Wednesday, April 28, 2010


I am a health care professional. I take a tremendous amount of pride in my work. The profession that I practice helps people lead better, healthier, more productive lives.

My profession demands that I be accurate 100 percent of the time. If I make a mistake, it could be a matter of life and death. On any given day, there are between 150 and 450 opportunities for me to make that mistake. The one that could kill somebody.

Fortunately, I have never made the fatal mistake. In my 15 years as a licensed pharmacist I can recall less than 10 times that I have made an error. A couple of the times I wasn't the one who made the error, but as the responsible pharmacist for the pharmacy it was ultimately my responsibility.

Everything that happens while I am on duty is my responsibility. The actions of the technicians and cashiers is my responsibility. If there is an intern or student in my pharmacy, their actions are my responsibility. It is a responsibility that I assumed when I received my license to practice pharmacy.

There aren't too many non-pharmacists/technicians who understand the responsibility that pharmacists have. Those who do are usually former pharmacy employees and spouses of pharmacists. They are the ones who hear first-hand of the near-misses that occurred in the pharmacy on any given day. They are also the ones who hear of the saves that happen behind the pharmacy counter.

Because I am a pharmacist, I care about the health and safety of my patients. In order to provide my patients with the best pharmaceutical care, I need to have adequate staffing. Both in terms of pharmacists and technicians.

So nothing burns my butt more than a directive from above telling me that I need to reduce pharmacist and technician hours in order to meet a number on somebody's budget spreadsheet. Each time that payroll is adjusted due to some imaginary rx/hour formula, resulting in an increased workload for the pharmacist, the chances for me to make an error are increased.

The formulas for scripts per hour are not determined by practicing pharmacists. They are set by people who haven't worked behind a pharmacy counter in years, if ever. They are set by people who are trying to maximize their return on their payroll expenses. They are set by accountants, with the help of lawyers who determine how many wrongful death lawsuits the company can handle before changes need to be made.

That's not being responsible. That's being reckless.

I hope and pray that I never make that fatal error. I hope and pray that it's not your family member who is harmed by a mistake in the pharmacy that is due to the pharmacy being inadequately staffed.

Something for you non-pharmacists in pharmacy management to think about as you review your payroll next week.

Friday, April 23, 2010

Solution to the impatient pharmacy patient

A little Twitter exchange with @raindropRPH has potentially solved the problem of the impatient pharmacy patient.

I had tweeted that I was waiting at my physician's office for my annual visit. She replied:

Love the irony of people waiting @ Dr's office, yet so impatient at pharmacy.

That's when it struck me.

We need to have individual waiting rooms for our pharmacy patients. A place for them to sit and wait for their prescriptions.

After the patients drop off their prescriptions, we could direct them to a general waiting area. Then, as their prescriptions near completion, they would be moved to individual waiting rooms. Just like how they waited at the physician's office they just came from.

We could send a tech around every ten or fifteen minutes to tell them that their prescriptions will be done soon. When the prescriptions are finished, the pharmacist would deliver them, offer counseling, and send them on their way to the cashier.

If nothing else, it would keep them from walking up every 15 seconds asking if their prescriptions were done yet.

Waddaya think?

Sunday, April 18, 2010

COR 103 & the BS detector

In community pharmacy, you always need to have your BS detector fully engaged. Usually it's used to test the story that a patient is using in an effort to obtain their controlled substance prescription several days before it is due.

As a community pharmacist, you develop this sixth sense almost automatically. It only takes about six months on the job to have a fully-functioning BS detector. Having been a community pharmacist for fifteen years, including stints in the inner-city, I would say that my BS detector is finely-tuned.

Sunday we had a call come in to the pharmacy. My lead tech took it. It was a call to identify the tablet. The caller said that he had found some tablets while cleaning his son's room and wanted to identify them. My tech's computer froze up, so she turned the call over to me.

I let the caller sit on hold for 45 seconds or so before picking it up. I let the caller explain everything to me again. It takes him about two minutes to explain everything to me that he just told my tech. His speech was a little slurred. The story has changed and now, the story is that the caller was disposing of his dead grandmother's medications and was wanting to know what he was throwing away. Now the BS detector is going off full-force. Now the challenge is to see exactly what this caller is trying to find out.

I ask for the color, shape, markings, etc so I could punch the info into the computer to try to get a match. All the caller would give me was the color (white) and the imprint (COR 103).

As soon as I pressed the enter key, the identification popped up.... Carisoprodol 350 mg by Core.

I inform the caller that, based on the information he has provided, that the tablets are Carisoprodol tablets.

What's that? he asks.

I inform him that it is a muscle relaxer.

Is it very strong?

I tell him that it's a fairly normal strength.

What is it's name again?



I even spell it out for him. I will not tell him that it is generic Soma. That would make his day to know that he bought the right stuff off of the street.

It's sad that we, as community pharmacists, have to have our BS detectors working every minute that we are in the pharmacy. It's unfortunate that so many people are seeking to escape their pain through chemistry. We live in a society that believes that there is a pill for every ill.

I don't know what the answer is. Maybe it's a ban on direct-to-consumer advertising. If the patient doesn't know about the latest, greatest medications then they won't beg their physicians for them.

Maybe it's stricter reporting requirements by prescribers on the medications that they are ordering. I believe that if the prescribers are hit with more paperwork, they won't order 75 Darvocets with 5 refills for Grandma Jones sore wrist. The same wrist that has been sore for 8 years. Mr. Smith might not get the Vicodins for the knee he hurt 18 months ago, yet refuses to get physical therapy for.

As long as prescribers continue to order the narcotics, benzos, and muscle relaxers for every Tom, Dick, and Sally that comes to the office with a chief complaint of "hurting all over", we don't have a chance at curbing the diversion of prescription medications.

But until then, I'll enjoy these next couple days off and allow my BS detector to recharge itself for Wednesday's pharmacy fun.

Information request

Quick question... does anybody know of any study that has determined the maximum volume of prescriptions per hour that can be filled safely by a pharmacist? Something by an organization like the ISMP or a similar group.

Leave an answer or link in the comments or email me . Thanks.

Tuesday, April 13, 2010

Perfect ending to my day

It had been a longer day than it should have been. Non-issues were becoming issues. The little problems that happen at the absolute worst moment were happening. All in all, a typical day in the pharmacy.

I looked up to see a woman marching back to the pharmacy with a receipt in on hand and a bag in the other. There was a box of some sort in the bag.

I thought great, somebody wanting to return a blood glucose monitor. We have three signs posted that state that all glucose monitor sales are final, that all returns must be addressed with the manufacturer. Somehow people always seem to miss those signs.

Perfect ending to my day.

The woman approaches the counseling window and pulls a blood pressure monitor out of the bag. I thought OK, this won't be as big of a hassle.

The woman states that she believes the machine is defective. Of course I want to know why. She states that she bought the device earlier in the day for her mother. They tried the machine on mom and the readings were BP 118/74 HR 72. Then the daughter tried the monitor. BP 118/74. HR 72.

They joked about how they were exactly the same. The woman's husband gave it a try.

BP 118/74. HR 72.

Then her sister.

BP 118/74. HR 72.


BP 118/74. HR 72.

You can see why they were wondering about the functioning of the monitor.

So I had her get the unit out to show me how they were using the machine. She placed it on her upper arm correctly. The cuff appeared to be the right size. When she pressed the start button, everything worked fine.

After inflating and deflating she points out the results. BP 118/74. HR 72.

I grabbed the monitor to take a look. Yep............ BP 118/74. HR 72.

Then I pealed the sticker off of the monitor that goes over the display screen. Beneath it was her actual readings. Everybody at her mother's house that day had failed to read the very first line of the directions that read Remove display sticker from display screen.

She looked at me.


Well, I've been having a blonde day. Thank you. Then she left.

Perfect ending to my day.

Thursday, April 8, 2010

The Scooter Store

I love the sites that have these motivational/demotivational posters.

Unfortunately, the town that I work in may be the world capital for motorized scooters. If you travel thru town on the main street, you will pass at least three people cruising on the road on one of these.

The only difference is that the people in the town where I work have the orange flags on their scooters.

For the record, I live 27 miles away from the town where I work. I work that far away by choice. I have plenty of time to blow off any steam before I get home. No need to punish my wife and kids for the offenses of my patients.

I have yet to see a scooter in the town where I live, unless it is a tourist.

Sunday, April 4, 2010

Quick thought on the bill passed two weeks ago

You know how much of a pain it is to process a Medicare Part B prescription for diabetic testing supplies that is missing some of the information, say like testing frequency or an ICD-9 code?

Or how much fun it is now that all Medicaid prescriptions must meet the tamper-evident criteria from three different categories?

Can't you wait until the government is involved even more than it is currently with regards to prescriptions and we get to deal with tamper-evident, ICD-9 coded prescriptions for each and every patient who walks up to the pharmacy counter, or risk audits and/or fines if the prescriptions do not meet any and all requirements thought up by some bureaucrat who has never worked in any type of health-care setting?

Me either.

Friday, April 2, 2010

Good Friday post

I cut this comic out of the Sunday paper years ago. I never get the Sunday paper, but one year I did. This was in it.

I tried to upload it as a single document, but the file size was to large for Blogger to upload as a single file.

That being said, I think that this is one of the most powerful documents that I have ever read. It's weird to think that a simple comic strip would have an impact, but for me it does. Johnny Hart did good with this BC comic from years ago.