Full Ahead

At this point in time I have successfully completed the second hell day in the new year. Generally the first three weeks of the year are a complete shit show in most retail pharmacy settings. Everyone is trying to figure out their new insurances and switch between pharmacies for one of a dozen different reasons.

Comparative to day one it was more successful in the fact that for once I didn’t leave anything hanging that I had to worry about the next shift picking up the ball and running with it. However from the time I walked in till about 5 minutes before close I had to keep the gas petal pinned to the floor along with everyone else. Again, nothing new, but when trying to come back to a normal or just slower tempo after having the throttle pinned for almost my whole shift is somewhat difficult.

When I found myself finished for the day a sense of panic hit me for a second. I still had what seemed like a bunch of wound up energy and was capable of running a gauntlet if need. The volume was stuck at 10 for a minute. Now that I am at home I’m closer to a 6 instead of the 2 I normally am at right before bed. Sleep will just have to take a back seat for now.

 

Drive Thru Requests

Every once in a while we’ll get an odd request in the drive-thru. It’s normally for some random one off item in the store. Although we are not obligated to one of us will leave the pharmacy and grab said item. (We we’re given a list of items that you can purchase via the drive thru which we will go get. Although we were instructed we are not obligated to get anything beyond that list we normally will anyway just to avoid a bad customer review.)

So my story takes place about an hour before close. Random SUV pulls up and driver asks I can get an OTC item so they don’t have to come in. I ask what it is and it was something I never heard of before. (Two things to keep in mind: 1st this would be the fourth time this evening that I was being asked for an oddity item 2nd the drive thru speaker system is showing its age.) After a few minutes exchange I finally figure out what they want and inform them I would have to venture on to the sales floor to look for it and would be a minute.

I was gone maybe 30 seconds and the instant I rounded the corner to be able to see out into the drive thru again the requester had pulled a David Copperfield (Disappeared) on me. Just up and gone. Normally I wouldn’t give a damn, but I had already put some effort into figuring out what they wanted and seeing if we had it and then the potential customer just peaced out on me. (I was in the middle of other tasks as well.) To say the least I was annoyed.

Rare is the time we get to go above and beyond the normal requirements of our job, but when one does it’s superbly annoying that one couldn’t deliver. Could care less about the recognition just hate having my time wasted. It happens enough with things I have little control over.

 

Epinephrine Pens

For those of you Facebook hero’s that have discovered how cheap epinephrine is by the ampule is now touting that everyone should be asking their doctor for a script of that and for a syringe please stop. I applaud your good intentions, but it truly isn’t a viable option. Pull up a seat and I will explain.

Yes, it is a cheaper….a lot cheaper. However, there is a trade off here and it’s time….that when it comes to the need to use epinephrine to counter act an anaphylaxis reaction there is precious little of. You see when opening an ampule of anything you first need to sterilize the top with an alcohol swab and then essentially crack the top off. (Each ampule does have an etched line around the neck to help with breaking it off) Even in an ideal setting you don’t always get a clean snap. (Since were talking about an emergency situation use you can most likely throw any semblance of a clean break out the window.)

Now that the vial is open remember to sterilize the top again. You must also make sure that before drawing any of the solution out of the ampule that you are using a filter tip needle on the syringe. Don’t want to draw up any glass shards. You may keep the person from suffocating, but failing to use the filter tip may result in micro pieces of glass being injected into a person. This could result in internal micro cuts throughout the body causing internal bleeding and/or high susceptibility to infection.

Let’s assume that you have done everything correctly to this point. (Did you draw up the correct amount of liquid?) Now you need to switch needle tips. (The filter tip doesn’t trap the glass, it just keeps it from contaminating the epinephrine in the syringe.) With the tip now changed you are ready to administer.

My point here is that again although this is a cheaper alternative it is not a viable alternative. It is a time consuming process in order to ensure the safety of the person receiving the medication. Which is why the brand name Epipen comes in the preset pens. Unless beyond the shadow of a doubt you know you can safely transport and maintain the integrity of the ampules, syringe, and needle tips don’t. You also have to ask yourself are you the kind of person that can maintain their cool to help administer the correct needed dose to save someone.

I’m sorry, but it is a much better idea to pony up the money from the pens than it is to try and quickly get through that process. Since I’m already on my soap box and I have everyone’s attention let me enlighten you to something that the manufacturer of Epipen doesn’t want you to know. THERE IS A GENERIC ON THE MARKET.

That’s right boys and girls there is a generic to Epipen on the market. It is significantly cheaper. (By a couple of hundred dollars.) The problem is that there aren’t enough studies out to prove that it’s an “AB” rated generic. To translate there isn’t enough data that allows for pharmacies to just change it to the generic that exists. When getting a prescription from your doctor for an epinephrine pen ask them to write it for just that. Saves time and money.

That way you don’t have to wait for congress to legislate something and you could start hitting the manufacturer in the bank account. Instead just lean on your legislature to start making inquiries into why the FDA is dragging their feet on getting the “AB” rating studies done.

 

 

 

 

Mace or Lance?

Yesterday during the craziness that ensued during the late evening I was hurriedly trying to count some medication and had to open a new stock bottle. My normal procedure to break the safety seal on the bottle is to use the blunt end of the counting spatula and just ram it home which normally rips the entirety of the seal off saving me a few seconds. However, some manufacturers use a significantly thinker safety seal on their bottles.

When I encounter this it requires a more pointed incision in order to pierce the seal and remove it from said bottle. So after failing to bash in the seal with blunt back end I turned around the spatula and pierced it with the more finer front end. It is at this point that I’m sure everyone is wondering why I’m rambling on about all this nonsense.

I’m trying to express a comparative for life’s problems. (Yes, I know, big word.) Sometimes you can just bulldoze through things and get the problem solved, but it some problems require a bit more finesse to get through and have to be tackled in a more precise way.

Sorry, Were Out of Stock

When any proprietor of any wares states they are out of something, please don’t ask if we really are. If anything the next questions should be, “When will you have more?”, or “Do you know who else might have it available?”. We will be most happy to provide those answers, but circling around for a second pass is pointless.

In the pharmacy universe there’s never a point in time where we want to be out of something. It’s a pain in the ass for us and we don’t enjoy delivering bad news to patients. That being said when you ask me, “Are you sure you don’t have any?”, I immediately stop giving a damn. At the point in time you will receive the bare minimum of service from me.

This is like going to a gas station and finding out the ran out of premium and then asking the attendant are they sure they are out. No they are hiding the tanker truck around back hording it all for themselves. What the hell people.

Use Your Words

Recently I’ve been struggling to find something to write about/be inspired by so I decided to pull another one out of my personal archives. On a side note apparently I have been doing this for a year now.

Another phenomenon that is becoming more prevalent in the pharmacy drive thru is patient’s not using their words. When the drive thru was put in one of the best directed speaker systems was also installed so as to minimize background noise and allow for ease of communication. Although it is over a decade old now, the technology has not degraded that much.

It is normally only isolated to a drop off situation, but when I ask, “How, can we help you?” some patients will give me a slight wave with a piece of paper in their hand. Now, I know this means that they are most likely dropping off a prescription, but since I assume nothing I will ask if you are. For all I know that paper being waved at me contains Minute Man Nuclear Missile Launch codes.

Ladies and gents it is a matter of respect for the people who are going to service you. I don’t go into a restaurant and just wave a piece at my server with my order on it. I communicate with words to convey what I desire. I expect the same from everyone else,

On a quick side note, we do have patients that are hearing impaired so using verbal language really isn’t an option. However, these patients are some of the best ones we have and communicate with us via an interpreter, written word, or when I have time through sign language. My skills are shotty at best, but given a minute I can coble a sentence or two together.

Wait Times

In the retail pharmacy universe when a prescription is dropped off patients have a two options. Leave it to be filled a later time/date or wait. When a patient indicates they wish to wait the intake technician does some pharmacy math  based on the current work load situation you will normally get a wait time that ranges somewhere from 5 minutes up to ½ hour.

If you get a wait time longer than that I’m going to assume that the pharmacy is experiencing critical systems issues. If this happens please be patient. A lot of the time is out of the staffs hands and are doing the best they can. If possible make arrangements to come back the next day.

However, and this one chaps my ass, if someone drops off a prescription and says they will be back later  (more than 3 hours) that day and you are not experiencing computer issues and the patient returns and nothing was done who the hell are you kidding.

Normally I wouldn’t give much of a damn about other pharmacies inability to function properly, but in the last 3 months on 4 separate incidents that I can recall it happened to family members of mine. Even that is not all that significant, but over the last 2 weeks we have had an influx of patients leaving a specific chain because they would tell them to return in 3 hours and then have nothing done. Seriously people, I know I preach not to rush the filling of medications, but I find that unacceptable.

It lowers the standards of the profession and damages the relationship between the patient and pharmacists in general.