Jaded Pharmacist

Irony is lost on this one

2011-05-01T15:32:00.002-05:00

Overheard a customer saying she had 'a whole new respect for those who serve the public.' That's always a nice thing to hear.

If only she wasn't saying to her friend on the phone while she was picking up her prescription...

(Another hiatus, I know. Right now, I've been regularly working at a nice slow store 2 days a week, so there is little opportunity for good stories to pass along. Oh well, can't complain about having a calm workload, right?)

So much for that...

2011-02-28T11:48:00.003-06:00

Two months. Two months staffing one store, and it was all I could take.

Without getting into details, suffice it to say I was over-stressed at this store. Losing sleep one or two nights a week was not something I was going to accept. Nor was I going to accept the feeling of dread of going in to work. Every. Single. Day. Not going to happen.

This is my first week back to floating. Right off the bat, there was a sick overnight pharmacist. In the first 3 days of floating, I pulled two 18-hour days (one 8am-4pm and 10pm-8am, the other 2-10pm and 10:30pm-8am). I ran on nothing but caffeine and will power and got home from both days utterly exhausted.

But not stressed.

In the upcoming weeks, I will:
- close at store at midnight, then open a store (2 hours away) at 9am
- have picked up 3 days in a row at stores 2+ hours away (staying in a hotel, of course) before leaving town for the weekend
- return to do 2 more overnights at a store 1.5 hours from home

Man, it feels great to be floating again!

Friday Night Thoughts

2011-01-08T12:00:00.002-06:00

- Patients with large quantities of meds should not be allowed to transfer pharmacies. The night was busy enough, what with the day staff not pushing ahead and being dragged down with trainees. A couple decided to transfer their meds to us. Between the two of them they had *twenty-seven* prescriptions, and they wanted to pick them up the next day. Fuck. I didn't even get a chance to touch the transfer reports until 9pm, and didn't finish and get out of work till 11pm, an hour after closing.

- To the gal who dropped off the ER script from 4 days ago. If it was such an emergency, why wait *four days* to fill the prescription? The script says 'void after 72 hours,' and asking me to call the ER and get the OK is not going to change that. Tough luck, try again.

- Almost considered switching to hospital. It can't be *nearly* this bad, right? Fleeting thought, however; a night of sleep took most of the residual anger away.

- Notice it wasn't a *good* night's sleep. Bad days at work always bite me in the ass. Dreamed I was working a 9-9 shift, and didn't realize the time till it was 9:30, tried to close down shop and got slammed by a horde of people with questions. Luckily, I woke up before it got too ugly, but sadly spoiled my hopes of sleeping in on a day off.

Three days into my set store. Thoughts so far: meh, hoping the bad vibes are due to the hassle of new year. If it's not though, the float pool will be calling my name...

Float no more?

2010-12-31T16:39:00.002-06:00

For the past 16 months, my work schedule has been delegated by the needs of the company. I was told where to go and when to work. Granted, I didn't mind: most locations had decent enough staff to work with and (sadly) I had little in the way of a social life to cause any conflict.

Those days are soon to be over. Starting next week, I'll be set to staff *one* pharmacy. I've had the past few weeks to reflect and weigh it out how it will go.

Pros:

- The state board requires the pharmacist's license to be on display while the pharmacist is at work. For floaters, this means having to lug around a license in a 14x18 frame to and fro. I will *definitely* not miss this.

- No more checking out and checking in emergency keys before and after work. Depending on the store this task could drain 2 to 10 minutes of my time. Each day. No tears shed over the loss of this experience.

- Set schedule. I never knew what days I would have off until the schedule was released. Now, I have every Tuesday off and every other weekend. A day to schedule appointments, and a consistent schedule to plan out events more than 4 weeks in the future.

- Pharmacy hours. No more working after 10:15pm during the week, and no working after 6:15pm on weekends. Also, no overnights.

Cons:

- Location. This store wasn't exactly on my list of stores to be set at; hell, it wasn't even on 'to be considered' list. The store is located in a less than desirable area of town. Not 'dangerous activity' area, but 'trailer park chic' area. Definitely will continue to be fully aware of Medicaid formularies here.

- Manager. I've heard stories that the pharmacy manager can be a bit overbearing. We'll see how this goes. Hopefully, my easy-going side will ebb this potential problem

- Coworkers. Not the ones in this store, mind you. The pharmacist, technicians, and interns at other stores that I always looked forward to working with when I see there store pop up on my schedule. This is going to be the toughest of all to overcome.

But I have to say, all in all, I'm looking forward to a new chapter. Here's to hoping a staffing position will give me more fodder (and energy) to keep this blog going with a bit more consistency.

Quote of the Week

2010-09-03T20:51:00.003-05:00

Talking with one of the staffing pharmacists, regarding a patient who insists his insurance will give him an override so he can get his Oxycodone early:

"The guy is always trying to get his Oxy early. And we know he's blowing through it. One month he came in with a new Oxycontin script and he requested brand because - and I quote - 'the generic isn't as easy to crush.'"

Wow. Once again, gotta love when the patient removes all doubt that your abuser-radar is functionally correctly...

Sick Day

2010-07-13T14:10:00.002-05:00

Yet another milestone in my career. I'm using my first ever sick day. It's also only my 5th missed shift since I started with the company as a cashier in 1999.

All I had was a scratchy throat and a very hoarse voice. By the end of last night, I was whispering; not to conserve my voice, but that was the loudest I could talk. Otherwise, I felt 100% A-OK.

This morning, I decided to call my scheduler and see if I could have my shift replaced. The moment she heard my voice, she said not to worry about it. I felt almost guilty about it, since I felt I was still able to function.

Now I'm almost glad I did. I'm sitting here in my barely cooled apartment (78 F), with a fever (only 99F, but my healthy temp is around 96.5F), and I am shivering.

Here's to hoping a day of rest and fluids will knock this over. Working tomorrow regardless...

Patient Quote of the Day

2010-07-05T13:52:00.002-05:00

From yesterday afternoon...

Patient (on the phone): I found a tablet and I want to know what it is.

Me: Okay, what does it look like?

Patient: Well it has the markings AN 41 on it. And it's a small orange-ish, round pill, about the size of a Klonopin.

Oh how I love it when you don't even need the old radar to spot one of these people. It really is quite nice of her to come up with a gem like that.

Of course, I wasn't too surprised when the Drug ID program came back saying Cyclobenzaprine...

Happy "I Don't Want to be a Mother" Day

2010-05-12T10:36:00.004-05:00

So I may be a few days late on this, but still worth mentioning.

Last Sunday, there was more to celebrate than the mothers of the world. US News and World Report wrote an article that shed light on another celebration:

The 50th anniversary of the birth control pill.

Oh, irony, how I love you...

Do as I counsel, not as I do

2010-03-31T17:39:00.003-05:00

What can I say? Sometimes the non-compliant ones are the ones who know better, which includes us pharmacists.

Case in point: Today I decided to go rollerblading. It's a nice, warm, sunny day and I'm switching back to overnights for the next 7 days. So I go out and hit the trail nearby. Two laps - roughly 8 to 9 miles - in the course of an hour. Without a shirt, hat, or sunscreen.

While on Doxycycline.

Oops.

Counting by Moonlight

2010-03-23T10:47:00.002-05:00

Surprise, another unexpected hiatus.

The reason this time? I've flipped my schedule by working overnights. One of the regulars at one of our 24-hour stores went on medical leave and I jumped on the chance to have a consistent schedule. It may mean working 10pm-8am, but it also came in a nice 7 on/7 off pattern.

So I'll quench your thirst with a couple gems I've had while twilighting:

Mouth or ears : only one can work at a time

Countless phone calls have entailed a patient (most cases a female, coincidently) call with a question. I have an answer, but I can't respond. Why? She is still talking, still rambling, still thinking she's providing valuable information. In reality, she's just irritating me because I'm trying to help her and she can't listen to me because she won't shut up! One night, I had my first 3 phone calls fall in this category; I was about to pull my hair out (if I had any, that is).

To B or not to B

A young guy walks in and asks to buy Plan B. I see ID, grab a box, and go to ring him up. He sees the price tag - $53. Cue eyeball-popping reaction. "Wow, that's a lot." Usually, I can bite my tongue, but my snarky comebacks can be misconstrued at rude. Tonight I wasn't able to stop myself.

"Compare that to the price of 18 years." In a delicate situation it's difficult to predict a reaction. Realization, anger, or embarrassment? Luckily, the first one happened. He chuckled. "Damn good point." I gave a quick run-down of what to do, what to expect, and he was off.

And he was back. He said when he got back to the car, the girlfriend asked how much it cost. When she found out she flipped, said that was way too much. Apparently, she wasn't *that* concerned...

I'm hoping to post on a more frequent basis, even if it's just short snippets of funny/quirky/annoying patients.

You know it's going to be one of those Mondays...

2010-01-12T00:40:00.002-06:00

... when you drive into work and see a fire truck and an ambulance sitting outside the store entrance.

So I walk in to start my 10-6 shift, and the pharmacy staff sees me and said, "You missed all the action."

Apparently (and I'm still not 100% clear how this was discovered) a patient picked up his prescription for Hydrocodone and downed the entire bottle in the store. Luckily it was just 12 of the 5/500 tablets, but still I'm guessing his liver wasn't happy with the huge load of acetaminophen it had to try to handle at one.

And sure enough, it was a Monday full of faxes, C-IIs, insurance updates, rejections, and questioned copays.

Any other good Monday stories out there?

Blame, planning, time management, and all other things that are never the patient's fault...

2010-01-06T11:12:00.003-06:00

JRPh isn't a complete cold-hearted bastard. Many times I'll be the one that's laughing and smiling and keeping the pharmacy in a nice pleasant mood. But the right kind of situation/patient comes around, and it can change pretty quickly.

Take yesterday. I was working out in a small-town setting. A woman stops by and is looking for help - and it's obvious because she's leaning her body over the counter and into the pharmacy (Note: strike 1). At this point, I'm on the phone, as is one other tech, and the last tech is counting out pills. Anyone with 2 brain cells can see we're busy.

"Hello?? Can anyone help me??" (Strike 2)

We acknowledge her and say one of us will be with her shortly. And lucky me, I'm the first one to finish up. So I walk over and help her.

"Hi. I live out of town and drove in for my dentist appointment, and half-way here I realize I forgot my pre-med (non-medical translation: 1 larger-than-normal dose of antibiotics to prevent infection) at home and my appointment is in 25 minutes. I was wondering if I could get a refill here. Oh, my prescription is with another pharmacy. I have the name and number."

At this point she seems pleasant enough, and I'm giving her the benefit of the doubt. I mean, we're all human and we forget something now and again. So I offer to call her pharmacy and get the information. After being on hold for about 3-4 minutes, I get the pharmacist who takes some time going through her profile and finds no active prescription with refills. He does, however, find the last prescription and gives me her dentist's name and phone number.

I thank him for his time, and relay this information to the woman and offer to call the dentist.

"Okay, but please hurry. I don't want to be late."

Hurry? Lady, haven't you noticed that I haven't diverted my work to anyone but you? I can't go any faster. Anyway, I call the office, get the receptionist and relay the information (including the fact she has an appointment soon). She then puts me on hold to grab her chart and/or the dentist. After another 3 minutes of waiting, she comes back and says she'll have to call me back after she grabs the dentist. Okay, sure.

I walk back over to the woman (who has yet to move from her hovering stance at my counter) and tell her this. She gets a worried look on her face, and I tell her I will get this going the second I hear back. She finally takes a seat.

Of course, she only sits for 5 minutes before she comes back up to the counter and asks if we've heard back. It's important to note the phone didn't ring once. At this point, the other pharmacist has stepped back into her spot and she recommends going now without antibiotics (it's now 5 minutes after her appointment time) - maybe they have some sitting there or something. She takes this and leaves. A few minutes later, the dentist calls back and talks to me. I tell him she has left to make her appointment. He says he'll give her a new prescription which she can fill right after her appointment to keep her covered.

Sure enough, an hour later, here she is again. "I got the prescription!" she shouts into the pharmacy at no one in particular because she didn't wait 2 seconds to be helped (Strike 3). I take the prescription and tell her it'll be about 10 minutes.

"Oh, it better not take that long. I have another appointment in 15 minutes." (Strikes 4, 5, and 6)

I tell her we'll finish this as soon as possible and ask her to take a seat. At that point, I switched over to Dickhead Mode. I made sure the prescription would take exactly 10 minutes to get ready. This lady needed a lesson, and I was going to give it to her.

Twelve minutes later, her prescription is ready and one of the techs rings her out. After she's finished, the tech walks up to me and says, "The lady pointed at her watch and said it took more than 10 minutes, and then complained that she was going to be late."

My response: "Ask me if I care."

Forgetting to take a med: Understandable - we're human.

Asking for help to correct said problem: Understandable, and I'm happy to do it.

Rush me to fit your schedule: No dice.

Complain that my helping you fix your problem didn't fit your perfect world: Don't care

Not once saying "Thank you": Rot in hell.

I've said it before (many times), and I'll say it again (many times): Lack of planning on your part does not constitute an emergency on my part.

You know it's bad when...

2009-12-09T19:06:00.002-06:00

So unless you've been hiding under a rock, the Midwest was slammed with a brutal snowstorm. My last experience with it was yesterday evening when I left work. It was just starting to pick up in intensity at that time. Took me 20 minutes to dig out my car from the 8 inches of snow that fell while I was hustling away at filling prescriptions for patients who were freaking out at being snowed in for days. The drive wasn't all that terrible at the time - despite blowing the powdery snow across the city and not seeing lane lines and only going about 20mph most of the drive home. In fact my only difficulty the whole drive home was getting up the incline of the entrance and in the garage. Let me tell you, I am more than satisfied in the extra rent I am paying for indoor, heated parking.

I woke up today with a call from the back-up scheduler. She wanted to see if I would be able to make it to a store 4 miles away that afternoon. At the time I agreed, but in a couple hours of talking with my friend who shacked up here to avoid the 40-minute drive home, checking Facebook statuses of closures, snow-ins, and driving horrors, I finally called the store and said I wasn't going to try to risk coming in today. Luckily they had a back-up plan in the event I couldn't make it. I still felt bad but not as bad as I would normally be when I miss a shift.

And that's my 'you know it's bad' moment. You know it's bad when I don't go in to work. In the 10 years of working with my company, this marks my 4th missed shift. The last time this occurred was September of 2003 (thanks to a broken-down car and no one to drive me).

So, I say to those in the Midwest and Northeast:

Midwest, already affected: I hope all of you are okay and dealing with the weather, work, and personal safety well -however you choose to balance.

Midwest and Northeast, to be affected - this is a very major storm. Please prep yourselves - grab extra food, and prep for 1-2 days of snow-in. Lots of snow and heavy winds will make most traveling and businesses difficult, if not impossible, to function.

Best wishes to all,

JRPh

Pharmacy Follies

2009-10-25T16:31:00.002-05:00

This week found me working my first overnight shifts. I don't mind it at all – actually had been contemplating this option for years while in college. I'm naturally a night owl; plus who wouldn't like the notion of working 7 days on, 7 days off? So when a help email was sent looking for emergency coverage for 2 overnight shifts, I grabbed them. The main problem occurred to me shortly before I was getting ready to go to work: I had been up since 9am that day, and needed to stay up till 9am to get through my shift and the drive home. Thankfully, the can of pop I had that day and the 2 bottles I consumed that night kept me going.

Both overnight went rather smoothly. Was a little rushed between 10pm (when the night staff left, leaving just me) and 11pm or so, but afterward was smooth sailing – just the occasional ER patient here, the quick phone call there. Both mornings after found me home, and up just long enough to check email before crashing to sleep.

Good thing I did the second morning. Email from the district office informing me my schedule changed for that day, and I was due at another store in 2 hours. A quick phone call to the scheduler saying, "Yeah, I just got off work an hour ago," got that reversed.

Meanwhile, a sampling of the inane questions I've received over the past week of so:
- My mouth is feeling dry. Can I drink a glass of water? No, haven't you heard that water is the leading cause of dry mouth???
- My ear is itching. Can I scratch it? Depends – can you reach your ear?
- I’m using ear softener drops. Will it hurt me to take a shower? No, stay smelly; it's preferable to clean body and ears. And yes, all three of this questions asked by the same person in the course of 2 days.
- I just used Capsaicin and now my skin is burning. What should I do? Considering that’s how Capsaicin works… but this chick just wasn't getting it, so I told her to wash it off and try IcyHot instead.

And no surprise that "flu frenzy" continues. Everywhere I go seems to be out of stock on:
- flu shots – seasonal and H1N1 (if they even had it to begin with)
- thermometers
- children's and infant’s Tylenol and Motrin
And every ER I've talked to have been swamped with parents sending their kids in with "flu-like symptoms." Luckily, I've intercepted a lot of parents – either on the phone or in the store – and gave recommendations on how to treat symptoms at home. At this point it appears the H1N1 is breeding and spreading in the ER and doctor's clinics because those who do have it are spreading it to those who think they or their kids/siblings/parents/friends/etc. have it. Every chance I get, I tell parents only to go to the doctor unless absolutely necessary (i.e. cannot treat or control symptoms at home). It's the flu (seasonal or otherwise) and treatment is still the same – symptomatic treatment with plenty of fluids and rest.

This flu season will not end soon enough…

Feeling like a Broken Record

2009-10-14T20:50:00.002-05:00

Various phone calls are having me say the same lines ad nauseum:
"Thank you for holding, this is Jaded, how may I help you?"
"I'm sorry, we are out of flu shots."
"No, our other locations are out as well."
"No, I don't know if any of our competitors have any in stock."
"We have another order, but we're not expecting any more as it is on back-order."

My apologies to any of my patients who feel like I don't care when I say this to you - after saying it dozens of times, it becomes automatic. The situation stinks, but it's not in my control.

Any other 'broken records' out there?

- JRPh

Floating

2009-09-06T21:04:00.002-05:00

Since getting licensed over 3 weeks ago, I've been getting first-hand experience on 'floating.' After working with several of these 'floating' pharmacists, I wasn't exactly thrilled at the idea. Seriously, what pleasure can you derive from a job position that gives you no consistency over where you work, when you work, and what day you have off?

Well, after 3 weeks of floating, I've discovered it's not as bad as I was expecting. Granted I've had one or two bad or hectic days, and yes they sucked. But:
- I always take pleasure in the fact that I don't have to go back into that store the next day (unless, of course, my scheduler has me working the same place two days in a row).
- If a situation gets out of control or I'm not sure how to handle it, I can still use the magic cop-out phrase, "I'm sorry, but I'm filling in here. That decision needs to be made by staff pharmacist/pharmacy manager." Keep in mind, I try not to use that phrase often, because it would suck to be the next person to come in and fix multiple problems.

One thing I have learned to appreciate in my floating experience is how good techs can make the day so smooth. The store I worked at through college had its luck by getting some well-trained techs, and even on high-volume or technical difficulty days, there's still a sense of flow and stuff still gets done. I've been at stores where the techs move to keep everything going, and just know how to do their jobs and how to do them well. Of course, I've worked at stores where getting the techs to do their job properly is akin to pulling teeth. Even a slow store can be a nightmare if the tech cannot or will not do their job properly.

The Day Has Come

2009-08-13T20:08:00.004-05:00

As you can see from the recent changes to the blog, I have finally transitioned from pharmacy intern to pharmacist.

I could say that it was a wonderful and exhilarating feeling; it was.
I could say it was a relief to find I passed the exams; it was.
I could tell you that everything has now changed...

Eh, not really. Other than everyone expressing their congratulations, I felt just the same as I did before I earned the title RPh. And I actually reflected on it for a split second while at work today (not that I had much time to think about it).

And how did Day One go down? Covering a pharmacist's vacation at my own store, while we were down one tech and scrambled through most of the day.

Nothing like hitting the ground running...

NAPLEX

2009-08-04T19:29:00.002-05:00

The first of my last two tests of my life (hopefully) is finished. All in all, I thought it went well. Highlights:

- Test-takers were placed in separate booths, each numbered. At first I was told I was in booth 12B, which I thought was strange, as the room wasn't so big to requiring labeling booths by number and letter. When I was shown into the testing room, I understood; booth 12B was in between booths 12 and 14, so as to avoid any grumbling from superstitious test-takers. It was a good chuckle for me.

- My test-taking skills have not changed since my last test over a year ago. In school, I was a fast test-taker, usually only needing 40-50 minutes for a 2 hour exam. This was no different. One hundred eighty-five questions and 4 hours 15 minutes to answer them; I finished in roughly 1 hour and 40 minutes.

- Everyone seems to come out of the test saying, "Oh wow, I had a lot of [insert disease state] questions!" I thought mine was pretty well-rounded, though I did have a few more multiple sclerosis questions than expected.

Now I get to turn around and study again for my law exam next Tuesday. I need to find the motivation again to study, especially for such a dry topic as law...

Irony much?

2009-06-27T01:13:00.002-05:00

Scrolling through all the prescriptions ready to be sold, I ran across one for a patient who ordered her cholesterol medication. Apparently she had ordered 2 refills, as there was a written note on the front:

"Cannot refill Namenda - last ordered 10 days ago."

In Transition

2009-06-08T23:56:00.002-05:00

Well a lot has happened in the past couple weeks. The big one being my long awaited graduation. And with the graduation came a change in my 'title' with the company - from Pharmacy Intern to Pharmacy Graduate Intern.

May not look like too much of a change, and it really doesn't feel like much of a change to be honest. However, the staff is doing what they can to help realize the change. They will come to me more often to counsel patients on new prescriptions and to take phone calls from patients who "want to speak to the pharmacist." A new change in state law has makes this change more tangible. A relief pharmacist brought to our attention that interns are now able to call for transfers. And - wouldn't you know it - there was a transfer to be done for the next day. Of course it can't be anything we see on a day-to-day basis; my first copy ever was from a CVS in Florida for Tikosyn.

And now comes the joys of studying ... yet again. This week my employer sponsors a 3-day review session for the NAPLEX exam, and I took advantage of the study aid.
- Structured review works best for me (even if it does ring similar to the classroom setting)
- Out of town, so it's an excuse to get away from the daily grind
- Located in a pretty sweet hotel chain, and at a decent rate
- Free study guide

Day one is finished, two days left. Speaking of which, my Day two is coming fast.

Jaded Rx (Graduate) Intern, signing off...

Doses Of Insanity

2009-05-14T00:02:00.004-05:00

So today apparently was "Horrid Prescription Writing" day in town. We had roughly 5 prescriptions in a row that we had to call and clarify what the hell the doctor wanted. Including...
- Do the math. Azithromycin 250mg, 2 tablets today then 1 tablet daily for 4 days, dispense #5. Hmmmm, calculator must be broken at the office...
- And it seems to be spreading. Levaquin 750mg, 1 tablet daily for 5 days, dispense #7. Wow, simple math completely bumbled. Resident nonethess; shouldn't this be more shocking considering we're nearing the *end* of a residency year?
- Promethazine 25mg, 1 by mouth as needed, dispense #20. How often? Every 3 weeks? 2 minutes? This is not a newly-prescribing doctor, they should know better (emphasis on the word "should").

EDIT: This continued into the next day. Levaquin 750, 1 tablet daily for 14 days, dispense #10. Oddly enough, when I called to verify how long of a treatment the doctor wanted, the nurse checked and responded, "I guess she only wants 7 days."
---

And then there was our patient and her famous disappearing act. She came in asking about her prescription. We've been dealing with this prescription for the past 3 days. She's trying to fill her Tramadol early. But she "lost it." Over the past 3 days, she has tried everything, and we have went a long ways for this. We've contacted the doctor to verify her story and to authorize an early refill, and we've calling her insurance company (Medicaid ... shocker) - which usually don't cover lost prescriptions, period. Today it was my turn to deal with her. Of course, she started the transaction so sweetly by coming to the counter and saying (read: borderline yelling), "It's been almost 72 hours, is my prescription ready yet?"
Of course, this sets off the nice side of me, because nothing makes me feel better about my job then people barging at the counter and getting my attention before ensuring I'm ready to help. I check the prescription, and it has a not attached that says the early refill has been okayed by the nurse, but the insurance won't cover for 4 days. I tell her this, and she goes on and on about "What am I going to do? I can't afford this and I need it." So I reiterate (3 or 4 times over the next few minutes) that her options are to either pay cash for a few days worth until insurance will cover again, or to wait until insurance covers. She turns away bitching and whining to her friend about her upcoming pain and suffering over the next few days.

But JRI, you're saying, how can you be so cruel? This woman is going to be in pain. This may be true, however:
- rudeness severely cuts my empathy; this may not agree with you, but it's how it is.
- badgering and demanding over 3 days rubs everybody raw; the entire staff has been fed up with her.
- this is the third time in the past month her Tramadol has vanished.
Now I know losing things is a part of life. However, some times tough love is needed for someone to learn. At this point, she needs to learn to keep track of her meds. Case closed.

---

Our receipts now offer surveys to provide feedback on our customer service and comments for praise/criticism. Most of the time, we get pretty neutral comments - both positive (good customer service, timely attention) and negative (too busy, hire more help). Today was a new one. One of our patients last week was "Very Dissatisfied" with her counseling on her prescription. I heard this and thought, "I guess we didn't discuss the medication too well." Boy, was I wrong. This patient explained she was very dissatisfied because she was "thoroughly counseled" on her medication and the "side AFFECTS." I chuckled, but I understand as we have a couple students that have recently finished their Counseling classes, and the curriculum requires a 'thorough' counseling for a good grade. I guess there's no pleasing everyone...

---

After work, I get into a chatroom and start chatting with an out-of-state nursing student. We get to the topic of what I'll be doing for work, and he asks if I'll be working in "a hospital or for a pharmaceutical company?" I explain I'll be working retail. "Can you explain, I don't understand..." Really, this guy has never seen a pharmacy inside of a Wal-Mart, Target, CVS, grocery store, etc. What makes this more headache-inducing, this guy earlier mentioned he's a *nursing student* and graduating next year. Really? No wonder I get frustrated talking some nurses...

I Will Never...

2009-01-29T21:14:00.002-06:00

While driving to my rotation on Monday, I was listening to one of the local morning shows. That morning, they were doing a morning segment called "I Will Never." Listeners could call in and finish the sentence: "After last weekend, I will never ..." When I heard this, I was thinking 'Ugh, I hate these stupid themes,' but at least I was close to the site so I wouldn't have to listen for long.

First caller: "After last weekend, I will never play pharmacist."
Needless to say, my ears perked. Stupid morning theme calls, you have my attention.

The back story: The caller's boyfriend was in some pretty bad pain, as he had just had a tooth (teeth?) removed, and apparently broke the jawbone. However, he didn't want to take the pain medication he was given, as it made him constipated. So, she - being the smart, know-it-all nurse - decides to swoop in and help him.

The result (and I quote): "... and I almost overdosed him on a blood thinner."
Whoa, what!

So she continues on, trying to defend herself: the "blood thinner" in question was naproxen (Aleve). Then she goes on to trash naproxen, about how it's just a bad drug, and even her friend (another nurse) agrees, and 'it's the worst drug on the market' blah, blah, blah. She goes on: "You're not supposed to take more than 4 in 24 hours, but I gave him 8 in 10 hours."

And one of the radio hosts says she loves naproxen, and "[she] uses it for headaches and it works great, because it also have caffeine."

By the end, I was yelling at the radio in my car, because I couldn't take all the wrong statements being uttered. Let's break it down:

"Nurse"
- Naproxen is classified as a 'non-steroidal antiinflammatory,' not a "blood thinner." Now, I'll give you the benefit that naproxen can prolong bleeding time, but get your shit straight...
- Naproxen is not a bad drug ... when used properly. If package directions are followed, it can be quite safe and effective. If taken as a prescription, it will (or at least should) be monitored by the doctor for efficacy and harm.
- Giving someone "8 [Aleve] in 10 hours" is not reason for calling it "the worst drug on the market." I recall the saying, "Every drug is a poison in the right quantity," though I can't recall who said it.
- You should not be calling yourself a nurse. You are just awful. You "help" your boyfriend by knowingly overdosing him on an anti-inflammatory, then you have the nerve to blame the problem on the drug, and not say, "I fucked up."
- Get your shit together, knock that 'know-it-all' persona out, or find another calling.

Radio Host
- My guess is you take Excedrin for your headache, as it contains caffeine. However, it doesn't contain naproxen.

Boyfriend
- Get another girlfriend, for your own safety. Or lock the meds up and keep the key.

* As a side note, I am not a nurse-basher. I have met, worked with, and talked to many competent and amazing nurses in my times working and at rotations. I do have a thing against nurses that think they are the best thing since sliced bread and won't listen to others or use common sense (if they have any).

Still Alive...

2008-11-20T21:47:00.002-06:00

Apologies for such a long time between posts. The rotation I finished 2 weeks ago was an intense one - not awful, not great, about a 6 out of 10. I left that one feeling like I didn't get too much out of it other than how to take criticism, and how the preceptor goes about her day with little authority on my own. The best thing I got out of that one was reading the history and physical notes from admissions of trauma patients. Here's a few of the good ones...

- A man was "minding his own business" when he was pushed/thrown out of a second story window. And -a total shocker... - blood alcohol content of 0.236.

- A woman taken into critical care after - and no one ever figured out how this happened - she ran herself over with her truck. Wrap your head around that one...

- A woman broke her tailbone (or some bone, I don't quite remember as I wasn't the student following this one) after she was bucked off her ... mule.

- A man with spinal fracture and leg fractures after his mule bucked him into a large tree branch. Two mule riders in a 5-week span - small world...

- Not really an amusing one, but a coincidental one. I go in on a Monday and interview a new admit from Sunday night - guy was hit by a drunk driver which spun his van around. Turns out, this was the same accident that happened right outside my house.

Hopefully, I'll have more frequent posting coming - no promises though. The rotation I'm at now can be busy at times, but it's much more enjoyable, as I feel like I'm *actually* contributing to the patients' care. Too bad, I'm missing a total of 6 days (2 for Thanksgiving, 4 for Midyear) of a good rotation...

He wanted what?!?!

2008-09-24T21:46:00.003-05:00

So while sitting at my rotation site (family practice clinic), one of the front desk girls comes back to ask a question. I'm at my station doing refill authorizations and pharmacy calls, and the girl and a couple nurses are right behind me.

Ever have that moment where you enter in on the weirdest and worst statement of the entire conversation. Here's this one I accidentally eavesdropped on:

"... and he says he wants a refill of his birth control."

Okay, my interest is peaked; I spin around in my chair. The nurses had the same confused look on their faces. Luckily, the front desk girl had a bottle in her hand. "This is what he wants."

Clonazepam.

I was stumped. I was confused. But most of all, I was amused. How on earth does he consider this 'birth control,' I ask you? So far the only explanation I can conger up is this: he uses it to fall asleep before he has to do the deed with his wife/girlfriend.

Thoughts?

Aggravating Phone Call

2008-09-21T21:17:00.002-05:00

I've touched on the subject of not being taken seriously as a student pharmacist. This weekend, I had the mother of all conversations dealing with this subject

An older-sounding woman calls and if I am a pharmacist, to which I respond that I'm am a student pharmacist. Next comes the dreaded question, and asks if a pharmacist is available. *insert teeth-grinding noise here* I responded by asked what her question was.

Big mistake.

The next 5+ minutes are spent with me on the phone cradled into my shoulder, back to and leaning on the counter, while she gives her husband's life story, and I'm not exaggerating.
- Diphtheria at age 8
- Only survivor in his city
- Heart abnormalities
- Lung abnormalities
- Multiple surgeries and procedures
- Kidney doctor
- Iron injection
- Allergic reaction to iron injection

All the while, asking a couple more times if I think I'm still qualified to answer her question. I tell her I'll do what I can and relay the question if I don't feel able to answer, all the while thinking, 'Just ask the f*cking question.'

And the question: After being told to buy Benadryl, she first bought a box of Benadryl with pink tablets, then recently bought a box of Benadryl with pink and white capsules. Are they the same?

I about lost it. I told her there was no difference. She thanked me for answering her question, but apologized for such a lengthy backstory.

Are you shitting me? First off, yes she should be sorry for such a lengthy - and completely pointless - backstory. What she should have apologized for was frequently asking if I was capable of answering her question. Luckily, she nor her husband are patients at my pharmacy, as this was yet another preface to her dragged-out phone call.

Rotation #2: NCS - Long-Term Care

2008-08-02T19:29:00.000-05:00

So another rotation has been finished – last week. This one was not originally on my schedule, but after a hectic rearranging of my schedule for surgery, we found one of my sites (a home infusion pharmacy) was no longer a rotation site, and I chose this one as a replacement. All in all, I had a good time at this site.

Pluses for the site:
- Short drive
- The hours – Monday to Friday 10am to 4pm, and a 1-hour lunch on days in the pharmacy
- Staff – the ‘substitute’ preceptor was a great guide, and the pharmacists made the effort to make sure I had a fun and educational experience
- Laid-back atmosphere

Minuses for the site:
- More driving – the pharmacists do consulting at the long-term care facilities, and the students tag along to fulfill the site requirements, and while they don’t expect the students to visit the far-away sites (they serve about 50 facilities across the state), I did end up traveling 2 hours for the last visit
- Easily bored – after the week of filling prescriptions into blister packs, I spend the days either consulting at the facilities (7 days) or sitting in the very back of the data entry/review room doing research on questions brought to me by the other pharmacists. And if I was done with those … well, I was twiddling my thumbs.

Preceptor remarks:
Strengths: developed a ‘knack’ for reviewing charts (not considering that was a weakness at the last site); good problem solving skills; good organization and thorough research
Weaknesses: converting book knowledge to clinical knowledge
Recommendations: ask more questions; think outside the box

And now, I have an ‘off’ block – yay. I’m still working 40 hours a week, but now I’m getting paid to do it!

Till next post…

Customer service nightmare ... nearly

2008-07-27T23:54:00.003-05:00

So I worked yesterday for the first time in 2 weeks. I was hoping it would be a smooth, no-worry day. Of course, a day like that in a pharmacy is as likely as a snowball surviving in Hell. And lucky me, I was the one to pick up the phone and get this gem of a dilemma. A mother calls to see if her daughter had a prescription of Adderall on her profile to fill. Get a name, pull up the profile, and nothing. No big deal, I get situations like this all the time, especially now that our state Board allows doctors to write 3 months of C-2 prescriptions at a time. However, this was not the case.

Mother: “That’s not right, I dropped off a prescription earlier this week.”
Jaded Rx Intern: “Hmm, interesting. Just to cover bases, you are sure you dropped the prescription off at our location. [We have another store down the street and we get confused all the time – patients and doctors alike.]
M: “I’m absolutely sure. I haven’t been to another pharmacy in over a year, and yours is 3 blocks away from home.”
JRI: *Gulp* “Okay, let me put you on hold, and I’ll do some searching and asking.”
M: “Okay.”

So I asked the pharmacist if the patient’s name rings a bell – no luck. I tell her the situation, and she starts sifting through the papers by the pharmacist terminal. Apparently, on Monday (the same day this mother dropped off the prescription in question) there were two C-2 prescriptions that were post-dated (=illegal); however, neither of these prescriptions were the Adderall order. I search through our pencil pouch that holds our held C-2 prescriptions – no dice. I search through our entered hard copies – nada. I look through the last few California folders of C-2 prescriptions – nothing. While this is going on, I have a potentially pissed off mother to answer to. Finally I pick up the phone.

JRI: “Sorry to keep you on hold so long; I was looking everywhere this prescription would be, and have found nothing.” [Lucky for me, it’s not too big of a deal. Her last prescription was picked up 25 days ago. We’ve got a few days to call the office and get a new prescription written.]
M: “What do I do now? She took her last one this morning.”
JRI: [What the?!?! Try again, lady. But let’s not go down this trail yet…] “Oh no. Well, our pharmacist is double-checking all the places I look to make sure I haven’t overlooked anything.”
M: “Okay.”

A minute of silence, then:

M: “[To her kids] Honey, slow down. And you, stop doing that! [To me] I’ve got 8 kids like this; you want ‘em?”
JRI: [She’s joking with me? Hey, if she’s being calm, I’ll take it.] “Uh, I think I’ll pass…”
M: “Oh come on. What are you, chicken?”
JRI: *chuckle* “Well, if it gets me out of taking them, yes I am.”
M: *chuckle*

So a recap: Mother drops off ADD prescription for one of her kids. She calls 5 days later to fill it – a model ‘good patient’ tactic. And we … lose the prescription that keeps her kid from running up the walls. And when I am expecting to be read the Riot Act from this mother, she’s … cracking jokes.

A couple minutes of silence, and I breaking the ice:

JR: “Tell you what, I don’t want to tie up your time waiting on a phone. Would it be okay if I gave you a call later today while we figure this out?”
M: “Ummm, sounds good to me.”
JRI: “Okay. I have a phone number on file of XXX-XXXX. Is it okay to reach you there?”
M: “Sure.”
JRI: “Okay. Thank you, and sorry for the inconvenience this may have caused.”
M: “Thank you.”

So after hours of searching high and low, we come up empty-handed. Before I call the mother back, the pharmacist and I try to see if the clinic they see has an on-call doctor. After a few phone calls, we get the phone number to get us directly to the doctor. We explain the situation, and luckily the doctor (who, ironically, is a patient at our pharmacy) okays a verbal order for a 3-day emergency prescription and agrees to mail a hand-written prescription to us. Now comes the problem of getting a 30-day prescription to take care of. The pharmacist says she’ll call the office Monday, talk to the doctor the kid normally sees, and ask to write another prescription. I offer to pick up the hard copy and drop it off at the pharmacy. Once the emergency prescription is ready, I call the mom. And I swear, this phone call changed my spirits on the entire day.

JRI: “Hey, this is Jaded Rx Intern calling you back. The pharmacist and I have looked everywhere – up, down, left, right, front, back, upside-down, and sideways – and cannot find this prescription. So, the pharmacist and I did some extra work. We called the clinic and got a hold of the on-call doctor. She okayed a 3-day prescription, which is ready to go right now. On Monday, the pharmacist will call the clinic and talk to your daughter’s doctor to get a replacement prescription. And since this mishap has not been your fault, I will pick up the prescription and drop it off at the pharmacy. I’ll give you a phone call when it’s ready to go.”
M: … pause … “Wow. Thank you for going above and beyond.”
JRI: *jaw drop* “It’s no problem. And I have to thank you for being so calm and understanding with this. In the rare occasion when a prescription goes missing, we get patients that will yell and scream till they’re red in the face.”
M: … pause … “What good would it have done if I was screaming?”

Read that again. That was a comment from what has to be the most level-headed patient ever. We committed a Grade-A fuck-up, and she never once raised the tone of her voice. I couldn’t believe it.

JRI: “Can you teach some of our patients that?”
M: *chuckle* “So the prescription is ready to go right now?”
JRI: “Yes. I waited to call until everything was set.”
M: “Perfect. I’m running errands right now, I’ll just swing by.”
JRI: “Good timing. Anything else I can do?”
M: “No, we’re good now. Thank you so much Jaded Rx Intern for all your help.”
JRI: “You’re welcome. Have a good day.”

I am still in shock over this. Had it been just about any other patient, I’d be sitting on a couple new assholes that had been formed over this.

Rotation #1 - VA Hospital, Internal Medicine

2008-06-24T21:52:00.003-05:00

My first rotation has come and gone. Overall I really enjoyed my time at the VA, despite it being shortened by a week due to my eye. It was a change of pace from my normal pharmacy work: from a retail setting to an internal medicine setting. Going from counting pill and dealing with dozens to hundreds of patients a day, to looking at chart and following 3 to 8 patients throughout the day, not to mention constant contact with a doctor who listens to your ideas and recommendations. Not to mention see a new definition of the word 'alcoholic.' The other two students and I saw 11 patients come in for detox, and all but one had alcohol levels above 0.300 (to put in perspective, most states set their limit for drunk driving at 0.08), with a winner at 0.429. These guys were drinking beer and liquor like it was going out of style; even more shocking, each one of them was awake - these level are usually associated with blackout or coma.
Pluses of the site:
- Close to home
- Great pharmacists to work with (anyone who can take and appreciate my sometimes morbid sense of humor is a plus)
- Doctors, physicians, and residents were open-minded to the students' recommendations and looked to us for information
- Outstanding computer system - I could pull up an electronic chart and read notes from doctors, residents, nurses, surgeons, even pastors - if a patient farted, a note was made in his chart
Minus of the site:
- Early hours - 7:30am to 4:00pm. When I have to set my alarms for 6:15 and 6:30, it makes for a rough morning. I think I only had 3 days at this rotation where I got home and didn't have to take a nap before going to bed
Preceptors notes
- Strengths: effective drug information resource, hard worker, strong communication skills, able to take constructive criticism to improve throughout rotation
- Weaknesses: improve on finding drug therapy problems more efficiently, translating classroom knowledge to clinical knowledge, spoke too fast at times, work on time management skills
- Recommendations: don't rush to get everything done and risk mistakes, don't be afraid to ask for help, don't be afraid to say "I don't know, but I'll check on that,"

Overall, not bad for a first rotation. Thought it was a nice transition to go from the classroom to a rotation with a faculty preceptor - almost like a stepping stone, if you will.

The Floods of '08 - and a silver lining...

2008-06-14T20:21:00.004-05:00

All week long, I've heard nothing but the Floods of '08. It is *the* subject, and I doubt there is a conversation that can go 15 minutes without referencing this topic - this includes the inane conversations I had to endure while waiting with the elderly in the eye clinic for 2 agonizing hours. For those of you concerned, your beloved Jaded Rx Intern is just fine. Despite the effects of the rising waters for the past week, I experienced my first flood-related inconvenience today. My drive to work is nice and simple - jump onto one street, take it east for 4ish miles, arrive at my awesome pharmacy. However, this trip involves a bridge - which has been flooded over and shut down. I had to drive north for about 1/2 mile, jump on the interstate for 4ish miles, then jump off, and drive south for 1/2 mile before getting to work. Not extremely inconvenienced, but it's a change I've had to endure.

However, a silver lining appeared at work. For the past couple years, our chain has been using a nice utility called workload balancing, where slow Store A can type and review prescriptions for busy Store B - but our state Board of Pharmacy said no to this. But with the floods shutting down stores and forcing patients to move to others, they have temporarily allowed workload balancing to let other less flood-affected stores (such as my own) help out other stores that have taken on extra work to take the slack for disabled stores. Every so often, I would type up prescriptions for 5 other stores in the state. I was excited to hear this, as we've been itching to see this in action (especially after my friend in Colorado said she ended up typing loads of prescriptions during the Katrina disaster). Hopefully, this will be a huge step in getting this permanently enacted here. Though it will probably be likely that my store has prescriptions typed for us, rather than the other way around.

Respect / Rotations

2008-05-26T21:28:00.003-05:00

Sometimes getting respect as a pharmacist can be difficult. An intern, even more so. I have had some version of this conversation more times than I can count.

JRI: Thank you for holding, this is Jaded Rx Intern, how may I help you?
Patient: Are you a pharmacist?
JRI: I'm a student pharmacist. May I help you?
Patient: I want to talk to the pharmacist.

Years back, I would transfer them to the pharmacist. I than started asking the pharmacist, "Could I have answered that question?" About a year ago, I reached the final step of confronting these patients.

JRI: Thank you for holding, this is Jaded Rx Intern, how may I help you?
Patient: Are you a pharmacist?
JRI: I'm a student pharmacist. May I help you?
Patient: I want to talk to the pharmacist.
JRI: What's your question?

At that point, the question gets asked, and at least 95% of the time I can answer their question with no problem (on occasion, I would ask the pharmacist for a second opinion, but would usually come to the same answer I came to). Yesterday, I had one of these conversations, and answered her question. Her last question at the end of the conversation was another first, which was somewhat insulting.

Patient: What year of school are you in?
JRI: I'm in my last year.

I understand - albeit to a certain point - why someone would ask this question. However, as a student, one of the best ways we can apply our school knowledge, and to assert ourselves, is to answer patient questions. Asking this question is questioning our knowledge, and the worth of our answer. Most students I know will not answer a question if they don't know it; we'll refer a question to the pharmacist if we don't know the answer. So ask your question, and don't doubt us. If you don't like our answer, odds are another intern or pharmacist will answer the same way.

---

In other news, I start Rotations tomorrow. All I can say is, about frickin' time. I had one devastating delay. Last year, I was 3 classes short of finishing the curriculum, and ineligible to go on to Rotations. I tried to finish on time, by taking 16 credits at my school, and 10 credits at the local community college - that lasted 6 weeks. So I repeated my P3 year, because of 3 classes - geography, history, and public speaking. What a crock, an assessment that many students, friends, coworkers, and even a few faculty members agreed with. Another year, another boatload of loans. But I did it - passed all my classes, and ready to start rotations.

Then another delay. The Friday before rotations start, I had an eye doctor appointment. That appointment shook me to my core. I was diagnosed with glaucoma, and urged to have surgery ASAP. And would you know it, there was a cancellation for the following Monday. But to me, that day wasn't just Monday, it was Day 1 of Rotations. After some internal debating and a barrage of emotions, I decided to take the opening. I then spent the rest of the day preparing for the surgery (pre-op physical, consent forms, etc.), and getting the pharmacy office to rearrange my Rotation schedule (as I was unable to go to an out-of-area rotation due to the necessity of follow-up appointments) and my first Rotation preceptor to determine how to go about this, as I would need a full week to recover.

But now the week has come and gone, and I'm finally going on to Rotations. Here's to hoping it goes well, and that week missed won't put me too far behind, or be too difficult to make up.

Recalls

2008-04-26T12:35:00.002-05:00

So today at work, we received 3 separate announcements for drug recalls. Shocked me a bit as it's a rarity to see so many recalls in a short time frame.

Recall #1: Levothroid - some lots were recalled because they were suspected to have a shorter shelf life than printed. A rather boring recall - most usually are - but we didn't have any bottles on our shelf.

Recall #2: Paroxetine - One manufaturer pulled several lots of their Paroxetine (20mg, I believe) after they found one bottle that contained - get this - Warfarin 4mg. Order an antidepressant, get a blood thinner. Kinda shocking, but once again, no affected bottles, as we don't get our Paroxetine through this manufacturer.

Recall #3: Digoxin - the drug alone clues this would be an exciting one. The manufacturer pulled all of their Digoxin because the tablets may contain twice the stated dose. Holy shit, this is a big recall. What's worse is we get our Digoxin through this manufacturer, so we're cleaned out. And we've had 8 people in the last week get Digoxin; we've called them all to bring back what they have, and we'll give them a week of brand Lanoxin (not affected by the recall) to last them until we get a replacement for the recalled Digoxin.

It's been a long time since we've had a recall affect our supply of anything. But the one we had this week is a doozy...

Compliance

2008-04-18T00:39:00.002-05:00

Now that the basketball season is (long) over, I can get back to posting on all things pharmacy. Good thing, since I still steam over how our team lost - don't get me started...

Today I bring you compliance - *the* buzzword of pharmacy. How often do you see your Metformins and HCTZs and Atenolols filled every 40-50 days, while your Vicodins, Xanaxes, and Tramadols get filled every 3 to 5 days. Whether it's not taking it enough or taking it too much, we have to deal with the backlashes of non-compliance.

Today I realize part of the reason compliance has gone to hell. Last year, I was diagnosed with an autoimmune condition in my left eye. Since then I have been on two eye drops. So far the regimens I've been through are:
- Eyedrop A, 1 drop 4 times a day; Eyedrop B, 1 drop 4 times a day
- Eyedrop A, 1 drop 4 times a day; Eyedrop B, 1 drop 2 times a day
- Eyedrop A, 1 drop 4 times a day; Eyedrop C, 1 drop every morning

The worst combination was using 2 eye drops four times a day. Try to remember to find 4 times in the day, relatively spaced apart, and a roughly 5 minute window to allow adequate absorption of both drops was a nightmare. Someone with nothing to do all day may have little trouble with this, but I had to manage this regimen with classes and working. Needless to say, I wasn't always compliant. Had I thought, "This can't get any worse," I'd be wrong. The pressure inside my eye jumped, so my regimen was completely revamped. One eye drop was stopped, but two others jumped on board. Now,
- Eyedrop A, 1 drop 4 times a day; Eyedrop D, 1 drop 2 times a day; Eyedrop E, 1 drop 2 times a day

The only information I've received on how/when to do these drops has been from my ophthalmologist (and my unofficial self-counseling). The timing recommendations they received were completely asinine.
- Eyedrop A at 8am, 1pm, 6pm, 11pm; Eyedrop B at 8:05, 1:05, 6:05, 11:05
- Eyedrop A at 8am, 1pm, 6pm, 11pm; Eyedrop B at 8:05, 8:05
- Eyedrop A at 8am, 1pm, 6pm, 11pm; Eyedrop C at 8:05
- Eyedrop A at 8am, 1pm, 6pm, 11pm; Eyedrop D and E at 8:05/8:10, 8:05/8:10

Are you kidding me with this? Anyone can take one look at my hectic, quasi-steady schedule and these dosing recommendations and go 'How in the hell is this going to work?' Obviously I take their recommendations with a grain of salt, and tailor around my schedule to increase compliance. But what about others who don't think this way, look at their watch at 8:30 and skip the dose because the time has passed?

Which comes to my point. When counseling on how to take a medication to a patient, don't just recommend generic timing schedule (every 12 hours) or a strict schedule (such as my recommendations). Get an idea of a patient's schedule and work around it (take after breakfast, after work, and at bedtime). If you get a patient-tailored regimen, you'll have a better chance for compliance.

Hopefully, sometime soon, I'll have a good 'you'll never believe this patient' story in the near future. Odds are good too, now that I'm up from 5 hours a week to 20.

Hiatus

2008-03-14T00:03:00.002-05:00

Sorry for the dry spell in posting. My pharmacy life has taken a sideline for the awesomeness that is March Madness. Usually I'm not as obsessed with college basketball as I am, but our school has been the story of the year for men's NCAA b-ball. Our men's team has broken numerous records and shocked nearly everyone to a NCAA tournament spot for the first time in almost 40 years. While this weekend is all about the women's team, I'm still pumped about it. And being in the pep band, I get front row viewing, paid hotel and tickets, and per diem for each of the tourneys. Can it get any better than that??

I hope to put up a pharmacy post sometime in the near future. But until then ... GO BULLDOGS!!!

Till next post...

The Feeling of Popularity

2008-02-07T00:49:00.000-06:00

I've been getting a lot of calls recently. The downer is most have had this composition:

"Hey JadedRxIntern, it's [pharmacist/tech] from [store location]. Just calling to see if you were available to work [day] - any hours would be great. Give us a call either way. Thanks!"

Let's examine.

My home store:
We have had 5 missed shifts in the past week - 2 of which were last Saturday (see "Crunch Time"), one shift each on Monday, Tuesday, and Wednesday - for a total of 38 hours. I stayed for 12 hours on Saturday, spent 2 hours catching the pharmacy up on filling prescriptions (I'm the fastest at my store) on Monday, was scheduled to work Tuesday, but couldn't go on today (dilated eyes + lots of white snow = blind and can't drive).

The store nearest my house:
One of their techs was on some sort of leave (medical, family, mental ... I have no clue), and unexpectedly needed an extension on the leave. I got the call on Monday, and after I finished power filling at my store, I stopped by and looked at the schedule to see when/if I could help. All I could offer was today, but had to call in since I couldn't drive.

The faraway store (where I worked during winter break):
Called this afternoon to see if I could work tomorrow. Called back and said I couldn't, and the pharmacist asked about future dates. Found out one of their techs broke her arm in two places and would be out till it was reset. Wound up picking up 8 hours on Sunday.

Nice to have this much popularity (despite knowing that the first two stores called everyone they had a phone number for and I just happen to have my cell at about a dozen pharmacies in the area)...

Crunch Time

2008-02-04T11:46:00.000-06:00

I went into work Saturday expecting the usual Saturday to-do.
- Enter, fill, sell prescriptions
- Answer phones and questions
- Put away the twice-weekly order
Y'know the normal to-do for Saturday that I could do on my 9-3 shift.

But it didn't happen quite the way I expected. The schedule for the techs that day was:
N- 8 to 4:30
Me - 9 to 3
D - 3 to 9
C - 5 to 10

At one point in the afternoon, I noticed D's shift was crossed off with 'OFF' written in ... and no replacement of the shift in sight. Ugh. And to make matters worse, the night pharmacist was a floater. Double ugh. So I told the morning RPh - K - that I'll leave at 2:30, come back and 3:30 and stay till 8 - give the day some extra coverage without going into overtime (which the store manager is obsessed over). He agreed, and I left.

I come back at 3:30. I noticed K's car still in the parking lot, and he's scheduled till 3. I feared the worst. I clock back in and walk in to the pharmacy. As I walk in, I hear K on the phone with C. C called in sick. Triple ugh. So K calls the manager on duty and asks him to call our other techs/students for help. He stops in to get phone numbers, and I run down the list of techs saying 'at 40', 'at 40', 'can't work', 'sick', 'out of town', and left with 3 people to call. Gave my preferences and let him go. He comes back 15 minutes later. No luck whatsoever. I mentioned that I can't work past 8, cause I'll go into overtime. He didn't care, and authorized overtime. Deal.

So the tech/student schedule that day was:
N - 8 to 4:30
Me - 9 to 2:30
Me - 3:30 to 10

Under ideal circumstances, my primary worry should be how all these shortages and whatnot would affect our patient's care. But the world I'm in, I had to put the budget and my store manager's HUGE anti-overtime attitude first. Makes me sick.

But, I still got what I needed done. The order was put away, the partials and out-of-stocks were taken care of, and even resolved a dozen of the near-record-high 75 insurance rejections.

Keep It Up, It'll Happen Again...

2008-01-25T12:23:00.000-06:00

Know it's been a while since the last update - lowered the workload for a couple weeks, and didn't feel like engaging in extra pharmacy "stuff" for a while. Nothing really exciting happened recently, but I'll leave you with a story from the hellish Thursday I had a couple weeks ago (see my last post "Sick").

I overheard most of the conversation while running between the drive-thru, the fill counter, and answering phones.

Patient BM comes to the pick-up window. "I'm here to pick up 6 prescriptions for BM." Tech - S - checks the computer, and only 5 are ready. I overhear this, remember that 2 prescriptions were for Chantix Starting and Continuing packs, and tell S this while on my way to the drive-thru. Apparently, he wanted six and he couldn't understand why only 5 were ready. Pharmacist - L - steps in and explains why only the Starter was filled, and that the Continuing pack was held to his profile. After trying to explain this for 3 minutes, BM just yells "Give me my prescription back then!" Fine, whatever. He pays for his prescriptions and other merchandise, and we figure everything is over with.

Oh, not even close. Despite the line of people behind him, he takes up half the counter space for a good 5 to 10 minutes. He's double-counting the prescriptions, and reviewing everything. Finally, this counter-hogging asshole bellows out, "I knew it! You screwed up again!" L reluctantly goes back to BM to see what the problem was. The prescription he was referring to was filled for Metoprolol Tartrate 50mg, 1 bid, #60. "The doctor said the Metoprolol is extended-release - you filled it wrong!!" L refuted - "The doctor did not write for the ER, so we filled it exactly as written." BM: "Whatever! Give me the prescription and my money back NOW!!" We give him the prescription and page the manager back to do the refund. Unfortunately, the sole manager was on the phone with a customer for some time. He ended up waiting 4 minutes, of course asking every 30-45 seconds, "How much longer is this going to take?" Finally, manager arrives, gives him his money back, and he leaves.

His prescriptions were written for that day, on hospital blanks. The prescriptions?
- Metoprolol
- Chantix
- Lisinopril
- Vytorin
- Plavix? (memory's a little fuzzy on the last one)

All this yelling and screaming, stressing himself out (and us as well), all for his prescriptions after being discharged from the hospital after having a fucking heart attack!!! All of us back in the pharmacy were ready to kick this dipshit out the door. I kept muttering to L, "You would think after having a heart attack, you would learn to chill the fuck out." L wanted to say to him, "I hear [grocery store pharmacy] doesn't make any mistakes," since we're no longer allowed to kick people out of the store (corporate policy bullshit).

Sick

2008-01-05T18:15:00.000-06:00

in two ways:
- Physically (on the rebound, but still a little stuffy)
- Of work

And it's not due to the massive amount of hours I'm working (90 hours in the past 2 weeks, and another 55 this week). It's the environment I'm working in.
Thursday night I get to my store, and it is complete chaos. Thursdays at my store have been generally bad, as that is when pharmacist staffing is least (although Wednesday is now just as lacking, thanks to a cut in the staffing budget). But it was unbelievable. When I got in at 4pm, there was 40 prescription yet to type, and another 50 to be reviewed for the next 2 hours. And, of course, 4pm is when most of the morning staff leaves. I was hoping to have a somewhat calm day, after working that morning at another store 25 miles away, and had started to go downhill physically. I honestly couldn't tell you how bad it was, because I'm trying to block it from my memory. All I know is that I got home saying it was my worst day at work EVER. The next day, I looked at the stats, and the numbers justified the chaos - 650 prescriptions entered and 580 sold (the store averages 450-475 a day).
And today wasn't much better. I walked in knowing it was probably going to be bad. It was a Saturday morning (the time when all the elderly call in their refills), it was a warehouse day, and the staffing was slim (we usually have a 3rd tech walking in at noon - today was at 3pm). I get into the pharmacy thinking "I'm going to make today a good day" - that didn't happen. In fact, the bad news kept coming - our store down the street (who is just as busy as us) was incapacitated by broken printers and sending people away. Most of them came to our tired, understaffed pharmacy. We were running around all morning and all afternoon with little or no help from management. By the time the other tech was begging to take her lunch, we page for one of the three managers back to cover . The first one that came by asked "Who says I have to cover your lunch?" Part of me knew he was joking, but I flipped out at him. He knew very fucking well that we were drowning in prescriptions, and told him that. He laughed at me. I had to walk away before I did something I would regret. Five minutes later, another manager came back to cover the other tech's lunch. When I left at 3:45 (I was only scheduled till 3), I was exhausted, irritated, and frustrated.

I know this time of year is busy and stressful, but this has been absolutely ridiculous.

The Power-Trip Tech

2007-12-04T13:33:00.000-06:00

After reading the post on the Anti-Tech, and hearing of the goings-on over last week while I was gone, I invented another term: the Power-Trip Tech. The Power-Trip Tech thinks he/she is the cock of the walk, and that everyone must follow what they say, because they know everything.

Back story:
The weekend after Thanksgiving, I was working with a floater pharmacist - J. She started with the company part-time last summer, and just within the last month quit her other job and went full-time with us. She's been at our store every other weekend, so she mostly knows our students, the one senior tech who works weekends, and a few of the newly hired techs. When we looked at her schedule, I was delighted to hear she was working the next Thursday and Friday at my store to cover our pharmacy manager's shift (now on maternity leave). I gave her a quick run-down of the schedule for those 2 days, and the techs/students she would be working with.

Last Saturday, I come in and J was back. I asked her how the Thursday and Friday went, and boy did I get an earful. While working Thursday and Friday, she got to work with what I now call the Power-Trip Tech (PTT). PTT spent most of Thursday being non-productive (very Anti-Tech) - talking on the phone to her mother and her husband (who also works in the chain), talking to customers/employees about buying Avon, bitching about how understaffed and busy they were, bugging management for help because they were busy, and trying to push her weight around and telling J what to do. None of this flew with J. PTT tried to tell J that she needs to pick up the phone. J's response - "No, I don't have to pick up the phone unless everyone has a phone to their ear and the phone is still ringing." J and PTT butted heads this way all day Thursday and most of Friday morning. The final straw came when PTT was fed up with J, took a tote with a waiting prescription, and tossed it down to J. "Here! This one's waiting." J was livid. She called management in, and they told her to take her break. (Side note: PTT came back from her break, and J could smell alcohol on her. Surprisingly, PTT was much more chipper and less of a pain to work with.)

Ironically enough, the day before I gave her a rundown of the staff, she was telling me about a tech at another store that kept trying to tell everyone - including her - what to do and where to go. Turned out to be PTT's husband. Small world, huh?

So, Pharmer Jane, did your husband have this theory in his arsenal? If not, feel free to share this with him.

Till next post...
Take care!

Another reason to hate insurance companies

2007-11-18T22:57:00.000-06:00

I couldn't believe the cajones on this one. So one guy comes up to me to ask about why his copay went up. He asked me because I've been around for ages, and knew me as I went to school with his kids (not too uncommon an occurrence since I work in the same area I grew up). He had been on Lotrel for years, paid his $25 copay, and his blood pressure was under control. Then Amlodipine/Benazepril came out and we informed him of this switch. He was cool, and was more than happy to pay only $8 a month. Over the last two months, he realized his blood pressure was higher, no longer under control. He had discussed and made sure other factors weren't causing the change (diet, stress, etc.), but the only change was the generic Lotrel. He talked to his doctor, and ended up going back to brand Lotrel. Comes to pick up his DAW Lotrel - $59 copay. He calls his insurance company, and they tell him 'Oh, your copay is supposed to be $25. The pharmacy is adding on the extra money, not us.'

Hmmm, smells a little bit like bullshit right now. So while, we're talking and I'm looking at him with the 'are you kidding me with this?' look, I pull up the claim information on the prescription. I don't remember the exact wording, but it was along the lines of "Non-formulary. Brand difference added to price ($34)." I showed him exactly what I saw and explained how the copays of brand name drugs change when generics are available.

I let him have a print copy of the claim. He said he'd pay for the prescription, but he'll be calling the insurance company back and asking why they were trying to pin it on us. I also gave him an recommendation of trying to take both drugs separately as generics - $16 a month is still better than $59.

Gotta love being the scapegoat of the medical world when anything goes wrong...

I swear I'm alive...

2007-10-30T00:50:00.000-05:00

Sorry I haven't posted in a while. Combination of factors for this:
- Tests galore
- Assignments galore
- Studying till the wee hours
- A lack of good work stories
- General laziness

But once I get a juicy story, I'll be sure to post here for my loyal readers ... who am I kidding, my loyal reader (if that).

Till next post...

What's the point??

2007-10-01T20:59:00.000-05:00

Topic: What's the point of having this on my pharmacy shelf?

- On September 19, the FDA approved the marketing of Soma 250. Maybe I'm just young (23), naive (can smell a seeker a mile away), or inexperienced (5+ yrs in retail pharmacy), but I see nothing but people complaining either: 1) the price of the now-branded Soma and/or 2) it doesn't work as well as the 350 (not too hard to figure out why that is...).

- Today brought the approval of Plavix 300 to be used in the hospital for Acute Coronary Syndrome. Oh, thank goodness this came out - how were we ever supposed to give this dose before when it only came in 75mg tablets???? (Damn, sarcasm doesn't transfer very well when typed...)

Two more drugs to add to the list of pointless medications. I'm sure they'll make good friends with the others - Proquin XR, Pexeva, and Jantoven for starters.

The two WTF extremes of Insurances...

2007-09-19T21:59:00.001-05:00

... and they both happened today.

First, the good WTF. Another tech took a prescription for a patient who was starting Gabapentin 300, 1 qhs. Typed it up as usual, and sent it to the pharmacist to review. The pharmacist comes up to me and says, "This quantity just doesn't look right." The tech typed it up for #30 - the clinic wrote for #300. So I went to correct the error, and thought - just for shits and giggles - to run it through her insurance for #300 for a 300 day supply. It went through. Ten months of medication for $14.30. I was floored. I've never anything more than a 100 day supply covered before, and then this happens.

Less than an hour later, a strange WTF occurs. Another patient has prescription called in for her, and her Medicare D doesn't cover it. It wasn't something expected to not be covered - Xanax, Phenergan w/ Codeine, OTC medications. They wouldn't cover #10 Propoxyphene-N/APAP 100/650.

Till next post...

One of the most commonly asked question - now in iambic pentameter

2007-09-16T17:50:00.000-05:00

Haven't had any good stories from work to tell (yet...), and I was sick of seeing nothing but my welcome post, so here's a poem I found in a Drug Topics magazine. I actually found it while at work - one of those rare 'downtimes' when there's no one dropping off or picking up prescriptions, and no ringing from the drive-thru or the phones.

How long will it take? How long will it take?
Patients are in a hurry ... don't have long to wait.
In front of all orders, they want to be next
Who cares if others are sick an need an Rx!

Just slap on a label and pour in some pills
How long could that take for a simple refill?
How long will it be? How long will it be?
The phones won't quit ringing ... we're busy you see...

Do you know what insurance you want us to bill
When the doctor calls back to OK your refill?
Pardon us while we ring up a patient or two,
Counsel on analgesics and treatments for the flu

There's a doctor on hold! Where's the Rx pad?
Someone needs help finding the toothpaste that's in Sunday's ad!
The insurance is down; the order is late
It's a typical morning, just one big headache!

Yes you're been on the same stuff year after year
And we'll call back the doctor and remind him you're here
After we redo the order for the man before you,
He wants one month, not three, or did he say two?

The printer needs paper; the fax won't feed right.
The orders are mounting; there's no end in sight.
Now, you want a tax statement, we'll work that right in
While checking out someone with pseudoephedrine!

You lean on the counter, shooting the breeze,
But we're trying to count and need quiet please!
Personnel wants a schedule; the tech went on break
Somehow your order is ready, make no mistake!

Could you call ahead in the future to give us some time?
Now we're ready to wait on the next guy in line.
He has five prescriptions and would like to wait
He just wants us to know ... How long will it take?

- Drug Topics June 18, 2007 - page 64

Till next post...

Welcome!

2007-09-09T00:09:00.000-05:00

Welcome to my new blog!

This blog will mostly be focused on stories from my schooling and my job - giving perspective of the pharmacy profession from the point of view of a guy who's been a student for long enough.

But for those that want a more inside look, here it goes:
- I'm 23 and been living in the same Midwest 'big little city' all my life. I hear a lot of people (mostly students from other larger cities and their suburbs) do nothing but put down this city. "It's so boring", "There's nothing to do", "Chicago/Minneapolis/Kansas City is so much better than here." Shut up, open your mind, and look - there are things to do, dammit!
- I work for a large-chain corporate pharmacy, and have been for over 7 years. Already I know I'm going to be hated/teased/harassed by other pharmacy bloggers for this. But I'm glad to work where I do, and do everything in my power to make my pharmacy a more 'patient-centered' pharmacy.
- Despite it being a 6-year program, I'm in my 6th of 7 years of pharmacy school. The extra year is not from failing any classes; it is because I had other focuses earlier in my collegiate career (fine arts scholarship, math minor) and was unable to complete the 'general education' classes.

Enough for now. If anyone wants to know more about me outside of the pharmacy world, feel free to visit my other blog - will contain pharmacy posts as well as my personal life posts.

Till next post...