. She couldn’t bend over to pick anything up off the floor if her life depended on it. She was literally wedged into her seat.

Is this fair?  I don’t think so.  I have a friend who travels a lot for a living.  He told me once that when he flies, he puts the arm rest down and wont move it for anybody.  “I paid for this seat, I want every foot of it”.  He was asked once by a rather large person to move the arm rest and he declined. ” I am sure he thought I was a jerk, but I dont care”.   Gutsy.

 I guess I can relate to this after being on the plane with the Aisle Lady.  Space is the single most valuable commodity on the plane, if you really think about it.  When you fly first class, you may get better service and food, but what you are really getting is more SPACE.  If you are lucky enough to be short and petite, your seat will seem generous, but if you shop at Omar’s House of Tents for a mumu to cover your ampleness, then the seats will be quite small.  I ask this:  If you take up more than one seat worth of space, should you pay for that?  After last night, I would have to say YES. The Window lady got completely hosed. Then to make matters worse, Aisle lady never shut up. Yak Yak Yak, for 3 hours.

Window lady was more than polite, I’ll give her that.  Being the pushover that I am sometimes, I am not sure I would have been gutsy enough to tell this lady NO to her request to lift the arm rest.  I have a hard time being the jerk.

As soon as the plane came to a stop she leaped out of her seat to be off as quickly as she could, standing in the aisle with her ample rear in my face for 10 minutes waiting for the door to open.  Yea, thanks for that.

What’s fair?

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