Blogging and privacy

I haven't blogged in two months due to some concerns about my privacy. The issue seems to have resolved itself.

I have been taking more home call after hours lately, and I have been getting some really stupid, annoying phone calls. I got paged last night because someone wanted to know when their delivery was going to arrive the next day. I have no idea! The after hours pager is supposed to be for emergencies only, but my definition of emergency seems to be very different than others. The patient gets a delivery every Monday between 10 am and noon. It has been the same way for the last 3 months. He still paged me "just to make sure". I hate hearing my phone ring now.

DSI in the workplace

I had dinner with my husband's family last week. We went out to this Italian place, and my father-in-law (another pharmacist) ordered this really, really large calzone. He couldn't finish it and decided to take it home. "That will make a great lunch at work tomorrow," I said to him. He looked at me and said, "I don't get to take a lunch break. I work a 13 hour shift, and they don't send me any coverage. I can barely take a bathroom break."

He just took a job with a different company that promised great working conditions and the highest salary I've ever heard of in retail. $57 an hour. He tried to get me to consider them when I was looking for a new job, but I thought it sounded too good to be true. Turns out, it was. Yes, he gets paid a lot, but he is expected to do 250 prescriptions by himself, with one technician. I'll take my lower pay for the uninterrupted lunch break that I get each day.

His company sounded great in the interview and pitch, promising the dignity, integrity, and self-respect that The Pharmacy Alliance is working for. I see no DSI in the workplace when a pharmacist--a so-called "professional"--is not even allowed a bathroom break and is expected to crank out a dangerously high number of prescriptions by himself.

My father-in-law is counting the days until he retires.

Seroquel's new indication

The funniest order of the day had to be: "Increase Seroquel to 100 mg bid. Resident is still throwing bananas at staff."

It would probably be easier to stop giving her bananas.

Career goals

I have decided, at the urging of a coworker, a former professor, and a few posters here (thanks anonymous!) to look in to some advanced certification. I've am going to pursue the CGP certification, which stands for Certified Geriatric Pharmacist. My boss seems to be on board with my goals and seems eager to help me. He built me a set of shelves for my reference materials, which I thought was a very nice gesture. I think he got tired of hearing me say, "I know exactly how to answer this question...with a book that is at home."

I had a very satisfying conversation with a doctor regarding a patient with Oxycontin issues. I had documented the issues with an expanded SOAP format, detailed my conclusions and recommendations, and he personally called me (vs. having his nurse deliver the message) that he agreed with all my conclusions on the patient, and he thought my recommendations were sound. We are starting weekly dispensing, because monthly allows her to get in to too much trouble, and he is going to re-evaluate her whole medication profile because her medications are seriously affecting her cognition. She loses track of time, forgets whole conversations that she has had, etc. He also told me that she is diagnosed with Borderline Personality Disorder. We seem to have come to a workable solution, at least for the time being, and we will re-evaluate in a few weeks to see how it is working.

I really felt like he viewed me as an equal to him, and he was speaking to me as another professional who was trying to help his patient, and who was privy to different information than he usually is. One of my technicians had been working near me, and was somewhat listening to our conversation. When I hung up with the doctor she remarked, "Wow...you sounded SO professional. You did such a good job! I wish [boss] had been here to hear that!"

I felt pretty good hearing that.

Update on the Board

The facility administrator decided that he overreacted and is not going to pursue action with the Board against my pharmacy. My boss had a meeting with him and they sorted things out. I'm relieved.

I've been working a lot of hours lately. I'm building up a clinical library, working on updating some policies and procedure manuals, etc.

I really don't have any good stories that I can share. I don't have much to post about anymore.

The State Board

Has anyone ever been reported to the state board of pharmacy for a medication error? I was informed today that a caregiver is planning to file a report with the state's board of pharmacy about a dispensing error. He thinks I did it, because I was the one who ended up discovering the error, but I wasn't involved in the original issue. I wasn't on that patient's care team that particular day.

What can I expect if the board of pharmacy decided to investigate the issue?

Where did this come from?

Hubby must have had a slow night at the hospital. When it's calm, he surfs the web. He came home and says to me, "Remember how we were talking the other day about installing a stripper pole in your exercise room?"

We were NOT. We saw some random reference about pole dancing for exercise and he has become convinced that I should try it.

"Well, I found a website where you can purchase a stripper pole. It's only about $300, and includes an instructional DVD and a safety mat in case you fall while practicing that upside-down spin."

Husband is now bent on convincing me that installing a stripper pole in my exercise room is a wonderful idea. "It would be a good way for you to relax when you come home from work!" Yeah, sure, I would love to come home and work a pole, learning that upside-down spin. And if I fall off? "Well, that's what the safety mat is for!"

Should I let him order it?

ESPN and pharmacy

My husband does not frequently send me email links to ESPN articles. Today, however, what shows up in my inbox? A link to this: http://sports.espn.go.com/ncb/columns/story?columnist=oneil_dana&id=3462805

Eutectics, Preachers face off in unknown St. Louis hoops

That's right. The St. Louis College of Pharmacy has a basketball team, and the name is the Eutectics.

Many do come to school and many do come out for the basketball team, at least for a while. The tricky part is keeping them. As the academic demands kick in, the Eutectics suffer a yearly roster reduction that Tom Crean could appreciate at Indiana.

"One year we ended up with eight [players], and two of the guys had never really played, so we were going six deep," said Boyer, a one-time team captain. "Playing time is normally not an issue here."

So if you go to an open house there, and say you'll play basketball, are you automatically admitted? That could be a really promising strategy.

Less than 2 weeks

My intern took his last exam yesterday. He's already passed two of them, and is just waiting now on NAPLEX results. I think he's going to be an amazing pharmacist. Very bright, willing to pull more than his share of the work, and extremely detail oriented. Last week, I had a rotten project dumped on my desk with only 2 days notice to get profile reviews done for 70 patients. The intern says to me, "I'll do it, if you want." Really? Seriously? You are VOLUNTEERING to take on a shitty project that may take all day?? I love you.

The project didn't take all day. It took two full days. This poor guy was reconciling orders from physicians with our profiles. He was supposed to just be checking that the medical records clerk had already reconciled them correctly, but as he said, "Did she even LOOK at any of these? They're totally different!" He also caught a bunch of spelling errors in directions and other random things. PRNs marked as scheduled and vice-versa. He's frustrated though, with how complex our operation is. I really hope he doesn't quit. My new goal is to keep my intern/soon to be new pharmacist colleague very happy.

The patient is lying, or how I spent 2 hours of my day

My workplace has different teams that you rotate though. Yesterday I was on the homecare team, dealing with patients we make med boxes for. The boxes are delivered once a week, and it's usually a relatively easy rotation.

Unless Sybil calls.

We open for business at 9 am. She started calling at 6:30 am, leaving message after message on the voicemail about how there was no Zyprexa in her med box that had been delivered two days prior. She left a message every 20 to 30 minutes. "I've been waiting downstairs in the lobby, why isn't the driver bringing me a new box?" To make a very long story much shorter, the technician manager finally decided to make up a new box, go out to her place to see what was actually in the box she had just received, and wanted me to go along to perform an assessment of what she was actually doing with these tablets.

She tried to just take the new box from us, but I asked her to go to her apartment and get her other box. It was practically empty. Few tablets of Zyprexa left (the one she told the voicemail she was "completely out of", no Depakote, no atenolol, few Soma, etc. Clearly, the box had been tampered with and she had removed many of the medications. The boxes are checked by at least two different people, usually three, so for more than half of the meds to be missing when she received the box is highly unlikely. I asked her what she did with them. "I couldn't sleep so I took more sleeping pills, but the other ones weren't there!" Tech manager asked if she ever takes anything out of the box to put in a different container. "no...." with a shifty eyed glance. Sure. Right. We totally fucked up the box.

We exchanged the boxes, showed her exactly what was in each slot and she acknowledged that it was right. On the way back to the pharmacy, tech manager and I were trying to brainstorm a way to keep her from tampering with her med boxes and lying about meds not being in there. Her insurance doesn't reimburse us for extra tablets dispensed because the patient misuses them, but due to her particular plan, we can't send her a bill for them. We discussed the option of a disposable med box, which has individual blisters for each dose where tampering is evident, but she could obviously still get in there.

When I got back to the pharmacy, I did meticulous documentation of what had been removed and called her psychiatrist to discuss. He said to me, "You're doing what you can, but she had to use it correctly. Don't send any more replacement boxes. If she's hoarding meds, she won't go without, and if she feels she needs a higher dose she needs to call me. She's only to get one box a week." I think I love him. Of course, that won't stop the constant phone calls of her insisting that we filled her box wrong, and what is she supposed to do she hasn't slept in FIVE days (though it varies from three to ten depending on what part of the day you speak with her).

Sybil has been discharged from at least three pharmacies. The way I understand it, Walgreens refused to help her anymore because she kept accusing them of shorting her tablets. The local independent tried his best, but she would claim that he took her money and gave her no bottle, even when he showed the signature log where she had clearly signed that she was picking it up. The last place she was at was similar to my location, and they got so fed up with her constant demands that they refered her to us. We need to come up with something better, because I don't think she has anywhere else left to go.

Any suggestions? This one patient is taking up a substantial amount of my time. I don't know whether she's lying on purpose or whether her mental health issues are so severe that she can't handle managing her own meds, even with a pre-filled med box being provided.