The Pharmacy Chick

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…

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.

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