Mock interview question #1

[bananaface]

By request...

This is a thread for discussion of a mock interview question. Please give your answer, and an explanation if appropriate. There is not necessarily going to be one correct answer to the question. But, there may be some answers that are better than others. I will be moderating discussion of the question.

Question:
It is 1am and you are the only pharmacist working at a small hospital pharmacy. A man approaches your outpatient window and says that he has just returned from a business trip to China and needs his heart medication. The particular medication he is on is one that should not be suddenly discontinued and he was due for a dose a few hours ago. He has never filled with your pharmacy, does not have an old bottle, but knows the name and strength of his medication. The hospital is too small to have an emergency room, so there are no physicians on the premises at 1am.

What would you do in this situation?

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[bt61184]

I know that you are unable to dispense without a prescription but certainly you don't want to turn a man away who needs medication or his heart might begin to act abnormally. Would it be a possibility to give one pill to him and take down all of his information and call his current pharmacy in the morning? After all, patient care should be a priority along with ethical actions, but the law should allow for this situation and it should be up to the discretion of the pharmacist.

 

[bt61184]

I guess it would also be very important to make sure he absolutely knows the name and strength of the medication he is currently taking too.

 

[meg]

Even if there's no ER and no physicians there, I believe legally they have to have a doctor on call for situations like this.

 

[PharmGirl85]

I know that you are unable to dispense without a prescription but certainly you don't want to turn a man away who needs medication or his heart might begin to act abnormally. Would it be a possibility to give one pill to him and take down all of his information and call his current pharmacy in the morning? After all, patient care should be a priority along with ethical actions, but the law should allow for this situation and it should be up to the discretion of the pharmacist.

I think that the best way to handle this situation is to have the doctor that prescribed it to him paged since this is an emergency. I would not feel comfortable just giving him what he says the medication is because there is nothing to verify it against. If he at least had his bottle from the previous fill, then I would be able to verify the name and strength of the drug. But I would not just give him a pill because there are many medications out there that have similar names, and look similar. What if you give him something that could be harmful; you could actually make things worse for him.

Patient care should be the number one priority, that’s why you owe it to the patient to make sure that you are giving this the correct medication.

 

[nerdystar]

I wouldn't give him anything. There is no gaurantee that he's 100% sure about what he's taking. I would page/call a doctor to examine him ASAP or call around to get the man's medical records so that a nurse or doctor could call the prescription in.

 

[bananaface]

Alot of people are bringing up good ideas and points. I'll let a few more people chime in before I start offering idea specific feedback.

 

[Khushi]

i agree that it IS possible for a patient to be mistaken in what his medication is.. but if he knows his condition, and states the name of the drug and strength, you can look it up to verify the info. however, i guess, just to be on the safe side, i`d also page a physician right then.

 

[Bananay]

By request...

This is a thread for discussion of a mock interview question. Please give your answer, and an explanation if appropriate. There is not necessarily going to be one correct answer to the question. But, there may be some answers that are better than others. I will be moderating discussion of the question.

Question:
It is 1am and you are the only pharmacist working at a small hospital pharmacy. A man approaches your outpatient window and says that he has just returned from a business trip to China and needs his heart medication. The particular medication he is on is one that should not be suddenly discontinued and he was due for a dose a few hours ago. He has never filled with your pharmacy, does not have an old bottle, but knows the name and strength of his medication. The hospital is too small to have an emergency room, so there are no physicians on the premises at 1am.

What would you do in this situation?

First of all the information is not enough to prescribe the drug. what if he is a reporter? what if they are just checking on you? what if he is a professional liar? I will never despense medication with that information rather i would look for emergency on call doctor to help him.

 

[Shovingit]

Patient care is always the number one concern, so you should try to get him what he needs, but not at the expense of the law. If the patient had been to my pharmacy before it might be different, but since we don't know him at all, and there are a hundred different reasons he could be lieing to you, I wouldn't just give him a pill. If it came down to it I would suggest he drive to the nearest physician staffed ER.

 

[chelu55]

Alot of good answer so far. Like many people have stated,"patient care." This could also mean not giving the patient the medication. There is a good possibility that the patient is incorrect. That medication error is not for the best interest of the patient and could effect both of you termendously if you were to provide it.There are too many patients out there not truly knowing what there are taking. To take that risk is definetly not for the best interest of both of you.
If I were the pharmacist I would tell him," You came this far, drive a little further and find a 24 hour clinic or the closest ED." I would be willing to call around and try to find a clinic open but thats about it. What more could one do.The patient must have a script if he/she has not gotten the medication filled at your pharmacy.

 

[ultracet]

oddly enough.. a very very very similar situation to this came up today on my rotation...

 

[Shovingit]

oddly enough.. a very very very similar situation to this came up today on my rotation...

it was bananaface testing you.

 

[ultracet]

it was bananaface testing you.

except i know the right answer

 

[Shooto2000]

I guess the only answer I can come up with is try to contact his physican like stated above and if I can't and he starts having heart problems call 911 or findthe nearest hospital with an open emergancy room for him to go to. LOL

 

[All4MyDaughter]

I had a similar situation come up tonight at work. Man walks up, says he needs his BP meds. We haven't filled it since June of last year. No refills, RX is expired. He's been using mail order but is going out of town tomorrow. Of course, he's out of the pills.

I offered to fax the doctor tonight to try to get more refills authorized for tomorrow. No good - pt is leaving early in the morning. I suggested he call the Dr's service himself and have him paged. He didn't want to do that.

I told him I was sorry we couldn't help him and he left.

Not exactly like the proposed situation, but kinda.

 

[imperial frog]

By request...


Question:
It is 1am and you are the only pharmacist working at a small hospital pharmacy. A man approaches your outpatient window and says that he has just returned from a business trip to China and needs his heart medication.

What would you do in this situation?

Wonder why I have the outpatient window open at 1am.

 

[ultracet]

Wonder why I have the outpatient window open at 1am.

haha
yeah i thought that too...

amazing that there is no ED and yet they can staff a pharmacy 24/7

 

[bt61184]

So mix the situation up a little bit......

Scenario 1:
You know the patient and he has a prescription history on file. Are you allowed to give out a temporary supply w/o a script until you can obtain one from the doctor the next day?

Scenario 2:
There is no 24 hr ED close by and the doctor he normally gets meds from is out of town. What now?

 

[ultracet]

or how about it is for a medication you have to dispense a full months worth or nothing at all...

 

[sdn1977]

Very, very good (& realistic!) question. Very, very good and thought provoking answers.....

 

[bt61184]

Yeah...like birth control pills or Amnesteem (weekly I Think). Those aren't necessarily life threatening meds though if stopped.

 

[ultracet]

Yeah...like birth control pills or Amnesteem (weekly I Think). Those aren't necessarily life threatening meds though if stopped.

nitroquick

 

[fidelio]

So mix the situation up a little bit......

Scenario 1:
You know the patient and he has a prescription history on file. Are you allowed to give out a temporary supply w/o a script until you can obtain one from the doctor the next day?

Scenario 2:
There is no 24 hr ED close by and the doctor he normally gets meds from is out of town. What now?

I think I'd still give him a pill after checking the medication up. I don't know if you're allowed to do that, but if you have his prescription history, it seems like the right thing to do.

Anyway, isnt' that what people are doing with medicare part D? Pharmacies were giving out pills that will be later reimbursed by federal gov't or something, right? because people need their medications and it seems apparent insurance companies and what not were not ready.

A lot of those people didn't have all their information either. So I guess based on this, that is why I'm saying I'd give that man his one pill so he'd last through the day.

 

[PILLMAN]

if you have no record for the patient & only going off what he tells you, i would not give him a pill. as stated before by others, there are numerous reasons why he may not be telling the truth, beyond the fact that when it comes to meds names & strengths, even pharmacists make mistakes let alone a patient.

if i do have a record of his prescriptions, then i may consider. as a patient, i've personally seen this "loaning" of pills before a refill rx is obtained. it seems like a good call in certain situations (very very few circumstances)

 

[bananaface]

In this situation, one main thing an admissions committee will be looking for is to see that you be willing to step up and take responsibility for helping the patient recieve the medication he needs. Anyone who sends the patient away without sending them someplace (an ER or urgent care center you know he can get to) is not going to look good to an adcom. In this situation, if there were a local ER open, there would be no reason for the patient to come to you. So, let's assume that you hospital is the only local one.

Pharmacists are permitted to give a 3 day emergency supply of medication to their patients if the choose. Most won't do it for controlled substances or for patients who aren't theirs. On occasion, a pharmacist might give a short supply to someone who brings them an empty labeled bottle, even if that person did not fill last at their pharmacy. Without a bottle, the vast majority of pharmacists are not willing to trust a patient's recollection.

So, you are going to have to find a prescriber. There is little chance that the patient's primary care provider (PCP) is going to be the one on call for his/her office that evening. Many community practive physicians have no one on call in the middle of the night. Your best bet is to page the physician on call for your hospital. Or, if no one is reachable or on call, you may know a physician friend who you can call and ask to help you out.

 

[fidelio]

In this situation, one main thing an admissions committee will be looking for is to see that you be willing to step up and take responsibility for helping the patient recieve the medication he needs. Anyone who sends the patient away without sending them someplace (an ER or urgent care center you know he can get to) is not going to look good to an adcom. In this situation, if there were a local ER open, there would be no reason for the patient to come to you. So, let's assume that you hospital is the only local one.

Pharmacists are permitted to give a 3 day emergency supply of medication to their patients if the choose. Most won't do it for controlled substances or for patients who aren't theirs. On occasion, a pharmacist might give a short supply to someone who brings them an empty labeled bottle, even if that person did not fill last at their pharmacy. Without a bottle, the vast majority of pharmacists are not willing to trust a patient's recollection.

So, you are going to have to find a prescriber. There is little chance that the patient's primary care provider (PCP) is going to be the one on call for his/her office that evening. Many community practive physicians have no one on call in the middle of the night. Your best bet is to page the physician on call for your hospital. Or, if no one is reachable or on call, you may know a physician friend who you can call and ask to help you out.

Tricky. I'm glad they're permitted a three day emergency supply. I was beginning to think pharmacists weren't allowed to do that with everyone saying they wouldn't give any pills.

 

[beccala33]

Bananaface,
I just want to say thank you. I really feel like this helped me... I am not sure what i would have answered if asked this in an interview. It's so nerve-racking being interogated! So a big, huge thank you from me. Any other thought-provoking questions for us?

 

[jky007]

yes thank you! that really helped

 

[ultracet]

and the state board of AL did not permit the dispensing of the nitroquick as you cannot break the pack and give 3 days...

just so you know

 

[Gosondth]

At least according to CA law: Pharmacist are allowed to dispense non-controlled substance without a prescription for a personal emergency. The only time they are allowed to dispense a controlled substance without a prescription is only in a "delcared state of emergency." I think there is an exception that separates CII from CIII - CV, but I don't recall offhand.

I hate Pharmacy Law.

 

[sdn1977]

At least according to CA law: Pharmacist are allowed to dispense non-controlled substance without a prescription for a personal emergency. The only time they are allowed to dispense a controlled substance without a prescription is only in a "delcared state of emergency." I think there is an exception that separates CII from CIII - CV, but I don't recall offhand.

I hate Pharmacy Law.

Gosondth - hahaha - yeah, CA law has more exceptions than rules sometimes (don't forget...hospice patients have laws all their own for controlled substances!). But, slowly, our state laws are becoming more aligned with federal law. I agree with bananaface..as pharmacists, we are dispensers of drugs AND drug information. It is in everyone's interest that we provide resources for all scenarios, when possible - even if that is being able to find providers prescribing in this situation. Admissions folks want to know if you are willling to be an advocate for the patient and use the resources you are familiar with to do that. Good question!

 

[fidelio]

Give us another question. This is kinda fun (but wouldn't be fun in an interview unfortunately. haha).