Tuesday, March 15, 2011

"You're Lucky to Have a Job"

I should be sleeping right now. I have to get up less than 6 hours from now in order to get ready to open the pharmacy tomorrow morning. I just really felt I had to get this post done. I've been wanting to write it for a week now, but I've been putting it off for various reasons. Anyway...

A couple weeks ago, I had a particularly rough day at the pharmacy. Nothing went right. A technician called out. We were incredibly busy. There was one insurance problem after another, and the phone would just not stop ringing! I was going insane.

Finally, with about 30 minutes left in the day, things started to settle down, and I got a little quiet time to finish up some paperwork that I didn't get a chance to do earlier. I started ranting to one of our technicians about how something has to change in this pharmacy because I don't know how much longer I can deal with all this crap.

She listened for about 30 seconds before saying, "well, just be happy you have a job." You see, working at the pharmacy is her second job, and she doesn't get paid particularly well for it. It was supposed to be something to supplement her income. However, she's getting laid off at her primary job. Without her primary source of income, she's unsure if she can make ends meet.

This made me feel kind of stupid for ranting about my situation to her. After all, she was right. I do have a job, and I get paid quite well. A lot of people would kill to have my salary, especially at my age.

However, later that night, I got to thinking that there has to be a point where "you're lucky to have a job" no longer applies. I understand that a lot of people don't have jobs. I understand I'm very fortunate to be paid very decently. However, just having a job and being paid decently shouldn't preclude me from complaining about shitty work conditions.

By the "lucky to have a job logic," my company could force me to fill 1,000 prescriptions per day by myself without any help at all while dealing with all the customer complaints and all the phone calls, and I'd have no reason to complain because at least I'm employed and making 6-figures. At some point, the stress reaches a level where it doesn't matter how much damn money I make, I'd rather be unemployed and broke than be treated like shit.

I can't think of a single profession that forces you to multi-task more than a pharmacist does on a daily basis. At a busy pharmacy, there's always 5 or 6 things going on at the same time, and the pharmacist is responsible for directly supervising EVERYTHING. While we're trying to fill prescriptions, the phone is ringing. It's a doctor calling in a script, and only a pharmacist can take that call. However, there's also a customer at the counter that wants to ask a question that only the pharmacist can answer. While trying to decide which to attend to first, the prescription for Celebrex you were typing into the computer just came up "prior authorization required," which means that you have to send a fax over to the doctor's office in order to let them know they either need to call the insurance company or switch it to something else. Naturally, the guy in line after the customer asking the question is looking to pick up that Celebrex prescription...

This goes on ALL DAY LONG, and it happens EVERY DAY. Oh yeah, and while you're trying to handle these pharmacy tasks, you just got an email saying another drug has been recalled. It's the third one of the day, which means for the third time, you have to check your shelves, quarantine the recalled product, and fill out the paperwork that corporate requires. The next email is telling you about the Aetna audit that's taking place next week. You have to make sure to make all those prescription files available for the auditor. And the warehouse is out of vial caps for the second time this week, and since you're running extremely low on them, you have to call a bunch of other stores to hunt down some that you can borrow.

Between filling prescriptions, dealing with customers, dealing with doctors, handling insurance issues, and following corporate policies, you're head is spinning all day long. You're constantly racing around. You work 12 hours without a proper break. You just briefly pause for 5 to 10 minutes to scarf down a sandwich, and then it's back to the grind.

And know what your reward is for busting your ass all day? Customers complaining, "20 minutes???? Is it really going to take THAT long??!?!?"

However, community pharmacists can't complain about this because, hey, at least we have a job, and we make over $100,000 per year. We should just shut up and take it because we're "lucky" to have the opportunity to be overworked and overstressed.

That's what the chains count on though. The reason they can get away with this crap is because, at the end of the day, most of us subscribe to this lucky to have a well paying job mentality. We hate the work, but we're addicted to the money, so even though we may complain, we won't do anything to really rock the boat and risk that paycheck.

I'm guilty of this. I want to quit my job so bad. Sometimes I actually get a little giddy imagining myself just walking right out of work one day and never coming back. I'm scared to death to do it though. I've become accustomed to my paycheck. I'm used to not having to pinch pennies. I'm used to just going out and buying what I want without having to worry about whether I can afford it or not. I'm addicted to the money.

Because of this addiction, my employer has me by the balls. They know that as long as they keep the money coming, I'll put up with whatever extra responsibilities they throw at me. The money provides an illusion of freedom when in reality, it is the thing that imprisons me.

However, I feel like I'm very close to boiling over. I'm not quite there yet, but I feel like soon, I'll reach the point where the money just isn't worth it anymore. It would be scary, but losing this job might be the best thing that could happen to me. It would be the kick in the ass that I need to find something that I'm happier doing.

***I said I was done writing here. However, I guess I haven't quite run out of things to say. I'm sort of feeling the urge to write recently, which is probably a sign of mind not being at ease. In any case, if I have something to write about, I'll write about it.***

Wednesday, March 9, 2011

Another Prescription Error That Could Have Easily Been Avoided

I'm going to turn this blog into ranting and raving against the forces in our profession that seek to put the public in danger. My focus will be on prescription errors, and how often the simplest of things can help avoid them.

Our pharmacy had another prescription error last week. This one, to my knowledge hasn't been reported to the Board of Pharmacy. Although, I almost wish they would report it because I would go before the board intent on kicking up a shit storm.

A customer presented to our pharmacy counter carrying 3 prescriptions. For the sake of this entry, we'll say this customer's name was Thomas Richards. Thomas has been on pain medication for quite some time. He's had several recent procedures that have required him to get a number of different pain meds. His need for opioid pain medication is perfectly legitimate. He is not the problem here.

The 3 prescriptions were for 3 different pain medications. They were from the same doctor's office, written in the same pen, and given to the patient at the same time. The technician at the drop-off counter, added Mr. Richards' date of birth and address to all 3 prescriptions, and told him the scripts will be ready for pick up in about 20 minutes. Everything was seemingly going smoothly.

The other pharmacist on duty was the one who inputted the prescriptions into the computer. He noticed that the doctor had given Mr. Richards prescriptions for MS Contin, Dilaudid, and Percocet. He wondered out loud why the doctor would give this patient both Dilaudid and Percocet. However, since that office is an orthopedic group, and we see a ton of interesting pain med combinations from them, we just kind of shrugged it off. I've seen patients get prescriptions for Percocet designated for moderate pain and Dilaudid designated for severe pain. It's not that common, but not unheard of. Therefore, we decided to just let it go. After all, it wasn't like they wrote the scripts for large quantities, and Mr. Richards was certainly in pain.

Twenty minutes later, Mr. Richards comes back and his prescriptions are all set for him. He pays and goes on his merry way. Several hours later, he calls the pharmacy saying we made a mistake. He said that the prescription couldn't have been for Percocet because he gets very ill when taking it. The doctors know that and wouldn't prescribe him that. The script was supposed to be for Flexeril.

I look back and double check the prescription. It most certainly said Percocet 5/325. I quickly checked the name and date of birth (that we had to write on the prescription when he dropped it off). Yes, it was filled correctly. Mr. Richards sighed and muttered something about the dumb doctor's office, and hung up. A little later the prescription for Flexeril was callled in to us. I guessed that he must have let the office know of the mistake.

Several days later, we get a call from that office. "The prescription you filled for Thomas Richards for Percocet was filled in error," proclaimed one of the nurses. "Mr. Richards was never prescribed Percocet. That prescription was for Thomas RICHARDSON."

Sure enough, when I went back and triple checked the script, the name on the top was Thomas Richardson, not Thomas Richards. It was a prescription error.

However, let's back things up just a little bit. How the hell did Thomas Richards get Thomas Richardson's prescription?

You see... This is a practice that I think is unfamiliar to the general public. Doctors don't actually physically write most of their prescriptions. They usually have a nurse write them, and then they sign their names at the bottom. We see it ALL THE TIME. The patient's name and all other prescription info will be written in these big, bubbly, girly looking letters, and the doctors signature is scribbled at the bottom. It doesn't matter whether we're talking about prescriptions for blood pressure medications or for Oxycontin. Many doctors don't write their own scripts.

Secondly, the only conceivable way that Mr. Richards was given Mr. Richardson's prescription was if the prescription was written out ahead of time and stored in some kind of file at the doctor's office. Obviously, the doctor or nurse did not see Mr. Richards and Mr. Richardson at the same time. If he was only writing for one patient at a time, there's no way that one patient could have come into contact with another patient's prescription. The only possible way was if a nurse had to sift through a file to find Mr. Richards prescriptions, and it just so happened that Mr. Richardson's script was mistakenly filed under the wrong name.

Moreover, the patient's address and date of birth was not written on ANY of the 3 prescriptions for schedule II controlled substances that Mr. Richards dropped off. The technician at drop-off had to inquire to the patient's address and DOB, and she was the one that wrote them on all 3 prescriptions.

Therefore, when the scripts finally made it to the pharmacy, all 3 of them were written in the same pen, from the same doctor's office, on the same prescription blanks, dropped off at the same time by Mr. Richards, and all had the same address and DOB on them (because the tech wrote them in on all 3). However, one was for Mr. Richardson instead of Mr. Richards.

The nurse who called to tell us about the error gave me the "YOU FILLED IT WRONG!" attitude, and quite frankly it really pissed me off. Yes, I suppose ultimately, it was a pharmacy error. However, the patient, the technician, and 2 pharmacists both looked at these scripts and didn't notice the slight difference in the name on one of the prescriptions.

It goes down as a pharmacy error, but if the doctor had A) not written the prescriptions ahead of time, and B) had included the patient's address and DOB on every prescription (which by LAW, they are supposed to), we would have easily caught the mistake.

It's just another incidence when pharmacies are the ones getting shit on for prescription errors, even though we're seemingly the only entity in all of health care the gives a shit about doing things to prevent them. Every time a doctor writes sloppily, every time he uses unapproved abbreviations, every time he doesn't include the patients date of birth and address on the prescription, and every time he doesn't provide his DEA #, there is a chance for a prescription to be either misfilled or therapy to be delayed to a patient due to the pharmacy's attempt to try to fill in the missing information.

Everyone laughs about doctors' messy handwriting. It's a big fucking joke. The public just assumes that's the way it is, and it isn't going to change. If the pharmacy can't read what the doctor writes and has to call to verify a prescription, the patient gets mad at us and not the doctor. The public jumps all over pharmacy mistakes, but the doctor can write illegibly, prescribe the wrong dose, wrong drug, or a medication with a significant drug interaction, and the public just shrugs it off.

Why is everyone so afraid of doctors and people in their offices? People come in and treat the pharmacists and pharmacy staff like dirt on a regular basis. They yell and scream about customer service. They look to us to fix everyone else's mistakes, and then get mad at us when it can't be done in 5 fucking minutes.

I'm sick and tired of it. I really am. I can't be the customer service representative, insurance trouble shooter, I.T. help desk, store printer technician, cashier, secretary, business manager, AND pharmacist at the same time. Every time you interrupt me with something that isn't related to verifying the safety and accuracy of prescription orders, the chances of someone being harmed by a pharmacy error increases. Every time my District Manager requires me to personally walk customers directly to any item in the store that they might be looking for, I'm interrupted from possibly teaching someone how to use an inhaler or inject insulin.

I'm a pharmacist. I'm not a fucking customer service rep. I'm not a fucking cashier. I make sure prescriptions are safe, accurate, and that patients know how to use them. Everything else is superfluous. I don't give a shit about the fucking inventory being over budget. Get an ordering department. I don't have time to spend 2 hours on the phone with an insurance company to get a claim to go through that provides a $2.50 profit. Get a billing department.

I know I'm kind of ranting off topic now, but my overarching point is that we're asked to do too many things at one time, and even asking other medical professionals to take literally a few extra seconds to write patients' addresses, DOB's, and prescribers DEA #s on prescriptions seems to be too much of a hassle for them. It would literally take 5 extra seconds, but they can't be bothered, and because they can't be bothered, the chances of pharmacy prescription errors increase.

If you're a prescriber reading this, and you're one of these fucks that don't take those 5 extra seconds, FUCK YOU! Seriously, you're scum. You make pharmacists lives miserable because you're too fucking lazy to do what you're supposed to.