The Worker's Plea
1. Tell me clearly what you expect of me.
2. Give me the opportunity and resources to perform.
3. Let me know how I am doing.
4. Provide me with guidance, support, and training when I need it.
5. Reward me according to the contribution I make to the business.
I happened upon this little piece of paper one day while returning from the Cough and Cold aisle. I picked it up as I do all little pieces of trash I walk past each day. I unfolded it to reveal, "The Worker's Plea" as the title and the items above listed.
I found these statements quite intriguing. Since that day, I have done the best I can to implement these ideals into my pharmacy and treat my fellow pharmacists and technicians according to this doctrine. Not long after I found it, I held a pharmacy staff meeting after closing hours (even required those no scheduled to come in -- don't worry, they punched in!). I went through every item on this piece of paper -- along with some notes that jotted in a little notebook in which I taped this sliver of paper.
I told my pharmacists my expectations of them -- allowing the technicians to hear this. I told my technicians my expectations of them -- allowing my pharmacists to hear this. This, I feel was pivotal. I often think that things change after I leave -- that the technicians "get away with more," or that the other staffers don't hold them to the same level of expectation as I do. Now that everyone is clear on their role in the pharmacy, we began to hold each other accountable.
A month or so after this meeting, I spent about 15 minutes talking with each technician and 30 minutes talking to each pharmacist about how I felt they were doing since their expectations were set -- an evaluation of sorts. These meetings were all held during time I was scheduled off -- so my commitment to excellence was displayed. Some were doing exceptional. My pharmacists had become more authoritative over the technician staff and held them accountable for their errors. My technicians took their role more seriously -- as an adjunct to a pharmacist -- a necessary cog in the machine! It was going well. Of course, some technicians still did not take their positions seriously -- they called in sick, wasted time doing various non-imperative tasks to avoid certain difficult or trying duties, or did not try to improve their performance after pharmacist correction (like inputting a script incorrectly). These points were made in the meetings, and change was expected.
Yet, we continued on with the same problems -- Technicians calling in sick, making the same error over and over on similar prescriptions, or wasting time away from the pharmacy. After expectations were set, staff pharmacists being made aware of expectations, and a meeting with me, I was perplexed as to why this stuff was continuing.
I had laid out my expectations of my pharmacists and my technicians. Technicians were given plenty of opportunity to perform their tasks, learn from their mistakes, and better their performance. I had a meeting with every member of the staff to let them know my evaluation of their performance in their job duties -- which I felt were constructive, to the point, pertinent, and not demeaning or intimidating in any way. They had all been properly trained in ever facet of pharmacy from start to finish -- they knew how to do the job right. They knew the seriousness of mistakes -- that lives could sway in the balance. We had retrained and added supplemental help when mistakes continued whether it be knowledge of sig codes (like a list of common ones next to keyboards), or miscounting (by requiring fillers to circle the quantity on the page that prints out), or selecting the wrong drug (by requiring fillers to WRITE the middle four numbers of the NDC on each page as a double check). Still -- the mistakes were happening, and we had been lucky in that I and my fellow pharmacists caught them. What was I doing wrong?
I'm sure by now you all see what was going wrong. Once I looked at the big picture, I saw it. I knew what it was. I couldn't believe that I missed it -- time and time again. I felt bad that I let it get to that point -- I felt like a huge dick.
I was so focused on correcting the mistake with negative feedback, I neglected to reward the correctly filled prescription with positive feedback. To me, it's much simpler. Knowing that the right medicine got to the right person is the reward. Educating people on their prescriptions is the reward. Hearing the positive feedback from the patient is the reward. Yet, the technicians may not get this feedback firsthand. It may not even be the type of positive feedback they are looking for. This was the problem. The technicians were so worried about the negative feedback (which was far from a 'bitch out'), they were allowing themselves to make silly mistakes over and over again.
You have got to tell your technicians when they do it right -- that you appreciate their accuracy, promptness, positive attitude -- everything. Less mistakes made by technicians means fewer mistakes get by pharmacists. We've got to thank them for being an imperative part of our pharmacy. Now, I let my technicians know they are appreciated by both kind words and actions. I applaud their efforts when they think out a particularly difficult prescription or really use their noggin' to solve a pharmaceutical 'puzzle.'
I've also implemented a few other things. On Friday, lunch is paid for by the pharmacists. Period. It took some coercion to get the other pharmacists on board, but we all split it evenly -- even if we are not working that day. Whatever the technicians decide is what we eat...and we don't skimp. Appetizers, deserts, several courses. Whatever! In the past, technicians called in sick on Friday for a 3-day weekend. Not anymore! Now, I have to keep track of who works Fridays to ensure that each technician gets an equal amount of "Free Food Friday."
I've also started a Blue Jeans Fridays. Not much to brag about here as it's not that innovative, but my technician's can wear blue jeans on Friday at a cost of one dollar. All of this money goes into a coffee can and once it gets up to a sufficient amount, we do something with it. One time we donated $150 to a local baseball team trying to get money to go to a tournament. Another time we had milkshakes from Sonic on a slow Wednesday.
Thank your technicians. Thank your pharmacists. Ensure your pharmacy is a positive work environment. You'll see it increase your level of customer service. You'll hear more positive feedback from your patients. And, best of all, you'll have less mistakes get out the door.
I'm not quite sure if I was meant to find it, just got lucky, or perhaps someone left it just for me -- But I can honestly say I'm very happy to have discovered The Worker's Plea. It has helped me help a few that help thousands.
Busting a fraudulent script
Every pharmacist has been in a situation before where they have considered calling the police on a person trying to pass off a fraudulent prescription. Some pharmacists pass the buck and merely give it back to the patient rather than deal with it. Others are pretty gung-ho and do their best to see the person into the waiting arms of the authorities. I kinda go back and forth. It's a case by case basis.
I recently got an email from someone giving out tips on how to ensure pharmacists have the best chance of busting the scam-artist. It all makes complete sense, but it may not be things that we would think of in the spur of the moment.
I've reposted the "scenarios" below with the permission of the author, but I have edited them somewhat to make them more clear/applicable. My thanks go out to the author -- Michelle.
-=+=-
Suggestion 1: Someone brings in a fake prescription. After they leave, you call the doctor and verify that this is a fake prescription. The office confirms that it is fraudulent, altered, or illegal for whatever reason and instruct you to not fill it and have the person arrested. So, you call the police, and they tell you to notify them when the person arrives and stall the scammer when they come in to pick it up. You wait until they show up. Here's a tip: tell your employees that when the customer walks into the store and announces their name, NOT TO STARE AT HIM LIKE HE HAS THE PLAGUE!! Your behavior gives you, and your intentions, away. Scammers will pick up on this -- noticing the attention and bolt.
Suggestion 2: The patient will call you to see if their prescription is ready. All fake scripts will be called on by the scammer first to "test the waters" depending on your (or your tech's) response here dictates whether they ever come in. DO NOT ASK "What exact time will you be here?" RED FLAG. Under normal circumstances, you wouldn't care what exact time it was picked it up. If you ask, the person will know that the police will be there to meet them, and he/she won't show up. This will remove the gratification you so desperately need to see the person leave your pharmacy in handcuffs.
Suggestion 3: Don't tell them over the phone that they shouldn't use the drive-thru. Scammers know it is easier for you to arrest them in the store, so when you tell them"Uhhhh, just come in the store, something is wrong with our drive-thru," or "We need you to come in the store to sign something," they will know you are lying, and they won't show up. Another thing about this that will backfire is when they do show up and the supposedly broke drive-thru is full of customers.
Suggestion 4: For the purpose of this suggestion, we'll call our prescription forger Sally Smith." If you work in a big chain, you have lots of customers. They know this -- that's why they frequent the busiest stores. You cannot possibly know all your patients by name immediately. So, let says Sally Smith walks into your Walgreens at 11:00am with a fake prescription for Xanax. She gives it to you and leaves. You call and verify that it is indeed a fake prescription. You alert all of your employees that when Sally Smith comes back in they are to call the police. You and your employees anxiously await Sallys arrival. Did Sally show up yet? Watch for Sally to some in! Well, Sally has been at this for awhile and before showing up, she decides to call you and see how you react on the phone, most often zealous pharmacists give themselves away when trying to get someone arrested. Its 3:00pm. Sally calls Hello, my name is Sally Smith. Is my Xanax prescription ready yet? If the pharmacist immediately responds with Um, YES! It is ready She immediately knows the jig is up because you knew who she was without checking the Will-Call-Bin or the computer system. What you should say is, Sally who? What's your birthday? Okay. Hold on. Let me check.....When did you drop it off? Oh, yes, Sally, yea thats ready for you. This is much more believable. If they sense anything, they just won't come in -- they can just forge another one and drop it off somewhere else.
Suggestion 5: Someone comes in with a prescription that you suspect is xeroxed. Medicare/Medicaid is slowly rolling out measures to counteract forging of prescriptions like watermarks, heat sensitive ink, and separate pads for controlled drugs. Anyway, you think its copied/altered. The customer gives you or your technician the prescription and leaves the counter but walks around the store pretending to be shopping. If you, as the pharmacist, are going to hold the prescription up in the air under a light like its evidence from a murder scene to see if it is copied, here is a tip, go somewhere where the customer cannot see you do this! They will be watching/waiting. If they see this followed by you grabbing the phone in an adulterous rage, they are going to bolt. In addition, go somewhere out of the pharmacy and call on the Rx. The patient might hear their name or see you say their name and assume you are going to find out it's fraudulent...and bolt.
Suggestion 6: If someone comes in late at night to fill a controlled substance, right before closing time, there is a reason. They know you cannot contact the doctor at that hour and you just want to go home so some pharmacists will just fill the prescription as is. Some pharmacists may decide to not fill it until they can call tomorrow and verify it. Just tell them that rather than give them the drugs or lie to them. And definitely don't blatantly lie to them by saying something like, "The pharmacist-in-charge already left for the night and took the narcotic key with them. I can't fill anything until she gets back tomorrow morning at 9am. You can come back then." These types of people have usually worked in a pharmacy or are very familiar with pharmacy workflow due to the frequency of their pharmacy visits. They will know that every pharmacist has access to the narcotic cabinet and just because one pharmacist leaves does not mean that narcotics cannot be filled -- how retarded does that sound? Turning away all prescriptions...yeah right! Assuming they are ignorant of the ins and outs of pharmacy is wrong, and it will keep you from catching them and seeing them punished for their crime(s).
-=+=-
The readers of this post are going to have varying degrees of opinions on this matter. We can all agree that is illegal, and we discourage it. Where we will have differing opinions is on what is done after the prescription has been determined as fraudulent.
1. Some will always call the cops.
2. Some will just tear the script up and tell the patient they know it was fake and tell them to not come back to their store (and make notes in the computer on the patient's profile).
3. Some will just write fake on it in sharpie and give it back to the patient when they come in.
4. Some will leave the script alone and tell the patient they don't have the drug and will give the script back to them.
5. Some will call the cops and have them come pick up the fake rx and make no attempt to have the person arrested in their store.
6. Some just fax the Rx to every pharmacy/doctor in their area and then give it back to the person and see what happens when they try and go to the pharmacy down the street.
None of them are wrong, necessarily. I am a big fan of Number 6. It's really quite humorous to hear the stories from fellow pharmacists when the person continues to peddle a forged Rx to every pharmacy in town, and they ALL know it's fake in advance.
Some employers refuse to allow their pharmacists to call the authorities or have an arrest made within the store -- as it might scar the store's reputation or bother the other customers/patients. I think this is a punk ass cop out. But, in this case, pharmacists are restricted to numbers 2, 3, 4, and/or 6.
So, what's the right way to handle the situation? What do you do? What have you done in the past? I realize that stories are sometimes pertinent to show what you have done in the past, but try and keep them short and to the point.
UPDATE!!!
Read the Fraudulent Prescription Writing Guidebook at:
http://deadword.com/site/stripmall/hogshire2/bottom.html
If we know the rules and tricks they pull, we can counter them.
Professional courtesy
I got an email from "The Chick in the White Coat" asking me about professional courtesies and my take on them. She was asking about things such as the loaning of pills, calling doctors for refills, and how they have become expected of pharmacy rather than something a pharmacy does as a courtesy for patients. These things have become the rule rather than the exception.
I've never worked in pharmacy when these things weren't the norm. I'm sure once upon a time, these things were done by a few pharmacists as a way to keep customers, gain new customers, and go above and beyond what was expected....as a way to expand business. Yet, now they must be done to merely keep business and ensure people are happy. I personally think it's kind of bogus.
Loaning of Pills. I do it. We all do it at one time or another. Most pharmacy statutes allow pharmacists to dispense an "emergency" 3-day supply to a patient when a doctor cannot be contacted (and a patient had been taking the medicine for an adequate amount of time). These statues also allow pharmacists to use their professional judgment in these situations -- meaning that we wouldn't give little Timmy another bottle of Amoxicillin but we would give Grandma Johnson a few more lisinopril. Most all of us do this on a case-by-case basis. I will usually give the person three days worth if they have been on the medicine for longer than three months. If a person is a really good customer and thought of by my staff in good regard, I will give them the benefit of the doubt and front three days after only one-month of therapy. That's not exactly fair, but me giving anyone any pills is not required by law. I personally think that the patient's should take more responsibility in their healthcare and actually read the fucking bottle. When it says ZERO REFILLS, don't wait until there's 1 pill left in the damn bottle to call your doctor (or pharmacy -- see below). If a patient wants a week's worth because they are going on vacation, they are shit out of luck in my pharmacy. As a reader has said in the past (and now I say all the time): "Lack of planning on your part does not constitute an emergency for me." You can either call your doctor's exchange/emergency line or take your bottle to a pharmacy at your final destination. They can call your doctor from there. [It goes without saying that no one fronts controlled meds to any patient under any circumstances.]
Contact doctors for refills. Again, this has become the norm. Each morning, we all have a tech chained to the phone making the daily, "doctor calls." I've handled this in a few different ways. Sometimes, I come in a little early to make the calls -- before the pharmacy opens. Most MD offices open earlier, and I can get them done before my staff even arrives. Over the past 6 months or so, I've made a huge push to convert all of my calls to faxes. I've got a pretty decent relationship with most of the nurses around town (and know most of the doctors), so I've gotten them to either buy a fax machine or allow me to fax in refills. I still have one doc that absolutely refuses to accept faxes for some weird reason -- but I am down to making only 4-5 actual calls each morning. I merely told them like this, "When I call you, I get a receptionist who makes me wait on hold before she actually inquires to what I want. Then she sends me to your extension where I have to listen to your obscenely long voicemail explaining the same thing over and over again that I hear 20 times a day -- what information to leave, how to do it, and to spell everything out. Then I have to leave the message and wait for you to get back with me later in the day -- at your convenience. Why don't I just send you a fax, save my time, and you can still get back to me at your convenience. The fax will have all the info on it and will add to patient safety. It will also reduce the amount of prescriptions called in by non-medical personnel that have little to no training in medicine." -- No one has ever told me to fuck off because I'm trying to increase patient safety. I even made one trip to a doctor's office to meet with him about it. He, of course, listened to reason -- regardless of how his nurse wanted it done.
I also do my best to try and get the patient active in the process. I've tried telling them that, "Hearing from the patient that they need a refill usually gets them in gear," after we've contact the physician once. I've also flat out told other patients to call the doctor themselves in instances of early refills or for refills of antibiotics and drugs that usually do not have refills for a reason. The patient's standard response is always the same -- "I just talked to them. They said you need to call." -- Well, I don't play that game anymore. As I said above, enough of my time and my staff's time is wasted on the phone holding for a nurse. Let's waste your time, dear patient. "You need to call the doctor and tell them to either call or fax me, because if I call, all I'm going to get is a voicemail line instructing me to leave a message -- after I wait for 5 minutes for someone to answer the phone to transfer me to the voicemail."
I've also recently installed a TTY-type device which connects me to a nearby medical group which houses something like 30 doctors. I just type my message, the doctor's extension, and it's done. They still get back to me whenever they damn well please, but it's convenient and really fast. I just take the receipt-paper printout and staple it to a blank Rx and it serves as my prescription.
I still haven't addressed the issue yet -- should we be doing this? Honestly, I think not. I think that patients should take a more active role in their healthcare. I believe that when they are out of refills, rather than depending on us to loan them pills and/or call their doctor, they should call the doctor themselves and state that they need more refills. I also think that doctors should ACCEPT THIS! Many doctor's voicemail lines boldly state, "If you are a patient, have your pharmacy call us." -- Why? I have no clue. If the doctor wants them to continue the therapy, what's the fucking issue? I understand that the office may want to know when the last fill date was, but that can be easily ascertained by even a technician when they call in the new prescription. At that point, the nurse can note that date (to track compliance) and decide whether or not the patient is actually due for a refill based in the sig and quantity dispensed. I think the nurses can handle that much...
There will be those out there that say our loaning of pills and calling MDs for refills does a lot in terms of ensuring patient compliance. I call this a load of bullshit. If a patient is not compliant with their therapy for themselves, why should I give a flying train full of antelope shit? The answer is, I don't. Here's what I think. I will help those that cannot help themselves -- the sick, the dejected, the broken, and the poor. I will not help those that refuse to help themselves. I will not care about you if YOU don't care about YOURSELF. Your health should be enough initiative to remain compliance with drug therapy. You took the time (and perhaps paid the money) to go see the doctor, bring the prescription to me, and get it filled. If your compliance depends on whether or not I give you three pills and call your doctor for additional refills, not only are you pathetic, you are doomed to have poor outcomes from your therapy.
TAestP Twitter
- RT @Beckagog: Try to get this trending to help save an awesome show we both like! @FOXBroadcasting #SaveTheFinder 4 days ago
- I love Geoff Stults and #TheFinder -- such a cool ass show. 5 days ago
- Are there sexier words a woman can say than "do you wanna watch a star wars tonight?" 1 week ago
- Just had a nurse call me and ask what APICAL meant....Atenolol sig for hold if apical pulse < 56 1 week ago
- Omg The Avengers rocked!!! 1 week ago
- I f-ing LOVE these things! http://t.co/6VajCPqq 2 weeks ago
- "...he might pull me over and give me that 'Good Driver of the Day' award I've been eyeing for so long! I just wanna win for the parade" 2 weeks ago
- It's like people think, "If I slow from 70 to 65mph, I'll get to stare and laugh at the misfortunes of others, and....." 2 weeks ago
- More updates...
Loading ...
^ Use this image to advertise this site! ^