Sorry for a lack of updates. CorpoPharm has been pleasantly slow, after a huge boom for the first quarter of the year.
This has made me reflect quite a bit on our day-to-day operation. I spend a good bit of time actually doing work -- receiving orders, doing miscellaneous pill counting, pulling outdates, data entry, ringing register, the likes -- but it seems a lot of time lately has been spent on two things:
1) Answering questions pertaining to the restroom
and
2) Answering questions pertaining to "extra" services
I can't even tell you what percentile of my day is spent playing GPS and pointing people to our bathroom. I've frequently questioned if people purposely drink a gallon of water/tea/soda/WHATEVER when they leave their houses, and say "Oh look, there's CorpoPharm. Potty break!". Now, I can understand the service workers who help us out, like our vendors that bring in orders, and our UPS men who spend all day in their trucks, and people such as that. But, I can't even begin to count how many regular people start out at the front door and make a beeline for our front registers, asking how to get to the bathroom. The directions are simple -- go all the way to the back, just after beauty. However, somehow they confuse "beauty" with "pharmacy counter". Yeah, you caught me. I'm hiding the toilet between Tekturna and Trileptal. I repeat the simple directions, and throw in a few hand motions to demonstrate down and right. We've remarked quite a few times that we'd like a tape player with a continuous loop, so we could just hit "play", let it roll all day, and go back to work. It's pathetic.
Part two -- "extra" services. No, not those kind of services. People frequently call up CorpoPharm and ask if we have delivery, if we can bring them a quart of milk with their delivery, and if we will keep their credit card on file so they could call us and have their photos and prescriptions and their laxatives and maybe some eyeshadow waiting, all paid for, as they run through the drive-thru. This is part of what is wrong with pharmacy. I've ranted on the drive-thru before -- I think it's great for disabled elderly people, people with SMALL children (read: NEWBORN to MAYBE 2, to be generous. If they can walk and hold your hand, GET OUT OF THE CAR!), and people who have just completed surgery and are still puking all over themselves from the anesthesia. So, when Joe Schmo pulls through, and says "Hey, can I get my photos here? Oh, and a pack of batteries for my camera, thanks!", I shut my window on them, after explaining that this is the PHARMACY department, and we don't do photos in the PHARMACY. You have to go to the photo counter. I don't hand my prescriptions to Susie up front, and ask her if she can just fill them and hand them to me right then. I wouldn't hand my film to my pharmacist, and tell them to step on it, that I have places to go. It's ridiculous, and people are truly trying to make us into less of professionals than we already feel like when people just dump a cartload of stuff at our counter, and say "The girl up front has one person in line, and I didn't feel like waiting for them to finish. I'm sure you don't mind ringing this all up! You're not busy." Don't even go there.
As for the delivery stuff. CorpoPharm offers delivery at SELECT locations. We are not one. We have not been one. If we had enough hours for a delivery driver, and we had an actual viable amount of people who needed delivery, I'm sure we could appeal to CorpoPharmacy to change this. However, most of our clients don't ask for delivery, so we are all too happy not to start a big fight to get a driver. Plus, it is not the delivery driver's job to get you your triple-a batteries, and maybe some pink lipstick (coral, not baby!) to boot. Their job is to bring your prescription to you, have you sign for it, and pay for it. The end. That's all it takes. That's all they're expected to do. If you have a serious reason you can't get something, and are nice to us, maybe, we can bring you a container of milk. But that lipstick isn't something you should expect the driver to want to grab you. You know we'd never get it right, anyway.
I don't know. It feels like we're almost becoming a joke back there. Between being the BDB (Bathroom Direction Booth) and fielding these ridiculous requests at the drive-thru and on the phone, it makes me shake my head much more often than I should at work. We are pharmacy PROFESSIONALS. We are not cashiers, so please do not bring us your entire cart. We're more than happy to help you with your medicine. Just stop asking these ridiculous things of us.
Wednesday, April 30, 2008
Thursday, April 17, 2008
E-Prescribing ... pros/cons?
Pharmer Jane's blog gave me a good topic to talk about tonight -- e-prescribing.
I'll admit it -- at the very beginning, I was totally drinking the Kool-Aid, believing this to be the answer to life's problems in the pharmacy. Finally! The doctor has to make the prescription clear and concise. The joke's on them! We will have our jobs done even more quickly and efficiently, PLUS, there's no hard copy for your typical Absentminded Abbie-type patient to misplace!
That was the beginning. It was quickly after e-prescribing started to filter through some of our regular doctors' offices that we realized what a headache it can be.
Sure, the e-scripting cuts down on a lot of errors. But, seriously? The local dermatology practices are huge on these systems, and change which one they prefer practically every 2 weeks. If I had even just a penny for every single issue with their rx's (no quantities, malformed sigs, typos, dosage forms being written for that don't exist, and so on), I could probably retire for at least a few years before I'd have to get back into the swing of things. But, when they write for "Plexion", how do we know if it's the cloths, the wash, or whatever else some pharmaceutical company churns out for another brand name zillion dollar "copay rape", as we've termed it at our store? They always write "as Directed in the qAM" or something just as ridiculous in the free-form text field that appears on their screens. It's also cute when the quantity field says "QS", and there's no duration specified. Just "as Directed". That's all they ever write.
And what about the doctors' office who can't even get their patient's chart correctly? Patient John McFarlander has been taking Diovan HCT for two years now, at least, and Dr. Idiot still thinks he's taking 80/12.5. Mr. McFarlander's been taking 160/25 for the two years. In fact, for the first 6 months, he took 2 80/12.5's a day. 2 tabs qd was what Dr. Idiot's nurse, Kathi, called into our pharmacist. We pulled all the 5 hard copies we had -- all phone-in's -- and they all said the same thing. "Per Kathi, please dispense at 160/25. Dr. Idiot states dose is correct at 160/25." Yet, it's always incorrect. Can you imagine an e-script from Dr. Idiot? Either he or his staff are desperately behind with their reading skills. In fact, Mrs. McFarlander sighed sympathetically with us as we frantically tried to get her husband's problem straightened out before he had to go to work. "They always do this, don't they? They can't keep it straight, can they? I can't believe this!"
E-prescribing was supposed to make it so much easier for someone to look at a patient's chart, and to find out where the problem lay. It was supposed to be fool proof! What happened to this dream world we were in with our Kool-Aid glasses held aloft to toast to this new technology?
I will be the first to say that I agree with e-prescribing, don't get me wrong. I'd rather sit and call Dr. Stupid's nurse 3 times a day to correct his malformed sig of "per Day or as Needed" on Peter Pan's amoxicillin than sit and try to decide if it says Duricef or Omnicef, let alone what strength it says for his wife. But, until humans are perfect, e-prescribing can't be. So, yes. There's a lot of issues. But, if it will help Mrs. Smith just once on her way out of the hospital and back home after contracting community-acquired pneumonia and bronchitis and needing to get some Augmentin, than I'm all for it. Just don't hit me with a retarded sig. Typically, these systems have some form of an input field for a sig. Don't fuck it up. It's simple.
I see the future moving towards e-prescribing as the only acceptable form of maintaining medication records for doctors and pharmacies, and even possibly, a system where we can share information easily from doctor to patient to see their previous history of medications, and any allergies known to either party, so when their Celebrex is denied, we can help the doctor figure out if it's easier to try some Anaprox DS, or maybe even meloxicam, if either are appropriate. Something like short-term antibiotics, and of course, controls/narcotics, should require tamper-proof, original hardcopies as many states require/request as it is, but hopefully the e-prescribing business continues to head in the right direction.
Sorry this isn't a 100% perfect entry, and that it sort of rambles a little. This is a big weekend at Casa CPhT, and it's not even here yet. There's still so much planning to do that this pharmacy tech is wondering how things will ever get done before the big start to the weekend tomorrow. What are your thoughts on e-scripting? I'm interested to see if anyone else is behind my thoughts on this one.
I'll admit it -- at the very beginning, I was totally drinking the Kool-Aid, believing this to be the answer to life's problems in the pharmacy. Finally! The doctor has to make the prescription clear and concise. The joke's on them! We will have our jobs done even more quickly and efficiently, PLUS, there's no hard copy for your typical Absentminded Abbie-type patient to misplace!
That was the beginning. It was quickly after e-prescribing started to filter through some of our regular doctors' offices that we realized what a headache it can be.
Sure, the e-scripting cuts down on a lot of errors. But, seriously? The local dermatology practices are huge on these systems, and change which one they prefer practically every 2 weeks. If I had even just a penny for every single issue with their rx's (no quantities, malformed sigs, typos, dosage forms being written for that don't exist, and so on), I could probably retire for at least a few years before I'd have to get back into the swing of things. But, when they write for "Plexion", how do we know if it's the cloths, the wash, or whatever else some pharmaceutical company churns out for another brand name zillion dollar "copay rape", as we've termed it at our store? They always write "as Directed in the qAM" or something just as ridiculous in the free-form text field that appears on their screens. It's also cute when the quantity field says "QS", and there's no duration specified. Just "as Directed". That's all they ever write.
And what about the doctors' office who can't even get their patient's chart correctly? Patient John McFarlander has been taking Diovan HCT for two years now, at least, and Dr. Idiot still thinks he's taking 80/12.5. Mr. McFarlander's been taking 160/25 for the two years. In fact, for the first 6 months, he took 2 80/12.5's a day. 2 tabs qd was what Dr. Idiot's nurse, Kathi, called into our pharmacist. We pulled all the 5 hard copies we had -- all phone-in's -- and they all said the same thing. "Per Kathi, please dispense at 160/25. Dr. Idiot states dose is correct at 160/25." Yet, it's always incorrect. Can you imagine an e-script from Dr. Idiot? Either he or his staff are desperately behind with their reading skills. In fact, Mrs. McFarlander sighed sympathetically with us as we frantically tried to get her husband's problem straightened out before he had to go to work. "They always do this, don't they? They can't keep it straight, can they? I can't believe this!"
E-prescribing was supposed to make it so much easier for someone to look at a patient's chart, and to find out where the problem lay. It was supposed to be fool proof! What happened to this dream world we were in with our Kool-Aid glasses held aloft to toast to this new technology?
I will be the first to say that I agree with e-prescribing, don't get me wrong. I'd rather sit and call Dr. Stupid's nurse 3 times a day to correct his malformed sig of "per Day or as Needed" on Peter Pan's amoxicillin than sit and try to decide if it says Duricef or Omnicef, let alone what strength it says for his wife. But, until humans are perfect, e-prescribing can't be. So, yes. There's a lot of issues. But, if it will help Mrs. Smith just once on her way out of the hospital and back home after contracting community-acquired pneumonia and bronchitis and needing to get some Augmentin, than I'm all for it. Just don't hit me with a retarded sig. Typically, these systems have some form of an input field for a sig. Don't fuck it up. It's simple.
I see the future moving towards e-prescribing as the only acceptable form of maintaining medication records for doctors and pharmacies, and even possibly, a system where we can share information easily from doctor to patient to see their previous history of medications, and any allergies known to either party, so when their Celebrex is denied, we can help the doctor figure out if it's easier to try some Anaprox DS, or maybe even meloxicam, if either are appropriate. Something like short-term antibiotics, and of course, controls/narcotics, should require tamper-proof, original hardcopies as many states require/request as it is, but hopefully the e-prescribing business continues to head in the right direction.
Sorry this isn't a 100% perfect entry, and that it sort of rambles a little. This is a big weekend at Casa CPhT, and it's not even here yet. There's still so much planning to do that this pharmacy tech is wondering how things will ever get done before the big start to the weekend tomorrow. What are your thoughts on e-scripting? I'm interested to see if anyone else is behind my thoughts on this one.
Thursday, April 10, 2008
Fun times
I haven't been able to think of good stories lately, mostly because I have to change things in them now. But, I think I have at least one now.
Last week, this guy stopped into our store. He was rather interesting. When I got to the register, where he was pacing, he looked me dead-on. "Do you know anything about cuts?" he asked me. "Well, what ABOUT cuts?" I answered. "Cuts! Like this one."
He rolls up his pant leg. There's an obviously infected cut across his leg. "I got this cut a few weeks ago. How do I make it better? I've been using homeopathic cream to fix it, and it isn't getting better. HOW DO I GET IT TO GO AWAY?"
I called John, my pharmacist, over. John sees the cut, and tells the guy to see the doctor, because it looks like it could be an infection. "Listen, John," the guy starts. "This isn't infected. It's looked like this for a few weeks. It's not a cut. You know how when you drink too much and your liver gets hurt, but after awhile, gets better? It's sorta like that. I cut it too hard and it won't heal very fast. I just want to speed it up. It's not infected. Really. I know."
This man was no doctor. Both John and I could plainly see this man's need for a good dose of some type of antibacterial agent, but this guy was too full of himself to be able to listen to our medical advice.
I just don't understand why, if they don't want our honest to God opinion, these people bother to waste our valuable time, when there were about 20 prescriptions waiting for both John and my attention that we could have done if it was not for this idiot. But he was sure it was just like hurting your liver drinking. Whatever.
Also, I got a customer complaint given to my PIC, John, the other day. Apparently, this lady asked for a refill on her skin cream (I think it was Vaniqa), and when I told her she had no refills, and that the doctor would need contacted, she told me fine. Well, apparently after the doctor called her at home and told her she needed a follow-up appointment to get more refills, since she'd been using that tube for about a year and a half (and I believe she actually got the tube shortly after it came onto the market), she decided she told us not to call (not true). So, John got an earful of how I was incredibly rude. Now, this lady is a whiner -- she has complained to us many times about how mean her doctor is because he requires her to show her face for an appointment every once in awhile to check her Synthroid dose, and all kinds of similar things -- so, I didn't get into trouble. But it was a good laugh, especially considering that she told me it was important for her to refill her Vaniqa. I guess she was afraid her ladystache would come back overnight.
Last week, this guy stopped into our store. He was rather interesting. When I got to the register, where he was pacing, he looked me dead-on. "Do you know anything about cuts?" he asked me. "Well, what ABOUT cuts?" I answered. "Cuts! Like this one."
He rolls up his pant leg. There's an obviously infected cut across his leg. "I got this cut a few weeks ago. How do I make it better? I've been using homeopathic cream to fix it, and it isn't getting better. HOW DO I GET IT TO GO AWAY?"
I called John, my pharmacist, over. John sees the cut, and tells the guy to see the doctor, because it looks like it could be an infection. "Listen, John," the guy starts. "This isn't infected. It's looked like this for a few weeks. It's not a cut. You know how when you drink too much and your liver gets hurt, but after awhile, gets better? It's sorta like that. I cut it too hard and it won't heal very fast. I just want to speed it up. It's not infected. Really. I know."
This man was no doctor. Both John and I could plainly see this man's need for a good dose of some type of antibacterial agent, but this guy was too full of himself to be able to listen to our medical advice.
I just don't understand why, if they don't want our honest to God opinion, these people bother to waste our valuable time, when there were about 20 prescriptions waiting for both John and my attention that we could have done if it was not for this idiot. But he was sure it was just like hurting your liver drinking. Whatever.
Also, I got a customer complaint given to my PIC, John, the other day. Apparently, this lady asked for a refill on her skin cream (I think it was Vaniqa), and when I told her she had no refills, and that the doctor would need contacted, she told me fine. Well, apparently after the doctor called her at home and told her she needed a follow-up appointment to get more refills, since she'd been using that tube for about a year and a half (and I believe she actually got the tube shortly after it came onto the market), she decided she told us not to call (not true). So, John got an earful of how I was incredibly rude. Now, this lady is a whiner -- she has complained to us many times about how mean her doctor is because he requires her to show her face for an appointment every once in awhile to check her Synthroid dose, and all kinds of similar things -- so, I didn't get into trouble. But it was a good laugh, especially considering that she told me it was important for her to refill her Vaniqa. I guess she was afraid her ladystache would come back overnight.
Sunday, April 06, 2008
Hitting the big-time
I got my first reader e-mail:
"Hi,
I was wondering if you could go on a rant about Accutane and the stupidity of the IPLEDGE system. So many more babies are born with fetal alcohol syndrome, yet the FDA does nothing about that. Unbelievable...I guess it all comes down to politics. In a way, I can understand why the FDA is concerned, because yeah it does screw up babies...but don't you think something is wrong with this picture when it's easier to buy a gun or get an abortion than go on accutane.
Thanks,
Susan"
I spent the day yesterday contemplating this, and I came to a conclusion -- I can a gree with some points in Susan's e-mail. I agree that there's nothing the FDA does about FAS, but what CAN they do, besides the warning on the alcohol bottles? I can also agree it's easier to get an abortion, but I agree with the iPledge system for the most part.
See, for those of you who aren't in pharmacy, and don't know how iPledge works, here's a brief rundown, to the best of my knowledge (some things may be a little off, since I'm only in the business of dispensing, but they're all in the ballpark) -- you have to make an appointment monthly with your doctor to get a script -- no refills are valid. To START on Accutane, both genders need to be signed up for the program by their physician, who has to be a member of the program as well. A woman of childbearing age has to wait a month to start their medication, as they have strict regulations about said woman taking pregnancy tests and/or blood tests every month. They are also required to use 2 forms of birth control, abstinence being allowed as one of them. This lasts for a month after the treatment ends, too. Males and females who cannot get pregnant just have to go to the doctor monthly for their prescriptions, and possibly some blood work.
Here's the main reason why I DON'T agree with the e-mail I received --
There's a serious NEED for the program to be so strict. Harming unborn babies with serious birth defects is no joke, and I'm not saying FAS is a joke, but these babies are born deformed and mentally challenged. According to the March of Dimes website, these are some of the most common Accutane-induced defects - "hydrocephaly (enlargement of the fluid-filled spaces in the brain); microcephaly (small head and brain); mental retardation; heart defects; ear and eye abnormalities; cleft lip and palate; and other facial abnormalities.". I don't know about you, but I'd much rather a woman have to take a urine test every month, and be on birth control, then see a baby born with these issues that WE have to support on their welfare plans, when these issues were so easily preventable in the first place. Yeah, it can be a pain in the ass for these people to go to the doctor every month and be tested, but in the end, it saves them from terrible acne, and any potential babies from these terrible defects.
So, unfortunately, I can't really agree on this rant, but it was good fodder for a blog. Thanks Susan.
"Hi,
I was wondering if you could go on a rant about Accutane and the stupidity of the IPLEDGE system. So many more babies are born with fetal alcohol syndrome, yet the FDA does nothing about that. Unbelievable...I guess it all comes down to politics. In a way, I can understand why the FDA is concerned, because yeah it does screw up babies...but don't you think something is wrong with this picture when it's easier to buy a gun or get an abortion than go on accutane.
Thanks,
Susan"
I spent the day yesterday contemplating this, and I came to a conclusion -- I can a gree with some points in Susan's e-mail. I agree that there's nothing the FDA does about FAS, but what CAN they do, besides the warning on the alcohol bottles? I can also agree it's easier to get an abortion, but I agree with the iPledge system for the most part.
See, for those of you who aren't in pharmacy, and don't know how iPledge works, here's a brief rundown, to the best of my knowledge (some things may be a little off, since I'm only in the business of dispensing, but they're all in the ballpark) -- you have to make an appointment monthly with your doctor to get a script -- no refills are valid. To START on Accutane, both genders need to be signed up for the program by their physician, who has to be a member of the program as well. A woman of childbearing age has to wait a month to start their medication, as they have strict regulations about said woman taking pregnancy tests and/or blood tests every month. They are also required to use 2 forms of birth control, abstinence being allowed as one of them. This lasts for a month after the treatment ends, too. Males and females who cannot get pregnant just have to go to the doctor monthly for their prescriptions, and possibly some blood work.
Here's the main reason why I DON'T agree with the e-mail I received --
There's a serious NEED for the program to be so strict. Harming unborn babies with serious birth defects is no joke, and I'm not saying FAS is a joke, but these babies are born deformed and mentally challenged. According to the March of Dimes website, these are some of the most common Accutane-induced defects - "hydrocephaly (enlargement of the fluid-filled spaces in the brain); microcephaly (small head and brain); mental retardation; heart defects; ear and eye abnormalities; cleft lip and palate; and other facial abnormalities.". I don't know about you, but I'd much rather a woman have to take a urine test every month, and be on birth control, then see a baby born with these issues that WE have to support on their welfare plans, when these issues were so easily preventable in the first place. Yeah, it can be a pain in the ass for these people to go to the doctor every month and be tested, but in the end, it saves them from terrible acne, and any potential babies from these terrible defects.
So, unfortunately, I can't really agree on this rant, but it was good fodder for a blog. Thanks Susan.
Tuesday, April 01, 2008
Real-life do-over
I've seen the blogging community through a lot of things, both on Blogger and on different servers. This was something new -- an anonymous blog, where no one would know who I was!
But. Over the past month or so, I realized just how much I was giving away. If I was a coworker of mine at CorpoPharm, I could identify who this was in a heartbeat. So, this morning, I went through, and kept posts where things were fairly vague. From now on, I'll be making up names for my pharmacists, and my coworkers. I've said some things that, while never crossing the line, may not look favorable to certain people in CorpoPharm. So, beginning now, it's a fresh start, basically. I guess Pharmacy Mike sort of inspired the 2nd half of this change -- rather than always use actual stories that happen at CorpoPharm, I may change some details, too, just so it's harder to figure out who I am.
I'm looking forward to this new start. Some of my readers know my real identity, since I've told them who I am. I trust that they'll keep my identity secret. We are fellow TPA dues-paid members, and we will look out for each other.
There will be a real post at some point tonight, if I don't get the call to help out a friend at their house with a moving project.
But. Over the past month or so, I realized just how much I was giving away. If I was a coworker of mine at CorpoPharm, I could identify who this was in a heartbeat. So, this morning, I went through, and kept posts where things were fairly vague. From now on, I'll be making up names for my pharmacists, and my coworkers. I've said some things that, while never crossing the line, may not look favorable to certain people in CorpoPharm. So, beginning now, it's a fresh start, basically. I guess Pharmacy Mike sort of inspired the 2nd half of this change -- rather than always use actual stories that happen at CorpoPharm, I may change some details, too, just so it's harder to figure out who I am.
I'm looking forward to this new start. Some of my readers know my real identity, since I've told them who I am. I trust that they'll keep my identity secret. We are fellow TPA dues-paid members, and we will look out for each other.
There will be a real post at some point tonight, if I don't get the call to help out a friend at their house with a moving project.
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