You just don't know!

By now, most of us who work in pharmacies have come to accept that there are misconceptions about what happens within a pharmacy.

The misconceptions aren't any easier to manage when your pharmacy is located INSIDE of a medical facility. If anything, they become far worse as both fellow employees and clients expect things from you that aren't reasonable, or even possible sometimes.

There have always been issues with prescribers when it comes to prescriptions, how long it takes for us to fill things, and overstepping our boundaries when it comes to what's been prescribed. With the increase in nurse practitioners, it's become more of a hassle as they expected to be treated the same as doctors (reasonable to ask), yet seem to in many cases be more offended when you question what they're doing.

Here in particular, we've gone through several of them in primary medicine. They often seem to be overwhelmed by what they got themselves into, not understanding the mental health aspect of this facility. One CNP infamously had a client ejaculate on her on her first day here.

It can be a bit rough if you aren't prepared. The regular prescribers are as most have worked in mental health for years. The CNP's coming in are usually new and/or are using this facility as a springboard into other places.

The first one was always requesting a single vial of albuterol solution for inhalation, something that we can't do. She also used to order a bunch of lab tests that weren't necessary and/or expensive. She didn't last long and was replaced by a new CNP who was more worried about how she appeared to clients than what she was prescribing.

More recently, some of the mental health prescribers have agreed to take on some primary medicine roles, and two new CNP's were brought on board to help expand the scope of primary medicine.

This would be fine and dandy, except one of the new ones likes to change her mind moments after she sends the e-script, only to change her mind several more times after that.

One's client chart had six different medications started, then discontinued the same day they were prescribed. That's not normal, nor good.

Worse, the prescriber thought that when they discontinued something in the main system, we received notification of that so we could do the same.

Except we don't. So we didn't.

And the client ended up with multiple blood pressure medications (not uncommon as many are used in conjunction with each other), not knowing which one they were supposed to take.

This led to a string of e-mails asking how the pharmacy wasn't aware of these discontinued medications and demands that the software send something our way. Our IT guy politely explained there's no way for that to happen, as the e-prescribing systems aren't designed to automatically send that out to pharmacies.

The first solution suggested was that the pharmacy check the main record and if there's a discrepancy, call the prescriber. This notion was shot down immediately as outside pharmacies wouldn't be able to check the main record.

Finally, my boss suggested that the prescribers put a note in the correct prescription telling us what medication to discontinue. This was reluctantly accepted as a solution, especially once our IT guy said this was the best way to handle the situation.

When asked who told the new CNP that we received discontinue orders, their response was "No one, I just assumed you did."

Assumed.

They had no credible information telling them that's what happened, they just assumed without asking.

The moral of this story is if you aren't sure, ask. You'll likely get an answer and if you don't, at least get some direction as to what to do next. Yet prescribers don't seem to like to do this. They don't know how insurances work with prescriptions, yet they'll act like they do when something is rejected.

They also don't like when you refuse to fill a script because the person it's for is shady as hell.

Finally, the notion with prescribers that we in the pharmacy are familiar with their e-prescribing software is one of my favorites. At least once a week we get a question asking why something on their end isn't working (like not being able to find a drug or manually enter directions) and we always say we have no idea, that we're not familiar with that side of the main software.

Yet they still ask because they don't know and instead of asking IT, they ask the pharmacy.

Makes sense, no?

So the misconceptions continue, and the lack of knowledge makes things more fun for everyone.

Until next time. take your meds correctly!

Once in a blue moon

How are you all doing out there in pharmacy land?

Once again, it's been a while since I decided to sit and write some things in here in this space that was supposed to help me deal with the things that were going on.

Obviously, much has changed in the 3 years since I last posted.

My pharmacy manager is the same, but the other pharmacist is different, the previous tech I was working with is gone, and I have two new partners to help me out here.

We also have a third pharmacist here as well as two other locations staffed by new people additionally.

When I said business was booming at the end of my last post, I had no idea how much it was going to explode.

We've gone from an operation that was lucky to hit 100 scripts in a day to routinely doing 300-350 on our busiest days. We've pushed past 4,000 scripts in recent months, a testament to how busy we've become.

But don't worry; the clientele have not changed much since I joined this pharmacy 5 years ago.

Oh, and I no longer work for my other job.

We've changed what pharmacy software we use, lost our courier, had several spats with USPS over the process of mailing scripts out, and have had a few spats with some fellow coworkers when they fail to understand how a pharmacy operates.

Our drug treatment program continues to be a tremendous pain in the ass, even with a new coordinator and constant complaints about the way the pharmacy is treated in the process. We've essentially been reduced to messengers and only when we absolutely put our feet down about dispensing someone their meds to some individuals listen to what we have to say.

But, life is good in the pharmacy. The entirety of the pharmacy staff across all three locations is great. The teamwork is tremendous, and we make difficult days seem pretty easy sometimes.

So while there have been rough stretches, I absolutely cannot complain about this place and the effect it's had on my life.

I can't promise I'll be rolling out posts regularly. The idea is to utilize Microsoft Office's cloud save feature to "jot" down ideas as they come to me while I'm at work or thinking about work, then follow Dr. Grumpy's model of waiting an extended period of time before actually posting the content.

Of course, the best ideas often fail to materialize and right now I'm going through a very tough stretch of time in my own personal life.

But I want to keep this going as it can give you some insight into the day to day operations of a small, independent pharmacy in America.

Or how insane it can be.

Anyway, here's to me actually updating this occasionally and engaging readers in conversations about pharmacy and healthcare in general.