Pharmacy Perfection

One of the biggest things I struggle with as a pharmacist is the idea of a profession that requires absolute perfection in everything you do; yet I am human. There is not a lot of room for error because it can detrimentally affect a patient. I remember back when I was as green as the spring grass freshly graduated from pharmacy school in 1999. I landed my first job with K-Mart, not exactly the job that I had dreamed of while I was attending pharmacy school, but they paid for my relocation from one city to another. They also did not do a lot of volume in the particular store where I was assigned. I do not remember the name of the pharmacist that worked there opposite from me initially. What I do remember about her is the words that came out of her mouth almost at her introduction, “I have never made an error while being a pharmacist.” I was too naïve at the time to realize that there was no way she was telling the truth. We are human; we will make mistakes. And at the time K-Mart did not have any mandates in place on flow or any bar-coding scanning to ensure more safety as Walgreens and CVS had. They were way behind the times as far as technological advances go.

I believe one of my first errors was dispensing Adalat CC 30 mg when the prescriptions called for 60 mg. Yes, I felt SICK. But over time I have come to realize that there are things you can do as a pharmacist to be more accurate whether it be hospital, retail, or anything in between.

According to a 2006 report by the Institute of Medicine, medication errors cause harm to roughly 1.5 million patients annually.5 Millions more are caught prior to administration, before they reach the patient. Not only do medication errors adversely impact the patient population, they are estimated to cost billions of dollars in additional treatment costs. Read more: http://www.uspharmacist.com/content/c/31431/

Here are some tips to help you become more accurate

1. Concentrate. Don’t allow distractions to stop your flow of thinking. If a technician comes up to you and needs something right away, go ahead, but realize when you start back on the order, you need to continue the exact same flow from beginning to end. Don’t try to “pick up where you left off.”

2. Do the same thing every single time. Consistency.

3. Do a second double check after you are finished checking. If that means pulling up the profile on the computer screen and holding up the order or pulling it back up electronically, just double check at the very end.

4. Any time you are going outside the usual, there is a higher incidence for errors. For example, if you have to build something from scratch in the computer on a new medication, you can be sure you are more likely to mess up on something else within the order than normal.

5. If you work retail, utilize every program they have to improve accuracy. In the hospital, just do another last review of MAR prior to moving to the next order. If in doubt; ask. It’s always better to phone the office if you work in retail or phone the nurse if you work in hospital to bounce off what you are seeing.

The most important thing is to make sure you have enough staff to safely fill medications and orders.

Rite Aid Failure

When will big retail pharmacy chains learn? Rite Aid deserves a slap on the wrist for what it has promised potential customers.

Really Rite-Aid? Really? You've stooped to an all new low trying to compete with CVS and Walgreens. Yes there are reasons that won't qualify a patient for the $5 reward for the pharmacist not complying... but guess who gets to explain to every patient the rules? That's right! Your employee. Way to make working for Rite-Aid to be the worst possible retail company to work for.

Stock is worth less than $1.50.

Instead of making your employees hate you Rite-Aid, how about coming up with something not so dangerous?

I suppose Rite-Aid is imagining most stores do less than 200 rxs/day. Are they hiring more pharmacists to help meet this demand? What steps are put into place to ensure this is something a pharmacist can do SAFELY. So a company whose shareholders have stock at $1.00 a share wants to give away more of their money when the RULE isn't met?

RITE-AID YOU FAIL. You fail on every level. You fail on appearance, professionalism, and ethics.

It won't be long though and Rite-Aid will be off the street for good.

This is Rite-Aid's hail mary pass.

How to Make the Transition from Retail to ANYTHING Else

You've finally reached the end of the line in retail.  You've had enough of the rude public, the non-pharmacist managers, and the corporate cuts.  You are ready to have an hour lunch (maybe) and normal bathroom breaks.  You are ready to feel a little more professional.  Sorry, retail pharmacists, you know it's true.  Yes, you probably make more money than me, but at least I'm not worried about my health.  (I was working retail in a terrible part of town.  All of the good areas were full with waiting lists of pharmacists ready to transfer out just like me.  I just chose a quicker path). The first thing that is entering your mind as I'm noticing on a couple of comments here is that you think a special amount of training is required.  Let's first think about hospital pharmacy.  You can transfer from retail to hospital pharmacy fairly easily.  Hospitals can train you.  There is a lot to learn, yes, but I was up-to-speed in two months.  I worked five years in retail, if that helps at all.

You will have to learn about the hospital's formulary, allergy list, and perhaps coumadin and pharmacokinetic dosing again.  You will certainly have a lot of pharmacists willing to help.  There will be no more jerks in line waiting on you to hand them their papersack with drugs; you will merely have a function to be a part of the team that helps to heal the acutely and chronically ill.  You will revisit sterile technique to mix IVs, chemo, and TPN. (I hope, though it seems the hospitals I worked in didn't observe this at all!)

And most importantly... you will have a life back.  No more driving home from work in retail and a customer follow you home.  No more jerks waiting until 3 minutes before close to get 10 prescriptions filled... all new.

I don't regret leaving retail at all.  I do regret losing the knowledge of some of the new drugs since graduation, but it's worth it for peace of mind and life.

I hope that helps.

To answer a question...

A comment was left on my blog asking me what did a work at home pharmacist do?  Good question!  I'm sure that most of the world has one image when thinking of a pharmacist.  The neighborhood retail pharmacist standing behind a counter with a phone propped on one shoulder (bad ergonomic posture) while typing in a prescription into a computer where the computer does all the brain work, etc...  There are many other pharmacist jobs out there... so many more that I want to take the time to address a few.  I am sure I will leave out some, so feel free to comment and leave more examples, if you wish. 1.  Hospital Pharmacist (staff) - the staff hospital pharmacist usually reviews orders that are entered from the chart.  In some settings the hospital pharmacist enters and reviews the orders from the charts, checks for drug interactions, appropriate doses, etc...  They also check carts that are filled with drugs for stock on each of the floors.  They also enter all chemotherapy orders (finding more mistakes, usually since dosage can be calculated by body surface area, etc...), mix chemotherapy and prepare, mix and prepare total parenteral nutrition (in layman's terms "IV food") that contains dextrose, lipids, amino acids, and a variety of electrolytes and salts, etc... that even within themselves have to be a specific concentration and even mixed in a certain order to prevent precipitation.  Precipitation in the vein is a bad thing.  They also mix and check IVs ranging from the easy vancomycin in sodium chloride to IVIG.  Some hospitals have staff pharmacists performing kinetics checks to make sure that the little 90 year old woman can renally (that's with the kidneys) clear certain drugs like vancomycin, tobramycin, and levaquin. 

2.  Specialty pharmacists in a hospital setting - Here we go, these are the pharmacists that did a residency - working for half of the pay for a year or more - learning a speciality.  Critical care pharmacists, infectious disease pharmacists, coumadin pharmacists, on and on and on...  These guys don't help much with the day-to-day stuff.  They usually do a lot of speeches, have pharmacist students under them during the year, have more of a 9-5 job, etc...  It's too narrow a spectrum for me, but it's definitely a brainer side of pharmacy.

3.  Work at home pharmacist - a lot of companies are centralizing their operations and in doing so the order entry/review front end work can be done from home.  Some companies that have many hospitals are condensing all of this into one job at home.  Depending on the company, you can be checking front end orders from charts that are scanned into a computer program like Pyxis all the way to handling one or two specialty drugs. 

4.  Retail pharmacist - makes a lot of money.  A lot of headaches.  A lot of stress.  And I never ever got to take a pee.  I remember most days holding my pee for 12 hours at a time all the while listening to the public bitch about their higher copay.  The real issue is that Eckerd, Walgreens, CVS, etc...  don't give you enough help hours so there's this frenzied pace of working that leads to the horrid mistakes you hear about on the news.  There's some good retail situations, but I found them few and far between.  Perhaps I am a wuss.

5.  Long term care pharmacist - front end and fulfillment responsibilities for servicing nursing homes.  Omnicare is your biggest player with Pharmerica/Kindred right behind.  Can be a good schedule. 

6.  Consultant pharmacist - the pharmacist that travels about nursing homes and residential places checking charts required by law and destroying expired controlled medications.  Making recommendations, etc... 

7.  Drug rep - Drug expert at one or two drugs - don't have to be a pharmacist.  Learns exactly what the drug company tells you.  Carries around charts and studies to look smart.  Gives away pens, free lunches, and sponsors speeches about the drug.  My personal opinion can be attacked here, but I feel this job is a conflict of interest for the public.  Some docs don't do their homework and what their drug rep tells them is what they believe.  Even if it is false.  Even if it is misled.  There are some good drugs out there, though.  I just bet the Avandia drug rep is a little nervous right now.

8.  Drug Information Center - mans an information center to answer questions from anyone, universities, and the public about drug questions, pill identification, etc...  The ability to know how to research and find what is needed.

9.  Pharmacy professor - self explanatory.

10.  Home Infusion pharmacist - takes call for new admits going home from the hospital on some sort of IV medication whether it be TPN, desferal pump, or an IV antibiotic... it's all IVs... no tablets, etc...  but a nice little clinical niche.

 I'm sure I'm leaving some out... but I wanted to at least let the world know pharmacists are more than the retail version.