Do they even look at these damn things?
I have a hospital near me that generates discharge scripts via computer. It's all based on what meds the patient was on during the stay in-house. I know the process there because I called and spoke with their pharmacist on duty one night. We hate our jobs equally.
It goes like this. The Ward Clerk generates a list of all current meds on the MAR (Medication Administration Record). This sheet includes PRNs, parenterals, orals, rectals -- the works. The doctor then goes down the list and circles YES or NO. This sheet is then sent to the pharmacist who removes the NO drugs from the profile (by D/C'ing them). Then, the pharmacist prints these sheets directly on the floor and they are reviewed by the patient's nurse based on what was said and what s/he expected. There is a space for the doctor to sign. My pharmacy will fill these w/o the docs signature because we deal with the hospital so much and these sheets are not "fake able." I will admit though, that only 1 out of every 50 are unsigned. So, for the most part, the doctor has the OPPORTUNITY to review these sheets again. A quantity is written in on the bottom as well -- usually it's ONE MONTH.
So I can say, without a doubt then, that at least THREE sets of eyes see (or should see) these damn things before being given to a patient -- Pharmacist, [Ward Clerk perhaps?], Nurse, and Doctor.
Why in the fuck did I get a sheet today that listed:
1. Fentanyl PCA 10mcg/hr Basal with 10mcg on Demand Every 10 Minutes.
2. D5NS 100mL/hr
- This was obviously in a 'set' with the Fentanyl to pull from a Pyxis if needed.
4. Heparin Lock Flush 100 Units prn
5. Ancef 1g one hour pre-op
How did this shit get by? It was fucking signed by the doctor. He even wrote in *his* DEA number to cover the fentanyl...the only Narc on the script.
There was more on the script of course - they always leave OTC/PRN stuff and we just use our professional judgment on how to get those things to the patients (Ibuprofen, Docusate, Baby ASA). Usually we just grab it off the shelf if they want it.
But seriously? Dextrose in Normal Saline? Would you like me to educate the patient on how to start a line on himself? Should I also work through with him on how to operate the PCA Pump he has in his bedroom - making sure he sets it for MICROgrams rather than MILLIgrams since it's fentanyl? [End Sarcasm]
I'm expected to review my work before it leaves my pharmacy. Why is this healthcare team not expected to do the same? I could get in serious trouble for not checking my final product prepared by my technicians.
If you care about the outcome I reached - I just scratched the bullshit out. Later in the night when it slowed down, I called the pharmacist on duty there and let him know that that stuff snuck through. He attributed it to "a student screwing around on the computer." I attributed it to his laziness or lackadaisical demeanor. He did not like my analysis -- nor did he apologize for the actions of himself or his student. If his lame-ass excuse was valid/true -- it's still his fault for not staring over the student's shoulder...which would be the law for the student entering orders in my state of residence.
This post comprises of the last few weeks of work, which have been unusually uneventful for me.... I start to worry as NOTHING EVER goes quietly for me. I couldn't write as the last post dive bombed, so I'll see how this goes, and if I cock up, I shall blog no more.
The *Angriest* one's funniest post to date (IMHO) comprised of a complete arse of a "pharmacist" (no way was that real) trying to communicate with a patient (which makes me think it is a couple of medical students taking the piss out of our profession-because doctors don't know or care how the drugs work).
There are two types of medical students-the chilled and relaxed (the minority) and the stressed and partied out (the majority, that become "omnipotent" assholes). So unfortunate that my little sister will fall into the latter category, though my blog is fast becoming an icon amongst the med students in her class-not quite what I intended!! Though a few have decided to try dentistry instead....as they now fear the wrath of the pharmacist!!
Omnipotent....used when describing a god because they are faultless and are never wrong, they know everything. Doctors may play with lives and like to play god, make mistakes like all humans do (otherwise they'd never learn ANYTHING-and usually we pharmacists are their reference guide) yet know FUCK ALL. I always laugh when a patient says they'd rather take their doctors word for it....because the very next week they are banging down your door because the doctor couldn't be bothered with them! For example, yesterday I had to call for an ambulance for a patient who was suffering from severe dehydration after a bout of food poisoning-which the GP dismissed as "hyperchondrical".....(fucking knob).
A local doctor (the same one as above, ahem) made the mistake of missing a patients adverse drug reaction to ibuprofen (Advil). I spotted it, reported it and did my duty. The doctor said to just dispense the prescription ("omnipotent" asshole). I told the patient that if he had any further trouble to talk to the doctor, as I was overruled. Like Pilate, I washed my hands....
Now, for the Dirty Ol' (wo)men. Now, you'd think that for all the censorship, rules and regs we have to face in our personal lives, that those that set the standard originally would adhere to it-apparently this is not the case in Bonnie Scotland....
Last week, a woman, in her 70s asked to speak to me. In front of other customers, she proceeded to describe how itchy her lips were and that the doctor had given her a cream for them. I could see nothing wrong, until she uttered the words that nearly put me off sex for life "NO, not those lips dear. The lips DOWN UNDER" and pointed. Nice. Then there's the "confident" (i.e. limp) men over the age of 60 getting Viagra for free, and they ALWAYS wink at me when I hand them their items (shudder). The worst has to be a man in his 90s (yes, over NINETY YEARS OLD), telling me that my name was very "Victorian" and he imagined me in a corset and crinoline dress... Never have I felt so used....
I think as a pharmacist you develop immunity as you always have to appear professional. When it happens to my staff though, I really laugh. These are women 20 years older than me, and they still get embarrassed, even though they've probably seen it all before! A member of my staff got very embarrassed the other day as she was witnessing a man take his trousers off-she froze and didn't know what to do! Thankfully he had another pair on under them! HAHAHAHAHA! I stood watching her face getting redder and him wrestling with his trousers in front of a shop full of people. Fair enough, I probably should have intervened, but I couldn't. (Probably the reason why I have an impacted wisdom tooth now, and am on antibiotics-which means that the alcoholic beverages are out for the next week, and the pain of it makes me VERY bitchy.Karma).
Just about everybody has taken their shot at "Why does my prescription take so long to fill?" Now, I will end this argument once and for all. For starters, here is the short version: "IF YOU WANT M&M's, BY ALL MEANS - GTFO! KTHX"
Now, I really like PharmacyTales Version (WHERE DID YOU GO, PT?), but the problem with it is that it is much too wordy. A visitor to the normal, American pharmacy would see that, scream TL;DR and run away screaming. The American public wants lists and pictures. I will now provide the perfect document to give to patients explaining WHY THEIR PRESCRIPTION TAKES SO DAMN LONG TO FILL!
Dear Pharmacy Visitor,
Recently, we've noticed an increase in prescription wait time due to many factors. To ensure all our patientsÂ have full knowledge of our policies and procedures, we've developed this list-type document so that each and every person knows the time and effort put into every prescription.
Prescription Filling Process:Â
Drop-off of Prescription(s)Â by Patient [Usually 1 to 15 New Rx's or Refills]
New Patient Addition (OR Existing Patient Information Verification)
New Insurance Addition
Scanning of New Prescription (In some of our locations)
Input of Prescription into Computer System
Pharmacist Verification of Typed Prescription
Computer-Based Drug Utilization Review (DUR)
Pharmacist Acknowledgement, Review and ResolutionÂ of DUR Issues
Â Â Â Â - These range from wrong/missing drug, dose, route, quantity, to drug interactions, poor doctor handwriting, unsigned prescriptions,Â and early/late refills.
Billing and Insurance Adjudication via Online Processes
Resolution of Various Insurance Issues (or Lack Thereof)Â via Phone Call to Insurance
Resolution ofÂ Other Ins.Â Issues via Phone Call to Doctor's Office for Info/Change
Selection of Correct Drug/Dose from Shelf
Counting of Correct Quantity
Placement in Bottle/Labelling
Pharmacist Verification of Tablet Dispensed to Original Rx
Printing of Supplemental Patient Drug Information
Bagging of Prescription(s) With Correct Pamphlets
CashierÂ Verification of Correct Patient
Ringing of Prescription/Additional Store Items
Correction of "Patient Issues" with Billing Amount
Patient Signing for Insurance Payment/HIPAA Policy
Patient Payment for Rx/Other Items
Pharmacist-Patient Private Consultation
Other Pharmacy Related Tasks -- Not *Directly* Related to Your Prescription:
All of the Above Steps for the Person(s) in Front of You in Line
Numbering/SortingÂ of Older Prescriptions for our Filing System
Shelving of Incoming Drug Orders/Stock Replenishment
Stocking/Straightening of OTC Drug Shelves
Calling of Drs. for Rx Refills for Other Patients [as a Courtesy]
Calling of Drs. for Order Clarification/Prior Authorizations/Etc
Answering of Patient OTC DrugÂ Questions
Answering of Assorted Store-Related Questions
Answering of Phone Calls Concerning ANY Issues
Taking Refill Requests from Pts Refusing to Use Computer-Automated Refill
Taking of NEW Prescriptions from Doctor's Offices
Ringing out of Items Not Related to Rx Sales
Ringing out/Logging of Pseudoephedrine Sales
Printing Rx History Forms for Patients for Tax Purposes
Cleaning of Pharmacy Area
LUNCH - We get one just like you!
Bathroom Breaks - We gotta go sometimes, too!
If you think you can help us optimize any of these steps, feel free to give our toll-free number a call at 1-888-ANG-REST.
Your Phriendly Pharmacist
I got a REDONKULOUS message today left on my voice mail. I couldn't believe it. I had to listen to it twice. You've GOT to read this. This is EXACTLY what it sounded like. Note: The (...) typed below represent actual PAUSES in the message.
Hello. This is Dr. Houston. I'm calling in a prescription for...uhh... Angela Edwards from myself, Dr. Houston. It's for Amoxicillin 500mg 30 of them taken po TID, and this is Dr. Houston. I also want to call in a prescription for Angie Edwards for...uhh...uhh... Promethazine with Codeine...one teaspoonful po every 3 to 4 hours. Give her...uhh...4 ounces. And this is Dr. Houston. So once again that is for Amoxil 500mg po every 8 hours and promethazine with codeine every 4 to 6 hours. This is Dr. Houston for Angela Edwards. Her date of birth is January of 1976, the first. Uhh... My name is Dr.Houston. My call back number is 555-5555 and my DEA number is AE111-1119. This is Dr. Houston. Thanks.
Holy shit. Wow. He said his name 7 times. He's sure proud of this name of his. I could understand that if his name was something cool like Dr. Sledgehammer or Dr. Whoopass. Anyway, everything was out of order. He gave me different directions on both prescriptions when he repeated them (Granted that TID is the same as q8h). He even said the 'DASH' in the DEA number (there's not really a dash in DEA numbers, it's NOT a phone number). I thought for a second it might've been a fake call or something - but no one calls in antibiotics and promethazine on fake calls. If it woulda been a farse, it would've been 10/650's an Xanax. I know a doctor I'll never go to now...
Here's how the call should've sound for those of you reading along (or not in pharmacy and not seeing any problems with the call). First, he should KNOW what he's going to prescribe a priori... Second, he should call like this:
Hello. This is Dr. Texas Houston. I'm calling in a prescription for Angela Edwards. Date of Birth January 1st, 1976. Prescription is for Amoxicillin 500mg po TID #30 and Promethazine with Codeine - one teaspoonful by mouth every 4 to 6 hours as needed - 4 ounces. My office number is 555-555-5555 and my DEA number is AE1111119. Thank you.
And that, my friends, is how you do it. 2 minutes versus 20 seconds...and the 20 second version is easier to transcribe. The first version needed translation...:-)