Tuesday, December 22, 2020
Wednesday, December 9, 2020
Tuesday, December 8, 2020
Perhaps you too will share this question.
CP: Dear BOP, do you have to approve pharmacist license applications?
CP: Do you have to approve companies that do business with the State BOP?
CP: Do you have to certify e-script providers and other vendors that do business with the State BOP?
CP: Okay. Do you suspend licenses of pharmacists in the State?
CP: If a pharmacist was asked to complete something as part of her registration, and told you "NO", could you revoke their license?
CP: If a vendor said "NO", could you do the same thing?
CP: Why not? You know that you have approved over 200 e-rx systems in the State. You know that one of the providers has refused to fix a known issue with their software.
(Here's the background. If an e-rx is sent by a prescriber, it passes from the office system to another processor who passes it on to Emdeon. They in turn pass it to a switch who is responsible for passing it to the pharmacy. IF, at any point it does not make it to Emdeon, whether due to a system outage or a "glitch", the e-rx is routed directly to my fax machine. This comes complete with no signature by the prescriber. My state has mandated that these Rx's are, in fact, not legal. We are required by the State BOP to call on each of these Rx's. They even have a disclaimer at the top that reads "Warning. This is not a valid Rx until called to verify by the pharmacist." What's even better is, we then have to transcribe it as a verbal order instead of an e-rx, thereby circumventing the intent of the e-rx in the first place.)
Still with me? Good. Now, despite repeated conversations between the company and the BOP, the company has refused to take the action that the other two big e-rx players have and that is to change their software to allow signatures to be printed on the faxes. They also contain a disclaimer that essentially reads "this started as an e-rx but due to a system error or glitch, got routed to your fax instead. It is totally valid so feel free to dispense it. Approved per State BOP", or something to the effect.
BOP: What's your question again?
CP: Why can't you just revoke their approval? Like you would a license?
CP: Oh. Okay. What do you suggest?
BOP: Call the offices that use this software and speak to their office managers. Explain the situation and why you have to call all the time, even though they get frustrated with you, and have them complain to their software vendor. Maybe, once enough offices complain about all the phone calls, the company will relent.
CP: Or you could just give them 90 days to be in compliance or threaten them with the loss of their license.
BOP: The Board of Medicine wouldn't go for that. Too many doctors would complain.
CP: Gotcha. So you approved a system that basically tells all the pharmacists to piss off, makes more work for us, then you tell us it is OUR responsibility to call on something you could fix, because you, the Board of Phrickin Pharmacy, are afraid of what a group of prescribers will do?
BOP: Yes. Pharmacists have no backbone and won't stand up to us. We only approve the systems.
CP: I got nothing. I need to relocate.
Wednesday, December 2, 2020
Pronounced: O SELT um a VEER
O Seltamivir, O Seltamivir
My how you help my symptoms
O Seltamivir, O Seltamivir
My how you help my symptoms
Your price is high but that's okay
You really don't work anyway
O Seltamivir, O Selatamivir
Nah you don't help my symptoms
Monday, November 23, 2020
Monday, November 16, 2020
Wednesday, November 11, 2020
Monday, November 9, 2020
Occasionally the misfiled bag will be discovered hiding in another bin weeks or months later but ofttimes it has been sold.
I'm going to try that at Best Buy and Target.
CP: I am here to return my purchase.
Blue Shirt: Okay. Was there a problem?
CP: This 70" TV I purchased was too small. It didn't fill the space.
BS: Okay. Um, where is the TV?
CP: Right here <sweeps arm around>
BS: I don't see a TV.
CP: It's okay. You can just return it and give me back my money.
BS: Do you have the receipt?
CP: No. Can't you just look it up?
BS: Do you have your rewards card?
BS: Oh. Okay then. Here's $800.00 cash. Have a good day.
Essentially, that IS what we are doing.
Thursday, November 5, 2020
Tuesday, November 3, 2020
Sunday, October 11, 2020
Pharmacists must self-report errors made.
Reporting errors in the pharmacy brings about two major results: a citation from the company and a lawyer making sure the company is safe from a lawsuit.
When we report errors, there is a question on the form: "What caused the error?"
The reply of "distractions and not enough help" is met with a scoff from the powers-that-be.
Do they attempt to fix it?
I have spoken truly about what takes place in the pharmacy. On the most basic level, we enter, count, fill, and check prescriptions. That has always been the job. Over the years, new tasks and distractions have been added to our workload, each one increasing the chance for a mistake to occur.
Phones ring off the hook. With corporate-mandated automatic outgoing phone calls, patients call to ask why they received a call or a text. We have to sell products and services. We offer immunizations. We are in an open area of the pharmacy where patients can just shout at us their questions. Drive-thru lanes that ring incessantly are a distraction upon one's focus and concentration.
Walk into any pharmacy and count the number of bodies behind the counter and match that with the number of stations available.
(Stations include: Drop off window, pick up window, consultation window, drive-thru window, Data Entry workstation, Counting workstation, Pharmacist checking station, and anywhere from 3-10 phone lines available.)
The employees are stretched thin but the corporate budget predicts the amount of help necessary to man the battle stations. Their numbers can't be wrong, right?
While manning all of these stations, sometimes multiple stations at once, your pharmacist is also checking your prescription for mistakes. Imagine reading a book in a crowded bar with a DJ playing music, a few friends trying to include you in the conversation, your phone going off as your kids are trying to locate you, someone tapping you on the shoulder every few minutes excusing themselves past you on their way to the loo, and random shouts of "GOAL" echoing from the match on the telly.
How much of what you were reading do you remember?
How many times did you restart that page, that paragraph, that sentence?
This is the life your pharmacist leads.
This is the life into which you put your life.
She is set up to fail and one day it will kill someone.
It will not be anyone's fault she couldn't remember what she read on that last page in her book, your prescription.
She is set up to fail.
Until pharmacies work to change their work environments for their employees, someone is going to die. Unfortunately, I believe it is going to take such an event to occur before changes happen. Pharmacies will file it under "cost of doing business".
Shouldn't you want something better for yourself, for your loved ones than to be considered a "cost of doing business"?
Focus is paramount in our profession. We are the last line of defence between your prescriber and an awful day.
Now another scenario for you. Imagine yourself lying on an operating table. We've all seen the movies where the staff are all in their precise locations, assisting with the procedure, monitoring the monitors. We usually have a surgeon, assistant, nurse, tech, and anesthesiologist. Each person has a specific job to do. Now imagine the hospital cut the staff in the OR down to just the surgeon and one nurse. Someone has to hand the surgeon his instruments. Someone has to monitor the vitals. Someone has to administer the anesthesia. Someone has to prep the patient and be on hand for calling in help when needed.
As the procedure starts and these two lonesome souls are wrists deep in your chest cavity, the phone rings in the OR and the surgeon has to answer it because the nurse stepped aside to call for a radiologist. Someone needs to know what's taking so long and where the vending machine is located in the waiting room. Oh, and a family member just poked her head in the door asking "how much longer?' because they have dinner reservations in 10 minutes.
Is this a most absurd scenario? A professional team being decimated to save a few dollars for the hospital?
Is this what your pharmacists and their teams deal with on a daily basis?
Is this an exaggeration?
No. Not really at all.
For 12 hours a day this is what we do with skeleton crews.
Is that the environment in which you want your pharmacy staff to work?
Apparently it is because patients like to yell and scream at the pharmacy staff for taking too long and don't consider the repercussions if their interruptions lead to a mistake.
Until someone dies, no one will care.
Except your pharmacist.
Unfortunately, when I discover I killed you, my life will end.
I will not be able to live with myself knowing what I did.
I will have to surrender my licence and leave the profession I love.
The pharmacy? No remorse.
Maybe a statement from their media mouthpiece about "thoughts and prayers" and how "that pharmacist no longer works for us".
But that's it.
They won't change a damn thing.
Until we demand it.
Actually, until YOU demand it.
Your pharmacists have been demanding it for years. But they don't listen to us. In their eyes, we are not smart enough to understand budgets and staffing demands.
I don't want to kill you.
I don't want to hurt you or anyone you love.
Please understand this.
I am going to kill you.
I don't want to, but it will happen.
Friday, October 9, 2020
Thursday, October 8, 2020
Wednesday, October 7, 2020
MICE ELF: Why not 30?
All the stars we steal from the night sky
Will never be enough.
Thursday, September 24, 2020
Sunday, September 20, 2020
Wednesday, September 16, 2020
Thursday, September 10, 2020
Monday, September 7, 2020
Tuesday, September 1, 2020
Monday, August 31, 2020
Monday, August 24, 2020
Tuesday, August 18, 2020
MICE ELF: You mean they made it all the way down here, extricated themselves from their vehicles, only to plant themselves behind the nearest pole at my pharmacy?
Monday, August 17, 2020
Thursday, August 6, 2020
CPP: The Professional Judgement Game?
CPP: My favourite! Is this because everyone likes to comment on your posts about how we should just call? Or how they wouldn't ever call? Or how a counsel with the patient would have cleared things? Or how a consul wouldn't have provided an answer?
CP: Like those cure-all natural oil remedies - essential-ly.
CPP: Nice. Let's see this test.
1. Amoxicillin 500mg - Take 1 tablet by mouth 3 times a day.
(Do we dispense tablets or capsules? Or does it matter on this particular Rx?)
2. Amoxicillin 500mg Tablets - Take 1 capsule by mouth 3 times a day.
(Do we dispense tablets or capsules? Or does it matter?)
3. Duloxetine 60mg Tablets - Take 1 capsule by mouth 2 times a day.
(How do you dispense this one? If you said tablets for either of the above based on the drug written, then you have to answer tablets here and you have to call the prescriber, right?)
4. Motrin 800mg Capsules - Take 1 tablet by mouth every 8 hours.
(Tablets? Capsules? Call prescriber? If you answered tablets to any of the previous 3, then this has to be tablets, rights? Or is it Capsules because it's in the name?)
5. Insulin Glargine
(Do you dispense Lantus or Basaglar? If you try Lantus and it requires a prior authorisation, can you just switch it?)
1. It doesn't matter. Just because "tablets" is written in the directions does NOT mean the prescriber intended for tablets to be dispensed. Often it's a default sig. Or pre-printed. Either way, it does not matter.
2. Meh. Same answer. It does not matter. Maybe his drop down menu only had tablets; or it was listed first. Same with the directions. As long as the patient gets 500mg of Amoxicillin, it doesn't matter. But if you claim that #1 HAS TO BE tablets based solely on the sig, then you must abide by your rule and dispense capsules here. Otherwise, your "steadfast" rules conflict and have no basis in real e-prescribing/dispensing.
3. Capsules. It's the only way the product is available. This is to prove that just because the directions use one dose form and the drug name is selected as another, albeit unavailable dose form, does not mean we have to move heaven and earth and call the prescriber to fix this. . . unless of course you disagree with either of the first two answers. In that case, stop wasting time. You know you just dispense capsules, so use that logic on #1 and #2.
4. Tablets. Period. Even though I have seen this very same prescription multiple times, there is no way the prescriber(s) intended to give the patient 800mg ibuprofen capsules. Tablets all the way. Again, if you disagree with any of the previous answers, then you MUST call this prescriber and verify capsules was correct as submitted. Another waste of time.
5. Please tell me no one does this. If a patient asks for ibuprofen OTC you can give them Advil or Motrin. Same here. If Lantus is not covered, try the Basaglar. It's written for the generic name, NOT the brand. Had the Rx been sent over as "Lantus Solostar", then you'd have to call, per insurance pain-in-the-assitude. I hate floating to stores and my first doctor calls are about these exact scripts; fix it.
CPP: Think everyone passed?
CP: Most likely. We have a great group of phollowers. I think we will catch shit from people justifying why they call (insurances and audits and on and on) but I stand by our answers. Even if I get audited on 1000 Amoxicillin Rx's over 5 years, I'm only out like $42.00.
Tuesday, August 4, 2020
MOOSE KNUCKLE: <hands over papers in hand>
MOOSE KNUCKLE: Right. I need to pick it up.
MOOSE KNUCKLE: She said she sent it.
MOOSE KNUCKLE: But I thought it was placed.
Tuesday, July 14, 2020
CP: The alcohol one.
CPP: Can I drink with this?
CP: Exactly. People always treat it as if it's a negotiation.
Pt: How much can I drink with this?
CP: Keep going.
CPP: I asked you this because I know you enjoy answering questions literally and thought you might have a quick quip for this.
CP: I do. Let's play.
Forcing Rx's Over Gums: Can I drink with this?
CP: Yes. Absolutely. In fact, I encourage drinking while taking this medication.
FROG: <excited> Really?
CP: Yes. A dry swallow is a difficult feat and will leave a bad taste in your mouth, or get stuck in your throat.
FROG: That's not what I meant.
CP: I encourage drinking. It is healthy to stay hydrated. It is a difficult task for a pharmacist, what with the "no drinks allowed on the bench" policies and the mandatory masks. Lemme tell ya, 12 hour days in these things really parches the ole gullet and they don't make them yet with straw holes.
FROG: I wanted to know if I can drink. . .
CP: I assume you CAN drink. Water would be the potable liquid of choice. As I said earlier, I solidly encourage drinking while taking this medication.
CPP: You know that's just cruel, right?
CP: Next time he will be more specific. Or get to the point faster.
CPP: Surely someone out there is going to think you're serious.
CP: I am serious. I would totally answer the first question this way. . . knowing my patients and the rapport I have with them, this answer would go over very well with the crowd. And don't call me Shirley.