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!