Thursday, November 26, 2009

Electronic Prescriptions: Now We Can Clearly Read All the Errors

I might be the only pharmacist in the world saying this, but I don't care. I'm so sick of electronic scripts. I swear I spend more time calling doctors' offices clarifying electronic scripts than I ever did for written ones.

The problem with electronic scripts is that you actually have to know how to use the program in order to send them accurately. Now, I have no idea what the software interface looks like. I just know how they show up on my computer, and often, there's some sort of problem with them.

The most common problem is whoever is inputting the script (medical assistants, RNs, and seemingly rarely the physician) keeps selecting the wrong drug. I can only assume that the interface is similar to our pharmacy computers where you type in at least part of the name of the drug and then choose the correct one from a long list of options. The problem is that while pharmacy employees work with these drugs every single day and are well aware how they're named and supplied, doctors' representatives seem to not really know which is the correct drug to choose.

Here's an example...

Drug: Tussirex
Sig: Take 1 teaspoonful q 12h prn
quant: 4 ounces

I don't even know what Tussirex is. Upon looking it up in the PDR, it apparently existed at one time as some sort of cough medicine. I've never seen it, and I'm pretty sure it doesn't exist anymore. Of course, any pharmacist knows that it was supposed to be for Tussionex. However, I can't just assume that. I've seen physicians write for products that are no longer available plenty of times before. Therefore, and especially since Tussionex is a controlled substance, I had to call the office to verify it. As you could have guessed, by the time we got the script, the office was closed and was no longer accepting phone calls. When we finally contacted the office a day later, the nurse confirmed what I already knew; She had selected the wrong drug.

Problems like that are amazingly common. Wellbutrin is another one that drives me crazy. Whenever I see an electronic script for Wellbutrin, there's probably about a 50% chance it was inputted incorrectly. There are 3 different formulations of Wellbutrin. There's just plain old Wellbutrin, the 12 hour Wellbutrin SR, and the once daily Wellbutrin XL. It's not at all uncommon to see scripts that read just like this...

Drug: Wellbutrin SR 12 Hour 150 mg
Sig: Take 1 tablet once daily.
quant: 30

This drives me insane because there are so many things that could be wrong with that script that even after calling the office, it usually takes forever for me to get it resolved. Was it supposed to be for Wellbutrin SR? If so, are they really only taking it once a day? Shouldn't it be twice daily with a quantity of 60? Or did the doctor really mean Wellbutrin XL, and someone just selected the wrong Wellbutrin? AHHHHHH!!!!

Then there's the ones that come across with completely messed up directions...

Drug: Klonopin 0.5 mg
Sig: Take 1 po qd po 1 po HS (30 days)
Quant: 60

That's exactly how the script came across. My first thought was that the doctor meant for the patient to take it twice daily. That seemed to make sense. The quantity was for 60, and it said 30 days in the directions. It looked pretty obvious to me, but once again, it was a controlled substance, so I just wanted to double check. Of course, I couldn't get anyone at the office right away, so I had to leave a message. Five hours later the doctor called back to say that it was only supposed to be 1 tablet at bedtime, and he had no idea why the script got messed up like that.

A lot of pharmacists probably would have filled that as twice daily, and it would have been an error (albeit not really the pharmacist's fault) because it wasn't what the doctor intended. That leads me to wonder just how many scripts are filled incorrectly due to someone in the office choosing the wrong drug or inputting the wrong directions? I'm guessing more than a few.

I think that electronic scripts were aimed at solving one prescribing problem: Bad handwriting. However in doing so, they opened up the potential to make plenty of other mistakes. In reality, bad handwriting was never the biggest source of prescription errors. The biggest problem causing incorrectly written (or filled) prescriptions is not double checking them before they go out the door. Prescribers (or whoever is actually writing the scripts, which I know often times is just the medical assistant, and the doctor just scribbles his signature on it) just quickly write out a script without ever giving it a second look. Therefore, careless mistakes are made. Usually the handwriting is at least good enough for pharmacists to figure out. I really don't call offices that much to clarify poor handwriting. Most of my calls for clarification involve the actual content of the prescription. Wrong drug, wrong dosage, wrong directions, wrong or missing quantity, etc. Without making double checking mandatory, these errors will continue to happen whether the scripts be hand written or electronically sent.

What I don't understand is why there's no emphasis on double checking the script before it ever leaves the office. Pharmacists double and triple check every single prescription before it leaves the pharmacy. If I'm the only person working, I will type the script myself. Then once the label prints, I will check what I typed against the hard copy. Then, I will grab the drug from the shelf and check the NDC on the bottle vs. the NDC on the label. Then I'll count it out. If it's a control, I'll double count it. Then, I'll check the name on the bottle vs. the name on the pharmacy receipt that gets stapled to the bag. Finally, I'll verify the patient's address before giving the prescription to them.

Notice that there's a half dozen checks in there for each script I fill. However, prescribers don't seem to even do a single double check. I know decreasing insurance reimbursements have them strapped for time while trying to fit as many patients in as possible. However, I can't imagine that it would take more than 5 seconds to check a prescription one just wrote for accuracy.

There's no excuse for the number of mistakes I see. Absolutely none at all, and since electronic scripts, at least from my observations, aren't doing anything to cut down on these mistakes, what's the point?

Monday, November 23, 2009

What's this??? I'm Actually Happy.

I guess it was a gradual (some would say it was at a glacial pace) process, but the realization hit me suddenly within the last couple of weeks. "Holy crap! I'm not miserable anymore. I'm actually happy." Not only am I happy, but I'm optimistic. I'm actually looking at the positive side of things instead of constantly dwelling on the negative.

It wasn't a magical transformation. It took a lot of hard work on my part. I didn't set out with happiness in mind. I wanted to take things one step at a time and see where I ended up. The first thing on my agenda was getting healthy and physically fit. I cleaned up my diet. I greatly cut back on most processed foods and anything with added sugar. Then, as I've stated several times in this blog, I started an exercise routine, and I've been pretty consistent. It's been almost 3 months since I started, and I feel more fit than I have in a very long time.

Being healthy and in-shape is a wonderful thing because it not only affects your body but also your mind. It's been pretty well documented that lack of physical activity can lead to depression. There was even a study that came out recently saying that processed foods (i.e. non-whole wheat carbs, and foods with added sugar) were linked to depression. It's become abundantly clear to me that we really are what we eat. If you have a poor diet, you're going to feel like crap mentally and physically.

Becoming healthier changed my entire mood. I just felt better overall. I felt more confident and less miserable. I had more energy, and therefore, I had more desire to go out and do things. I started hanging out with friends more often. I branched out and met some new people. Again, there was no particular goal in mind. I just decided that I no longer wanted to watch life pass me by.

My more active social life ended up expanding my circle of friends. I mentioned a couple months ago how I was dying to go on a vacation. Well, along with one long time friend and a couple other relatively new friends, I booked a vacation in February. It's only a 5 day trip, but I'm very excited for the chance to travel with a bunch of friends to a place I've never been.

I've also been talking to this sweet girl that I met not too long ago. We've hung out several times and talked on several other occasions. She's a very nice person, and I think I just might like her. We'll see how things unfold, but for now I'm just happy that things seem to be falling into place for me for once.

There's that saying "the definition of insanity is doing the same thing over and over again and expecting different results." That was me for all these years. I wrote about my miserable life. I lamented on how I was alone, single, and seemingly going nowhere. I wished things would change. However, I didn't do anything about it. I just sat around hoping for some sort of miracle to fall into my lap and fix all my problems.

Finally, I realized that I had to do something or else I would be doomed to misery for the rest of my life. I didn't have any idea how I wanted things to play out, but I knew that the first changes had to be in myself. Without making those changes, none of this other progress could have occurred.

I move forward from this point without any regrets. I'm happy, hopeful, and looking forward to whatever the future may bring.

Friday, November 20, 2009

Hand Sanitizer

There are no studies to back me up. Despite this, I'm convinced that the use of hand sanitizer in a non-institutional setting causes people to get sick more frequently. In institutional settings (i.e. hospitals or long term care facilities), studies have definitively shown that the use of hand sanitizer dramatically reduces the risk of spreading infections from patient to patient. However, to my knowledge, the use of hand sanitizer has never been studied in the general public. Just like we have different guidelines for treating community vs. hospital acquired pneumonia, I believe the use of hand sanitizer works differently in the community than in a hospital.

In hospitals, most of the patients are already immunocompromised. They're sick. They have open wounds, catheters, tubes, and other entry points into the body that aren't in your average person walking the streets. Hospital workers must frequently wash and/or sanitize their hands in order to prevent resistant bugs from being spread patient to patient.

In the community, people are relatively healthy. They generally aren't immunocompromised in the ways that hospital patients are. In addition, a healthy person is covered from head to toe in bacteria. Lots and lots of bacteria. However, this is not a bad thing. The normal flora covering your skin and mucosal linings help keep you healthy. The presence of this normal bacteria prevent more dangerous bacteria from adhering and forming growing colonies.

I postulate that hand sanitizer in a community setting is bad for you because it does exactly what it claims to do. It kills 99.9% of bacteria on contact. The only problem is that it doesn't discriminate between bad and good bacteria. It just kills 99.9% of everything on your skin. Therefore, upon eliminating the normal flora on your skin, bad bacteria are better able to latch on and replicate unimpeded.

People seem to have this idea that we should live in a sterile environment. They spend an inordinate amount of time cleaning and sanitizing themselves and every surface they might ever touch. It's next to impossible to convince these people that they actually have an immune system, and it does fight off germs if you let it. However, when you kill off your normal flora with sanitizers, you're weakening one of your body's primary defenses against infections.

I just wish someone would do a study on this. I'm almost positive that it would show people who use hand sanitizer regularly get sick more often than people who don't.

Saturday, November 14, 2009

Money: The Great Divider

I went to this dinner party last night (yes, it was as exciting as it sounds). A girl I know just got a new apartment and wanted to have some friends over. The apartment was very nice. Hardwood floors throughout. Very spacious. We were all joking that it looked like an apartment you'd see on Friends.

A bunch of us were sitting in the living room in front of the television armoire, and someone decided to check out the TV inside. It was almost comical. There was this huge armoire, but inside was a tiny 19 inch flat screen TV, only a little bit bigger than the screen on my laptop. Everyone kind of joked about it, and I remarked that you could get a pretty nice 32" flat screen for around $300 these days. Of course, one of my friends looked at me and said, "Only $300? That's a lot of money! We all aren't pharmacists!"

This short anecdote illustrates how seemingly all my friends and everyone I meet, on some level, can't get beyond the fact that I make a lot more money than they do. I never talk about my salary. I don't show off expensive things. My clothes are just as normal as everyone else. I've worn the same moderately priced watch for about 6 years now. I do everything I can to not let on how much money I make. However, in the end, no matter how close friends we are, they still hold it over my head in some way.

Back when I was young, stupid, and still in school, I used to constantly talk about how much money I'd be making. I didn't brag about it. It was more of a statement of "wow, I can't imagine that." At the time, I worked with a pharmacist who was only a couple years older than me. She warned me that it's probably best to never tell anyone how much money you make because once you do, they start looking at you differently. I didn't understand why that would be the case. Money, while important to living a comfortable lifestyle, never factored into how I judged a person.

Well... maybe a little bit. I always had a little bit of contempt for the uber rich who had everything they could possibly want and still wanted more. However, $100 to $200 thousand per year doesn't make you uber rich. It makes you pretty comfortable.

In any case, upon becoming a pharmacist and noticing for myself how people looked at me when I told them I was making over $50 an hour, I stopped talking about money altogether. I never bring it up anymore. I try to act like everyone else. However, when I do that people will remind me about the money.

If I don't want to call a big raise playing poker...

If I talk about wanting to save money by cutting back on eating out...

If I'd rather not spend my money on some expensive item...

In all these cases, someone will inevitably cut in saying, "C'mon, you make more money than all of us combined."

Even every new person I meet will say to me, "You're a pharmacist? I heard they make a lot of money." I swear that's the first thing out of everyone's mouth. I'm so sick of hearing about it. It makes me feel bad for having a good job. It makes me feel like everyone else thinks I'm better than them in some way.

I've actually been thinking of some sort of career change, and I think a lot of it has to do with this issue. I can't do it yet because I still have loans to pay off. That'll only take a little over 2 more years at my current pace, and at that time, I think I'd seriously consider changing professions entirely. I want to do something that makes me happy regardless of how much money I make. I want a job I look forward to every single day. Maybe that job doesn't exist. All I know for certain is that I've never even bothered looking for it.

The other option that I've been kicking around is after my loans are paid off, donating half my salary to charity. I make $120,000 per year. If as a single guy, I can't live comfortably off $60,000 per year, then there's something wrong with me. At the same time, I'd be doing good for the world. Maybe I could even start my own charity foundation, although I would have no idea where to start.

Those are just some ideas I'm kicking around. I just wish I could explain to people that after a certain point, money doesn't make you happier. Once you get to the level where you can live comfortably, the only thing the extra money allows you to do is buy more stuff. Stuff doesn't make you happy. I'm not any happier having a big screen TV than I was when I was watching an old 20" TV in a 100 square foot college dorm room. My condo's granite counter tops and hardwood flooring don't care about me. They're nice to have and nice to look at, but they don't make me any happier. Money hasn't gotten me the admiration of women. If anything, making much more than all my friends has only served to alienate me.

OK... That's enough rambling for today.