Monday, March 29, 2010

A few good words

Sunday night after finishing my shift at the pharmacy, I hurried out to head to my small group meeting at my church. The church I attend is fairly large and Sunday School style classes for adults just are not feasible. So the church has us meet in small groups to have Bible studies and form more intimate bonds with others within the church.

We've been working our way thru a particular study for the past few months. This week our chapter focused on James 3:1-12. If you want to look it up, go ahead. The point of the passage is that our tongue, even though it is a small part of our body, can do a lot of damage if it goes uncontrolled. We discussed areas in our lives where we need to watch the words that we speak.

We talked about how it is so easy to speak in a negative manner, and how it takes many positive words to counter the effects of one negative word. Then we did something that I wasn't expecting. Our group leader selected somebody and every person in the room said something positive about them. We continued around the room until each member of our group had been recognized for their positive traits, as seen by the others in our group.

It was an uplifting moment for me. I have known some of the people in the group for over ten years, others for only six months. It was interesting to see what these people saw as my positive traits. Some of the things that I have insecurities about were seen as strengths by my group.

As I was driving home, I thought about how the night's lesson applied to my work life. Am I positive when speaking about other people? How do I speak about our patients? Do I look for the positive in my technicians? Do I stereotype patients who are receiving government benefits? How do I speak about my manager? district manager? I've decided that, moving forward, I'm going to be more positive in my comments both to and about the pharmacy staff that I work with.

Looking back over my 15 years in community pharmacy, I can only recall three or four times where I can remember receiving a genuine, positive comment from somebody within my company. During evaluations I've had positive comments read to me, but actual positive comments have only come around every four or five years. But those few instances made an impact. In one case, it kept me from taking a position with a competitor.

I know that management from several pharmacy chains visit my site, as well as governmental agencies, hospital systems, and academia. I see it in the reports that are generated by the programs that monitor traffic to this site.

Right now pharmacist/pharmacy staff morale is in the crapper. Everybody on the front-lines of pharmacy is busting their tails and what do we see... declining margins, decreased staffing, increased workloads. Yet we are able to keep the pharmacies operating and not killing patients in the process. We're not doing it for loyalty to the company. We're doing it out of loyalty to our patients and our staff.

So management, the next time that you swing by one of your pharmacies it would be nice to hear a kind word. Not the canned crap that we are used to hearing. Those words are empty and mean nothing. Show us that you appreciate the efforts that are being made by the pharmacists and technicians out there.

And then listen to what we have to say. There are many excellent ideas held by the people who work in the pharmacies. You need to be open to the ideas. Not every great idea comes from somebody with a VP after their name on a business card.

We only complain because we care about the profession. A wise person once told me that people only stop complaining when they stop caring.

Pharmacy is not the place where people should stop caring.

Sunday, March 28, 2010

DTC Advertising

I'm tired of the two minute long television ads for Abilify and the seven page magazine ads for Welchol. I would be less inclined to hate the drug manufacturers if they kept their DTC advertising like the following:

Then there would be no more questions at the pharmacy counter like "where is the Patanase?"

Monday, March 22, 2010

A deadly profession

By now most, if not all people in the world of pharmacy have heard the story of Eric Cropp. He's the pharmacist from Ohio who was involved in the case where a little girl received a fatal dose of sodium chloride in the chemotherapy IV. Rather than having normal saline in the bag, she received 23 percent.

The technician who prepared the IV was preoccupied with her wedding plans. On the day of the incident, the pharmacy computer system was not functioning correctly and orders were piling up.

Mr. Cropp was sentenced to six months in prison, six months house arrest, and 400 hours of community service after being convicted of involuntary manslaughter. The Ohio State Board of Pharmacy revoked his pharmacist license. In Ohio, when your license is revoked you can never practice pharmacy again. Suspension yes, revocation no.

As a result of this error, the State of Ohio has passed legislation that requires all pharmacy technicians to be certified. Another example of government being reactive rather than proactive. But in all honesty, would technician certification really have made a difference in this case? I don't know, but I want to share some thoughts.

First of all, this reminds us of the seriousness of any error that we might make. One little mistake and it could cost somebody their life. We've all made mistakes at one point or another. It's serious stuff. If you want to see laser beam focus, check out a pharmacist who was just notified about an error. It doesn't matter who made the error, patient safety is the main concern.

When it comes to IVs, the pharmacist is the last line of protection for the patient. I don't know the inner workings of inpatient pharmacies at the hospitals, but it would be difficult for me to not prepare the IVs myself. Heck, I don't even allow my techs to reconstitute antibiotics without checking the volume of distilled water that the draw up prior to adding it to the powder. And I only do that if I'm trapped on the phone and can't get to our area where we reconstitute the meds. Just as this incident with Mr. Cropp illustrates, it's my license on the line, not the technicians.

This incident also reminds us of the effects of being distracted in the pharmacy. In this case the technician had her mind on something else and wasn't the most attentive. Normally the pharmacist would catch the error, but he was distracted as well. I know what it's like when the computer system has issues. Throw in a couple calls from the floor from nurses wondering "where the damn meds are" and I'm sure Mr. Cropp was overwhelmed and just trying to please everybody.

This case also illustrates the importance of adequate staffing. For pharmacists in the retail setting, you need to stick to your guns when management comes after you to decrease your payroll budget. Can the pharmacy operate with fewer technician hours? Yes, probably. Can we do it and ensure that there we be no errors? We can never do that. We need to remind them that every distraction that the pharmacist faces, be it ringing phones, people asking where the aspirin is, etc, is a chance for an error. Ask management if they want that error to occur when you are filling a prescription for one of their family members.

We need to remember that the products we work with are called dangerous drugs for a reason. All it takes is one little mistake to be reminded how dangerous these medications are. Most of us will never make a mistake that kills a patient, but we need to remember that each and every medication that we handle has that potential. Remember Mr. Cropp, the family of the little girl, and the consequences of one mistake.

Thursday, March 18, 2010

Your vote is needed

No, this isn't a post to encourage you to contact your Congressman to express your opinion on the vote that is upcoming.

I set up a little poll on the sidebar on the right to see if local communities have associations where pharmacists actually meet. I'm looking to see if you are involved in organizations that are city or county level. If you are only involved at the state or national level, please vote no.

If you have any comments on pharmacist associations, please shoot me an email at

Wednesday, March 17, 2010

My thoughts from Monday's drive to work

I hopped in my truck Monday morning to drive to Happy Drug World. I flipped on the radio and listened to the talk radio station that I like. A caller came on who was sort of boring, so I turned the radio off for a couple minutes.

That's when it hit me.

The sense of dread. I was not looking forward to my day at the pharmacy.

Usually I like going to work. We have a good team at my pharmacy. All but one of my technicians have been in pharmacy for at least six years. Three have over 20 years of experience. The other pharmacists are great to work with. I've known the pharmacy manager for over 25 years. He is the step-father to one of my high school buddies and is one of the people who influenced my decision to go to pharmacy school.

The dread wasn't due to the volume of work that I would be heading into. We are a fairly busy pharmacy. A lot busier than my last job where we filled 800 scripts during a busy week. We usually hit 400-500 scripts on Mondays. Thanks to e-scripts and our work flow, we don't feel like we are that busy.

The dread came from a different place. It was from that place deep down inside me that realizes that I really can't have an impact on the health of my patients in my current practice setting. At Happy Drug World my job is to fill prescriptions correctly. Counsel the patients. Repeat. No real opportunities to make a difference. If I take the time to make a difference, the work piles up. And up. And up.

It probably doesn't help that I just came back from the Community MTM session at APhA 2010. I met pharmacists who conduct MTM encounters on a daily basis. That's their job. No filling scripts. No walking out to the OTC area to show a patient where the store-brand cetirizine is. Just medication therapy management.

The pharmacists who work in the MTM arena looked like they were happy to be pharmacists. They discussed some of the cases where they have been able to impact the lives of their patients. I was sitting next to another retail pharmacist. We didn't have patient cases to discuss. We had stories about the customers who come into our pharmacies. It seemed like a totally different world to the MTM pharmacists. Maybe that's why I went to the meeting. To find out how to get to their world.

As pharmacists, we shouldn't dread going to work. We should have an energy, a passion about what we do. We just need to find out how to separate our profession from the product that we are tied to in the eyes of the public.

Wednesday, March 10, 2010

Nutitional supplement for phamacists

Think about it.

Especially if you are a chain pharmacist whose management is passing down yet another set of tasks for you to do on Saturdays that have nothing to do with patient care. Or maybe your tech hours have been cut and the upper management wants to add a drive-thru to your pharmacy.

Whatever the case may be, if you don't grow a set and speak up for yourself and your profession, the non-pharmacists who make the decisions will continue to pass down asinine programs that don't promote the profession and continue to push the retail aspect.

We are medical professionals.

Remember that.

Tuesday, March 2, 2010

A friend sent this to me, I liked it

MTM software

Been spending every free moment preparing for the "Delivering Medication Therapy Management in the Community" session at APhA 2010 next week. As a result, I let a comment slip thru that is basically an advertisement for MTM software on my last post.

In an effort to be fair, I am posting a list of the commercially available electronic documentation systems that are listed in Module 2 of the study guide. Personally, I have worked with two of the systems for Medicare D MTMs.

Here's the list:

If anybody wants to float me a version of their software to test and review, contact me at

Now it's time to get back to reading/studying.