ALL Pharmacists SHOULD know the Drugs

[Truthspeaker]

I just want to make a point how important it is for pharmacists to actually know the drugs thoroughly. Doctors are coming to you with questions, but if you got to look up the answers it kind of defeats the purpose of seeking you out. Anyone can go to Micromedex or Lexicomp to get an answer. I've even seen some pharmacists I work with googling for the answers.

ED pharmacists and Critical Care pharmacists can spit out the answers to the questions in mere seconds because they are used to answering split second questions with no references available. This should be standard for every pharmacist.

"Looking it up" is fine when you are answering a question for a nurse, because some of the nurses have trouble calculating rates, understanding concentrations or reading a compatibility chart....but the doctors expect you to know the stuff or at least be familiar with it. Doctors can most definitely use Micromedex, Lexicomp or UpToDate. You aren't fooling them...

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[deleted556323]

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[Phart]

Am I the only person who uses Siri during rounds? oops.

 

[Truthspeaker]

Hold up, I just want to know what the excuse is for pharmacists not having a good knowledge base for the drugs without relying on a reference or internet software? I mean, it's better to look it up than say the wrong thing, sure. Still you better believe the docs will stop asking you for answers if it takes them longer to ask you and get a response than for them to just "Look it up" in the first place.

Let's say a patient is about to get the alteplase aka TPA bolus and a doctor wants to know how fast you give the bolus. Well, if you take 2 minutes to look it up then you just caused the patient harm because time is brain. You should just KNOW the answer. The doctor may have researched it ahead of time but he thought YOU would know the answer because YOU are the expert on drug information...or supposed to be.

 

[Phart]

Nah. I prefer to make up some fancy BS excuse like "Let me check the literature to confirm", then go on safari, google it, click wikipedia. As long as I get paid at the end of the day and no one is hurt, who cares.

 

[Truthspeaker]

Nah. I prefer to make up some fancy BS excuse like "Let me check the literature to confirm", then go on safari, google it, click wikipedia. As long as I get paid at the end of the day and no one is hurt, who cares.

I respect your honesty, but you won't fool your colleagues if they can answer the same questions quickly and succinctly without the unnecessary excuses. In the clinical setting, I've known pharmacists to go to their clinical coordinators about other pharmacists who aren't pulling their weight. You won't fool the docs or your bosses which can hurt your reputation and earning potential.

When your bosses "check the literature" on you and your interventions, they will be giving the other pharmacist who is a stud at answering the clinical questions the bigger raise and promotion.

 

[sosoo]

on multiple occasions i get caught up with refills for hydroxyzine "HCL" for anxiety. its like the doctor does not know the difference between "HCl" vs pamoate. and sadly the previous pharmacists doesn't know it either. and i keep having to explain to the pt why HCl is not helping with their anxiety. to say that pharmacists are drug experts is laughable. a lot of pharmacists cannot retain info after a few years out of school.

 

[Abby Atwood]

Everyone looks up things occasionally. I've seen doctors reference their sources (including UpToDate) in notes. Knowing what resources to reference is valuable, and not all providers know what those resources are. This is a kind of silly example, but I was recently asked what med guides are.

Pharmacists don't necessarily have years of practice experience before they are operating without supervision. I occasionally have to look things up because I never encountered that information in school or in practice. I'm a 2017 grad. I try really hard to not be the person who needs to look up everything by devoting a lot of free time to reading journals, reading up on new drugs when they are approved, and doing unrequired CE; however, my experience level in pharmacy is similar to a medical interns experience in medicine. I'm going to need to look stuff up sometimes.

- I edited to take out my thoughts on UpToDate. It's not my favorite, but my opinion is not that relevant

 

[UGAZ]

I've been working in clinical practice more than 10 years and occasionally, I still look things up. I guess it really depends on your practice. If you are working as an ICU pharmacist, you should know inside out all the drip starting rate/max dose/titration and monitoring parameters (without looking up). However, if you're just a general staff pharmacist, it's understandable to look these up since you don't see them as common as the ICU satellite pharmacist. I look up all the times when it's ped dosing. I am not a ped expert and my place doesn't have a lot of ped orders.

Also, it depends on individuals. Some pharmacists are very sharp. Some aren't. I've worked with pharmacists who literally are walking drug dictionaries, while some are idiots.

 

[PolarPop]

ED pharmacists and Critical Care pharmacists can spit out the answers to the questions in mere seconds because they are used to answering split second questions with no references available. This should be standard for every pharmacist.

Just because you get a quick answer doesn't mean it is always the right answer. The ED pharmacist where I used to work would give quick answers all the time and they were wrong more often than they should have been. I would rather have my coworkers take a minute and look something up or call for help for things they aren't as familiar with.

 

[CetiAlphaFive]

I just want to make a point how important it is for pharmacists to actually know the drugs thoroughly. Doctors are coming to you with questions, but if you got to look up the answers it kind of defeats the purpose of seeking you out. Anyone can go to Micromedex or Lexicomp to get an answer. I've even seen some pharmacists I work with googling for the answers.

ED pharmacists and Critical Care pharmacists can spit out the answers to the questions in mere seconds because they are used to answering split second questions with no references available. This should be standard for every pharmacist.

"Looking it up" is fine when you are answering a question for a nurse, because some of the nurses have trouble calculating rates, understanding concentrations or reading a compatibility chart....but the doctors expect you to know the stuff or at least be familiar with it. Doctors can most definitely use Micromedex, Lexicomp or UpToDate. You aren't fooling them...

We literally don't give a **** what you think.

If something absolutely cannot be wrong, we're going to make sure it's not wrong.
We don't have the problem with ego that you and other physicians do

If we're having to look something up, it's because you're likely asking a goofy, irrelevant question that isn't important.

Go up to literally any family practice MD and ask him the most basic question about TPA.
ten bucks says they get the question wronh more often than a fresh graduate pharmacist.

99% of the time, the pharmacist knows the answer, but is confirming their answer.

 

[Truthspeaker]

Just because you get a quick answer doesn't mean it is always the right answer. The ED pharmacist where I used to work would give quick answers all the time and they were wrong more often than they should have been. I would rather have my coworkers take a minute and look something up or call for help for things they aren't as familiar with.

Wrong is subjective, especially when monday morning quarterbacking decisions ED providers make, including ED pharmacists. It's easy to say what meds the patient SHOULD have got a few hours later when notes and labs are up. However, when that patient hits the ED and is unresponsive and/or coding...well that is no time to be looking everything up on the computer or your phone.

Sure, ED providers can make mistakes, but I've seen regular staff pharmacists second guess simple stuff such as giving Insulin IV for hyperkalemia because the "blood sugar wasn't that high". Do these patients really have time for an inexperienced pharmacist to read through a Hyperkalemia overview on UpToDate or Wikipedia before okaying the order?

 

[CetiAlphaFive]

Wrong is subjective, especially when monday morning quarterbacking decisions ED providers make, including ED pharmacists. It's easy to say what meds the patient SHOULD have got a few hours later when notes and labs are up. However, when that patient hits the ED and is unresponsive and/or coding...well that is no time to be looking everything up on the computer or your phone.

Sure, ED providers can make mistakes, but I've seen regular staff pharmacists second guess simple stuff such as giving Insulin IV for hyperkalemia because the "blood sugar wasn't that high". Do these patients really have time for an inexperienced pharmacist to read through a Hyperkalemia overview on UpToDate or Wikipedia before okaying the order?

Surely you mean IV insulin with a glucose chaser.

It'd be real embarrassing for you to get something wrong in your ego stroke thread.

 

[Truthspeaker]

99% of the time, the pharmacist knows the answer, but is confirming their answer.

I see. They didn't truly know the answer if they needed to step away and look it up.

If we're having to look something up, it's because you're likely asking a goofy, irrelevant question that isn't important.

Goofy questions? There were shortages going on so I asked a pharmacist resident what pressor he could get up here the fastest and he asked me what the generic name was. Then he asked me if I could wait until a pharmatech could come restock a machine. Absolutely not I said. Luckily, the ED pharmacist swung by a minute later with a Norepinephrine bag in his hand. I was certain that ED pharmacist saved the patient's life.

 

[Truthspeaker]

Surely you mean IV insulin with a glucose chaser.

It'd be real embarrassing for you to get something wrong in your ego stroke thread.

Don't be fooled by the glucose in the chart, it might be 500 mg/dl currently but you are only seeing information from this morning. Besides, if you are holding up an insulin order because there is no dextrose ordered, how about paging the doctor recommending some dextrose instead of keeping the order in limbo?

 

[CetiAlphaFive]

I see. They didn't truly know the answer if they needed to step away and look it up.
Goofy questions? There were shortages going on so I asked a pharmacist resident what pressor he could get up here the fastest and he asked me what the generic name was. Then he asked me if I could wait until a pharmatech could come restock a machine. Absolutely not I said. Luckily, the ED pharmacist swung by a minute later with a Norepinephrine bag in his hand. I was certain that ED pharmacist saved the patient's life.

It's almost as if the distinction between specialties are there for a reason.
Will wonders never cease?

Do you think if an Onco pharmacist interacted with you they would make a thread skewering MDs as a whole if you weren't able to answer a question regarding alternative chemos?

Also, it's common knowledge that MDs deal in brand names and pharmacy deals in generic names.
Not sure why. They definitely should've known that, though.

 

[PolarPop]

I was going to keep replying to this thread but that would obviously be pointless. The OP is clearly out for vengeance after some poor pharmacy resident didn't bring him/her a levophed drip fast enough.

 

[Charcoales]

If someone asks a question about something I don't regularly use and is high-stakes, I am looking that **** up to confirm. I dont give a **** about how impatient someone is. It's my job to be as close to 100% right as possible. Not going to risk safety for ego.

 

[Truthspeaker]

I was going to keep replying to this thread but that would obviously be pointless. The OP is clearly out for vengeance after some poor pharmacy resident didn't bring him/her a levophed drip fast enough.

Sorry, I'm a bit confused. I've done nothing but praise the pharmacists who know what the doctor wants BEFORE it is even ordered, while at the same time encourage other pharmacists to meet the same standard. Even retail pharmacists should know what a pressor is. You guys are surely saving lives by vaccinating a big chunk of the population. However, if your patient has an anaphylactic reaction from your vaccine, that is NOT the time to be looking up on your phone what the recommended treatment is. You'll need to give the pressors, the epi, ASAP since you are the one responsible for that patient's life.

 

[zelman]

Hey @Truthspeaker what's your specialty?

 

[gwarm01]

When your bosses "check the literature" on you and your interventions, they will be giving the other pharmacist who is a stud at answering the clinical questions the bigger raise and promotion.

So.. are you a student on rotation or what?

 

[BidingMyTime]

If someone asks a question about something I don't regularly use and is high-stakes, I am looking that **** up to confirm. I dont give a **** about how impatient someone is. It's my job to be as close to 100% right as possible. Not going to risk safety for ego.

This. I would rather get in trouble for being too slow with an answer, then get in trouble for giving a wrong answer that kills someone. If it's something I don't work with every day and haven't seen for awhile, I am going to double check my answer, even if I think I am 99% right. Truthseeker acts like every situation is immediate life and death, but there are many situations that are not. If the patient isn't coding, then it's better to take 1 minute to make sure the answer is correct, than to "guess" and do the patient serious harm. Even in the CCU and ER, most situations are not so imminent that the patient is going to die if 30 - 60 seconds are delayed getting the right answer, rather than giving a "maybe right" answer.

Sorry, I'm a bit confused. I've done nothing but praise the pharmacists who know what the doctor wants BEFORE it is even ordered, while at the same time encourage other pharmacists to meet the same standard. Even retail pharmacists should know what a pressor is. You guys are surely saving lives by vaccinating a big chunk of the population. However, if your patient has an anaphylactic reaction from your vaccine, that is NOT the time to be looking up on your phone what the recommended treatment is. You'll need to give the pressors, the epi, ASAP since you are the one responsible for that patient's life.

Now I agree with you that every pharmacist, especially a hospital pharmacist, should know what a "pressor" is. I'm wondering if there wasn't some communication failure going on, when the pharmacist asked you what the "generic" was, I'm thinking he didn't hear your request correctly and misunderstood what you were asking for. Maybe you could have spoken a little calmer and clearer, so he could understand you better. Or maybe s/he was a *******, I don't know.

But your anecdotal situation about one pharmacist not understanding your request one time, really tells us nothing about pharmacists knowledge in general (or even this one individual pharmacists knowledge in particular.)

 

[owlegrad]

All right this has been fun but you can't make threads in pharmacy just to degrade the profession. (If you aren't a pharmacist)