Me: Psst. CP. It's me.
CP: I know it's you. What's up? Besides me, now.
Me: I was having a think and couldn't sleep.
CP: Let's hear it.
Me: Pharmacists keep complaining about having to report their flu shot numbers either hourly, daily, weekly, or by the shot, right?
CP: Yes. It's as if the powers-that-be don't want us to do anything else.
Me: Right? Well, you know that report we always run to help adjust our inventory?
CP: The NDC report? Yeah. We run it to see how much of an item we used over a period of time in order to adjust our stock up or down. It's helpful just before Tamiflu season starts so we can ensure we order enough. Same with all the other "seasons". I think I see where you're going with this.
Me: If we can run that report for the dispensing of any NDC for any date range, why can't corporate do the same?
Myself: Oooh. Here's a thought. If they find it really necessary to know how many shots are being given on any day, why don't they figure out how to get an NYSE stock ticker installed in their offices? Think about it. It would be a big digital board in every corporate/regional/district office (also available as an app on phones of DMs) that showed how each shot was trending in each store/district/region, etc. It'd be like watching CNBC but for shots.
CP: I like it. I can see it now: Bob! We have a crisis! Shares of Fluarix are down across the Eastern Seaboard. What's going on? A hurricane? Now? During the middle of our mega shot push? Someone get over there and start vaccinating the evacuation routes. They're going to be sitting still for quite some time anyway.
Me: Why isn't HD moving at all right now? We need to start nailing the old people. I know past history of a stock doesn't guarantee future results but I'm not waiting until October to see these move. Someone get Arizona and Florida online right now.
Myself: Can't you just see the corporate overlords sitting in front of their stock tickers in their offices, pants off, salivating and cursing as the numbers refresh every 30 seconds?
Me: I like the way you both think.
Myself: Of course you like the way we think. We're the same brain.
CP: Seriously, if we can run the report, why can't they? And if I could spend less time on conference calls discussing shots, and reading emails about pushing flu shots, and not worrying about tracking and reporting flu shots, I could give more flu shots.
Me: Why don't you just run the report?
CP: That's the beauty. That's all I ever do. They never question why I fax them the NDC report.
Myself: Psst. You should get in on HD right now. I hear it's going to explode in October. Shhh.
Saturday, September 15, 2018
Friday, September 14, 2018
More Shot Shit
ME: Okay, CP. What was with the plea last week to gain more followers?
Myself: Yeah. Was it a crisis? A cry for help? An ego boost?
CP: Nope. The ego is quite healthy. It was to prove a point.
ME: What point?
CP: Mind Blowing Thought: If no one is meeting the goals you set, perhaps the goals are unrealistic.
Let's examine my request. I asked everyone to share my post on the daily.
I asked them to share prior posts they enjoyed.
I asked them to tag friends and beg them to become followers.
I asked them to write recommendations.
I asked them to do it daily.
What happened?
a. My goal was too high?
b. Not everyone followed the directions? Were they not clear?
Flu shot goals are unrealistic.
Tech scheduling goals are unrealistic.
The expectation that I could increase my followers by an arbitrary number of 40%, or 52,000 (when I average growing by ~300 per week) is insanely outrageous.
People will either love me or loathe me all on their own.
People will either get flu shots or they won't.
For some inane reason, corporations believe in the Field of Dreams approach.
ME: What's that?
Myself: If you build it, he will come.
ME: Oh.
CP: Except in this case, it's if you ask them, they will lie prostrate before you and beg to be shot.
ME: Pharmacies really believe that? People will be so enamored by your persuasive suggestion that nothing can stop them from getting a flu shot?
CP: Yeah. You should read the emails. "It's all in the ask" was a favourite of mine years ago.
Myself: Let me guess, you're going to throw out some awesome statistics to prove what a Sisyphean task they've set out for us.
CP: Here goes. . .
What are your company's expectations? "Unrealistic" should be the answer no matter what number you give. Here is an example of averages in statistics: On average, 55-60% of the US population votes in presidential elections. The numbers vary little from elections after 1920 going as low as 49% to a high of 63%. It is fairly accurate to say voter turnout is ~56% every year since 1920.
As it regards pharmacy, let's assume the following:
On average, 42% of the population receives the flu shot each year. The numbers vary little year to year. This is, for all intents and purposes, a finite number. (And the number of the counting shall be 40%. No more. No less.)
Your company expects an increase in the number of flu shots administered by your store.
Where will we get these shots?You can receive a flu shot from your prescriber, an urgent care clinic, in hospital, during an ER visit, from the fire department, at the county health department, any pharmacy on any corner in any town, or during any vaccination clinic provided by any of these groups. The needle has only moved slightly on that since pharmacists came onboard with the immunization programs around 2003. (A study showed growth from 35.1% to 40.3% from 2003 to 2013.) That's significant, but not a truly impressive growth since half the states adopted laws in 2004 and the rest took up to another decade to make the change. Since 2013, the numbers have remained fairly constant, with 40.3% rate in 2009-10 and 43.3% in 2016-17.
CDC statistics show that pharmacies are increasing in the piece of the vaccination pie but certainly not double-digit growth as the corporations seem to project.
Since the 2013-14 season where pharmacies were responsible for 21.9% of adult flu shots administered, the change to 2017-18 season (28.2%) has only been ~6% over 5 years.
Yet, somehow, employers expect each store to show growth larger than the numbers predict. (And some years, the numbers do go down.)
Myself: Wow. Where'd you find all the stats to back up your statements?
CP: The CDC. Based on our current population of 325.7 million people, and the distribution of 160 million doses of vaccine, the CDC doesn't even expect to administer to more than 49% of the population. Optimistically, if pharmacy suddenly were responsible for 30% of all adult flu shots this year (43.3% of the population = 130 million shots in total), we would administer only 39 million shots. Based on the 43.3% figure of last year, and pharmacy being responsible for 28.2% of those, we, as a group, only gave 36.5 million shots.
ME: So what you're saying is stop pushing pharmacists around with unrealistic goals and making them check in every day with flu shot totals.
CP: Basically, yes. Or, as Godsmack put it: "I'm getting back, get back on track, get off of my back
I'm getting back, get back on track, get off of my back bitch"!
As I said earlier, "Mind Blowing Thought: If no one is meeting the goals you set, perhaps the goals are unrealistic". How about we just quit beating people over the head with pushy vaccination tactics and instead be available to administer them when patients want them?
Myself: Yeah. Was it a crisis? A cry for help? An ego boost?
CP: Nope. The ego is quite healthy. It was to prove a point.
ME: What point?
CP: Mind Blowing Thought: If no one is meeting the goals you set, perhaps the goals are unrealistic.
Let's examine my request. I asked everyone to share my post on the daily.
I asked them to share prior posts they enjoyed.
I asked them to tag friends and beg them to become followers.
I asked them to write recommendations.
I asked them to do it daily.
What happened?
a. My goal was too high?
b. Not everyone followed the directions? Were they not clear?
“If words of command are not clear and distinct, if orders are not thoroughly understood, then the general is to blame. But, if orders are clear and the soldiers nevertheless disobey, then it is the fault of their officers.” Sun Tzu.
Nope. Directions were clear. They were typed and people commented they understood.
c. People just didn't want to follow me?
d. Do they not like me?
e. Do they already like someone else?Flu shot goals are unrealistic.
Tech scheduling goals are unrealistic.
The expectation that I could increase my followers by an arbitrary number of 40%, or 52,000 (when I average growing by ~300 per week) is insanely outrageous.
People will either love me or loathe me all on their own.
People will either get flu shots or they won't.
For some inane reason, corporations believe in the Field of Dreams approach.
ME: What's that?
Myself: If you build it, he will come.
ME: Oh.
CP: Except in this case, it's if you ask them, they will lie prostrate before you and beg to be shot.
ME: Pharmacies really believe that? People will be so enamored by your persuasive suggestion that nothing can stop them from getting a flu shot?
CP: Yeah. You should read the emails. "It's all in the ask" was a favourite of mine years ago.
Myself: Let me guess, you're going to throw out some awesome statistics to prove what a Sisyphean task they've set out for us.
CP: Here goes. . .
What are your company's expectations? "Unrealistic" should be the answer no matter what number you give. Here is an example of averages in statistics: On average, 55-60% of the US population votes in presidential elections. The numbers vary little from elections after 1920 going as low as 49% to a high of 63%. It is fairly accurate to say voter turnout is ~56% every year since 1920.
As it regards pharmacy, let's assume the following:
On average, 42% of the population receives the flu shot each year. The numbers vary little year to year. This is, for all intents and purposes, a finite number. (And the number of the counting shall be 40%. No more. No less.)
Your company expects an increase in the number of flu shots administered by your store.
Where will we get these shots?You can receive a flu shot from your prescriber, an urgent care clinic, in hospital, during an ER visit, from the fire department, at the county health department, any pharmacy on any corner in any town, or during any vaccination clinic provided by any of these groups. The needle has only moved slightly on that since pharmacists came onboard with the immunization programs around 2003. (A study showed growth from 35.1% to 40.3% from 2003 to 2013.) That's significant, but not a truly impressive growth since half the states adopted laws in 2004 and the rest took up to another decade to make the change. Since 2013, the numbers have remained fairly constant, with 40.3% rate in 2009-10 and 43.3% in 2016-17.
CDC statistics show that pharmacies are increasing in the piece of the vaccination pie but certainly not double-digit growth as the corporations seem to project.
Since the 2013-14 season where pharmacies were responsible for 21.9% of adult flu shots administered, the change to 2017-18 season (28.2%) has only been ~6% over 5 years.
Yet, somehow, employers expect each store to show growth larger than the numbers predict. (And some years, the numbers do go down.)
Myself: Wow. Where'd you find all the stats to back up your statements?
CP: The CDC. Based on our current population of 325.7 million people, and the distribution of 160 million doses of vaccine, the CDC doesn't even expect to administer to more than 49% of the population. Optimistically, if pharmacy suddenly were responsible for 30% of all adult flu shots this year (43.3% of the population = 130 million shots in total), we would administer only 39 million shots. Based on the 43.3% figure of last year, and pharmacy being responsible for 28.2% of those, we, as a group, only gave 36.5 million shots.
ME: So what you're saying is stop pushing pharmacists around with unrealistic goals and making them check in every day with flu shot totals.
CP: Basically, yes. Or, as Godsmack put it: "I'm getting back, get back on track, get off of my back
I'm getting back, get back on track, get off of my back bitch"!
As I said earlier, "Mind Blowing Thought: If no one is meeting the goals you set, perhaps the goals are unrealistic". How about we just quit beating people over the head with pushy vaccination tactics and instead be available to administer them when patients want them?
Tuesday, August 28, 2018
Students Are The Phuture
and I fear how they are being educated.
Intern (noun): A student or trainee who works, sometimes without pay, in order gain work experience or satisfy requirements for a qualification.
CP: I always strive to present real world, everyday situations to my students on rotations. I only have them for a limited time and know they cannot possibly see everything but I want them to see things and to practise things they may not see on their other rotations.
Me: Very noble of you. I know you love to teach.
CP: Exactly. That's why I always have hired interns and students on rotations throughout the year. I host as many as I can.
Myself: Doesn't it get exhausting?
CP: Not when I know these students are the phuture of our profession. I want them trained correctly. I think of it as training my replacements.
Me: There has to be a reason you are talking with us today.
Myself: Yeah. You don't usually let us out to play with others.
CP: It's the students.
Me: Obviously.
Myself: What about them?
CP: They just don't get it. The last crop that rotated through was full of some of the most clueless students I'd ever seen. I kept asking myself, and them, why did they pick pharmacy? Granted, this was a small handful, but the situation has become noticeably worse over the last 5-10 years.
Me: Examples?
CP: I had one student who looked as though he'd rather be anywhere other than in a pharmacy.
Myself: Isn't that where they're going to work?
CP: Yes. I understand they may not choose retail but, I've never seen someone so opposed to even making an attempt at learning anything.
Me: Example?
CP: I asked him to tell me what quantity we dispense on a Proair Inhaler and to calculate the days supply.
Myself: Easy. Grab a box and read it to see it's 8.5 grams.
CP: Precisely. Except he just stared at me. Like I was going to turn into a digital Proair board that would flash him the answers. Every day was like this. Absolutely no desire to learn anything or try.
Myself: Lame. What else?
CP: This one takes the cake; and is also the reason for the entire post.
Me: <about time>
CP: Shut it. As you notice, I defined "intern" earlier, correct?
Me: Yes. A student.
CP: I received a summary review from the students I had on rotation over the previous year and read all the comments so I could learn what worked and what I could improve.
Myself: Always learning. You're pretty smart, CP.
Me: Uh-oh. What did you see?
CP: I read this comment: "I think the students on rotations should not be expected to complete tasks an intern usually does".
Me: Dafuq?
Myself: I'm going to state the obvious here for you, CP. Students are, by definition, interns, and vice versa, correct?
CP: Correct.
Me: So, what was the point of the complaint?
CP: We had our hired interns working a few shifts while the students were there and apparently the students believed the interns should have done all the work.
Myself: But how would the students learn if everyone else was doing all the work?
CP: You are a genius. That's why we get along so well. I really am at a loss to describe how I felt after reading that. I still can't get my head around it now as the new rotation season dawns. As I have stated many times, I want to encourage people to love their profession. As a preceptor it is my obligation to foster their enthusiasm and channel it into a love for their chosen profession. These students decided to make pharmacy their career. I loathe the pharmacists who host students and complain about how awful the profession has become. If you're training my kid, don't sour her on her life's dream because you found the experience awful. Seriously, don't teach students. They are entering the profession today. Teach them how to succeed based on today's environment, not on the environment when you started.
Me: What you're saying about this last example is, you can't make them learn.
CP: "I'm trying to free your mind, Neo. But I can only show you the door. You're the one that has to walk through it."
Me: Deep thoughts, by Morpheus.
CP: I just don't know what the students expect anymore. I used to believe in the quality of program to make up for the lack of quality in the students. However, with so many schools open now, the talent pool has been so diluted that we are destined to become the homeopathy of healthcare.
Intern (noun): A student or trainee who works, sometimes without pay, in order gain work experience or satisfy requirements for a qualification.
CP: I always strive to present real world, everyday situations to my students on rotations. I only have them for a limited time and know they cannot possibly see everything but I want them to see things and to practise things they may not see on their other rotations.
Me: Very noble of you. I know you love to teach.
CP: Exactly. That's why I always have hired interns and students on rotations throughout the year. I host as many as I can.
Myself: Doesn't it get exhausting?
CP: Not when I know these students are the phuture of our profession. I want them trained correctly. I think of it as training my replacements.
Me: There has to be a reason you are talking with us today.
Myself: Yeah. You don't usually let us out to play with others.
CP: It's the students.
Me: Obviously.
Myself: What about them?
CP: They just don't get it. The last crop that rotated through was full of some of the most clueless students I'd ever seen. I kept asking myself, and them, why did they pick pharmacy? Granted, this was a small handful, but the situation has become noticeably worse over the last 5-10 years.
Me: Examples?
CP: I had one student who looked as though he'd rather be anywhere other than in a pharmacy.
Myself: Isn't that where they're going to work?
CP: Yes. I understand they may not choose retail but, I've never seen someone so opposed to even making an attempt at learning anything.
Me: Example?
CP: I asked him to tell me what quantity we dispense on a Proair Inhaler and to calculate the days supply.
Myself: Easy. Grab a box and read it to see it's 8.5 grams.
CP: Precisely. Except he just stared at me. Like I was going to turn into a digital Proair board that would flash him the answers. Every day was like this. Absolutely no desire to learn anything or try.
Myself: Lame. What else?
CP: This one takes the cake; and is also the reason for the entire post.
Me: <about time>
CP: Shut it. As you notice, I defined "intern" earlier, correct?
Me: Yes. A student.
CP: I received a summary review from the students I had on rotation over the previous year and read all the comments so I could learn what worked and what I could improve.
Myself: Always learning. You're pretty smart, CP.
Me: Uh-oh. What did you see?
CP: I read this comment: "I think the students on rotations should not be expected to complete tasks an intern usually does".
Me: Dafuq?
Myself: I'm going to state the obvious here for you, CP. Students are, by definition, interns, and vice versa, correct?
CP: Correct.
Me: So, what was the point of the complaint?
CP: We had our hired interns working a few shifts while the students were there and apparently the students believed the interns should have done all the work.
Myself: But how would the students learn if everyone else was doing all the work?
CP: You are a genius. That's why we get along so well. I really am at a loss to describe how I felt after reading that. I still can't get my head around it now as the new rotation season dawns. As I have stated many times, I want to encourage people to love their profession. As a preceptor it is my obligation to foster their enthusiasm and channel it into a love for their chosen profession. These students decided to make pharmacy their career. I loathe the pharmacists who host students and complain about how awful the profession has become. If you're training my kid, don't sour her on her life's dream because you found the experience awful. Seriously, don't teach students. They are entering the profession today. Teach them how to succeed based on today's environment, not on the environment when you started.
Me: What you're saying about this last example is, you can't make them learn.
CP: "I'm trying to free your mind, Neo. But I can only show you the door. You're the one that has to walk through it."
Me: Deep thoughts, by Morpheus.
CP: I just don't know what the students expect anymore. I used to believe in the quality of program to make up for the lack of quality in the students. However, with so many schools open now, the talent pool has been so diluted that we are destined to become the homeopathy of healthcare.
Wednesday, August 15, 2018
Sometimes I'm Right
. . . and your prescriber is not.
CP: Honestly, it's not about who was right and who was wrong. I like my ego stroked as much as the next platypus, but at the end of the day the patient was helped, medical crisis averted, life went on.
Me: What are you on about now, CP?
CP: Helping people.
Me: Um. . . like, hooray or something? Want me to wave a flag? Should I call a press conference? Correct me if I am wrong, but don't we do this every day?
CP: Yes. Yes. Yes. And, yes.
Me: Why is this different?
Myself: Yeah. Why so special?
CP: Have we ever had a problem and when we told other people about it, they didn't believe us?
Myself: Like the fact that you talk to both of us in your head?
CP: Yes. I mean, no. We see patients all the time who are going through whatever ordeal is theirs at the moment and we don't understand them. We are tasked with helping them, but sometimes, sometimes the answers aren't there.
Me: So what do we do?
Myself: We listen and we dig and we offer support.
CP: Precisely.
Me: So what happened?
CP: We had a patient call us recently who had been experiencing breathing troubles. None of her providers could explain it. She knew something was wrong. She told her neurologist who ran tests. She complained about her new medication but was told "there is no way that medication does that". So she saw a new neurologist, who ran more tests, who also brushed off the potential for this newly prescribed medication to affect her this way.
Me: And they found what was wrong?
Myself: No, dumbass. It wouldn't be a good story otherwise. Keep going.
CP: She called me.
Myself: And then?
Me: And you said she was crazy.
CP: No. I told her that, while I had not seen instances of this medication causing these side effects (dyspnoea and crushing chest pain) and after asking her my litany of questions (did anything else change? did they rule out heart attack?)
{--for purposes of speeding this along, we had a lengthy discussion and she told me all about her tests and how long this had been going on, etc. . . --} I said it may be possible and that I would research it and call her back.
Myself: And then?
CP: I researched it and called her back. Were you not paying attention?
Me: Sorry. I thought you'd want a second to let people catch up.
CP: Thanks. Anyway, after a little digging, I was able to find a record of these effects occurring in a small percentage of patients.
Myself: And then?
CP: Dude. Seriously? Find a new movie to quote. And then she thanked me. She spoke with her new pulmonologist who didn't believe her either. However, this prescriber turned to the new prescriber in their practise and asked her opinion. She said she had never heard of it either. . . until she read a study in a journal last week about this exact scenario.
Me: Vindication for the patient!
Myself: And th. . . um. . . What next?
CP: She called to thank me. She said they were surprised I figured it out, but recognised I had a special set of skills.
Me: I love a good story.
Myself: Yeah. Can I have milk and cookies now? <yawns> I'm tired.
CP: Remember kids, just because no one has seen it, doesn't mean it isn't happening. Think of all the prescribers out there who spent decades of practise never seeing measles and now are scrambling to identify it.
Me: Sometimes it's the simplest explanations. We are so programmed to run tests when the simplest option would be to hold the new medication for a few days.
Myself: She stopped the new medication and her symptoms resolved over the next 2 days. Simple.
CP: And now I get pie. She promised me a fresh pumpkin pie this fall.
CP: Honestly, it's not about who was right and who was wrong. I like my ego stroked as much as the next platypus, but at the end of the day the patient was helped, medical crisis averted, life went on.
Me: What are you on about now, CP?
CP: Helping people.
Me: Um. . . like, hooray or something? Want me to wave a flag? Should I call a press conference? Correct me if I am wrong, but don't we do this every day?
CP: Yes. Yes. Yes. And, yes.
Me: Why is this different?
Myself: Yeah. Why so special?
CP: Have we ever had a problem and when we told other people about it, they didn't believe us?
Myself: Like the fact that you talk to both of us in your head?
CP: Yes. I mean, no. We see patients all the time who are going through whatever ordeal is theirs at the moment and we don't understand them. We are tasked with helping them, but sometimes, sometimes the answers aren't there.
Me: So what do we do?
Myself: We listen and we dig and we offer support.
CP: Precisely.
Me: So what happened?
CP: We had a patient call us recently who had been experiencing breathing troubles. None of her providers could explain it. She knew something was wrong. She told her neurologist who ran tests. She complained about her new medication but was told "there is no way that medication does that". So she saw a new neurologist, who ran more tests, who also brushed off the potential for this newly prescribed medication to affect her this way.
Me: And they found what was wrong?
Myself: No, dumbass. It wouldn't be a good story otherwise. Keep going.
CP: She called me.
Myself: And then?
Me: And you said she was crazy.
CP: No. I told her that, while I had not seen instances of this medication causing these side effects (dyspnoea and crushing chest pain) and after asking her my litany of questions (did anything else change? did they rule out heart attack?)
{--for purposes of speeding this along, we had a lengthy discussion and she told me all about her tests and how long this had been going on, etc. . . --} I said it may be possible and that I would research it and call her back.
Myself: And then?
CP: I researched it and called her back. Were you not paying attention?
Me: Sorry. I thought you'd want a second to let people catch up.
CP: Thanks. Anyway, after a little digging, I was able to find a record of these effects occurring in a small percentage of patients.
Myself: And then?
CP: Dude. Seriously? Find a new movie to quote. And then she thanked me. She spoke with her new pulmonologist who didn't believe her either. However, this prescriber turned to the new prescriber in their practise and asked her opinion. She said she had never heard of it either. . . until she read a study in a journal last week about this exact scenario.
Me: Vindication for the patient!
Myself: And th. . . um. . . What next?
CP: She called to thank me. She said they were surprised I figured it out, but recognised I had a special set of skills.
Me: I love a good story.
Myself: Yeah. Can I have milk and cookies now? <yawns> I'm tired.
CP: Remember kids, just because no one has seen it, doesn't mean it isn't happening. Think of all the prescribers out there who spent decades of practise never seeing measles and now are scrambling to identify it.
Me: Sometimes it's the simplest explanations. We are so programmed to run tests when the simplest option would be to hold the new medication for a few days.
Myself: She stopped the new medication and her symptoms resolved over the next 2 days. Simple.
CP: And now I get pie. She promised me a fresh pumpkin pie this fall.
Friday, August 10, 2018
Chicken Pen
You know I need a chicken pen
To inject my insulin
Basaglar gone under the skin
For the dia-beet-us
#WhyILoveEScripts
To inject my insulin
Basaglar gone under the skin
For the dia-beet-us
#WhyILoveEScripts
Tuesday, July 31, 2018
The Goldilocks Directions Challenge.
Too Much? Too Little?
We have to find the set of directions that are "just right" for the label; the directions that are easiest to understand; that convey the prescriber's intentions clearly; the directions that, hopefully, leave the least amount of room for error and misinterpretation.
Our job is, and has always been, to interpret what the prescriber wrote and translate it into patient-friendly directions; ones that can be easily understood. (From med-speak to patient-speak. . . so to speak.)
I thought of this after yesterday's Humira picture and could envision all the possible ways pharmacy staff would type this.
For some pharmacists and technicians, verbatim, seems to be the mantra. (My call center loves to type directions word-for-word. They're so bad they even type the typos, and sprinkle in a few new ones that weren't on the e-script. But that's how the call center TRAINS them.)
Should the directions for "Humira 40mg / 0.8ml Pen" be typed on the label as:
A. "Inject the contents of 1 pen subcutaneously every 2 weeks"
B. "Inject 40mg subcutaneously every 2 weeks"
C. "Inject 0.8ml subcutaneously every 2 weeks"
D. "Inject the contents of 1 syringe (40mg) subq every 2 weeks"
E. "Inject the contents of 1 syringe (0.8ml) subq every 2 weeks"
YES. I KNOW. THEY ALL SAY THE SAME THING. BUT. . .
Which direction allows for the least chance of a mistake on the patients' part?
Personally, I believe the MORE information you put on a label, the LESS clear and MORE confusing it becomes for the patient(s).
Answer the question I asked but consider the following examples as my reason for asking:
Example 1:
Zofran is available as 4mg/5ml solution.
If you put both mg and ml on the label, it can lead to an error. I hate putting on the label verbatim what came through on the e-rx:
"Give 2mg (2.5ml) by mouth . . . "
"Give 2mg (2.5ml) by mouth . . . "
That is too much info that can lead to confusion by a tired mother/grandmother/sitter, etc. and the pharmacy staff typing it.
Example 2:
How many times have we filled prescriptions for elderly patients where prescribers don't always use the most logical strength? (Granted, they may be making dose adjustments, but keep it simple for this argument.)
Ativan 0.5mg Tabs : "Take 2 tablets (1mg) by mouth. . . "
or. . . "Take 1mg (2 tablets) by mouth . . . "
Both of these are real-world examples.
Both are confusing.
Both can be read backwards.
Both can lead to errors.
Remember, the more information you provide to help, the less helpful you truly are.
Answer Key: A.
The only correct, not-open-to-interpretation answer is "A".
Why? D complicates the directions with too much information.
B and D? Who measures anything in "mg"? (and patients will ask that exact question.)
E isn't awful BUT, the more information you type, the more likelihood you can make an error while typing. (Accidentally typing "1ml" or reversing the "1" and the "0.8" happens occasionally.)
C? That's the best alternative answer I will allow. If my techs type it, I won't send it back. However, it is still open to questions from patients ("how do I measure 0.8ml?")
Example 2:
How many times have we filled prescriptions for elderly patients where prescribers don't always use the most logical strength? (Granted, they may be making dose adjustments, but keep it simple for this argument.)
Ativan 0.5mg Tabs : "Take 2 tablets (1mg) by mouth. . . "
or. . . "Take 1mg (2 tablets) by mouth . . . "
Both of these are real-world examples.
Both are confusing.
Both can be read backwards.
Both can lead to errors.
Remember, the more information you provide to help, the less helpful you truly are.
Answer Key: A.
The only correct, not-open-to-interpretation answer is "A".
Why? D complicates the directions with too much information.
B and D? Who measures anything in "mg"? (and patients will ask that exact question.)
E isn't awful BUT, the more information you type, the more likelihood you can make an error while typing. (Accidentally typing "1ml" or reversing the "1" and the "0.8" happens occasionally.)
C? That's the best alternative answer I will allow. If my techs type it, I won't send it back. However, it is still open to questions from patients ("how do I measure 0.8ml?")
Thursday, July 19, 2018
In Fiduciary I Trust
At least, that's the motto by which they live, right? It's a trustee-beneficiary relationship.
The beneficiary is trusting the trustee to make sound decisions on her behalf, right?
Sitting in a prescriber's office, minding my own, when the conversation piqued my interest. (Couldn't help it. She was really quite loud for the quiet space.)
Fiduciary Lady Opining: I'm your fiduciary. You know what that is?
Recipient Of FLOs Largesse: No.
FLO: I make your decisions for you and you trust me.
ROFL: Ok. That makes sense.
FLO: I look out for your best interests.
ROFL: Ok. That's good.
FLO: You're getting your shots today.
ROFL: Hooray. Which ones?
FLO: Tetanus, Meningococcal, and . . . wait. Not this one.
ROFL: Why not?
FLO: It's HPV.
ROFL: What's that?
FLO: A sex disease. It was made for girls.
ROFL: Uh-huh.
FLO: For people with vaginas! You don't have a vagina, do you?
ROFL: HaHa, no.
FLO: Then you don't need this. They decided they needed more money so they said boys had to have it now too.
ROFL: But I don't have a vagina.
FLO: Which is why you're not getting this one.
Poor Nurse: The doctor will be in shortly.
FLO: He's not getting the HPV shot.
PN: No problem.
FLO: What's the name of it?
(There was a conversation that went on for 3 minutes as they tried to figure it out and I couldn't take it anymore.)
CP: GARDASIL!
PN: Thank you.
FLO: What's this pertussis? I thought he was getting tetanus?
PN: It's whooping cough.
FLO: He's not coughing.
PN: And we'd like to keep it that way.
<PN leaves>
CP: Psst.
FLO: Yes?
CP: I'm talking to your boy too.
ROFL: What?
CP: Are you attached to your penis?
FLO: What?
ROFL: What?
CP: How'd ya like warts on your naughty bits?
<They both cringe>
CP: <holds out phone after googling "genital warts"> Here's what you can look forward to without the vaccine. Have a nice day!
PN: You can come back now, CP.
CP: Thanks. I think you're going to give that HPV vaccine now.
PN: Yes. You really need to stop doing that.
CP: If people are going to loudly announce they're responsible for making decisions for their ward, the least they could do is ask questions in order to make INFORMED decisions instead of propagating IGNORANCE. I'd have no problem with her refusal had it been based on anything other than uninformed, empty rhetoric.
Thursday, July 5, 2018
Professional Differences
Why are the same laws not applied universally?
If you wish to understand the issue, look no further than any law affecting healthcare in America. States pass new rules/laws all the time. Some affect both prescribers and pharmacists and we must both obey and implement them.
Prior to graduation, I had to take a law class.
Prior to receiving my license, I had to take a law test (and pass it!).
I'm fairly certain prescribers had to do this as well.
In the years since I graduated, laws have changed and new ones have been passed.
This means that your practice has to be fluid in order accommodate these changes.
You cannot simply rely on what you learned in school. You have to evolve; to adjust.
Herein lies the difference between the prescribing and dispensing professions.
Pharmacists: this law takes effect 7/1/18. You MUST be compliant on this date or you shall be publicly flogged, pilloried, or stoned. There are no exceptions for failure to comply. If prescribers do not comply, it is incumbent upon the pharmacist to phone the prescriber to bring him up to speed, retrieve the missing information, and get lectured by the lady answering the phone (LAP).
LAP: What do you need?
CP: As of July 1st, your prescribers must obey these laws.
LAP: Laws? We don't need no stinkin' laws!
CP: You do.
LAP: We didn't know about this.
CP: You work in a urology group, right?
LAP: Yes.
CP: Urine trouble!
LAP: Lame. I've heard that one before.
CP: I know. Just like I've heard what you're about to tell me next.
LAP: 1. We've never had this problem with any other pharmacy.
2. You're the only pharmacist who calls us on this.
3. We never had to do this before.
4. Our prescribers don't do that.
CP: 1. Yes. I know.
2. Yes. I'm the only pharmacist who cares about her license.
3. That's because the law took effect July 1st. There were communiques.
4. They will.
Prescribers: you get an email from the state; you get a letter from the state; you get more of each, approximately 1 per week for 6 months leading up to Doomsday. You get to plead ignorance for months. There's something called a "grace period". For some reason, you are allowed to remain noncompliant and ignorant of the law change for months. You receive more, somewhat-sternly written letters with a picture of the Board of Medicine shaking its finger at you and a little "tsk tsk" added for effect over the next 6 months. Yet you still plead ignorant.
This reminds me of my favourite prescriber joke:
Q: Why are doctors always on bottom?
A: Because they can only fuck up!
If you wish to understand the issue, look no further than any law affecting healthcare in America. States pass new rules/laws all the time. Some affect both prescribers and pharmacists and we must both obey and implement them.
Prior to graduation, I had to take a law class.
Prior to receiving my license, I had to take a law test (and pass it!).
I'm fairly certain prescribers had to do this as well.
In the years since I graduated, laws have changed and new ones have been passed.
This means that your practice has to be fluid in order accommodate these changes.
You cannot simply rely on what you learned in school. You have to evolve; to adjust.
Herein lies the difference between the prescribing and dispensing professions.
Pharmacists: this law takes effect 7/1/18. You MUST be compliant on this date or you shall be publicly flogged, pilloried, or stoned. There are no exceptions for failure to comply. If prescribers do not comply, it is incumbent upon the pharmacist to phone the prescriber to bring him up to speed, retrieve the missing information, and get lectured by the lady answering the phone (LAP).
LAP: What do you need?
CP: As of July 1st, your prescribers must obey these laws.
LAP: Laws? We don't need no stinkin' laws!
CP: You do.
LAP: We didn't know about this.
CP: You work in a urology group, right?
LAP: Yes.
CP: Urine trouble!
LAP: Lame. I've heard that one before.
CP: I know. Just like I've heard what you're about to tell me next.
LAP: 1. We've never had this problem with any other pharmacy.
2. You're the only pharmacist who calls us on this.
3. We never had to do this before.
4. Our prescribers don't do that.
CP: 1. Yes. I know.
2. Yes. I'm the only pharmacist who cares about her license.
3. That's because the law took effect July 1st. There were communiques.
4. They will.
Prescribers: you get an email from the state; you get a letter from the state; you get more of each, approximately 1 per week for 6 months leading up to Doomsday. You get to plead ignorance for months. There's something called a "grace period". For some reason, you are allowed to remain noncompliant and ignorant of the law change for months. You receive more, somewhat-sternly written letters with a picture of the Board of Medicine shaking its finger at you and a little "tsk tsk" added for effect over the next 6 months. Yet you still plead ignorant.
This reminds me of my favourite prescriber joke:
Q: Why are doctors always on bottom?
A: Because they can only fuck up!
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