I witnessed a miracle today

We have a gentleman, I use this term very loosely mind you, whom is banned from virtually every other pharmacy in the city. We know this because we were the first to pass him off roughly a year and a half ago. Someone decided though that they would contact the state and have him restricted.... to my store. Whoopdy-fuckin-do.

He's one of those people who calls every five minutes. I mean literally every fucking five minutes. I counted today, he called nine times in a period of 40 minutes. A couple times I didn't even have time to walk across the pharmacy to get to the other phone before he would call again. His drug of choice?

Tramadol.

We finally get the ok on his candy, cause he's not using it for medicated purposes, and I tell him that. He says he'll have a buddy come and pick it up for him in three minutes. Of course all the lil colorful warning lights are going off my head. With an idea, I bring up his profile and see he has not signed a HIPAA form.

Gladly I tell him that until he signs this form no one else will be eligible to pick up his prescriptions (i.e. we waive our rights of responsibility). He goes he just had 3 vertebra crushed in an accident and is stuck in a wheelchair. I could smell the bullshit through the phone. I proceeded to tell him that I would gladly bring the form out to his car to have him sign. He mutters something and hangs up.

82 seconds later (yes, I counted) he walks in the door. Praise Jesus, Allah, the flying-spaghetti-monster or whatever you believe in, as this was a miracle. He went in the space of less then a minute and a half from being wheelchair ridden to being able to walk. You don't even see this shit on televangelists shows.

I think I was close to God today... or maybe it was just the tramadol in the air...

I work with a genius

I may have mentioned that we have a nursing service pharmacy. They can do anywhere about 1000-1500 scripts a day. Theres usually 5 pharmacists working with a RN and about 10-15 techs. Needless to say it's an extremely busy and hectic place.

It is also vastly outdated. There is no flow in the place whatsoever and its become one giant bottleneck. They announced several weeks ago that they were going to redo the layout of the building (literally gut the entire thing) and add some much needed offices and all that jazz. Was a brilliant idea. This was announced roughly 2 weeks ago. They are starting demolition on Wednesday.

Yes they are starting to tear down this immensely busy pharmacy before the plans have even been finalized. Now I know I didn't eat paint chips when I was younger, or sniff glue for that matter, so perhaps I do not fully understand this logic. But if you have a pharmacy which averaged scripts in the four figures, do you really want to start gutting it without the plans finalized?

Needless to say whenever my manager comes in to whatever store I'm at, I grab a bag of popcorn and sit down to hear what hilarious story she has for us today. Thank God I don't work there. Just gives me something to giggle about on a daily basis. Man I'm evil

The End of Relaxation

A new semester is upon me this coming Tuesday. Gone is the relaxation that was winter break... wait was it really relaxing? Would I rather deal with a drunk/stoned individual yelling at me for not being able to use his Food Stamp card to pay for his pain meds or would I rather spend a night in the library studying physics and chemistry and accounting (I'm technically a business major/chem minor). Honestly its a push.

I survived last semesters Biochemistry hell. Eeked out a B- in it which I will gladly take. Brought my GPA for the semester down to a 3.4, but shit after what I went through I'll take it.

Another semester means the beginning of another blessed event.... drinking! Since I'm the only one who stays here during break it gets rather dull, but I'm already tasting the two dollar pitchers tuesday night. Mmmmmmmm

Mystery Drug

I was counting the minutes until 6pm (the time unto which I am released from the clutches of Hell) when a woman came to the pharmacy counter. She was a polite woman, which I took kindly to. A prescription was handed to me, I told her the usual spiel, and walked to my terminal. Then I looked at the script and saw:

Diltiazem 0.3%/Lidocane Gel
As Directed, 60gm

Ok... I'm going in my head. Diltiazem is a calcium channel blocker used mainly in hypertension. It is usually in tablet or capsule form (very pretty capsules I might add). So why the hell is this saying its a cream.

Quick google search... well sure enough it is a cream but is usually used in some sort of hospital setting. Used for 'anal fissures'... got a slight giggle out of that. I stroll on over to our wholesaler computer and type the name in the search field.... and get nada. I search under various brand names for Diltiazem and still nothing.

Finally I decided to call the wholesaler, 15 minutes on hold and they don't know what the hell it is. I call our nursing service pharmacy (where our most experienced pharmacists are) and I stump all four of them. None of them have heard of it before, nor have any idea where to get it.

I called the doctors office, but I called 1 minute after they closed so naturally I was greeted with a recording. I was stumped. The pharmacist was stumped. The robot was stumped.

After digging on the net and a couple of books for another 15 minutes we explained to the woman the situation and asked if she would be willing to come back tomorrow. She was quite cordial and told us to take our time and that she'd call us tomorrow evening. Nice lady.

So when I get into work tomorrow I shall call the only compounding pharmacy in our little city. Been a while since I've had something thats actually eluded my googling prowlness. Perhaps I need to the batsuit to solve this mystery...

How I know I'm an adult...

Barely 2 years ago when I went to a party or some other gathering to kill my precious brain cells I would usually stick to hard alcohol (namely Captain Morgan as the Captain is my bestest friend). Never would start out with beer or would even consider really drinking it.

Today I came to a realization. I came home and I wanted a beer. Not to become drunk or anything, but I was thirsty and I decided that of all the things in my fridge that a beer would taste the best. How in the hell did I get to this stage? Whats next, gray hair?

Fallout

I had a meeting with my manager Friday afternoon and went over the situation. Obviously she and I both agree that we are kind of fucked in what to do. See our company operates in two different states. We have a bunch of pharmacies in one state, and only one in the other. He works in the that other state. And we only have one other person that has a license in that state currently.

What it comes down to is, they confront him and he will be gone. Either he'll quit, or they'll fire him. Then that store is left without a pharmacist. Now this is our busiest store and we would be forced to close it. So, as my manager said, we are now stuck between a rock and a hard place.

I guess she is going to go over their records on Monday and speak to the owner about how to deal with this. I just know that I do not want to be around when the shit hits the fan because it is going to be traced back to me.

At least I can look back and say I did the right thing. I hope.

Ethics Continued

I'm having a meeting with my manager later today about this pharmacist issue. I have since discovered that he has been letting a patient get 150 Soma 325mg every 4 or 5 days for the last year as well. This shall be fun.

Pharmacy Ethics

Each day we are presented with an ethical dilemma. Do you take the proper route and remain true to yourself, or do you take the other route and hope for the best. In pharmacy, ethical decisions are usually quite routine as you have to look out for the patients best interests.

I have discovered in my pharmacy travels that in a chain there is always one store thats a little... lax on the rules. Sometimes this is a good things, other times not so much. Today I was at this store in our chain and I have become accustomed to looking the other way towards practices which I do not believe in. Today, though, there was a string of events which has led me to question this store's pharmacist. I am left wondering how to bring this up my superiors in a tasteful matter, but respectful of a person whom has worked for us for well over ten years. It is a dilemma I am not enjoying grappling with tonight.

This pharmacist never makes a hardcopy on phoned presciptions (i.e. when the doctor or nurse or usually the custodian calls in the prescription). Thus we have no long term record to verify the proper dosing. This pharmacist never signs of on anything but Schedule II drugs. This pharmacist, and his trained staff, will almost always fill a prescription even though we need to contact the doctor for more refills (which leads to us being burned several times a week). I have seen this pharmacist dispense controlled drugs even though we were waiting for the mailed Rx to arrive.

Today though was something new. A woman came to the drive thru window. She is a well-known customer by us. Few years ago she was caught getting her Hydrocodone filled at several other pharmacies in the area. This lead to her being locked, by Medicaid, to solely our store. She receives on a regular basis Hydrocodone 10/500 #100 which is supposed to be a 13 day supply. She always picks it up on day 10 or 11.

Today she came to the window and asked for that said prescription. We stated that it was out of refills, which it was, and had not heard back from the doctor. She replied that she had talked to him this morning and he said he would call it in right away. Then something occurred which I have never seen in the 7+ years I have been doing this. The pharmacist filled the prescription.

He gave 100 Hydrocodone 10's to a woman with a past history of abuse on her word. I was flabbergasted. I refused to bag this prescription, I refused to sign anything relating to that prescription. I do not want to have my name attached to anything relating to this prescription.

This store three years ago lost its controlled substance license from the state for nine months stemming from a semi-illegal internet pharmacy that the owner had started. The store was literally raided and all drugs and records confiscated. Since then the store has been under close scrutiny from the state and today's incident, as with some of the others, will most likely be discovered in time.

So tonight I am left with a decision. I have been staring at my cell for the last hour trying to decide if I should call my manager and schedule a meeting tomorrow. The hard thing is I truly do like the guy. He's a 30 year veteran of the pharmacy world, so he comes from a different era (thus the lax behavior). The last year he has become a bit more grouchy and demanding from how he once was. He is one of the hardest working and dedicated pharmacist in the company (He usually works something like 28 days, 11 hours each, straight with a 2 day break). And I am now left with a decision which will most likely lead to his termination.

I understand the ethics involved. I know what I have to do. Its still a really really shitty choice I have to make, and there will be a ton of fallout from this. I think its time to pick up that phone now...

The Hospitals Are Out To Kill You...

About four months ago the two main hospitals in our area started using a new form of electronic prescription. I have no idea why because there was nothing wrong with the ones I had been using, but alas what do I know.

We have thus come to the conclusion that the hospitals are out to kill their patients. That can't be, you may state, they are always out to heal you. While that may be the case they are also making our jobs a complete pain in the ass. Let me display Exhibit A:



Looks pretty fancy eh? Nice and clean, drug and sig in big bold letters along with the patient name. But wait, looks can be deceiving. Those of you non-pharmacy geeks I shall explain.

It states that the drug is Norvasc (Amlodipine). Thats clear enough.

Below that is the strength and the sig. What that sig is saying is "Take 10mg by mouth once daily". Thats clear enough as well.

Gives you the start date, the quantity, the refills....

and then at the bottom theres the instructions. "Take one-half tablet daily". But wait, you may be saying, on the top it says take one tablet daily. So which one is it?

Welcome to my world. What follows is a phone call to the nurse to clarify a prescription which should have been clear in the first place and then a return phone call about 2 hours later. As you can see the correct directions were the half-tablet daily.

To make matters worse a handful of doctors do not use quantities, they use days. So where it says Quantity: Sixteen on this prescription, Dr. Jackass would write it as Days: Thirty-Two. That may not be a big deal accept 95% of the scripts we come across are the quantity variety. So when you're crankin out 300+ scripts and you see the same form prescription you've been seeing all day, you naturally assume that the information on the script will be the same. Needless to say this has called a large amount of problems and when you call the office to discuss this all they tell you is that; "Well this is the way we're going to do it, so get used to it."

Things are stressful enough on a daily basis and now we have to deal with this bullshit. I miss the days when you'd get a script and you just couldn't read the handwriting. At least that was a legit excuse...

Clusterfuck in Review

I was prepared for Hell. I had my whisky. I had my ibuprofen. I had my stress buffalo (cause its way cooler than a stress ball). And I had my burritos. I was set.

And it wasn't that bad. Computers didn't go down, insurances didn't go down, wait lines when calling insurances were at max 20 minutes. Hell even some Part D rejects would tell you who to properly bill. It was like after three years they finally got their shit together.

It still sucked though, 35o prescriptions in an 8 hour period, with virtually none going through on the first try, but it wasn't near as bad as years pass. The whisky still sits there. As does the ibuprofen and the stress buffalo. The burritos, however, are both in and out of my system (word of note, never eat a bean and cheese burrito in the midst of a busy day). And as Friday ends I bask in the fact that we survived this week in one piece.... eh what the hell am I thinkin, theres still another 2 weeks left for things to go down the shitter. Fuck.

D-Day is here...

Well celebrating the new year last night my thoughts started to dwell on the upcoming work day. While we are closed today, the new year truly because for us on Wednesday the 2nd. It is, by far, the most dreaded day of the year for myself. This being said after we did 110 Rxs in an hour on Monday (just a pharmacist and myself mind you) and I was still dreading Wednesday.

Why you may ask? Because the New Year is always a clusterfuck. What is a clusterfuck you now ask? Let's consult a dictionary I found on a bench at Perkins.

Clusterfuck noun/verb [kluhs-ter-fuhk]

def: 1) A sex session involving 5 or more people and a goat
def: 2) Britney Spear's parenting description
def: 3) The beginning of the year in which no one has new insurance cards, no one knows what insurance they have, insurance companies switch group numbers by one digit, insurance companies merge and/or disappear, this followed by a massive intake of Whiskey.

Obviously I'm referring to the third definition given in this glorious dictionary. It was bad enough 3 or 4 years ago. Then the government decided to shit out the child known as Medicare Part D and it went to an entire new level. I remember the first year or computers being down 60% of the hours we were open, a pharmacist breaking a monitor by beating it while on hold for 90 minutes, and a collective drinking session at the end of the week.

Last year was better, but was still fucked up and turned an 8 and half hour day into an 11 hour day. Now we're lining up for Part D, Chapter 3. We have been at least informed of some insurances which are changing processors and some people did bring in cards. But its the big unknown that scares the sperm out of me. I can only hope the yelling (i.e. the people who were upset that we didn't fill their prescriptions on the 31st when it was still 24 days too soon) will be kept to a minimum and the computers will not crash.

That being said I bought myself a nice bottle of Johnnie Walker Red Label (I am not paid enough for the black label which I love dearly) and am saying a small prayer right now. Say a little prayer while you sleep tonight for all the pharmacies in the country. Lord knows we'll need it.