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.
Headhunters
I got the message below from what I like to call a headhunter. What do they do all day? They call us, hardworking pharmacists in the trenches, at work. They bother us incessantly....non stop. Feigning interested in our day. Telling us about "exciting opportunities" in "various healthcare field" with "immediately openings available in our area of the country."
That's right. They call me at my job, who currently pays my bills, and asks me if I want to quit and work for any company that will take me. They will promise you the world. Can they deliver? They don't know. They don't care. They likely read off a script just like every other telemarketer in America.
I understand as well as anybody that it takes a ton of different people to make the world go around. For every job, there is a worker willing to take that job at that wage. It may not be what I would want to do, or what I could earn, but the job is there nonetheless.
But, how in the fuck do these people make their place in the world? I just don't get it! I could not imagine a pharmacist, regardless of their level of disgruntlement, saying, "Yeah, I'll quit this bitch for whatever job you can find me with XYZ company." I've never heard of someone doing it. So, I've never heard of a success story. To make matters worse, they bother us at our already hectic jobs. This pisses us off and REALLY makes me want to jump ship!
What makes this specific commenter all the more asinine is that I had a run in with her a while back. The Pharmacy Alliance had an oft-used email listserv prior to their meeting in Texas. She chimed in with this same recruitment chum. I didn't reply in a swear laden hate-speech. I didn't even tell her to go fuck herself. I just replied with, "Whoa."
Now, at work, I like to fuck with these people. The way I see it is that my time is money. I'm sure my time is worth more than there's, but I'm a huge dick and I like to get a laugh at other people's expense. I often ask them for all the details and not pay a lick of attention. Then I ask them again. After that I'll ask them random questions they have no business knowing until they get the hint. "Ma'am, why can't tigecycline be used for bactermia?" or "Why is Zyvox contraindicated in people on MAOIs?" or "What's the max daily dose of Oxycodone in a properly titrated person" or my personal favorite, "Why can't enteric coated aspirin be used to treat a headache?" If they still don't get the hint, I ask them, "Why does Mickey Mouse have big ears?" -- That's usually the fuck off question that gets em.
Bonus points for answering the real questions in the comments.
A new submission (form: "Contact Form")
============================================
Submitted on: June 4, 2008
Via: http://www.theangriestpharmacist.com/contact/
By <edited out IP> (visitor IP).
| Contact Form | |
| Your Name | Libby <edited> |
| I am a | Not in Pharmacy |
| Email Address | <edited>@vermilliongroup.com |
| Website | http://www.vermilliongroup.com |
| Comment | Please contact me if you would like to find a new position! We have contracts with a lot of the Hospitals throughout the US looking for full time Pharmacist, Pharmacy director's and Managers. We work with several large retail chains as well!! We would love to help you find your dream job!!
Libby <edited> |
AMA No Dice
I got a fax today from the local E.R.
"Patient XXX left the ER today at 1800 after receiving a morphine shot Against Medical Advice. At this time it was discovered that a pad of ER prescriptions was found to be missing. All prescriptions from this ER need to be verified via phone call and will hereafter be pink rather than white."
Holy. Fucking. Shit.
This drug seeker has found herself a world of trouble. This fax went to every pharmacy in a 50-mile radius as well as every hospital within a reasonable distance. All for what? A fucking shot a morphine that will get her a buzz for less than 6 hours. On top of that, any script she tries to fill at any pharmacy will be scrutinized, verified, and likely canceled.
I sincerely hope she has insurance too. If that's the case, she'll have to pay the ENTIRE bill. That's right folks, if you have insurance and leave AMA, your insurance will not pay a single fucking dime. You get to pay the entire ER/Hospital bill....
What's the going rate on a shot of Morphine these days? My guess is about $600 when all is said and done.
"Omnipotent" Assholes and Dirty Ol' (wo)Men….
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).
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