I Don’t Like Change

Much like every other human being I am a creature of habit. Although I can easily adapt to a change in my daily routine every once in a while a deviation from the normal path keeps me lost in the woods for a bit. Today was one of those days.

When working in the pharmacy we have a lot of standard operating procedures (SOP’s) to help govern what we do, but to also keep us on a good work flow pace. Occasionally a wrench gets thrown into that, but we can normally adapt to that. Today however, I had to participate in a conference call in the middle of my shift in order to prepare for a project that I am attached to. When I finished with it I tried to return to my normal operations, but found myself kind of walking around with the constant feeling that I wasn’t doing what I was supposed to do.

In all reality I pretty much have most days planned out start to finish of what I am going to do. Just makes my life easier. Normally I just use my mental punch list of things that need to be done, but occasionally I will make a more complex list for myself just so I don’t get distracted and keep on grinding. At the same time though I also keep time built into my day to allow for the unexpected deviations that may occur. I also find it helpful to place assign a priority level to the days tasks just incase I find that I need to shelf or way lay something due to time needed to be dedicated to other tasks or again the unexpected getting in the way.

To illustrate my point here’s Stewie from Family Guy.

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Last Man Standing

Since Christmas Eve one family member after another has taken ill for at least 24 hours or more. This includes my work family. One by one I have watched some ailment put them out of commission for an extended period of time. Everyone that is except me.

I am an island on to my own. When some sickness makes the rounds I can normally weather the storm and at worse only have to deal with some of the minor annoying symptoms associated with whatever the affliction is. I’ll have to attribute this to my robust immune system.

Through the pharmacy I have the “pleasure”  of interacting with hundreds of patients in a week and as a result of that their illnesses as well. I’m also exposed to many a students through my teaching endeavors and the illnesses they bring with them to the classroom. I would say my immune system is always working over time combating and adapting to the various illnesses that are hurled my way.

I also never bought into the constant use of hand sanitizer. If memory serves me the CDC and other federal health agencies put out studies saying that people were over doing it. To put a fine point on this I make sure I’m clean and sterile when I need to be, but the rest of the humans on the continent I share with need to calm down with the scrubs and the lotions. Your body does need a certain level or bacteria on it and in it anyway.

It’s like I tell my coworkers and cohorts all the time. Just lick the counter/keyboard and get it over with. The illness is going to claim you anyway just get it over with now. Unless your me and the New York City sewer rats.

Why Didn’t You Remind Me?

One of the things that continues to baffle me is why patients think we should remind them that they are due to get their medication(s) refilled. Does the gas station call you to tell you to refill your gas tank? Does your grocery store remind you to get more food for your refrigerator? The answer to both is no. So why some patients place the responsibility to know when to refill your medication on the pharmacy is completely beyond me.

At least once a week I have someone say to me, “I’ve been out of my medication for three days. Why didn’t you guys call me?”. Seriously, if you are relying on the pharmacy to remind you to pick up medication that is most likely life sustaining you are in for a rough ride. There are a litany of things I would love to say to the patients at that point, but since I have to answer to “the man” at the end of the day I apologize to the patient and tell them to give me a few minutes so that I can fill their medication they so dearly need now.

Several innovations have been created so as to help mitigate this problem. Automated refills. Phone call reminders both automated and personal that a medication is due to be filled and/or that it is ready and to come pick it up. E-mail reminders. There’s also an app with an alert function. If we could send carrier pigeons we would. Yet despite all that, we will still get people coming in wondering why we didn’t call them to fill their medication.

 

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.

 

 

 

 

I Suggest Patience

As we start the new year everyone resets with their insurance or starts anew with insurance because of a carrier change or are just getting it for the first time. Either way, things are going to take some time.

Let me start by clarifying that just because we work in the health care industry does not mean we should and/or do know everything about insurances. Our knowledge is normally limited to the field of practice we are in. Please also realize that unless it is major change that your insurance has enacted and even then it will be limited we are not privied to everything they do and change.

Most places are equipped with tools to help cut through the bullshit, but we still have to sift through some white noise occasionally.

A lot extra time wherever you are going to be using your insurance for the first time. Rushing us will not result in positive experience. You are most likely patient # 3,142 of the day with an issue that we are trying to resolve in an expedient manner.

As always yelling will accomplish a whole fuck ton of nothing. In fact if you make the mistake of yelling at me it will only result in all work coming to a grinding hault until you come back to reality and speak to us as a rational adult.

And Your Grand Total Is…

If you remember that part from Supermarket Sweep then you most likely had an awesome childhood like me and enjoyed watching that game show. Give yourself a bro five and keep reading.

When your at the register I’m going to assume you are in a hurry much like the person manning the register wants to get you the hell out of there because there is either a line of people or there are a bakers dozen of other tasks to complete before the shift is over. However, please wait to be told your total before trying to give a form of payment.

Firstly, despite how advanced some of the cash registers are they are still computers and depending on the network they are hooked up to it may take a beat or two before the payment part of the transaction can be completed. Please don’t try and swipe, tap, or insert your credit/debit card mid transaction. In most instances there is going to be something that undoes or prevents the actual processing of the card. Just have it ready in your hand and then use when instructed/prompted to.

Second, please don’t try and hand us cash while we trying to get to the point where we can take it and put said money in the register. Again, wait for the total to be announced. Please get your money out and ready to hand over when asked for it, especially if you know you are going to have to dig for it, but standing there with the money essentially being shoved at us isn’t going to make the register close the transaction any quicker or the draw pop open any sooner for that manner. When it is done to me in the pharmacy I will take and promptly place money on the counter because I am not ready to receive it. (I have had a couple people pick it back and try to hand it to me again at which point they are informed I wasn’t ready to take it and need to wait for the register.)

Again, all parties involved are generally interested in completing the sale quickly, but most of us running the register want it done correctly as well too. At my location we do have the best touch screen register available, but even they can be overly sensitive. So yes, we are going to take an extra couple of seconds to avoid a headache. Just take those extra couple of seconds to ponder the meaning of life.