Friday, May 31, 2013

Everyone Knows!

The grocery store housing my pharmacy has an issue with their heating/cooling. I don't know all the details but apparently they have to have a NASA engineer come out twice a year and switch the system from HEAT to COOL in the summer and then COOL TO HEAT in the winter. And since they only do this twice a year, we end up suffering the latter part of each season until the switch over.

This past fall we were well past the need for the air conditioning at the store. It was cold outside and colder inside because the air conditioning was blasting out cold air all the time. For a company that prides itself on customer service, the managers weren't very impressed by patients/customers complaining about the indoor temperature. I can deal with it myself by wearing a sweater or warmer clothing under my lab jacket, but at one point I had had enough of people complaining to ME about the temperature like I have anything to do about it.

So I flagged down the next assistant manager I saw walk by (I call them Sub Commanders because the company I work for is much like the Romulan Empire) and asked him if something could be done about the temperature... and that I had received several complaints from customers, thinking that might sway him.

In all honesty, this was his reply: "When you go to the grocery store, EVERYONE KNOWS you wear a jacket!"

News to me. I swear it was so cold I saw his breath when he answered.

Wednesday, May 29, 2013

37 Tablets Missing

I fill an Rx for generic Xanax for a seriously whacked-out dude. It is for quantity 60. Because it is a controlled substance, we count them multiple times. I remembered counting these tablets because the generic has an odd shape and it is hard to count. I document on the label that I counted the prescription twice. The guy gets his medication and leaves.

Four hours later he calls me to tell me there is only 23 tablets in the bottle. I put him on hold and go to the bottle on the shelf and do a back count. The back count is spot on for what the computer says we have. I tell the guy on the phone. He says someone else must have his medication because he definitely has only 23 tablets in his bottle. He says he went straight to work, put the bottle in his desk, then when he went to get a tablet later he thought the pile of tablets looked small so he counted them and that there were only 23.

Now you know, I'll be the first to admit that pharmacists make mistakes. In most cases Pharmacists count by fives, and 99.9% of the time if there is a miscount it is either off by one tablet or five tablets. But this guy is saying I shorted him 37 tablets. So I think back to how this could possibly have happened. Just to make sure, I check ten prescriptions that were processed on the computer before he came in and ten prescriptions after. I pull every bottle on the will-call shelf and make sure all the correct medication is in the bottles that we still have on the shelf. I call the people that picked up their medication during this 20 prescription window.  Everything checks out. And like I said, I distinctly remember counting out 60 of the rectangular-shaped tablets. I counted them twice and placed a check mark on the label each time I counted them, just like I do with all controlled substances.

I explain all this to the patient. He still insists that I made an error. When I suggested that maybe someone took medication out of his desk, he says that's not possible. I asked him if he was at his desk for the past four hours. He says no, not all the time, but that he's sure no one was in his desk. Of course I have no idea how he knows this, but we're a "give the benefit of the doubt" kind of company, so I let it go.

I told him that he would have to talk to the manager. He did call the manager and a regional manager. They backed me up on what I was saying (miracles do happen). I was hoping he would transfer out the medication to another pharmacy, but instead when he ran out of the 23 tablets he insisted on a refill. I called the doc for an early refill request and explained what happened. It was approved. This time I filled the medication again, but counted to 60 three times, and documented it on the label. Then I did a back count of what we had on hand.  It checked out too.

The whacked-out guy who NEEDS to be on Xanax comes in. Would you believe he stood there at the counter and counted the tablets in front of me, and when he was done he says, "There's only 58 here!" All I could do was sigh. That's all I could muster out. Really? Seriously, dude? Do you think if I actually stole your medication before that I'm actually going to try and do it again? Is this paranoia part of the reason you're on the medication? I grabbed a counting tray and in front of the patient counted out the 60 tablets. Three times. He stood there, silent.

I still don't know exactly what happened to the 37 tablets, but I'm thinking miscounting had something to do with it, but not from me...

Tuesday, May 28, 2013

Size, Color, and Frequency

We have a patient, Mr. Staples, that has been coming to this pharmacy for several years. He is a nice enough guy, but his little quirkiness is starting to get annoying. On my first day in the pharmacy, he came in to pick up a prescription, and I was told by the pharmacy manager not to staple his bag. I thought he was kidding. No, he wasn't kidding. Mr. Staples reminded me himself as I was about to bag up one of his prescriptions. But that's not all. Mr. Staples will come to the pharmacy, inform you that he is about to pick up a prescription, then wander about the store, picking up a few items here or there and dropping them off at the edge of the pharmacy counter. Sure, that's ok, but when he's done and comes up to pay for everything, this is when it gets weird. I'll start by ringing up his prescription. Then he gets out his club card and scans it himself... then he starts scanning his own groceries which have been carefully placed far enough away so that we can't touch them. Then he bags his own groceries. Ok, so he has some issues with people touching his stuff. That's ok, I don't like people touching my food. But this is a little weird because he must know that people touched the packages at the warehouse, the delivery truck, and in the grocery when they were placed on the shelf for sale, right?

Well, that's not the end of Mr. Staples' weirdness. He loves to discuss his bowel movements, in detail. Size, color, frequency... I know all about this man. When it is slow, and he finds me there, I'm a fish in a barrel. I can't get away. I'm stuck. I have to listen to his worries about size, color, and frequency. Although I'm a pharmacist, he sees me as a healthcare professional who can diagnose the meaning of various sizes, colors, and frequencies, despite the fact that my replies like "What does your doctor say?" and "I don't know what to tell you" doesn't seem to sway him a bit from continuing. I've worked out a system with my technician that after five minutes, she goes to the other end of the pharmacy and calls the pharmacy phone number using her cell phone so I can break free. But if I'm alone... fish in a barrel.

Mr. Staples is very concerned about his sleep. He's a regular user of generic Ambien. Ambien is a nice little controlled substance hypnotic that induces sleep extremely well. Hence, the name... AM for "morning" and BIEN (Spanish for "good") -- translation "morning good." Not all drugs are named so well. Ambien has been available as a generic for years now. It is called Zolpidem. Zol is for "Morning" in Swahili... naw, just kidding. Anyway, the package literature says that you should only use Ambien/Zolpidem for no more than a few months because it is habit forming. Well, apparently doctors don't care because most people on the drug have been on it for YEARS. Mr. Staples is no different.
Among Mr. Staples' phobias, he also suffers from some sort of fear that he's going to run out of his sleep aid. He has on hold at our pharmacy one good fill of a 30 day supply ready to fill at any time. He sees his doctor regularly (but somehow forgets to discuss size, color, and frequency) and gets extra prescriptions that he keeps in his "hip pocket" just in case. He has felt a need to remind me of this several times. Just in case of what, I don't know. He also keeps a quantity of 90 at home at all times... you know, just in case there is a disruption in the supply chain or something. (If there is a disruption in the supply chain, how are the written prescriptions in his hip pocket going to help?)

Recently Mr. Staples came in to fill another quantity of 30. He does his own drug rotation at home, using the 30 he obtained 60 days ago, thus keeping his stock fresh. Well, he discovered that the quantity we filled 60 days ago was from another manufacturer (which we likely explained in detail 60 days ago). After taking ONE tablet and not falling asleep in 15 minutes, he said he had to "chew off" part of another tablet to fall asleep. Therefore he's not happy with the generic he obtained. Pharmacies shave a few bucks here and there by going with the lowest price on a continual basis. Generics are FDA approved one to another, but Mr. Staples is not convinced. He doesn't like the generic we dispensed him 60 days ago. There is nothing we can do about it now except give him (at a loss to the company) a quantity of our current generic, which he is also squinting his eyes at me about.

Fortunately, the current generic Zolpidem incident of 2013 has avoided my having to discuss size, color, and frequency... for today.

Monday, May 27, 2013

Happy Memorial Day

The Secret of Happiness is Freedom,
and the Secret of Freedom is Courage

Saturday, May 25, 2013

Be a Pharmacy PRO

From the Frantic Pharmacist:

In the endless procession of people we wait on at the pharmacy every day, I have come to truly appreciate the Pharmacy Pro. I'll give people a pass for their first couple of visits (maybe) but after that, well ----  these are the true marks of you, the Pharmacy Pro:

1. You hand me your prescription insurance card with the prescription, or in the case of an e-prescription, when you check in. Each and every time. Even if you've been to the pharmacy 40,000 times before. It's the newest and most current card. It's not your dental or medical card. If the prescription's for a family member, you give me their card, not yours. I already love you for that.

2. You are acutely aware of your surroundings. If the place is going crazy and there are lots of people waiting, you say "I'll stop back later." If you know you have multiple prescriptions, you do the same regardless. I love you for that.

3.  You are aware, at least generally, of what your doctor has sent us. If there are things you don't need filled, but just kept on file, you tell me up front. I love you for that.

There's more... Read the rest of the article HERE.

Friday, May 24, 2013

COOL GADGET: Biolite Campstove CHARGER

This is WICKED cool! 

The BIOLite Campstove Charger

Charge your iPod or other USB device while you cook! This can be great for a Prepper or anyone wanting some iPhone/iPod juice out in the middle of nowhere. That's a nice charging unit to have to charge your device(s) if the sky is overcast and/or solar options are unavailable.

What will the BioLite CampStove charge and how quickly will it do it?

The CampStove is compatible with most devices that can be charged through a standard USB port. This includes cell phones, smartphones, MP3 players, LED flashlights, headlamps, and rechargeable battery packs, among other devices. Please note that not all manufacturer’s products may be included.

Charging times vary by device, as well as by the strength of the fire and other variables like outside temperature. For an Apple iPhone 4S (2G), 20 minutes of charging with a strong fire can provide you with 60 minutes of talk time.


Here's the link to the BioLite Wood Burning Campstove

Watch the video for a demonstration:

Thursday, May 23, 2013


I'm a pharmacist and I take medication. I remember to take my medication. But that's just me. I have family members that have a hard time remembering to take their medication. I even know of other pharmacists who have a hard time remembering to take their medication.

That might change. There is a NEW wireless medication bottle by a company called Adhere Tech (that's for ADHERENCE to your medication regimen) which is crafted with technology to help improve medication adherence. According to reports, this container can somehow measure the number of tablets/capsules inside the bottle and send that information via cellular technology to the Internet. In other words, it will tweet, email. instant message, call you via phone, or send a text to let you know the status of the medication, letting you know if you've taken your meds or not.

The software will also keep track of how well you're adhering to your medication regimen and keep a log of data you can share with your doctor or Medication Therapy Management profession (your pharmacist). By keeping track of how well you're taking your medication and increasing that adherence, this is sure to reduce hospital visits and increase overall health of the patient.  

When this will be available to the public is unknown at present, but this is the website to check: The Smart Pill Bottle

Wednesday, May 22, 2013

It is a Good Day to Die

In Klingon that's "Heghlu'meH QaQ jajvam.."

WHO are these people that have time to make up a language and a ONLINE TRANSLATOR to translate any language into Klingon? Seriously... I  barely have time to shave in the morning. I squeeze in some blogging here and there where I can, but in no way would I ever have the time for this kind of undertaking.

Of course... maybe that's why this happens:

"Will not kill you for food" translates in Klingon to "wej bIHegh Soj."

Tuesday, May 21, 2013

Strange Assumptions

A lady appears at the DROP OFF window. They materialize there like being beamed in from the Enterprise.

"Hello, how may I help you?"

"Yes, I just moved into the area and I want to PICK UP my medications." (She's at the DROP OFF window... and you know how I feel about that).

So I'm thinking she's been in already and talked to my pharmacy partner Mickey and he took care of the transfers already. I ask for her name.

"Myscript Automatic."

"Ok... let's see here..." I type in her name on the computer. Nothing. I ask for her birthday. Nothing. I verify the name and date of birth again. Nothing.

"I don't have you on the computer. Did Mickey get your information?"

"Who's Mickey? I just moved here. I want to pick up my medication."

"Well, Ms. Automatic, uh... I don't have you on the computer. Have you filled with [our chain] before?" I ask.

Ms. Automatic rolls her eyes. "Noooo, I filled my prescriptions with [national competitor] in [another state]." She's getting perturbed. "Why don't you just look me up on the computer and fill my prescriptions now?"

So now I have a clue what's going on. This is yet another patient that thinks all pharmacies are connected together and that you can step into any pharmacy anywhere and get your prescription any time.

I do my best to explain that no, there isn't "one" pharmacy patient/customer database shared by all pharmacy competitors and that I'll need to contact her old pharmacy and transfer her prescriptions to our pharmacy. I tell her this isn't something that happens instantly and I'll need time to actually do it.

Ms. Automatic rolls her eyes and this time sighs strongly. "But I was on AUTO REFILL at my old pharmacy. Don't my refills automatically transfer to my new pharmacy?"

This time I sigh. I try to think for a moment how I might explain this in a way which might be brief and make sense. I can't think of a way, so I just tell her, "No, I'll need to talk to your pharmacist back in [another state]."

"Ok, then I'll be back!" Ms. Automatic is a good 30 feet away from me before she hears me calling her back to the pharmacy.

"I need the name of the pharmacy and their phone number if you have it."

More eye rolling. "Really? Didn't it come up when you typed in my name and birth date?"

I give up. Seriously. May I remind you that THESE PEOPLE VOTE!

Monday, May 20, 2013

Melvin McReedy

Melvin has been coming to this pharmacy for many years. He's quite a guy. He's about 70 years old, always dressed in medical scrubs (although does not work in a medical field -- he's retired), and smells bad.

Melvin has been developing Alzheimer's disease for several years. As the disease gets worse, Melvin gets angrier and angrier. He does one of two things. He'll call in a medication for himself, dutifully typing the Rx number on the phone pad (you have to give him credit for that -- too many people just can't seem to do that), and then select a time for pick up. It will pop up on our computer and we fill it. Then it will sit there, on the shelf, day after day, until we call him. He then gets mad and tells us he never called it in.

The second thing he likes to do is show up to pick up a medication he apparently forgot to phone in, and then proceeds to get mad because it is not ready for him to pick up. Swearing is Melvin's favorite pastime because he sure lays it on us a lot when things don't go his way. He works with nasty words the way other artists work with oil and canvas (obscure movie reference -- do you know the movie?). I cringe when I see him because I never know what is going to come out of his mouth. It took him a good two years to learn my name but now he has it down and I've finally earned his trust, but he'll still go off like a gunshot if you don't have what he wants when he wants it.

A few years ago the company developed an addition to our computer system called Auto Refill. Just as the name implies, it will automatically print labels for patients two days before they (normally) run out of medication. This is a brilliant system, win-win for both patient and pharmacist. For the patient, they don't have to do any thinking... just come in when you run out of your medication and it is there on the shelf waiting for you. If you forget after a few days, the system automatically calls you to remind you. Plus, if you are out of refills, it will automatically fax the doctor for a refill, providing seamless drug therapy. For the pharmacist, it prints out a stack of labels two days ahead of time and we can fill them during down times in the pharmacy. And the BEST feature is that people who for whatever reason are afraid to type in their Rx number when they dial the pharmacy and then get connected to the pharmacist/tech and bug us during business times; now they don't have to bother. [Oddly enough, it's TOO CONFUSING for some people...]

Now since this system was developed, I have talked to Melvin at length about how he doesn't need to call in his Rx anymore. I told him we can put him on Auto Refill and he can just come in and get it when he runs out. He liked the idea and agreed, then promptly forgot all about our conversation. Thirty days later he called in to type in his Rx and the computer told him he couldn't get it for another 30 days (because it was waiting for him on the shelf) and he would get angry. The first time this happened he came in and screamed and swore at my tech. She told him he was on Auto Refill. More swearing, then telling us he didn't want any part of this Auto Refill nonsense and hell this and damn that. I promptly took him off Auto Refill. Then about 30 days later he came in and asked for his medication. When I told him I would need to fill it, he immediately started swearing asking why it wasn't on Auto Refill and what was wrong with our F---ing damn computer, hell this and damn that.

Auto Refill and Alzheimmer's disease. Take my advice: Don't mix them.

Saturday, May 18, 2013

Pointing out the Silliness

It's just silly, really.

Go to this Website

Move your mouse.

A picture will pop up with a finger pointing to where your pointer is on the screen.

It's just silly.

But fun.

Friday, May 17, 2013

Attention Pharmacy Students!

This would have been really handy when I was in pharmacy school... a better way to solidify pharmacy facts in your head: 

Spaced Repetition Learning (SRL)

Research on memorization shows that the best time for a new fact to be remembered, “cementing” it in memory, is often just before it is about to be forgotten.  Based on this discovery, ideal repetition sequences have been mapped out: a new fact memorization might best be first practiced several minutes after the first time, then several hours, a day, several days, several weeks, several months, etc.  At a point which will vary based on the individual, the fact has been permanently memorized and will never be forgotten, even with very rare reminders.

SRL software implementations include eSpindle Learning, Flashcard Exchange, Course Hero, Memrise, Mnemosyne, Skritter, SuperMemo, Winflash, and OpenCards.

See the original article HERE.

Thursday, May 16, 2013

Digital Tablets -- Dangerous for Eyes?

A recent article suggests that digital tablets and iPads might be hard on your eyes.

People who use computers regularly for prolonged periods of time can often suffer from eyestrain. When the eye muscles work harder and become strained, resulting in dry, tired eyes and headaches. Smaller screens means that text is crowded into a smaller area and then the eyes need to work harder to read it. To avoid eyestrain, experts recommend to limit the amount of time you spend using the tablet, especially for reading. 

For gamers, research suggests that aspects of vision could be improved. When playing an action or adventure game, the player needs to focus and demonstrate coordination with spatial awareness and fast reactions. For regular players, these skills gained might be transferred to real life, particularly in tasks such as driving and sports. Quickly recognizing a target or an enemy in a game could improve the ability to see hazards on the road.

Whilst there is valid evidence to support both points, it seems clear that the digital technology can be used to your advantage to improve coordination, contrast sensitivity and even reading skills. As the digital tablet revolution seems set to grow and prosper, it’s important to use the device with caution. Limit the time you spend on your tablet and take regular breaks to reduce the risk of eye strain or dry eyes.

Wednesday, May 15, 2013

Store Communication Fail

A true story from @surveyor53 on Twitter:

Heard on overhead speaker:

"Price check on Tampax please..."

A few minutes pass... the courtesy clerk thought he heard thumbtacks, not Tampax and replies:

"Please clarify price check - is that for the ones you press in with your thumb or the ones you drive in with a hammer?"

Thanks to 44spl @surveyor53 on Twitter for permission to share...