Stupid Voicemail
I've never really bitched about this much, but the quality of the voicemails I receive has deteriorated to a point that I cannot take it anymore. I'm tempted to shut my VM system off and require all practicioner's offices speak with a pharmacist. I have the powah! I can do it...
I've got a pretty good system installed. I can replay or even fast forward or rewind a second by pressing a button (many seconds if hit repeatedly). But, when nurses are calling in these fucking scripts as one long word, it doesn't matter. Worst of all, no one spells anymore - Not patient names, not doctor names, nothing.
Case in point: Nurse today called in an Rx that sounded like this (read as fast as possible and slur the words together) -- "Hey this is Ann calling from doctor Badduda first name Mowaffaq prescription is for Shalonda Teddleston date of birth 5-5-75 for Lortab 7.5 #15 taken 1 BID prn pain office call back number is 555-6969."
Here's what is wrong with this voicemail:
1. She works for a foreign doctor. You have GOT to spell those names. I could care less where they are from, but I'm not familiar with spelling of their names. If it were John Smith, I'm cool with it. It's not. Spell the fucking name.
2. Patient's name could be spelled multiple ways. Is the last name spelled with T's or D's -- they sound the same in a crappily left message.
3. Birthday of May 5th? FIVE FIVE sounds like NINE NINE. Make sure you are audible!
4. Lortab was mumbled. I misheard it. I originally wrote down FORTAZ. Of course, once I reread it, it didn't make sense. So, I read between the lines. (Fortaz is an injectable antibiotic and wouldn't be given prn and it's a 1g+ dose -- not 7.5mg).
5. In a fast, mumbled message, BID can sound like TID. How much fucking more time does it take to say twice a day or every 12 hours?
6. Office number is always given so fast it's pretty much inaudible. You know it by heart, I don't. Would you fucking slow down?
As you can see, the voicemail system has given me 6 opportunities to screw something up in a 15 second voicemail. If the voicemail had been 30 seconds and the bitch had slowed down a bit, there would have been no problems on my end and no gripes.
There's just no rationalization these fucking LPNs and RNs can give that makes this ok. It's unsafe. They sound more retarded than they actually are, and they are putting our 'healthcare team' at risk for making a dangerous mistake...all because they don't have an extra 15-20 seconds to speak slower. Way to go, bitches.
Now, the fun goes both ways. I've been known to leave a fast voicemail in my day -- mostly in response to this kind of bullshit. Next time I have a refill request for this bitch, I'm gonna talk as fast as possible. She won't get it. She won't put one and one together (well, if she does, she'll get eight).
Most of my calling has been converted to faxing. I'm pushing to move ALL of it there....because of this bullshit.
I'll probably call her tomorrow and explain the situation to her...slowly. See if maybe I can reason with her. It won't work, but maybe, just maybe, the hamster wheel in her head will turn a few times and she can spare 15 seconds for me.
-=+=-
Here's a fun game I like to play. Some nurses call in and "want to talk to the pharmacist" to phone in a prescription. When I get fast talked, and I'm actually TALKING to the asshole --err-- nurse, I always take my time. I write as slow as possible. I repeat everything, maybe even twice. I speak as if I've had a stroke and in a thick southern accent...think Deliverance mixed with Cleveland from Family Guy. I love it when they get frustrated and try to hurry up and get off the phone. "Just to make sure I get everything right, please repeat the prescription back to me again." I end the phone call by saying that they need to slow down a little bit or the patient could be the one that pays for their haste. "Would you rather me fill your child's prescription as fast as possible, or diligent and correctly? Only one can happen. Your haste makes mistakes. If you don't have time to call in a prescription get a fax machine, hire more help, or call them all in at the end of the day when you have time. Your patients will wait, they have no choice, and they will rejoice that you are giving them Toprol rather than Topamax."
Movie etiquette
I recently went to the movies. I, of course, went and saw The Dark Knight. I enjoyed the movie, but as I embarked on my experience, I noticed from start to finish that people are either complete assholes or flaming imbeciles. With this post, I hope to help quell some of the emotions (anger) that I am feeling right now.
First and foremost, at blockbuster movies you are going to have to get there early to get good seats. I arrived about 45 minutes before showtime to I could sit in the back, upper section...in the middle of course. If you get there late, I don't feel sorry for you having to sit your ass in the front section. Along the same lines, since I arrived 45 minutes early, if I see your ass running to the door as the start letting people in, I am going to kick you so hard your prostate will shatter.
Now, moving right along, let's talk about the seating in general. There's about 220 seats in the giant digital screen theaters these days. The Dark Knight and other big movies will fill every fucking seat. Meaning, when you go in don't leave a fucking seat in between you and the next schmuck. It's a pain in the ass, and it does nothing but cause problems. Seriously -- I am sick of Americans and their insatiable need for personal space and property. Are you really that scared that your arm might touch another human being's elbow? Fucking crap people...Just sit next to someone, that way when people come in after you they don't have to stand at the end of the row saying, "is that seat taken??" over and over again.
I saw 2 couples to my right leave a space in between them...in The Dark Knight...where every seat will be filled. Finally, some smartass, not unlike myself if in the same situation, came in and said whilst pointing, "You and you, move down so the rest of us can sit..." -- The quickly moved down -- hopefully they realized they were idiots -- and since they are idiots I claimed the armrest as my own...
Finally, don't even bring your fucking cell phone. You don't need to talk. You don't need to text. You don't need another opportunity for me to hate you and think that you are a fucking asshole -- I already do. If I built/owned a theater, you can bet your ass I'd line the ceiling and walls in copper mesh to keep all radio/cellular signals OUT of my place of business. That'd be the only way to keep the modern-day hippster off of his phone for 2 hours.
It never fails, out of the corner of my eye, I catch a glimpse of some prick pulling out his iPhone...checking his email or some other stupid bullshit that could've waited. Just don't even fucking bring it. Seriously...
Let me explain something
I don't mind prescription coupons. I don't really give a crap about putting them in. The info on them is always pretty self explanatory. Here's what I hate about coupons though, being expected to keep track of them by drug reps and having to explain to people why they can't use them -- which pisses them off.
When a drug rep gives me coupons, most of the time I pitch them. Sometimes, I'll slide it on the shelf next to the drug. However, I rarely remember I have them when a patient presents a script. I just forget or don't care. So, they help no one!
The thing that pisses me off most of all is when a patient brings a coupon, and it's expired. It says plain as day right on the front the expiration day. These assholes just think they are gonna sneak one by the dimwitted pharmacist. Not quite...Now, I've heard that sometimes they extend the dates on the coupons, so I input them and run them anyway just in case, but I inform the patient to not get their hopes up.
Then you have the older breed. The entire older generation is concerned with every single penny. They are the most frugal generation this world has ever seen. They have their social security, their Medicare, and their savings...and gosh damnit 'you put that fucking coupon on there and I don't care how the hell you do it' -- Tight wads. Little do they know, the coupon cannot be used because they are on Medicare Part D. They don't understand the concept of that being illegal -- against the rules -- they just know that they have a 20 dollar coupon and the pharmacy is trying to cheat her out of it! We must get a cut of every coupon we cheat people out of. Hell, you can even show them the fine print on the coupon. They don't care.
"Take off the medicare and just use the 20 dollar off coupon," they say.
"But, ma'am this is $90 worth of medicine. Your copay would only be $28. It's in your best interest to just forget about the coupon."
"My doctor said to use it. He's God and always right. So, call his office and maybe they can give you the machine code to get it to work."
"Well, alright - it went though. Your total is $70."
"I knew if you'd call ole Doc Cartwright he'd set you straight. He's the best. Put you in your place didn't he?"
"Ohh, yes ma'am, he gave me a grand scolding. Told me to kiss his ass!"
So, to sum things up:
Cash Customer = Coupon Great cost savings
Insurance Customer = Run on Insurance, Coupon covers copay
Medicare Part D = No coupon allowed, won't understand why
Medicaid = No Coupon allowed, doesn't give a shit because they don't pay regardless
Discharge Scripts
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
3. Naloxone
- 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.
TAestP Twitter
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