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Friday, December 28, 2018

Like Water For Water

With flu season getting ready to come into full swing, and everyone believing they have the flu now that they've spent the holidays with their families, it's to break out the winter advice.
Here is the first of the season.

Original Grandpa: Do you have something over the counter?
CP: Yes. We have lots of things over the counter.
OG: I'm looking for Onti-biotics
CP: There are no antibiotics OTC.
OG: I don't know how to pronounce it.
CP: Then I don't know what you seek.
OG: Os-Cal-Ium?
CP: Yeah. I know what you need, but I'm waiting to see if you pull a muscle.
OG: Ob-ste-tri-cium?
CP: Keep going. This is entertaining.
OG: On-top-of-Old-Smoky?
CP: Oooh. Onomatapoeia?
OG: No. I give up.
CP: Bummer. I bet it's oscillococcinum.
OG: Sounds better when you say it.
CP: Practice. Shall I find it for you?
OG: Yeah. I don't know where to look or what it looks like.
CP: Or how to say it, or anything else about it so let's run to the pharmacy and get it. Here it is. Now buy it.
OG: I was hoping you had an off-brand.
CP: We do.
OG: You do?
CP: Yep.
OG: What is it? I'll take that.
CP: Hold out your hands.
OG: Okay.
CP: <pours air from my cupped hands into his cupped hands, careful not to spill any> Now take a deep breath. If you like, I can sell you a bottle of water to wash it down.
OG: Hmm. Maybe I'll just stick with the name brand.
CP: Suit yourself. It's your money.

Monday, December 10, 2018

A Little Thought Exercise

Have you ever completed this exercise? I've seen it used during childbirth classes in particular. You start with all the important things you want for your baby and eliminate one thing at a time until you arrive at the most important. This is usually "A Healthy Baby"; sex, hair and eye colour, etc don't matter, so long as the baby is healthy.

I was thinking about this when my staff and I were recently trying to prioritise the tasks ahead of us for the day.
(It was a busy time and the corporate metrics were nagging the backs of our skulls.)

We had prescriptions to type.
We had prescriptions to fill.
We had prescriptions to check.
We had calls to make to offices and patients.
We had returns to stock to complete.
We had an order to shelve.
We had shots to push, and administer.
We had phones to answer.
We had patients picking up prescriptions at the counter.
We had pickups at the drive thru.
We had drop offs at the window.
We had all the other crap to do that each company requires.

We were short-staffed, as always.
As my techs and intern were asking what to do next, (we were behind on wait times) I replied calmly with:
"The prescriptions. Spend your time and effort on the data entry, on the filling, and on the accuracy required of both. I will focus on checking them and making sure we don't kill anyone."

At the end of the day, after eliminating all of the "important things" from our pile, when we come to the MOST IMPORTANT item, should it be
a.) correct Rxs with safe, happy patients or. . .
b.) metrics?

In case you need help deciding what to do next, look at this list and the most important item shall become clear.
I get annoyed when I occasionally fill in at other stores and we are in the weeds with prescriptions (>1hr behind) and someone decides he is going to pull returns or outdates or make courtesy refill reminder calls. Dude, you are doing the wrong work at the wrong time. If we get caught up on prescriptions, you can do the other stuff. It's not going anywhere.
Those tasks can wait.
Those tasks can't call the 1-800-I-HATE-YOU complaint number.
Those tasks won't be affected by a misfill.

At the end of the day, our job is to make sure the correct prescription is filled correctly for the correct patient with the correct medication, correctly. Period.
When corporate asks why your other tasks are lagging, tell them they can pick which day you stop filling prescriptions correctly.
"How about next Tuesday? We can all work on everything else, except filling prescriptions correctly or, at all. How's that? We will change Taco Tuesdays to Task Tuesdays. Or, short of that, you could give me enough tech help to do all of it simultaneously. Your choice."


A little thought exercise. You write down each of the things that are important in your life on these little cards. Then you eliminate one card at a time until you get to the one that that's most important to you.


Tuesday, December 4, 2018


Dear CP, 
Honest question, but please post anonymously if you are able... In what universe is it more cost effective to leave open bottles of medicine on the shelf until they expire simply because they are non-preferred? I cannot see how this is more profitable than using the drugs already on hand.

Good question. Here are my two cents.
I cannot understand why/how a company would not want to decrease its inventory by dispensing all of its partial inventory. Everywhere I have worked, I have been able to dispense a partial/completion to remove these little bastard open bottles from my shelves. If your company does not, why not?

I worked for an independent and discussed the inventory issue with her. At one point she had 3 open bottles on her shelf, each one contained 10 tablets. There is no way to properly dispense these to the patient. (Can't do 3 partials on a fill.) Had she performed a partial/completion when the new NDC arrived each time, this would not be an issue. Instead, she has 3 open bottles that are eating up her inventory.
Another company has individual stores with over $1 million in EXCESS inventory. Some of it is partial and non-preferred bottles. If the company took time to reallocate this inventory (or just dispense it) instead of letting it expire, they could afford to hire 7 pharmacists; just based on the inventory at this one store. (Let that sink in for a moment.)

Yes, the reality today is that companies do not make deals with the wholesalers like we used to do. Add in temporary (and long-term) backorders and we sometimes have 7 or 8 NDCs on the shelf for any given product. It's dead inventory unless/until we get it again.

Why is there not a way to use this effectively? Why would we want to allow these products to die? We already paid for them. It's like accidentally buying brown eggs instead of white and allowing them to go bad in your fridge, or just tossing them altogether. You've already paid for them. It is literally throwing money away to not use them.

The only answer I can offer is time. It takes longer to do the right thing than the easy thing.

What say you?

Monday, December 3, 2018

This Is Not A Negotiation

Wildly Imagining My Partaking, Yes?: Hello. I have a question for you.
CP: I love questions. Do I have to reply with "I have an answer for you" before I respond? Or can I just give you my answer without a preface?
WIMPY: I suppose either would work. 
CP: Then fire away my good man.
WIMPY: I wish to receive a 90 days supply of my medication.
CP: That's a statement.
WIMPY: However, I only have enough money for some of it now.
CP: Another statement. <taps fingers on counter>
WIMPY: What?
CP: This is like learning German; I'm waiting for the verb.
WIMPY: Can I get my whole 3 month prescription up front and make payments every week?
CP: Like an installment plan? Or layaway?
CP: Please please please quote your namesake for me.
WIMPY: I'll gladly pay you Tuesday for some medication today?
CP: <titters> Worth it.
WIMPY: So you'll do it?
CP: <snickers> Nope. That's like my company paying me on January 1st for an entire year of work and expecting me to show up every week. I'm sure we'd start off the best of friends those first few weeks but by February? You're not returning my calls and texts, your FB status says "it's complicated" and there are pictures of other pharmacies on your Instagram.
WIMPY: What do you suggest?
CP: An installment plan. How about you pay me every week and in exchange, I'll give you medication every week. It's a true win-win. You get medication and I get 52 refills.