Ask the Pharmacy Management Consultant™

[ZpackSux]

This thread will answer questions pertaining to health systems pharmacy management. I believe the opportunity in pharmacy administration is tremendous for those ambitious pharmacy students and pharmacists. Complacent 9 to 5 wishers and retail questions need not reply to this thread!

[tussionex]

i'm interested in medical informatics...may i join the thread?
i don't sux...

[sdn1977]

OK - I'll be one of the first to ask you a question.....

What are your methods for convincing "change" within a pharmacy dept?

I don't want to know about the hospital itself (altho others might.....P&T, dept meetings, etc...).

I'm more speaking to the really "easy" stuff that pharmacists lets "slide".

For example, in a hospital.....the clinical manager identifies a drug that should have parameters documented - lets take your very favorite - Xopenex rather than albuterol. OK....the very best way is for the clinical manager & dop to get to P&T & have a whole dept policy. But, in the absence of that.....how to get pharmacists to be strong enough, professionally, to address each order as it arises.

We can translate that to the retail setting (altho I know you don't want to) - Norvasc & Ambien have just become generic. Medicare Part D will pay $3.10 for a brand & $1.00 for a generic (if dual Medicaid/Medicare coverage). So - these little folks still want brand name, but it costs the pharmacy a bundle.

I know my own methods of getting the change to happen.....I just have trouble getting other pharmacists to "buy into" the change & want to be involved. Their feeling is - well, its not their dime, so if the pt wants it - so what???

Motivating staff is hard - heavy handedness is not effective. Any ideas???

[ZpackSux]

Originally Posted by tussionex

i'm interested in medical informatics...may i join the thread?
i don't sux...

Yes you may!

[ZpackSux]

Originally Posted by sdn1977

For example, in a hospital.....the clinical manager identifies a drug that should have parameters documented - lets take your very favorite - Xopenex rather than albuterol. OK....the very best way is for the clinical manager & dop to get to P&T & have a whole dept policy. But, in the absence of that.....how to get pharmacists to be strong enough, professionally, to address each order as it arises.

The staff pharmacists are set up to fail if they have to perform interventions on their own without a protocol to back them up. That being said, a journal club between pharmacists or constant education should be provided to the staff. I used to throw journals, articles, and pharmacy financials around the pharmacy...staff thought I was just sloppy and was leaving things around everywhere. I wasn't. What I threw around, they read.

Education, Confidnece, and Interventions go hand in hand.

Originally Posted by sdn1977

We can translate that to the retail setting (altho I know you don't want to) - Norvasc & Ambien have just become generic. Medicare Part D will pay $3.10 for a brand & $1.00 for a generic (if dual Medicaid/Medicare coverage). So - these little folks still want brand name, but it costs the pharmacy a bundle.

I know my own methods of getting the change to happen.....I just have trouble getting other pharmacists to "buy into" the change & want to be involved. Their feeling is - well, its not their dime, so if the pt wants it - so what???

Motivating staff is hard - heavy handedness is not effective. Any ideas???

Leadership! You need to let the staff know that they have choices..and can indeed choose the attitude they bring to work. Let's be honest. Every job in the world becomes mundane after a while..and becomes stagnant. A pharmacy is the playground we play in. Instill play ethics into your work...and make our customers day everytime we interact with them.

Put up a daily Menu in the pharmacy. An Attitude Menu that each staff can choose. Make sure "angry" or "stressed out" is not on the menu. And the item they select, they are accountable for it throughout the day. Cheesy you say? Goes great with wine.

[trx]

How do you develop a team of motivated employees that want to be actively involved in keeping the pharmacy running, instead of merely doing what is their job only (if lucky) and nothing else. Some people are quite content with doing what they think is on their limited list of job duties and do not care about helping others out for the good of the pharmacy as a whole. It's so frustrating and I feel like I'm asking too much from people by asking them to care enough to "step outside the box" for a moment (of course they should be rewarded even if the least is some praise and acknowledgment and appreciation, rather than be taken advantage of).

Sorry that you have to be the object of my frustration but thanks for letting me use this response as an excuse to rant.

[ZpackSux]

Originally Posted by trx

How do you develop a team of motivated employees that want to be actively involved in keeping the pharmacy running, instead of merely doing what is their job only (if lucky) and nothing else. Some people are quite content with doing what they think is on their limited list of job duties and do not care about helping others out for the good of the pharmacy as a whole. It's so frustrating and I feel like I'm asking too much from people by asking them to care enough to "step outside the box" for a moment (of course they should be rewarded even if the least is some praise and acknowledgment and appreciation, rather than be taken advantage of).

Sorry that you have to be the object of my frustration but thanks for letting me use this response as an excuse to rant.

Sometimes you can't change the world. But you can always give your best and pick up where others slack off. Why? Because you care.

I remember years ago when I was a clinical coordinator.. I was done with my work..and was in my office. But it looked really busy in the pharmacy..so I went out and told the pharmacists.."hey..let me help you catch up..." So one pharmacist sez.. "Really??..Thanks..." Then he proceeded to put his feet up and started to read the paper... I should have whacked him on the head but .. I look back and now think that was really funny.

Try giving it a 110% for the next few months...help others. Let's see if they'll follow your new found attitude and energy. Positive energy can be contagious. And it can certainly start from you. And I promise you'll be recognized, praised, and rewarded.

[sdn1977]

My experience is a bit different.....altho just as rewarding..

My own experience is that I was not necessarily recognized at the time, rewarded at the time, praised at the time...in fact - you can oddly be criticized & at times ostracized at the time. It takes a strong person & personality to separate yourself from the situation & the end result.

Your reward system is something you have to build within yourself. If you work with a great management staff - they'll reward you. But, if not - your contributions may go uncommented, but not unnoticed. Thus, you might get a great LOR for some other position.

Likewise, when the pharmacists are criticizing (sp? - I just can't get that word tonight!) you because you're not having to send up yet more DSS or zolipidem, etc..for the pyxis....if you've "pitched in" as Zpak suggested - it will come back to you. It may not be for months or years. It may also not even be with the same staff. But, your reputation for willingness to help out when the pinch is on will be remembered.

Now Zpak - you were one of the very few dops I've ever experienced who was willing to take a shift. Comment on that......learning how each shift operates, what the problems are, what policies don't work on all shifts or on weekends.....how do you take the "ideal" & make it practical???? Why is it important to do that?

Likewise, have you any comment on how to encourage new pharmacists to build in their self-reward system (for lack of a better term)? I've got my own thoughts, but his is your thread.......

[tussionex]

i have two DOPs, actually [ i work part-time at a second hospital]

one DOP will cover any shift...including the IV room and the overnight, is accessible to staff if needed, and encourages pharmacists' autonomy.

while the other holes himself in his office all day and is virtually incapable of slingin' hash alongside the rest of his staff...while being a control freak, and not allowing any creative thinking among his staff.

whose staff respects who more?

[trx]

What should I do to prevent myself from being a disgruntled, dissatisfied, unhappy employee (the details of my situation/problem are below)? I have an idea of what kind of pharmacist leader I do NOT want to be, but right now, I'm a frustrated employee who is trying to stay optimistic and hopeful despite working with people who really do NOT look like they are remotely enjoying their jobs (wiping shelves in the back of the pharmacy instead of counseling patients )? It is hard to stay optimistic when I am looking up to these pharmacists.. and I realize that they are not satisfied with the non-monetary aspects of their jobs. It's also sad to see that the techs and some interns also mutter negative things under their breaths, too.

I would love to TRY and initiate change and create a better working environment and motivate my peers like the ideal example I've seen from my wonderful hospital rotation.. however, it's frustrating when I'm new and not confident and still learning without much guidance.

Any comments? Advice? Ideas for change?

ps If you even got this far, my story is that I'm interning in a retail pharmacy and am very frustrated because I do not feel like I've been trained adequately. The pharmacy manager who actually does care about advancing the profession and producing an army of competent pharmacists from interns is the only full-time staff pharmacist who is more than willing to train me... but I do not always get to work with him, and when I do, there's not always enough free time for me to be trained in other aspects besides filling prescriptions. The only other full-time pharmacist would rather dust and wipe shelves than train me, let alone answer my questions willingly. I am not expecting people to hold my hand and train me step- by- step so I am trying to learn all of this by myself. I just hope for some positive leadership...

[ZpackSux]

Originally Posted by sdn1977

My experience is a bit different.....altho just as rewarding..

My own experience is that I was not necessarily recognized at the time, rewarded at the time, praised at the time...in fact - you can oddly be criticized & at times ostracized at the time. It takes a strong person & personality to separate yourself from the situation & the end result.

Your reward system is something you have to build within yourself. If you work with a great management staff - they'll reward you. But, if not - your contributions may go uncommented, but not unnoticed. Thus, you might get a great LOR for some other position.

Likewise, when the pharmacists are criticizing (sp? - I just can't get that word tonight!) you because you're not having to send up yet more DSS or zolipidem, etc..for the pyxis....if you've "pitched in" as Zpak suggested - it will come back to you. It may not be for months or years. It may also not even be with the same staff. But, your reputation for willingness to help out when the pinch is on will be remembered.

Now Zpak - you were one of the very few dops I've ever experienced who was willing to take a shift. Comment on that......learning how each shift operates, what the problems are, what policies don't work on all shifts or on weekends.....how do you take the "ideal" & make it practical???? Why is it important to do that?

Likewise, have you any comment on how to encourage new pharmacists to build in their self-reward system (for lack of a better term)? I've got my own thoughts, but his is your thread.......

There were many different reasons why I staffed.

1. Lead by example
2. Learn what really goes on each shift
3. Get to know other hospital staff and show them we appreciate them
4. Opportunity to work with everyone in the pharmacy
5. Teach and show other pharmacists that it's ok to do outrageous interventions and write SOAP notes on the chart
6. Most importantly, working a shift allowed me to take some days off during the pay period.

Working with pharmacists allowed me to teach some of the less confident pharmacists how to renal dose, IV to PO..antibiotic streamline...PK dosing etc. Believe it or not...you'll be surprised to know many disgruntled pharmacists deep inside want to do more than just distribute. But sometimes they just don't want to admit the lack of clinical skills to others.

I used to always say to them, "hey..I know you know how to do this...but this is how I do it..."

And when working a shift... I tried to make at least one delivery..not to a delivery room...but to the nurse who called for a med. The nurse usually has no clue who I am... and will ask my tech on the next run.."Hey..who's that good looking guy that brought me the med?" "Oh..he's the director...and happily Married!"

To be honest, yeah..it would be much easier to just work 9 - 5 and sit in my office. But to me, that would be the worst way to run a department.

[ZpackSux]

Originally Posted by tussionex

i have two DOPs, actually [ i work part-time at a second hospital]

one DOP will cover any shift...including the IV room and the overnight, is accessible to staff if needed, and encourages pharmacists' autonomy.

while the other holes himself in his office all day and is virtually incapable of slingin' hash alongside the rest of his staff...while being a control freak, and not allowing any creative thinking among his staff.

whose staff respects who more?

Hmmmm... that's a complicated question to answer. You just stumped the PMC.

[ZpackSux]

trx,

You have choices in life. And you're asking the right questions. Obviously you don't want to become an unhappy and disgruntled pharmacist. That's good.

Next time you're at work, try the following. Ask the tech and the pharmacist:

What da heck you doing? Can you show me?

More importantly, if your personality is introverted...fake it and become an extrovert...easier said than done.

If I was at a gloomy retail pharmacy where everyone was unhappy and not willing to teach anything, I would grab a bottle of Dulcolax and jump on top of a counter and yell..."I swear..I'll take the whole bottle of this and release a fast blast on the floor if you guys don't teach me anything!"

But then again, that's just me and I can get away with it.

[sdn1977]

Originally Posted by ZpackSux

There were many different reasons why I staffed.

1. Lead by example
2. Learn what really goes on each shift
3. Get to know other hospital staff and show them we appreciate them
4. Opportunity to work with everyone in the pharmacy
5. Teach and show other pharmacists that it's ok to do outrageous interventions and write SOAP notes on the chart
6. Most importantly, working a shift allowed me to take some days off during the pay period.

Working with pharmacists allowed me to teach some of the less confident pharmacists how to renal dose, IV to PO..antibiotic streamline...PK dosing etc. Believe it or not...you'll be surprised to know many disgruntled pharmacists deep inside want to do more than just distribute. But sometimes they just don't want to admit the lack of clinical skills to others.

I used to always say to them, "hey..I know you know how to do this...but this is how I do it..."

And when working a shift... I tried to make at least one delivery..not to a delivery room...but to the nurse who called for a med. The nurse usually has no clue who I am... and will ask my tech on the next run.."Hey..who's that good looking guy that brought me the med?" "Oh..he's the director...and happily Married!"

To be honest, yeah..it would be much easier to just work 9 - 5 and sit in my office. But to me, that would be the worst way to run a department.

I just knew you'd say this!

Look at my comment in the clinical thread.....it refers exactly to what you are illustrating here - the need to lead by example & side-by-side.

Oh....and your comment about "that good looking guy"....means nothing without pics

Right back at ya!

[sdn1977]

Originally Posted by trx

What should I do to prevent myself from being a disgruntled, dissatisfied, unhappy employee (the details of my situation/problem are below)? I have an idea of what kind of pharmacist leader I do NOT want to be, but right now, I'm a frustrated employee who is trying to stay optimistic and hopeful despite working with people who really do NOT look like they are remotely enjoying their jobs (wiping shelves in the back of the pharmacy instead of counseling patients )? It is hard to stay optimistic when I am looking up to these pharmacists.. and I realize that they are not satisfied with the non-monetary aspects of their jobs. It's also sad to see that the techs and some interns also mutter negative things under their breaths, too.

I would love to TRY and initiate change and create a better working environment and motivate my peers like the ideal example I've seen from my wonderful hospital rotation.. however, it's frustrating when I'm new and not confident and still learning without much guidance.

Any comments? Advice? Ideas for change?

ps If you even got this far, my story is that I'm interning in a retail pharmacy and am very frustrated because I do not feel like I've been trained adequately. The pharmacy manager who actually does care about advancing the profession and producing an army of competent pharmacists from interns is the only full-time staff pharmacist who is more than willing to train me... but I do not always get to work with him, and when I do, there's not always enough free time for me to be trained in other aspects besides filling prescriptions. The only other full-time pharmacist would rather dust and wipe shelves than train me, let alone answer my questions willingly. I am not expecting people to hold my hand and train me step- by- step so I am trying to learn all of this by myself. I just hope for some positive leadership...

OK - I can come up with a couple. But, first, tell me - are you a pharmacist or an intern? If you're an intern, are you there on a rotation or as an employed intern?

Those are important first off because they set the stage for how you are viewed from your colleagues point of view.

My obligation to an intern on a rotation is one of teaching as well as exposing them to the work environment.

My obligation to an employed intern is just to have them there as an employee in so far as to how much they can do, legally - tech vs intern.

But....give me your circumstances & I'll give you some pointers. We'll just ignore Zpak because he initially said he didn't want retail comments, but he'll be spending the rest of the day in the bathroom with that whole Dulcolax thing......

And - this is real life & pharmacy management systems eventually need to interact completely with each other - both inpt & outpt, which sadly they don't even come close to doing!!!

This is a HUGE fault of our health care system as it relates to pharmacy. Those of you who are not just health care system pharmacists, but computer software gurus need to work on a national level to get all these pieces tied together. Yeah...this will require huge lobbying nationally - a whole different topic & thread - we'll leave it at that & just hijack this one for a bit for your retail issue.

Tell us when you feel better Zpak & we'll get back to hospital systems..

[ZpackSux]

Originally Posted by sdn1977

I just knew you'd say this!

Look at my comment in the clinical thread.....it refers exactly to what you are illustrating here - the need to lead by example & side-by-side.

Oh....and your comment about "that good looking guy"....means nothing without pics

Right back at ya!

Funny woman!!!

[tussionex]

Originally Posted by ZpackSux

Hmmmm... that's a complicated question to answer. You just stumped the PMC.

can you guess who I respect more?

[ZpackSux]

Originally Posted by tussionex

can you guess who I respect more?

Yes I can!

[trx]

Originally Posted by ZpackSux

trx,

Next time you're at work, try the following. Ask the tech and the pharmacist:

What da heck you doing? Can you show me?

More importantly, if your personality is introverted...fake it and become an extrovert...easier said than done.

If I was at a gloomy retail pharmacy where everyone was unhappy and not willing to teach anything, I would grab a bottle of Dulcolax and jump on top of a counter and yell..."I swear..I'll take the whole bottle of this and release a fast blast on the floor if you guys don't teach me anything!"

But then again, that's just me and I can get away with it.

Desperate times may call for desperate measures.

[trx]

Originally Posted by sdn1977

OK - I can come up with a couple. But, first, tell me - are you a pharmacist or an intern? If you're an intern, are you there on a rotation or as an employed intern?

But....give me your circumstances & I'll give you some pointers.

Originally Posted by ZpackSux

Try giving it a 110% for the next few months...help others. Let's see if they'll follow your new found attitude and energy. Positive energy can be contagious. And it can certainly start from you. And I promise you'll be recognized, praised, and rewarded.

All I really hope for is trusting that I am worthy of decent training, if anything, because I still need to go a long way before I can earn anything else. It's hard for me to find out how to get to this point because I'm trying to learn as much as possible on my own (even if it requires offering to help out more in addition to my full-time rotation) since I don't feel like I have any support from the pharmacists. I really believe that everybody can benefit if I can contribute more. From what I've observed from their actions and reactions, some (actually one.. and she is one of 2 full-time partners there) apparently don't feel the same. Although this environment is in retail (I'm employed as an intern), I feel like it pertains to pharmacy management and can be applied to any pharmacy setting. I'm also on rotations (I'm a rising 3rd year) in a hospital and I've witnessed how a positive atmosphere created by and sustains satisfied employees who yield results that is anything but the bare minimum.

[gaba101]

Originally Posted by trx

my story is that I'm interning in a retail pharmacy and am very frustrated because I do not feel like I've been trained adequately.

I, too, am finding it difficult to intern (as an employee at a retail pharmacy) and learn. There was this one pharmacist I loved working with (nobody liked this pharmacist b/c she was strict to the bone) because she would bring me along side and show me how to do certain calculations or if i did dsomething wrong, she'd make sure she didn't let it slide or just tell me i did something wrong but actually SHOWED me how to do it right. When we got prescriptoins that involved calcluations, she'd give me the opportunity to do them first and then check my work. However, she got so overwhelmed w/ retail that she left. The other pharmacists left use me to do work (which I can't disagree since I'm getting paid) but I'll never learn if you just have me fill fill fill and ring people up. Among the ones left, one is just bad to work with--you know those women who talk about their kids none stop? try sitting on your @$$ and talking to your kids and your husband on the phone non-stop. esp. when me and the tech are flying down the pharmacy and she's just sitting there on her @$$ or pause from her phone conversation a bit and ask you "why arent you filling"? or patients would be waiting 10 min past their promised time and you'd have to beg her to verify the Rx so the patients can go home. by the way, she's the PIC. At any rate, looks like I'll be moving to a new location because I wasn't able to come in as frequently this year to (INTERN AND LEARN ABOUT PHARMACY) work so she wants to find a good tech to replace me. I'm sorry that my schoolwork was more important than filling prescriptions while you sit on your @$$. Are most retail pharmacies like this during the school year? that not understanding. At any rate, sorry to hijack your thread, ZPACK. Just...frustrated.

how is this related to the thread? bad pharmacy management on behalf of the lazy PIC.

[trx]

Originally Posted by gaba101

I, too, am finding it difficult to intern (as an employee at a retail pharmacy) and learn.

The other pharmacists left use me to do work (which I can't disagree since I'm getting paid) but I'll never learn if you just have me fill fill fill and ring people up. Among the ones left, one is just bad to work with--you know those women who talk about their kids none stop? try sitting on your @$$ and talking to your kids and your husband on the phone non-stop. esp. when me and the tech are flying down the pharmacy and she's just sitting there on her @$$ or pause from her phone conversation a bit and ask you "why arent you filling"? or patients would be waiting 10 min past their promised time and you'd have to beg her to verify the Rx so the patients can go home. by the way, she's the PIC.

I'm sorry that my schoolwork was more important than filling prescriptions while you sit on your @$$. Are most retail pharmacies like this during the school year? that not understanding. At any rate, sorry to hijack your thread, ZPACK. Just...frustrated.

how is this related to the thread? bad pharmacy management on behalf of the lazy PIC.

I've seen all of those bad experiences you've just mentioned but I still have hope because I do see some competent people who do care enough and have developed good pharmacy reputations. I hope that I never forget what it's like to be learning and how frustrating it is that I cannot find a support system. Every experience can be a learning experience, and experiences like these teach me what I should avoid turning into... I just don't see how a pharmacy can prosper and how anyone can benefit when people do not enjoy their jobs and in turn do not care about trying to give the best services possible. It also doesn't help when it looks like management doesn't care about employee satisfaction either (ie enforcing, instead of discouraging, lunch breaks, etc). What changes can be made beside desperately trying to hold on to hope/optimism and just do the best one can despite what anyone else is (not) doing? (I should note that these observations are mostly based on what I've seen in retail).

[sdn1977]

Originally Posted by trx

I've seen all of those bad experiences you've just mentioned but I still have hope because I do see some competent people who do care enough and have developed good pharmacy reputations. I hope that I never forget what it's like to be learning and how frustrating it is that I cannot find a support system. Every experience can be a learning experience, and experiences like these teach me what I should avoid turning into... I just don't see how a pharmacy can prosper and how anyone can benefit when people do not enjoy their jobs and in turn do not care about trying to give the best services possible. It also doesn't help when it looks like management doesn't care about employee satisfaction either (ie enforcing, instead of discouraging, lunch breaks, etc). What changes can be made beside desperately trying to hold on to hope/optimism and just do the best one can despite what anyone else is (not) doing? (I should note that these observations are mostly based on what I've seen in retail).

OK - since I've seen & done both sides - hospital & retail, I'll comment on your disgruntlement with retail.....chime in if you have issues with hospital & Zpak will come back...

So..If you're an employed intern....we (the actual PIC, pharmacists, staff & corporation) see you differently than one who is on rotation. You may not like it nor think its fair (fairness has very little significance within our business...), but it is the truth.

We see employed interns as techs - they can act as a tech, but sometimes, they don't know the "system" as well as a tech. When things get busy & time is tight, we need a good & competent tech. Its hard to be considered "less" than a tech, but we need someone who can process the rx fast, with good explanations for rejections & the ability to know the stock well enough to pick the right NDC for the drug prescribed. Otherwise, we get short-tempered & can just "fix" things faster, particularly when the time is close to have the order being sent.

Unfortunately, sometimes that is not you. That doesn't mean we don't want to teach you - because really, you are cumbersome if you can't function like the "best" tech. But, teaching takes time & sometimes your time is not our time.....which is why we have you process the order or ring up rx. But, when you do those things - do them the very best way you know how.

Also....when you have a question, write it down....ask it later - we're usually able to answer it or reproduce it.

Now.....the circumstance when you're doing a rotation as an intern, or working as a graduate intern & looking to become a functional pharmacist at that setting....now, as a pharmacist, I have a different set of requirements & expectations of you. I want to teach you the how & why of what is being prescribed. I want to tell you how to process & really, really, what to do with that rejection. Now....do you just tell the pt it is not covered? Probably not...you move on from there - the supervising pharmacist should help you thru this process.

Again - there are times when time doesn't allow good explanations. I will make notes to come back to it (even in the hospital setting) & you should make notes as well. Not everything can be dealt with at the acutal time it takes place. We'll get back to it!

Certainly, there are pharmacists who are not teachers who have interns "thrust" upon them - that has happened to my supervisor - he hates to teach. He gives them to me.

But...you must realize you will have to do things differently as an employee than as a student....which gives you experience to do things differently when you're actually an employed pharamcist.

Some days are great - you change people's lives, you make a difference, you harvest the peaches....some days you just barely make it...you hold on by your toes. But - each day is an education - it may not be what you wanted to learn on that day, but you learned something!

Mostly, you have to develop your own self recognition system of how well you do your job. Over 30 years, I've not had very many people tell me that I did a good job. You just know it...but, you have to develop that ability.

pm me if you need more info!

[gaba101]

Originally Posted by sdn1977

OK - since I've seen & done both sides - hospital & retail, I'll comment on your disgruntlement with retail.....chime in if you have issues with hospital & Zpak will come back...

So..If you're an employed intern....we (the actual PIC, pharmacists, staff & corporation) see you differently than one who is on rotation. You may not like it nor think its fair (fairness has very little significance within our business...), but it is the truth.

We see employed interns as techs - they can act as a tech, but sometimes, they don't know the "system" as well as a tech. When things get busy & time is tight, we need a good & competent tech. Its hard to be considered "less" than a tech, but we need someone who can process the rx fast, with good explanations for rejections & the ability to know the stock well enough to pick the right NDC for the drug prescribed. Otherwise, we get short-tempered & can just "fix" things faster, particularly when the time is close to have the order being sent.

Unfortunately, sometimes that is not you. That doesn't mean we don't want to teach you - because really, you are cumbersome if you can't function like the "best" tech. But, teaching takes time & sometimes your time is not our time.....which is why we have you process the order or ring up rx. But, when you do those things - do them the very best way you know how.

Also....when you have a question, write it down....ask it later - we're usually able to answer it or reproduce it.

Now.....the circumstance when you're doing a rotation as an intern, or working as a graduate intern & looking to become a functional pharmacist at that setting....now, as a pharmacist, I have a different set of requirements & expectations of you. I want to teach you the how & why of what is being prescribed. I want to tell you how to process & really, really, what to do with that rejection. Now....do you just tell the pt it is not covered? Probably not...you move on from there - the supervising pharmacist should help you thru this process.

Again - there are times when time doesn't allow good explanations. I will make notes to come back to it (even in the hospital setting) & you should make notes as well. Not everything can be dealt with at the acutal time it takes place. We'll get back to it!

Certainly, there are pharmacists who are not teachers who have interns "thrust" upon them - that has happened to my supervisor - he hates to teach. He gives them to me.

But...you must realize you will have to do things differently as an employee than as a student....which gives you experience to do things differently when you're actually an employed pharamcist.

Some days are great - you change people's lives, you make a difference, you harvest the peaches....some days you just barely make it...you hold on by your toes. But - each day is an education - it may not be what you wanted to learn on that day, but you learned something!

Mostly, you have to develop your own self recognition system of how well you do your job. Over 30 years, I've not had very many people tell me that I did a good job. You just know it...but, you have to develop that ability.

pm me if you need more info!

dayam, can i work with you, SDN? lol. So pretty much rotations will teach us the most. Then again, I always hear (and I don't mean one or two in the blue moon but quite often from various students in various schools) students doing busy work on rotations (just read WVU's blog, haha) and i've witnessed interns on rotations not getting to do anything--stand around, or a couple of times, the pharmacist ordered them to help the tech w/ the pyxis machine (recall that pyxis is what an intern "employee" can do...since you were on the subject of differentiating duties and expectations of intern employees from interns on rotations). Sure, report the problem to your school, you say, right? what good will that do for ME since any changes made will not take place until next year. I guess I'm just nervous that if I hold out hope for rotations to teach me the most and then I get stuck with several bad ones (paying to stand around and not learn), I will never be a good pharmacist (or even an "okay" one since "good" requires years of experience).

[sdn1977]

Originally Posted by gaba101

dayam, can i work with you, SDN? lol. So pretty much rotations will teach us the most. Then again, I always hear (and I don't mean one or two in the blue moon but quite often from various students in various schools) students doing busy work on rotations (just read WVU's blog, haha) and i've witnessed interns on rotations not getting to do anything--stand around, or a couple of times, the pharmacist ordered them to help the tech w/ the pyxis machine (recall that pyxis is what an intern "employee" can do...since you were on the subject of differentiating duties and expectations of intern employees from interns on rotations). Sure, report the problem to your school, you say, right? what good will that do for ME since any changes made will not take place until next year. I guess I'm just nervous that if I hold out hope for rotations to teach me the most and then I get stuck with several bad ones (paying to stand around and not learn), I will never be a good pharmacist (or even an "okay" one since "good" requires years of experience).

Look - not every minute of every day is a great minute - even as a pharmacist. Not me, in the ICU, not Zpakc - as a dop or consultant, not Tussionex, altho - as a night shift pharmacist....every minute of her day(night) is full.

The point is - there are ALWAYS routine & boring things to do! Each & everyday when I work in the hospital, I have to do a CII count (when I'm working the shift that counts). Twice a month, in retail, I have to do a CII count. There is NOTHING more boring than counting CIIs - trust me!!!!

Likewise...in retail, some stuff just is awful - credits that don't go thru online - you have to call (or someone does) & get the credit manually done. Well - guess what, I'm paid 3 times what you're paid....if I'm busy....I'll get you on the phone to do it. That gets me home on time & gives you a peek into the real mundane stuff of pharmacy.

Now...are there interesting things - you bet!!! But - just ask anyone in any business. I'm married to a dentist - the most difficult root canals he had 27 years ago are mundane today. Likewise, I worked with one of the biggest names in cardiovascular surgery (he's got a catheter named after him) - CABG's became routine for him. No - they weren't boring & you always have to be on your game, but ..... someone opens the incision & someone closes it.

Likewise...in pharmacy...someone fills pyxis & someone has to reconcile it. Someone responds to codes or gets the tpa dosed & mixed.....or someone fills pyxis. Its just that simple.

Being a pharmacist is a multitue of jobs. You have to experience & be good at each and every one of them. When you get to be "too good" to do one job, then you've been at it too long. Because, that is the one job that might have to be done correctly just that one time.

You have your lifetime to be a pharmacist. Take this time to be a student. Being a student is a harder job to have when you have to be a full time pharmacist....but, you won't learn everything you need to know in the years you're in pharmacy school. Some of my best & most worthwhile learning has taken place after I graduated. I hope I still am able to learn until the last day I work.....

[Caverject]

Originally Posted by sdn1977

pm me if you need more info!

no please continue by all means...this may have more pages then the current Remington book!

[sdn1977]

Originally Posted by Caverject

no please continue by all means...this may have more pages then the current Remington book!

that's EXACTLY where you should have your nose right now - in Remington's or some place similar (G&G, KodaKimble, etc...)

[ZpackSux]

well..this consultant is headed out to New England for the week...

I'll eat lots of lobsters for ya...and will come back with a screaming gout!

[tussionex]

Originally Posted by gaba101

dayam, can i work with you, SDN? lol. So pretty much rotations will teach us the most. Then again, I always hear (and I don't mean one or two in the blue moon but quite often from various students in various schools) students doing busy work on rotations (just read WVU's blog, haha) and i've witnessed interns on rotations not getting to do anything--stand around, or a couple of times, the pharmacist ordered them to help the tech w/ the pyxis machine (recall that pyxis is what an intern "employee" can do...since you were on the subject of differentiating duties and expectations of intern employees from interns on rotations). Sure, report the problem to your school, you say, right? what good will that do for ME since any changes made will not take place until next year. I guess I'm just nervous that if I hold out hope for rotations to teach me the most and then I get stuck with several bad ones (paying to stand around and not learn), I will never be a good pharmacist (or even an "okay" one since "good" requires years of experience).

hey, don't worry so much...not all your rotations will be amazing and not all of the will suck! i promise!
i had a few that were challenging, insightful, interesting and i learned a lot...i also had a few that were dull, full of busy work, and not really germaine to what i felt i wanted to do in my practice.
my advice? if you're stuck at a site that gives you tons of busy work or where the staff is too busy to teach....get your scut work done as well, much more importantly, as quickly as possible....bring a board review book and spend your time studying.
that way, you won't feel like you're wasting your time, and when your preceptor does have the time to teach you, you will be loaded with new questions!

don't sweat becoming a "good" pharmacist on rotations....it really does take years...but you'll get it!

[tussionex]

hey, SDN...not all the hours of the night shift are filled with glamour!

we have some very dull nights....we bulk-compound IV's [time consuming, but not really loaded with action] and....wait for it....we count the ENTIRE vault every night!

that's usually one pure hour of enjoyment....but, like you said...ya gotta take the good with the bad...

[at least we take turns counting, and can sucker a tech into helping ]

[sdn1977]

Originally Posted by tussionex

hey, SDN...not all the hours of the night shift are filled with glamour!

we have some very dull nights....we bulk-compound IV's [time consuming, but not really loaded with action] and....wait for it....we count the ENTIRE vault every night!

that's usually one pure hour of enjoyment....but, like you said...ya gotta take the good with the bad...

[at least we take turns counting, and can sucker a tech into helping ]

'cmon! When we come on in the AM, you're all looking beat, have endless stories of crazy doses, weird orders & more codes than occurred in the entire week!

Sounds glamourous to me! But, thanks - the one week in a year or so I have to do it is sheer pain, so you can have it .

Aaaaah - I do know about the vault count, only we do it during the day. Did I ever share why??? Well....one day the AM pharmacist came in & couldn't find the night guy anywhere.....looked all over - gone! Ah well, he figured he had the runs or something & was across in the lab bathroom (the closest one). Then....a bit into his shift, he has to get some CII, goes into the vault & there is the night guy - down on the floor - fortunately, not dead, but OD'd for sure. Hmmmm..after some narcan in the ER, he was put on leave & went into rehab. We never saw him again.

So....the counting went to the day shift - techs did it......until, we consistently came up short . Funny! So, then.....it went to the pharmacists - ugh!!! And thats where it has stayed, every day......all of them.....365 days a week......each & every one.....endlessly.....

But, I don't think you're old enough to remember the days before pyxis. I'm sure Class of 1978 does if he did hospital at all & perhaps Zpak is old enough. Before pyxis...the way CII's were signed out was on a sheet with about 20 tear off overlays. I'm trying to find a way to describe them. You know, the 3 or 4 part physician order sheets? Have you seen those which are 3 parts? Well....think about one back sheet with 20 overlays, each one down from the other, like a receipt book. Well...the pharmacist had to type (yes - with a typwriter - something from the old days!!!) the name of the drug, strength, etc....then, that would be sent with the drug to the floor & put in a book. So, when the nurse signed out a percodan (old days, remember???) she would write the pts name, date, MR# & her name of each one of these overlays. The overlays would then come back to us & we'd have to reconcile them.

Now - talk about mundane, awful, horrible, mind numbing stuff - this is what I did many, many times as a student. Type up those awful sheets, reconcile those little tags - ugh! Its a wonder I learned anything at all.

The point, gaba, hang in there - each place, task, thing you do has a purpose. You may not know it at the time & it may change (in the CII case for the better!!!). But, it all goes into molding who you become & how you handle the mundane as well as the interesting. If nothing else - it gives you stories to tell students years later .

But, gaba, look for Tussionex on the floor of the vault if you can't find her .

[sdn1977]

Originally Posted by ZpackSux

well..this consultant is headed out to New England for the week...

I'll eat lots of lobsters for ya...and will come back with a screaming gout!

I'm so jealous!

[tussionex]

you'd probably find me on the floor dead of boredom...

the only good thing about spending an hour in the vault is that it's an hour away from the phones....i can listen to music and not nurses for a while!

[ZpackSux]

Originally Posted by sdn1977

'cmon! When we come on in the AM, you're all looking beat, have endless stories of crazy doses, weird orders & more codes than occurred in the entire week!

Sounds glamourous to me! But, thanks - the one week in a year or so I have to do it is sheer pain, so you can have it .

Aaaaah - I do know about the vault count, only we do it during the day. Did I ever share why??? Well....one day the AM pharmacist came in & couldn't find the night guy anywhere.....looked all over - gone! Ah well, he figured he had the runs or something & was across in the lab bathroom (the closest one). Then....a bit into his shift, he has to get some CII, goes into the vault & there is the night guy - down on the floor - fortunately, not dead, but OD'd for sure. Hmmmm..after some narcan in the ER, he was put on leave & went into rehab. We never saw him again.

So....the counting went to the day shift - techs did it......until, we consistently came up short . Funny! So, then.....it went to the pharmacists - ugh!!! And thats where it has stayed, every day......all of them.....365 days a week......each & every one.....endlessly.....

But, I don't think you're old enough to remember the days before pyxis. I'm sure Class of 1978 does if he did hospital at all & perhaps Zpak is old enough. Before pyxis...the way CII's were signed out was on a sheet with about 20 tear off overlays. I'm trying to find a way to describe them. You know, the 3 or 4 part physician order sheets? Have you seen those which are 3 parts? Well....think about one back sheet with 20 overlays, each one down from the other, like a receipt book. Well...the pharmacist had to type (yes - with a typwriter - something from the old days!!!) the name of the drug, strength, etc....then, that would be sent with the drug to the floor & put in a book. So, when the nurse signed out a percodan (old days, remember???) she would write the pts name, date, MR# & her name of each one of these overlays. The overlays would then come back to us & we'd have to reconcile them.

Now - talk about mundane, awful, horrible, mind numbing stuff - this is what I did many, many times as a student. Type up those awful sheets, reconcile those little tags - ugh! Its a wonder I learned anything at all.

The point, gaba, hang in there - each place, task, thing you do has a purpose. You may not know it at the time & it may change (in the CII case for the better!!!). But, it all goes into molding who you become & how you handle the mundane as well as the interesting. If nothing else - it gives you stories to tell students years later .

But, gaba, look for Tussionex on the floor of the vault if you can't find her .

ehh...u know..there still are hospitals still using the paper system!!!

[ZpackSux]

Originally Posted by sdn1977

I'm so jealous!

It's beautiful here... little chilly... people are friendly...

But I miss my family...

[ZpackSux]

Originally Posted by tussionex

you'd probably find me on the floor dead of boredom...

the only good thing about spending an hour in the vault is that it's an hour away from the phones....i can listen to music and not nurses for a while!

You would never die of boredom...you would probably start a booger picking contest or something..

[sdn1977]

Originally Posted by ZpackSux

ehh...u know..there still are hospitals still using the paper system!!!

NO!!!! I don't believe that!!! Tell me no!

Are you kidding - do they still have typewriters???

Where??????

Ahhh - & I'm guessing they have students who reconcile these crasy pieces of paper.......how do they get other stuff done - like kinetic monitoring? Do they go to the lab & fetch the lab report? Don't tell me they wait until it appears on the chart???

[sdn1977]

Originally Posted by ZpackSux

It's beautiful here... little chilly... people are friendly...

But I miss my family...

Yeah...you take the good with the bad......they miss you too!

[tussionex]

Originally Posted by ZpackSux

You would never die of boredom...you would probably start a booger picking contest or something..

dang it, you caught me!

[Farmercyst]

Originally Posted by tussionex

dang it, you caught me!

Next time you'll have to scrub the left-overs off the bottles.

[sdn1977]

OK - serious question,.....

What do you see are some of the "systems" problems which contribute to drug errors & what do you see are some of the "personal" (ie person specific) issues which contribute to drug errors within a hospital management system?

What are the "easy" fixes - changing narcotic & other drugs placement in vaults & pyxis, etc..

What are the more difficult fixes???

[tussionex]

sdn...awesome question, but i have to get ready for work.

i will contribute later and am looking forward to others' responses...

[ZpackSux]

Originally Posted by sdn1977

OK - serious question,.....

What do you see are some of the "systems" problems which contribute to drug errors & what do you see are some of the "personal" (ie person specific) issues which contribute to drug errors within a hospital management system?

What are the "easy" fixes - changing narcotic & other drugs placement in vaults & pyxis, etc..

What are the more difficult fixes???

Medication Errors arise from many different faucets. The "systems" problems which contribute to errors arise from something as simples as old burned out computer screen on the Pyxis to medications with Look Alike and Sound Alike names. When I used to prepare Med Error report, I can tell you Med Errors occurred in many many different ways.

One of the most important ways to reduce med errors isn't the "easy" fix. It is creating a "non-punitive" culture in reporting the errors. Because, most likely, it's the faulty system that contributes to the error when an error occurs due to a human factor. In a way, we set up our staff for failure.

One technology update which reduced significant med errors at one of my previous stops was the E-MAR and bedside scanning. And we took away the profile dispesing from a Pyxis in the Med Room and instead filled patient specific med carts (filled by an automation) which were rolled around in a computerized med cart with EMAR and a scanner.

So, if a medication is not on the EMAR...or if the medication doesn't scan with the patient, then the medication is not given. At the same time, if the meds were missed, the EMAR prompted the nurses the meds are due.

We took away many medication administration errors. But we did not take away the Transcription Errors...where pharmacist still had to decipher the orders physicians wrote. And to decrease this error, we worked on CPOE...where physician would do the order entry and pharmacist would confirm. I never got to finish this project...but this would have eliminated the paper orders and charts.... E-Chart.

Medication Error is a subject you can spend a semester on. Or more.
But it's quite boring.

But I traveled through NH, VT, and ME....and met wonderful people along the way.

We stopped at a little town in NH..where my partner said..."there is a wonderful Italian joint..but he doesn't always open." It was a beautiful town in a valley surrounded by trees and mountains. We stop..and it's open.

He was a one man show, the owner..sitting outside drinking wine kicking back.

We order our food and he brings it out a sizzling skillet...still cooking. Wonderful wonderful food. I started to ask him questions... what the heck are you doing in the middle of nowhere. Come to find out, he had 38 Italian restaurants in Boston area..sold it one by one. I asked "what the heck did you do with all that money." He sez..."I buried it." Mind you, he has a very thick Italian accent. Then he said..."True story, I was buying this house near a mountain in February..he wanted $150,000. I told him I give you $130,000 cash.. the owner said ok.. but I told em...I can't pay you till May. Because my money is buried..and the ground is still frozen..."

Then he opens his oven...where there were about 10 fresh baked Italian breads...grabs one out..wraps it..and said..."Take this to your wife.."

I'm stopping there on my next visit.. and will bring Sarah.