TAXI !!

Woman approaches the counter and we determine that a prescription has been faxed for her from within the clinic. The woman speaks not a word of English. Not ONE word. We fill the prescription. Meanwhile, two other prescriptions show up for her. Through a series of grunts and hand gestures, it becomes apparent she has a taxi waiting and cannot wait for these. She wants them sent to Walgreens. We pull up a list of Walgreens addresses in the area, and she points to one. We call them and fax the prescriptions. I am absolutely sure she will show up at a different Walgreens and they will spend a lot of time trying to figure this one out. I think all their computers are connected so I'll hope for the best.

Next day, man walks in with eight prescriptions. He agrees to wait after a discussion about 'how long?' We're caught up so we start in on them, and he steps out to call a taxi. He returns in a few minutes and seems to expect them to be ready, and we tell him we've just started entering the third one. More time goes by while two technicians work diligently on his prescriptions. They're trying to go fast, so I catch a couple of mistakes. The taxi driver arrives. The customer steps up to the register and stares me down as I'm trying to check everything. I tell the clerk to start ringing him up while I finish. As she does, he asks "Do you need my insurance card?" Sigh.... He claims to be familiar with all the medications, which I doubt since a couple of them involve gradual dosage increases. But, he's gotta get that taxi, and the rest of us need to get out of the way. I sure didn't have a good feeling about that one.

Also had a customer who had been using his Pulmicort Flexhaler with the dosage counter at zero for (probably) several months. He seemed to think it was kind of funny. Yeah, no big deal --- it's just an inhaler. Really more of a plaything. Sigh........

Economics is Everything

"$25 gift card with transferred Rx" reads the sign at the local Big Chain pharmacy today. So much for encouraging people to fill all their prescriptions at one pharmacy with the hope that all potential dangerous drug interactions can be detected. I'll be bracing myself this week to see prescriptions bounced around like ping-pong balls. And next month, the customer will attempt to call in the refill back to my pharmacy using their Big Chain prescription number, sending me on a wild-goose chase to figure out what the heck they want me to fill for them. Or more likely, they just show up with Big Chain's bottle(s) and look stunned when the technician tells them we've got to call the other pharmacy and it may take a little longer.

It's always been an attractive gimmick and a sign of the economic times, I guess. Our company has already put out the word that we are to decrease waste. The first thing that comes to my mind is the paper, paper, paper -- not the least of which is the stuff we have to cram into each prescription bag that gets thrown away (sometimes on the customer's way out the door).
We also need to start charging a shipping fee for mailing prescriptions. You want the convenience, you need to pay a buck or two. We're often mailing prescriptions that cost less than the packaging material needed to send it, and they are paying pharmacy staff' to chase down credit card numbers and expiry dates.

We'll see what happens. Don't misunderstand, I'm glad I have a job.

A Salute to the People Who Know Their Stuff

In the pharmacy world we piss and moan about other people we encounter in our daily work --
bitchy nurses, dumbass doctors, and yes, other pharmacy personnel who we find lacking in competence. And heaven knows, there are plenty of them out there. But in the last couple of months I've found myself close to a couple of surgical procedures -- one as a patient, the other as a family member. And I've been truly impressed and appreciative of many of the people I've encountered as they do their daily work.

I'm a big believer in recognizing people who do a good job, especially when you know that it's totally routine for them, and they're probably sick and tired of giving the same post-op spiel 20 times a day, or explaining the blood pressure cuff, or soothing yet another person who's sweating out having an IV placed. You can always tell the people who are true professionals. They make you feel like you are the center of their world; they know exactly what you're going to feel before you do; they anticipate everything, they crack a few jokes, they smile, they ask "Are you OK?" over and over. You don't really appreciate these things till you're on the other side. And for these people, it's all in a day's work but they never act like it is. And when the procedure's over and the problem is fixed and you get to go home and live your life, you've got to remember to say a little thank you for those medical personnel whose everyday skills you relied on.

Of course I include many of my fellow pharmacists in this salute. But when you're nervously stuffing your clothes into a plastic bag in some pre-op holding room and the damn hospital gown
flaps open in the back revealing your least attractive feature --- well, I have a special feeling for the nurse who reaches over and gently closes it. I salute you.

0.07 ounces of pure gold?

I find Abreva helps shorten the duration of a cold sore if you start applying it really early. The price averages $15-16 bucks for a teeny tiny 2 gram tube, so when I saw a $3 coupon in the Walgreens ad I figured I would pick one up. Well, the price had been jacked up to $17.99, so with my 3 bucks off I was pretty much back at what used to be the regular price.

I should have stomped up to the pharmacy counter and asked when is it going generic ? (Wal-breva, anyone?) Now I know how my customers feel. I shouldn't even mess around with the stuff. Valtrex, 2gms twice a day for two doses, is the ticket. It's expensive too, but I know it's going to work.

I just needed to complain to someone!

A Few Random Do's and Don'ts

A pretty routine work week, but a few things kept repeating themselves... which leads me to offer this short reminder in the form of "do's and don'ts"......

For you prescribers out there:

DO pick up the phone and call me if you fax a prescription for your patient for antibiotic #1 and then change your mind and fax another one for antibiotic #2. It would be very courteous of you to inform me of your change of heart before the patient is out the door, requiring me to run out into the rain in a vain attempt to corral our patient back into the pharmacy. I'm sure you expected me to call YOU for clarification because I've got so much time on my hands, but in this case that's a non-starter.

DO take just a moment to proof-read the medication order you are about to bestow on your patient, and on me. A month's supply of medication X at one tablet per day is generally a quantity of 30 tablets --- not 15, and not 20. I don't have time to call you, even though I have to. The patient's not gonna be happy paying a full co-pay for a 1/2 month supply, and c'mon, this is the easy stuff!! Similarly, Augmentin 875mg BID for 10 days would be 20 tablets. If you write it for 28 tablets, did you mean 14 days? These are the eternal questions we all face, and legally I can't make the decision for you. When I call your office, please DO have someone pick up the phone.

For our valued customers:

DON'T toss your insurance card at me as I am ringing you up at the cash register. It is not a credit card. It needs to be processed as the prescription is being filled.

DO avoid conversations with me such as:
"Do you have your insurance card?"--- No.
"Have you filled prescriptions here before?"---- I 'm not sure.
"What kind of insurance do you have ?" ---- It's through my wife's work.

DO meet me halfway. Help me out here, and I'll be glad to get you on your way as quickly as possible.

This week was deja vu all over again!

Saturday Follies

Weekends in the pharmacy are often spent putting out fires --- dealing with issues that should have been dealt with during the weekdays when (a) the pharmacy was fully staffed, (b) doctors' offices are open, and (c) the daily drug order arrives to replenish our stock. A mistake that was made during the week will always rear its ugly head on Saturday. Some problem that no one followed through on will also take the form of a customer staring you down first thing on Saturday ("They told me they would order it and it would be ready.") When I worked in hospital pharmacy, people seemed to be more vigilant about making sure we were supplied for the weekend. Since there was always another shift following right after you, people passed on messages and FYIs a little more reliably. That seems to be lacking in my retail setting and it does bother me when I'm working alone on the weekend and really get dumped on.

Customers like to call in refills on Thursday that need their doctor's authorization, and show up Saturday morning, without CALLING FIRST, to find that it has not been approved yet. I break the bad news that they're probably looking at Monday or Tuesday. This is usually not well received. And no, I can't give you a few Ambien, or a Flonase, or (sorry) some Viagra to get you through the weekend.

Weekends also mean that the people we're dealing with down the medical food chain are more likely to be fill-ins, substitutes, or on-calls. To be honest, sometimes I don't mind a little challenge to my problem-solving skills and I feel good when I can work a solution for someone. Other times I really get mad at being stuck with the situation when it should have been taken care of in the Monday-to-Friday business.

This weekend I went above-and-beyond to solve a problem for someone whose doctor's office made a mistake -- it had nothing to do with the pharmacy whatsoever. It put me behind in checking prescriptions and the people waiting got pretty impatient, but there wasn't anyone else who could help this person. I could have turfed it off, but I tried to help -- and to all those impatient people waiting, your pharmacist trying to help someone may be another reason your prescription takes so damn long to fill.

Keep the Crap off my Counter

During really busy times our pharmacy counters are covered with stuff and the stock bottles really start to pile up. I've worked with other pharmacists who always seem to operate under a huge stack of bottles, loose paper and prescriptions that may or may not already be done and dealt with. I hate clutter and I get especially nervous when too many stock bottles are filling up the counter. It increases the chances that someone will grab the wrong one and a mistake will sneak through --- it happens to you once and you never forget it. I will go out of my way to get bottles reshelved and off the counter before moving on to the next bunch of prescriptions coming down the line. Also, once a piece of paper is dealt with, I say BE GONE --- to the trash, to the prescription file, to the call box, whatever --- off my counter.

I'm afraid I also get annoyed at working around people's water bottles, coffee cups, pop cans and half-eaten food. Everyone's told they're not supposed to have this stuff out but they do, especially if they've got a milquetoast manager. Once I have moved the same Coke can for the 15th time in a day, I start to think about throwing it across the room. And when that phone cord sweeps across the counter and almost knocks over an entire line of assorted beverages, it's time for everybody to just dry out for awhile.

Also, how is everybody drinking so much when we can't go to the bathroom?

P.S. I'm still interested in hearing anyone's comments about med guides (thanks to those who already have commented).