This Is Sickening

Caught this off a headline from Fark today:

Belford's slick web site offers affordable bachelor's, master's and doctorate degrees in just seven days. Get credit for what you've learned in life for only $449.

What that is is a website that will give you a college degree, quite literally in any field you want, for a small fee. They supposedly make you take a test which relates to your life experience in a subject and then they justify the results of that test as to whether or not you deserve a degree in that subject. In other words, its nothing more than a big pile of bullshit.

I mean honestly I have busted my ass the last four years, have had countless sleepless nights, missed numerous family events all to get a degree in something I am actually interested in. How the hell is it fair that someone can go online and take a simple test and get a piece of paper that says they received a degree from Fuck Me Up The Ass University.

Innocent or not, when Lichtenberger (like all Belford graduated) ordered her degree she could also request transcripts, make up your own graduation date and even pick her grade point average. A perfect 4.0 costs an extra $75.

Williams also went online and applied for the degree "vegetable psychology." When asked for his experience, Williams typed that he had "helped a lot of tomatoes grow." Within seconds he was approved for a bachelor's degree!

Shit instead of bustin my ass maybe I should go get a degree from there, give myself a 4.0 and attempt to get into pharmacy school that way. Hell I'll even create my own degree! We'll call it "Advanced Drug Pushing" with perhaps a minor in "Creative Writing: Pharmacy Denials". Perhaps I'll start a fund in order to purchase the degree, that outta be worth something pharmacy school applications.

I think the biggest kicker is that there are several regents on the University of Tennessee board who have done a similar system to receive their 'doctorates'. I've always thought that the education system was seriously fucked up and this only furthers my thoughts on the matter. Seems like from Day 1 as a freshman you get fucked up the ass until the day you leave campus. By then you're shittin pancakes on a daily basis, but who cares!

In hindsight I should have just gone to this website and gotten my chem degree. Instead I studied my ass off and drank a lot of beer and played a lot of Halo and taped a lot of dorm doors shut.... Ok in hindsight it wasn't all that bad, but it still woulda been a helluva lot cheaper.

Story from: http://www.newschannel5.com/Global/story.asp?s=8674699

Pharmacy Term of the Day -- Nurses

Nurses are a double edged sword, they are either you best friend or your worst enemy. Honestly it seems like it's split 50-50. For every nurse that comes in the store asking for "The latest proton pump inhibitor for my GI problem" (cause it's cool to spout off knowledge and not ask for Prilosec) you have another who will hunt a doctor down while he's on vacation to get an answer to a question.

Understand they will frustrate the living hell out of you. Often when you talk to some they act as if we interrupted them in the middle of surgery on a dying patient to ask them a question. Even more often the question is about something that they fucked up on. Many of them also will give superior attitudes to you, and the pharmacist even, for virtually no reason.

When you find the good ones though they will be like a God to you. They will mention to the doctor that maybe, just maybe, he could write a little clearly. Or they will call you after a patient leaves the office as they noticed an allergy that the doctor had not. Or they will even call to thank you for helping a patient out with a difficult problem.

Not every nurse is horrible, but nor is every nurse a godsend. Just remember, that even when you have a shitty one, there's always that spectacular one at the other clinic. Although it is nice when those shitty ones fuck up and you can call them on it. :)

Trivia Geek

Anyone who knows me personally knows that I am full of useless knowledge. Ask how a hurricane forms or what really caused the Civil War (still shocked most people still think it was slavery) or how are cardboard boxes are constructed, and I usually know the answer. Really really bugs the hell outta some people, because I just randomly spout this shit off, but I find it cool.

Always liked the show Jeopardy, but would never try out for it as I would most likely freeze on camera and then crap my pants much like the patients who come into our pharmacy. That being said I came across an article on Fark about a guy who was on the show and documented his experience. Thought it would make a good lunch time reading or if you're just having a slow day at work. Enjoy

http://joshreads.com/?page_id=1650

We don't get no respect

It really irks me in the media when I see pharmacies blasted for the mistakes they make. Ya know what? We do make mistakes. Usually we catch them, but occasionally one will get out. Of those that get out, 99% of them we realize what we did and rectify the situation in a timely manner. We are human after all and are not perfect.

Then you have exposes on Dateline and other 'news' outlets exposing such mistakes. Think about what we do in a day. For instance last week, during an eight hour shift, we filled 342 prescriptions. That's one prescription being filled every 43 seconds all day long. On top of that, at last check, our accuracy rate was in the 98th percentile. Funny that these outlets often leave that part out.

What is even more irksome is the fact that they leave out to true culprits of errors, the doctor's office. This was an actual exchange from Friday afternoon:

• Faxed on refills for a Lisinopril 10mg QD #30 prescription
• Received back an authorization for Lisinopril 20mg QD #60, so I called to verify the dose and directions (as it was still QD, but now #60). I was told what I faxed on was the proper dose and directions
  
• Five minutes later we get another fax saying the 10mg is an error and its really supposed to be Lisinopril 30mg

Now think about this, in a period of ten minutes I received three prescriptions for three different strengths. If, for whatever reason, we were extremely busy and three separate people received had that information, how confused would we be? Some more from Friday:

• Faxed on Simvastatin 20mg, received back an okay on Pravatatin 20mg
• Faxed on Gabapentin 300mg BID, received back Gabapentin 600mg TID
• Faxed on APAP 325mg, received back an okay on Aspirin 325mg (note this was a Warfarin patient as well)

How are we supposed to function with errors like this being sent to us? Do you know how often we'll get a script for Amoxcillin only to have, right on the Rx, an allergy to Amoxicillin? Honestly we have to call one of the office's at least a half dozen times a day just to clarify something which should not have been wrong anyway. It could just be the hospitals here, but I saw the same thing when I lived in another state. A lot of it has to do with e-prescribing and picking the wrong item from a drop down menu, but that's no excuse to not double check. Hell we have to triple check things in the pharmacy before they even get out to the patient.

Yet we're the one's who are blamed for screwing up. One mistake out of thousands and thousands of prescriptions, and we're chastised. Never mind the fact that we routinely fixed a dozen errors a day, that doesn't matter.

To paraphrase the late Rodney Dangerfield "We don't get no respect."

Full Moon

There are stretches where you reach a point where you don't know what the hell is going to happen. Maybe a madman will come in with a clown and demand all the Snickers bars. You honestly just have no friggin' clue. I am wrapping up one of those weeks. Lets tally whats all happened in the past week.

1) Patient 1: I'd like to call in some refills, but I don't know the numbers. I'm pretty sure I know what my name is

2) Patient 2: I need my Lexapril filled for my asthma (Lexapro is an antidepressant, Lisinopril is a blood pressure med)

3) Went to open a box of vials and found, instead of vials, 13 boxes of Pulmicort 0.1. Opened the next box and found the same thing. Turns out someone returned them to our wholesaler in vial boxes, who then thought they were vials, and then shipped them to us when we ordered vials. Paid $70 bucks for $9,500 of meds. Ka-ching

4) Patient 3: I hope you, your family and your future children burn in hell for all eternity. (when I asked to see the paper with her insurance information on it)

5) Me: I need to know when your transplant was so I can bill this to Medicare.
Patient 3: Its in your goddamn file for me
Me: Ma'am we're a pharmacy, we don't have all of your medical records especially when you had your transplant
Patient 3: Why the fuck do you need to know that information?
Me: So I can bill your insurance for it
Patient 3: Who the fuck told you to fucking bill my insurance?
Me: Ma'am the total cost of this prescription costs over $7,000
Patient 3: No it doesn't, its free cause you're an asshole and you're just gonna give it to me
(Note: This exchange actually happened and was conducted with me in a very calm voice and her screaming at the top of her lungs)

6) Patient 4: Do you have that pill for when you get drunk and wake up next to some chick?

7) Received a prescription for a child named Pepsi. No joke.

8) Patient 5: I found these on the floor and I wanna know what medication they are
Me: (Looking closely) I believe they are dried peas...
Patient 5: That's what I thought, thanks!

Honestly, it never comes in small doses, they always fucking come in these large droves. Most of that occurred on the same day. Worst part is you don't have time to pee and you start laughin' from this shit and you have to try your best from squirting in your pants.

Now THAT'S the shit they should teach in pharmacy school, how to not piss your pants while laughing at customers at work. I'm such a genius at times

Diabetes Management w/ U-500 Insulin?

We've had a couple people come in with prescriptions for U-500 Humulin insulin lately. The head pharmacist and I couldn't figure out why the hell patients would be using such an insulin on a regular basis. We were curious this morning, and slow, so we called up the diabetes educator in the clinic down the street.

Apparently they have found that those people who are insulin resistance are more receptive to treatment with U-500 insulin rather than U-100. They are getting the same dose, but in a much lower volume. In essence its almost as if the U-100 floods the system and then over loads it. With the U-500 though, usually in a 2/10 cc dose, the system isn't flooded and the insulin is used more efficiently.

Apparently this is going to be the future of insulin management, baring the patient is wise enough to know not to use more than a very small amount of the U-500 insulin. One would assume if this catches on that there will be a calibrated pen model in the not too distant future. Just an interesting tidbit of knowledge I stumbled upon today and thought I would pass along.

Strange Requests

One of the oddest aspects of this job can be the strange requests patients give you. I once had a little old woman return a Azithromycin pack because it was made in Croatia and she "wasn't taking no eastern Europeon crap". We once had a patient who refused to take anything that was a round tablet because "caplets work better."

Earlier this week we received a phone call from a former patient of ours who recently moved to Nebraska. He had a request for us. He wished to have us tell his parents, when they came into pick up their prescriptions, that he was almost in a tornado the night before, but that he was ok.

We couldn't quite figure out why he was calling us instead of calling his parents directly. We also couldn't' figure out the proper way to break the news. Should we type a note and put it on the bag? Maybe hand write it to make it more personal? Should we put our arm around them or offer them a hug? I mean honestly what the hell would you do?

The parents haven't come in yet and we're still not quite sure what we'll do. At least we not being asked to tell someone they have herpes. Now THAT would be awkward

Pharmacy Term of the Day -- NPI

You hear the term NPI thrown around a lot lately in the pharmacy world and I am always floored with how many people, tech's included, who do not really know what it is. The NPI stands for the National Provider Identifier. Sounds mighty important doesn't it? Like it has a wang the size of the Eiffel Tower.

Anywho, prior to the NPI you would have to use one of several different doctor IDs in order to bill for services. There was the UPIN, and the DEA number, a separate Medicaid number and their astrology numbers. Ok I made that last part up, but you get the point. Basically it was a collective pain in the ass to make sure you had all of the doctors IDs in the proper order. The NPI was created to relieve this 'bag o' numbers' and put everything in one nice and neat package.

In our area we have been using solely NPI numbers for only about five months now. Granted NPIs were starting to be assigned in late 2006, but it was absolutely AMAZING to find out which doctors didn't even know what a NPI was at the turn of this year. Perhaps the most fun of the NPI, and by fun I mean having bulb catheter removed while its still inflated kind of fun, is searching for the number.

You see the government wasn't smart enough to create its own searchable website with everyone's NPI in it. Nah, that's just too damned easy. Instead you quite literally have to google "NPI search" and use one of the sites that shows up. Often you'll have to go to two or three sites just to find the number you need.

Then there is my absolute favorite part. You can search for a doctor on three thousand different websites and not be able to find him even though you know he has one. Whats the problem? Turns out that Dr Steve Johnson's first name is really his middle name. Yep, no where on his script will it say Dr A. Steve Johnson or Dr Asshole Steve Johnson or give you any hint whatsoever that it could be something different. Call the office you say? Why they're just as shocked as you that Steve isn't his first name. Its really a wonderful treat.

So in conclusion a NPI number is designed to simplify the pharmacy world, and I'm sure it will accomplish this job wonderfully. Until you have all of the numbers though its a royal ass fuck. And I mean that in the nicest way possible :)

Distrurbing Trend

I have often thought one of the larger epidemics this country may face in the coming years is that of prescription drug abuse. Granted it is a serious problem now, but I've always had an inkling that it would get worse over time.

Today I received one of my annual drug store magazines and was flipping through it when something caught my eye. Normally they print in these magazines the overall usage of drugs nationwide. This one had a comparison of usage for top drugs over the past five years, and what I saw kind of blew my mind.

In 2003 there were 89.6 million prescriptions written for Hydrocodone/APAP. In 2007, just five years later, that jumped up to 119.1 million prescriptions. That is a 33% increase in volume over just five years time.

Mean while drugs such as Levothyoxine, Atenolol, Furosemide, Liptor (classic maintenance drugs) all remained relatively the same. The only other increase of this proportion was with Amoxicillin which rose from 38.7 million to 53.2 million in the same amount of time. That is a 37% increase!

Now you cannot tell me that in five years more people are getting hurt and more people are needing antibiotics. It is well known that many doctors will give patients an antibiotic just to 'shut them up' even when they don't need one. That is yet another problem for another blog post.

The part that really gets me though is why the Hydrocodone dispension numbers have gone up so much in the last five years. One would assume we would be regulating a controlled drug like that more and ensuring that such an explosion in usage would not occur. It's funny because I've always thought that we were using more and more of this, but I wasn't quite sure. Usually I chalked it up to me just not noticing it in my early years. Obviously this is not the case.

You have to wonder if, or when, this prescription drug issue is going to spiral out of control. Its only been in the last few years that the FDA has seemingly gotten their act together in several areas, and perhaps this is the next area to clean up for them. Until then, I guess I'll keep dispensing our hydrocodone as if its Pez...

Where to go from here

This blog has existed now for roughly eight months now since its inception. Since that time I have been trying to decide what form this pharmacy blog should take. There are plenty of better pharmacy bitchers out there (see DrugMonkey and The Angry Pharmacist, my inspirations) so I saw no need to contend with those two. Granted I have just as many pissed of stories as they probably do, they can convey their feelings of those matters in a much greater way then can I.

After eight months I have decided to take this blog in a slightly different direction. I will still bitch about things, I will still share stories of fucked up customers and I will still bitch (gotta emphasize that part :) )

I am going to be turning this blog into a slightly more educational tool for those interested in pharmacy or those just starting out. I'm hoping to give a better feel for the field through my stories and experiences and to now give a better insight to terminology and just how things work. Part of it is the fact I like being a teacher and part of it is I'm tired of seeing pharmacy students come in and act completely bugged eyed about how the world actually is (story on that coming later this week)

We'll see how it goes from here on out, not sure how many regular readers I have, but things won't change too much. Speakin of which, I have to go answer the goddamn drive thru window, chick is here who wants her diapers. Figures