The Pharmacy Chick

The USA Today article raised to national attention the mistakes made in pharmacies due to workload issues. Something came to mind today as I was on the phone with yet another dr’s office….What about the mistakes we catch before they are ever filled? No, not the ones we make..the ones OTHERS make but we find and prevent.

How many times have YOU pharmacists out there had to call a Dr’s office when your computer prompt tells you of an allergy? How many times have you had to call back when somebody prescribes a Z-pak for somebody on warfarin? Serotonin syndromes, QT elongation, whatever, these are interactions that are real and day after day, we catch this stuff. Why do we catch this stuff? Because we have the necessary information to prevent these kinds of problems.

Its kind of a long introduction to the point I am trying to get at:

Patients should find a pharmacy and stick with it. The filling of a prescription is not a game, but a certain group of people are treating it like it is.

With the advent of pharmacy coupons and chasing the deal, patients are sacrificing their safety for a gift card. I dont wish harm to anybody, but don’t expect a lot of sympathy from me if it happens.

Sometimes it makes a person wonder why we don’t make people sign disclaimer when they walk in. Patients with multiple dr’s going to multiple pharmacies, taking multiple drugs.

If I was pharmacy King: here’s what I’d have the patient sign: I (insert patient name) assume all responsibility for the prescription I am about to take. I acknowledge that this pharmacy does not posess my entire drug profile, nor does it have my complete list of physicians or disease states. I came here for the gift card (by the way, where is it?), and next month I will fill my rx someplace else for THEIR gift card. I may die taking this medication today but I will die with a purse full of gift cards whom I will leave to my next of kin. WooHoo!

Ok, so its not likely anybody will actually sign anything like this, but wouldn’t it be fun? It seems that the responsible patient is a disappearing component in the filling process. If a customer is going to use 6 pharmacies every month like a game of musical chairs, then he/she is going to assume liability for his/her own monitoring. Its getting stupid out there.

How can we, on one hand, advocate collaboration between doctors to improve patient care, then encourage poly-pharmacy by handing out cash rewards. Its a practice that needs to stop. Already illegal for anybody on Medicare, Medicaid and Tricare/Champus, I wonder how long before other private insurers are going to put the cabosh on using monetary enticements to use their benefits.

I know I dont feel a lot of personal responsibility to these people. They waste my time transferring prescriptions all over town, and when it comes time for counseling, all they want to talk about is gift cards: how many can I get, how can I use them, when can I get another one. etc etc etc. They dont want to hear about side effects. They want to add to their card inventory.

All I can say to these patients is this: don’t expect ME to care when you don’t.

Happy bargain hunting, and good luck, you may need it someday.

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He came to pick up his metformin prescription. I didnt’ know what he did for a living but by his physical appearance, I’d bet it didn’t involve dress shirts and ties. By all appearances he was a recent diagnosis, as his profile had no previous diabetic meds or supplies. I went about my standard counseling: Take exactly as directed, don’t skip doses, take at meal times, test your blood sugar if the dr directs, avoid alcohol–His head shot up.

“What happens if I drink?” he asked, adding “I rarely drink however”. “Great, then you won’t have anything to worry about”. I told him about the metabolic condition lactic acidosis that can occur with alcohol. “so, will I die if I have a beer?” . We went back and forth, me discouraging the use of alcohol in his diabetic state, and he asking me the same question in about 6 different ways. I had enough. I folded my arms across my chest and said “If you are trying to get me to tell you its ok to drink, its not going to happen. What you decide to do is your business, but professionally I am going to tell you that alcohol use is to be discouraged 1) because you are diabetic and 2) you are on metformin. OK?”

I rarely drink…yea right.

Tags: customers | |

The USA Today published an article focusing on pharmacy errors in the workplace and their relationship to work load http://www.usatoday.com/money/industries/health/2008-02-11-prescription-errors_N.htm. It’s a good read for anybody not our field to realize that there is a damn good reason why your prescriptions shouldn’t be treated like its a race to the finish line. Its also a wake up call to all of us IN the field as to why it should be OK to tell Ms I’m-in-a-hurry to cool her jets and sit down. Nobody wants to be the victim of a pharmacy error, and there are always two victims: the patient and the pharmacist. I have never met a deliberately neglectful pharmacist. No pharmacist wants to hurt a patient, but almost everybody has thrown the dice now and then, gambling that they have done everything correctly when they have a fire burning under their feet.

I try to be respectful to all my patients, whether they deserve it or not (and trust me, some dont deserve much), but occasionally somebody will cross that line and cop an attitude when I tell them it will be over 30 minutes for their prescriptions. They assume “the posture” and usually spit out “THAT long?” To which I generally reply–”This is not a race and I am not serving fast food–I work at 2 speeds, SAFE and UNSAFE, you pick”

One thing that was not mentioned specifically in the article was the concept of interruptions in the workplace, something that probably more frustrating to me as a pharmacist than the workload is itself. It is one thing to have much to do, and plug along one at a time, getting it done. Its another thing entirely to have the same amount to do, but suffer the failure of not getting anything done without at least 2 interruptions. You know what I mean. The inability to bring one single prescription from beginning to end without having to stop somewhere along the line, breaking that line of concentration. I have had days where I have done 200+ rx’s and it has been a breeze, with myself and 2 techs. AND, there have been days where I was ready to stab the next person who interrupts me even ONE MORE TIME.

Even the pharmacy layout condones this. Mos of us work in a fish bowl. Walgreens may not do much right, but they have at least put the bulk of their pharmacy behind a wall. Most pharmacies are open from drop-off to pick-up. I can be seen at every spot in the pharmacy but the cubby hole where our coats are hung. Unfortunately, I cannot work back there….

What I am getting at is this. Every part of the filling process is important, but every part of it is fully in view and completely interruptable. I can be inputting a prescription and hear “ahem, can I ask you a quick question?” I would love to say “NO, I am saving a life here. you must wait til I am finished”. Do Doctors see their patients in the waiting room? Do surgeons perform surgery in the hallway? Do lawyers counsel their clients in the lobby? How many times have you called an office to get clarification on a prescription to be told “the Dr is with a patient, I’ll get back to you when he is done”

Some jobs can be done in the public view, but I am pressed to say that Pharmacy shouldn’t be one of them. Yes we should be available, to counsel, to help, to whatever. But we should NOT be ON-DEMAND. I could never walk into a Dr’s office, my Accountant’s office, my Lawyer’s office (thank God I dont have one), and say “I want to speak them…right now” You would likely be greeted with “AND, do you have an appointment?” If other professionals pace their day and have gatekeepers to shield them from unnecessary interruptions, why can’t we do the same to some degree, to minimize our risks, and maintain our sanity?

Think about it for a minute. Do we really need to be in view 100% of the time to be good pharmacists? If somebody wants to ask a question of a pharmacist, do they really need to hang over the counter and interrupt, creating a potential mistake? We are only human, and humans we will always be.

There is a chain in the city I work in that is all about SERVICE–they even get graded by so called “secret shoppers” to make sure they meet all the criteria from the Hello to the Goodbye. I have talked to their employees and they have told me what a stressful environment it has created. They get points for doing it right and deductions for missing something. For the company, its all about getting 100% on these secret shoppers, and not much else. I doubt that company will ever put a wall up to shield their pharmacists from interruptions.

A national celebrity’s infant child was given a (likely) fatal dose of an anti-coagulant in a hospital recently. Fortunately it was caught soon enought before harm was done and the antidote was administered. I believe the dose was 10,000 times the amount for an infant (don’t hold me to that figure, I dont have it in front of me) I wouldn’t want to be the nurse to did it, and I certainly woudn’t want to have been the pharmacist who sent it up to the floor. It was an error of similar packaging. High profile person+huge mistake=big fallout.

Every mistake is a breakdown somewhere along the workflow route. I truly believe that the fewer the interruptions, the healthier the work environment (including a lunch and break for EVERYBODY) , the better the layout, sufficient labor, and the proper technologies (scanners etc) and the time to counsel properly, the fewer the mistakes.

Now I’ll get off my soap box.

Tags: mistakes, national news, pharmacy life | |

The people who have the most time on their hands choose to bug me when its the busiest?–you know who they are–Joe Retiree-Flyfisherman has to call you at 9:30 am on Monday morning to order is 6 rx’s and Oh, can I pick them up at noon?

Every phone call that comes in at 2 minutes before closing are never simple? (don’t you just want to let them ring?)

Nobody ever loses their HCTZ?

the complexity of the problem I have to solve is inversely proportional to the amount of time I am allotted to fix it??

“quick questions” never are?

“help desks” never do?

“customer service” only serves their companies and not their customers?

an audit will never find an UNDER payment?

customers will beat you bloody if you short them a pill but will never call you if you toss in that extra 1 pill just to see if they notice??

the phone rings and customers flock to the counter just as the first bite of food enters your mouth?

GOT any more??

Tags: customers, employees, insurance, pharmacy life | |

He came up to the pharmacy window and asked to speak to the one who does the hiring. He looked somewhere between 18-24 (who can tell nowdays?). Since I am the PIC, the duty fell to me and I was called over. I looked him over and had to wonder Do you have a mirror and if so, did you look in it this morning before you came over? He was unshaven, had baggy jeans on–you know the kind, where they stay up by seemingly defying gravity, clinging precariously under the owners butt cheeks. (an aside: I dream of the day as a little old lady walking up to one of these teens and yanking these gravity defying pants right down to their ankles)… He was wearing a shirt that literally begged to be tucked in, and a “do” that rarely saw a comb.

He slouched (always an impressive characteristic) and the eye contact was sketchy. I asked him “what position are you interested in?” and he said with a straight face: “I would like to start out as a technician and work my way up to the Pharmacist” Had I had coffee, I would have had a comedic moment and spit it onto the counter. My gut instinct was telling me this young man was looking for any job that gave access to all those nicely bottled controlled substances, but I held my tongue. He was gutsy, I’ll give him that, plus I need to control my stereotypical judgements…

“Did you know that the position of Pharmacist requires a college degree that takes about 7 years to obtain?” I asked. No, he wasn’t aware of that fact. I referred him to our corporate office, told him about the national certification program for technicians, and knew darn well he wouldn’t do anything about it.

I wonder if he thought I would just toss him a jacket, a name tag, a spatula and a tray and say “Get to work”?

Worse yet, would anybody fall for it?

Tags: employees, pharmacy life | |

He brings the pharmacy chick a prescription and smugly announces: “I want this filled, I called my insurance–they said its covered!”

My brain is thinking this is not covered

I take the Rx, process it and behold-”REJT” “ndc not covered on plan”

Pharmacy Chick’s brain: here comes the argument

“This is not covered by your insurance”

He looked at me as if I had just insulted his mother “I CALLED my insurance company, they said it was covered” a little vein popping in his forehead.

Here is where it gets complicated: This is a vaccine, a product and a procedure. I tried to explain that it may be covered 1) if he submits it manually or 2) if its done in a doctor’s office. BUT, its not covered as billed as a prescription.

He didn’t take this well–His doctor doesn’t carry the vaccine and he was in no mood to fork out the cash. I have him a copy of the rejection and told him that the rejection is now on file in his insurance company’s computer. He spits a few complaints and takes the rejection and leaves.

Buh Bye.

Tags: customers, insurance | |

I like to go to the gym, especially in the winter months when I don’t get outside as much as I do in the summer. I was in the locker room, toweling off from my shower and as buck naked as naked gets. And that’s the moment I got face to face with one of my customers. Now granted, its not like I was a slobbering drunk and the end of a gay bar. I was only drying off after a shower, but it WAS the first time that any customer of mine that was not immediate family had seen me au-naturale. We exchanged a few pleasantries, and moved on.

I’m no prude but I have always kept my professional life separate from my private life. I have a few “crossovers”–people who have started out as customers and who I now see outside work occasionally– but for the most part the only people who I mix business/pleasure are those who STARTED out as friends then chose to do their business with me. Most of these know that the person with the white coat on is rather conservative and low key, and the person with the white coat off, is a little more fun. I also don’t hang out with employees after work, neither from the pharmacy nor the store. Frankly I think that most of us (after spending 40 hours a week together) would just as soon NOT hang out together.

I think its important (for me) to have a private life. When I am at work, I am on a stage, and my performance meets my company’s expectations. For some reason, when a customer runs into me away from work, I revert to “pharmacist mode”. I cannot explain it. I’m a little more stiff, a little more formal….always friendly and approachable, but still “properly” reserved. Some customers actually seem embarrassed to see me outside of work–as if I am going over their profile in my head or something. If the truth be known, I empty my brain of all things work related when I walk out the door. The very last thing I am thinking about when I run into Mr X, is his drug profile.

Therefore I felt more exposed that normal when I had my locker room incident. I guess I think I should at least be clothed when I see my customers. So I open up to you– What kind of “separation of church and state” do you maintain in your life?

Tags: customers, personal life | |

I am in my street clothes, coat on, in a darkened pharmacy, gates down. I just got to work.

So what is it about that scenario that begs for some dude to come up and ask me: “are you open!?” I think it must be the husband of the woman who chased me down the aisle at 10 minutes after closing time with the cash register in my one hand and my purse in the other asking “is it too late to pick up a prescription”

That usually gets me right under the skin. After being owned by the company for 11 hours, once the clock strikes “closed” it’s now MY time. I usually politely say no. This time was different. He called about 10 minutes before closing time. He was running late, could I stay just a little longer so he could get his meds? I knew the name, so I told him I would wait, just come to the back, even tho it will be dark in the pharmacy. He arrived around 20 min after we closed, smartly dressed but tired looking, picked up his stuff and graciously thanked me–He had to work late..again. Thanked me again and told me “if there is anything I could do for you, let me know”. I said “THANKS, but I know what you do for a living–I hope I never need you!” He smiled and left.

He is an oncologist.

Here’s to doing the right thing now and then, even when you wanna go home.

Tags: pharmacy life | |

Pharmacygirl has it right. I hate coupons too–just endured a 4 week blitz of coupons. I am ready to throw a sharpened spatula at the next person who hands me another gift-card coupon. I figured my 4 week total at almost $4000 given out in gift cards. AND these are the kind of gift cards you can redeem for something else so they aren’t stuck using it in the store–no-siree, they can eat at Olive Garden or buy a shovel at Home Depot with their proceeds. You know, it should be taxable income if you ask me, considering how many I hand out to those few people who have made it their personal hobby to torture pharmacists with their weekly drug transfers. I know their faces, I dont even have to guess- I see the name, I know the coupon is in their sweaty hand.

I got one guy who had 4 rx’s monthly- went to 4 different locations on the same day and transferred one to each store. Then reversed it the next month. Then on the third month, transfers them back to the 4 stores, but each with a different rx till after 8 months each store had transferred back and forth all 4 of his rx’s once. Then he moved on. Do the math: 4 of our stores, and 4 competitors with 4 rx’s bouncing back and forth 4 cycles. At $25 per transaction thats $100 per month for 8 months. Nice take bucko.

Then I had the lady who was at my counter transfering a 15gm tube of cheap cream, from Store X then 15 minutes later was at that very store X transferring something else from me. She had a coupon for both stores. The other pharmacist about popped her cork. She lectured me for 5 minutes on her distaste of this and she was going to do this and that and call the Board and stop this nonsense. I said “I understand, I share your feelings but nothings going to change and the Board of pharmacy doesn’t care” Its not a legal issue. They’ll probably just laugh at us–what do they care if we want to give away our profits as long as our noses are clean and all our records are in order?? I talked to her a few days later and that is EXACTLY what the Board told her…

I know, I know, “dont get all riled up, its not coming out of your pocket” I hear it all the time, but “time” is the key here. I don’t have enough of it to deal with all these imbiciles tranferring their Atenolol 50mg #30 every month to a different drug store chasing coupons.

Loyalty Shmoyalty–these are coupon chasers and nothing you can show me will change my mind. I work in the trenches see? I will transfer the same rxs out next month that I transferred in THIS month. Does this foster new business? My boss told me once with a straight face mind you, that these programs are to “intice people to try you out and see if they like the store and the service you provide” I laugh in your face! I do the mandatory counselling and all they want to talk about is the coupon ” Did I get it?” “when can I use it” ” when can I get another one?”

I get a week of reprieve for now–but since we take competitors coupons, I doubt it will be much of a reprieve. I am waiting for the mother of all coupons, somebody will do it I know someday– $100 ……One C-note for the new or tranferred rx. Thats when I will jump on the band wagon. I’ll find some sucker Dr. who will give me 20 Ibuprofen 600 with about 4 refills and I’ll pay my groceries for a couple of months on the $500 I plan on collecting …yup, just waitin….and I’ll do it with a straight face.

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I haven’t seen him face to face in a year. He lives in assisted care (finally) with his wife, but I talk to them both on the phone. They are both delightful people and it doesn’t matter if I fill 30 prescriptions a month for them or 3 (30 is closer however), I’ve have bent over backwards to get their meds covered and keep them properly medicated. You see, they both have many medical conditions, highly fragile in their needs. And he recently reluctantly tranferred his prescriptions. He called me to APOLOGIZE! For months after moving we still filled his monthlies, with some member of his family coming to get his grocery bag full after he got his soc-security check. Because his new abode is not very close, it was a burden for his family to get his stuff, but he insisted. We were valuable to him and he trusted us. I talked with him and his voice was cracking because he SO didn’t want to leave us, but the med service at the care center would basically assume all the care and all he had to do was swallow what they handed him–no longer having to remember all these complicated regimens. I told him it was OK–and he would receive better care this way.

They’ve had it hard–its time somebody takes care of something for them.

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