Can a retail pharmacist refuse to compound?

[crossurfingers]

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I've noticed some floaters who cover overnights sometimes and when there are compounds in our queue pointed out to them they say they don't do compounds because they aren't certified. I can understand the capsules which are more complicated, but they are refusing simple creams and oral suspensions. Then it's either tell the patient it won't be ready or stay late or come in early to make it myself. All pharmacists should be able to compound those simple things without certification, am I correct? Sometimes I feel like they just don't want to do the extra work.

 

[awval999]

No pharmacist HAS to fill any prescription. I'm sure the supervisor wouldn't be happy. And yes, I'm quite sure they are just being lazy. And yes, I'm quite sure they know how to mix two creams together.

 

[owlegrad]

If it goes against their conscience to compound of course they can't be made to do it. It's a professional decision to compound or not to compound.

Alright, sorry about that, couldn't resist. It is undoubtedly laziness, if it is really a problem (how often does it come up?) you should probably get the sup involved.

 

[Dred Pirate]

yes - if it is simple, complete laziness. It is not unusual to tell the patient it will take longer. If it is something more complicated where you don't have proper supplies, it is OK. But ya, there is no need to have a certification to mix two creams together. Your certification is called your diploma and license.

 

[maria1oh]

There are plenty of other things that won't get done when floaters are there. A lot of them refuse to touch the automation machines because of all the training and regulations so it won't get refilled with vials,labels,and medications. 14 day returns, cycle counts/inventory stuff, temperature logs, trash, WLM, filing scripts, readyfills, filling the midnight scripts for pick up the next morning, etc. it's also not fair to overnights to be stuck doing the compounding when they have no tech help.
We usually leave 5-10 prescriptions on hold of controls/narcotics that were too soon to fill and have the overnights fill it past midnight to have ready for pick up at the next morning (after 6am). We once had a floater say they did not feel comfortable filling all those narcotics/controls so we had a bunch of angry customers the next morning when I came in and none of their controls/narcotic scripts were ready. The rph had refusal to fill...but I think it was laziness.

 

[farmadiazepine]

I worked overnights for 3 years and was damn good at what I did. I also did overnights at other stores as a floater.

Overnight pharmacists are some of the hardest working pharmacists you will ever find. They do everything on their own, and they know how to do absolutely everything. When I floated overnights to other stores, I saw first hand how much shi* was left for the overnight, and I didn't do anything that was left for me. It pissed me off that a compound that was so easy to make, like 2 creams mixed together, was not made during the day, and left for the overnight. I would take those labels and stick them into the doctor call. Even when I was told to make it, I would come up with some excuse, because I know how easy it was to make it, and it was bullshi* that it wasn't done and that it was intentionally left for the overnight. The mentality always was "leave it for the overnight, they don't do anything anyway."

Of course, when it really came to something important, like clonazepam suspension for a baby with seizures for example, then I would do it. The problem was when the lazy day time pharmacist left work for me which I know could have been done, then I would throw a fit.

Listen, when you have an overnight floater, do not expect them to do anything. You better train your staff to do everything. The overnight floater is doing YOU a favor by being present. That should be the definition of an overnight floater, simply to be present so you don't have to shut down the store. That floater is awake while everyone else is asleep like normal people. Don't ever give those floaters a problem. Don't expect an overnight floater to put away truck, to do compounds, to take care of whatever your normal overnight pharmacist does. It doesn't happen. I hate being taken advantage of, and I hate being awake at stupid hours of the night to cover someone. What I hated the most was the day pharmacists leaving shi* to be done overnight. Then I see all their lunch and cakes and deserts, and it looks like they were having a party during the day. F*ck that.

Now that I am working days and am my own boss, my shi* gets done at the end of every day and not a single thing is left for tomorrow. I don't get why none my day time pharmacists were capable of doing that when I used to work overnights. Now that I'm working days, I do everything, and more.

 

[BidingMyTime]

@farmdiazepam, I think that is pretty ridiculous that you would refuse to do work you presumably had time to do. Day shifts can be extremely busy, so busy that there is no time to "mix 2 creams togethers". As for lunch, cakes, and desserts, more than likely, the pharmacist ate bites in between their work. When was the last time you worked a day shift in a chain pharmacy? Having night shift get caught up on everything there was no time do to during the day, is the only thing that keeps a lot of pharmacies going.

 

[BidingMyTime]

@OP, what state are you in? I'm not aware of any state that requires a "certification" to make compounds (well, NY has their wet lab, but that is required to be a pharmacist at all.) So yes, the overnight pharmacists should be making those compounds, and if for some reason they passed pharmacy school and don't know how to make them, well, they should call another 3rd shift pharmacy and get instructions on how to make them.

 

[WVUPharm2007]

If it's a compound that deals with female reproduction, no. It must be done and you are a terrible person if you don't do exactly what the patient wants.

Otherwise, you legally allowed to enjoy complete autonomy and can do whatever you please. YMMV with your individual employer, however. They get to tell you what to do.

 

[farmadiazepine]

@farmdiazepam, I think that is pretty ridiculous that you would refuse to do work you presumably had time to do. Day shifts can be extremely busy, so busy that there is no time to "mix 2 creams togethers". As for lunch, cakes, and desserts, more than likely, the pharmacist ate bites in between their work. When was the last time you worked a day shift in a chain pharmacy? Having night shift get caught up on everything there was no time do to during the day, is the only thing that keeps a lot of pharmacies going.

Time we PRESUMABLY have. That's the problem right there. PRESUMABLY.

Let me explain one thing about working overnights. Time is relative. 8 hours, or 10 hours, or 12 hours of overnight is not the same as 8 or 10 or 12 hours of working day time. When you work overnight, your body clock functions completely differently, time actually exists and moves differently, and the world is a very different place, right up till about 6am when the world starts functioning again normally. You have to remember what overnights do. They fill prescriptions while trying to have a clear mind at 3 am in the morning. It's not easy. It's difficult. Yes, it's so easy to mix 2 creams together, but if I am floating overnight, no I'm not going to do it.

Yes, get another overnight to work. That's a good idea. See how your store is the next day. All overnights are the same, we all think the same. No one is ever going to give us the Paragon award no matter how much we bust our ass or how much we get shi* done. That's why when I float overnight, I can care less about your particular chain store.

And I'm serious about the time thing. Just because I work a 10 hour shift overnight, does not mean I have 10 hours to do work. I spend the first 6 to 8 hours cleaning up all the bullsh** and mess from the day shift, and dealing with all the problems left either intentionally or unintentionally because it was forgotten. Then I spend my last 2 to 4 hours doing what I need to do. That's when I look at time linearly, but like I said, time exists completely differently when you work overnight. I just simplified it right now into a straight line so you can understand.

 

[zelman]

Time we PRESUMABLY have. That's the problem right there. PRESUMABLY.

Let me explain one thing about working overnights. Time is relative. 8 hours, or 10 hours, or 12 hours of overnight is not the same as 8 or 10 or 12 hours of working day time. When you work overnight, your body clock functions completely differently, time actually exists and moves differently, and the world is a very different place, right up till about 6am when the world starts functioning again normally. You have to remember what overnights do. They fill prescriptions while trying to have a clear mind at 3 am in the morning. It's not easy. It's difficult. Yes, it's so easy to mix 2 creams together, but if I am floating overnight, no I'm not going to do it.

Yes, get another overnight to work. That's a good idea. See how your store is the next day. All overnights are the same, we all think the same. No one is ever going to give us the Paragon award no matter how much we bust our ass or how much we get shi* done. That's why when I float overnight, I can care less about your particular chain store.

And I'm serious about the time thing. Just because I work a 10 hour shift overnight, does not mean I have 10 hours to do work. I spend the first 6 to 8 hours cleaning up all the bullsh** and mess from the day shift, and dealing with all the problems left either intentionally or unintentionally because it was forgotten. Then I spend my last 2 to 4 hours doing what I need to do. That's when I look at time linearly, but like I said, time exists completely differently when you work overnight. I just simplified it right now into a straight line so you can understand.

It sounds like you might be on LSD. You should get your space/time perception evaluated.

 

[TheFerret]

Time we PRESUMABLY have. That's the problem right there. PRESUMABLY.

Let me explain one thing about working overnights. Time is relative. 8 hours, or 10 hours, or 12 hours of overnight is not the same as 8 or 10 or 12 hours of working day time. When you work overnight, your body clock functions completely differently, time actually exists and moves differently, and the world is a very different place, right up till about 6am when the world starts functioning again normally. You have to remember what overnights do. They fill prescriptions while trying to have a clear mind at 3 am in the morning. It's not easy. It's difficult. Yes, it's so easy to mix 2 creams together, but if I am floating overnight, no I'm not going to do it.

Yes, get another overnight to work. That's a good idea. See how your store is the next day. All overnights are the same, we all think the same. No one is ever going to give us the Paragon award no matter how much we bust our ass or how much we get shi* done. That's why when I float overnight, I can care less about your particular chain store.

And I'm serious about the time thing. Just because I work a 10 hour shift overnight, does not mean I have 10 hours to do work. I spend the first 6 to 8 hours cleaning up all the bullsh** and mess from the day shift, and dealing with all the problems left either intentionally or unintentionally because it was forgotten. Then I spend my last 2 to 4 hours doing what I need to do. That's when I look at time linearly, but like I said, time exists completely differently when you work overnight. I just simplified it right now into a straight line so you can understand.

Sounds like you should switch to days. I worked overnights and I loved every minute of it. I didn't have a problem with the work. Yea, the day shift left a lot of stuff for the night shift but I wasn't bitter - which is exactly how you sound.

 

[WVUPharm2007]

Time we PRESUMABLY have. That's the problem right there. PRESUMABLY.

Let me explain one thing about working overnights. Time is relative. 8 hours, or 10 hours, or 12 hours of overnight is not the same as 8 or 10 or 12 hours of working day time. When you work overnight, your body clock functions completely differently, time actually exists and moves differently, and the world is a very different place, right up till about 6am when the world starts functioning again normally. You have to remember what overnights do. They fill prescriptions while trying to have a clear mind at 3 am in the morning. It's not easy. It's difficult. Yes, it's so easy to mix 2 creams together, but if I am floating overnight, no I'm not going to do it.

Yes, get another overnight to work. That's a good idea. See how your store is the next day. All overnights are the same, we all think the same. No one is ever going to give us the Paragon award no matter how much we bust our ass or how much we get shi* done. That's why when I float overnight, I can care less about your particular chain store.

And I'm serious about the time thing. Just because I work a 10 hour shift overnight, does not mean I have 10 hours to do work. I spend the first 6 to 8 hours cleaning up all the bullsh** and mess from the day shift, and dealing with all the problems left either intentionally or unintentionally because it was forgotten. Then I spend my last 2 to 4 hours doing what I need to do. That's when I look at time linearly, but like I said, time exists completely differently when you work overnight. I just simplified it right now into a straight line so you can understand.

I have no idea what you are talking about. Nights can be worse than days in spots, sure. Those occasions when you are alone with a huge line, 2 in drive thru with 10 waiters...its unmatched by a day shift anywhere in the country. But lets be honest, its MOSTLY lower stress. And you do have time to do things. Don't forget that 15 minute guaranteed break you get when the computers reboot. Mike and Friends get a de facto lunch, baby.

 

[farmadiazepine]

I just finished watching Interstellar for the first time literally 5 minutes before. It was such a great movie.

 

[BidingMyTime]

Let me explain one thing about working overnights. Time is relative. 8 hours, or 10 hours, or 12 hours of overnight is not the same as 8 or 10 or 12 hours of working day time. When you work overnight, your body clock functions completely differently, time actually exists and moves differently, and the world is a very different place, right up till about 6am when the world starts functioning again normally. You have to remember what overnights do. They fill prescriptions while trying to have a clear mind at 3 am in the morning. It's not easy. It's difficult. Yes, it's so easy to mix 2 creams together, but if I am floating overnight, no I'm not going to do it.

I have filled in overnights before, and I had no problem clearing up all the stuff from dayshift, and keeping everything else going. I'm sure there is the randomly bad night here and there, but most of the time, there is no reason not to be able to get everything done (now maybe you had some toxic work environment that is the exception?) I had to hustle, for sure, but then I have to hustle for day shift as well (with a 1000 more interruptions from either nurses or customers--stuff that I didn't have to deal with during night shift.)

And I have no idea what you mean about the time dilation, unless your overnight pharmacy is on another planet or something, the time at night on earth, is exactly the same as the time at
day on earth.

And I find it bizaare that you liked WVUPharm's post, when he says he has no idea what you are talking about?

 

[WVUPharm2007]

Did you also do all of the bull****, too? Cycle counts, waiting bin maintenance, etc? A lot of day people think its just Readyfill...

 

[maria1oh]

There are some stores I enjoyed working nights but there are others that are a nightmare. Walking into 3 pages vs 30 pages makes a big difference.

 

[crossurfingers]

I am in Texas. I have also been an overnight floater before (but not in Texas). According to farmdiazpine, those pharmacies that I worked overnight at were taking advantage of me. I've been left to complete 5 compounds, plus 100 refills for the next day and other random stuff. I've even put away truck before. I just can't fathom how you could just flat out refuse to do those things though. I mean, it may be busy at night but at least make an effort to try to get that stuff done. When you switch off with the pharmacy manager who gives you a list of things to do, do you just say "no, I don't do that"? That takes some balls that I don't have. If my pharmacy supervisor agreed that an overnight floater should just essentially be present I would volunteer for overnights more often. I am aware that there are some stores that are a mess and horribly busy but the store I am at isn't. It may be busy for one person alone until about 1am but after that you're mostly left alone. And we don't have a lot in the queue to be cleared for the next day either compared to some other stores (maybe 30-40 refills for the overnight to fill). When I've worked for 24 hour stores it's been their policy to tell patients it takes overnight to make compounds (the regular overnighter is certified).

 

[cozypark]

I don't think overnight pharmacy's job is just being there opening pharmacy. You need to finish up whatever is left from daytime & getting things done for next day. I don't understand why some pharmacists refuse to do jobs what are left from daytime.

I just do not agree with the attitude "There are nothing to do at night. So you need to finish whatever busy daytime pharmacists left for you."

I worked as overnight pharmacists.
After midnight, you are the only person to do drop-off, production, pickup, drive-thru, picking up phones, filling ScriptPro, RTS, cleaning trash, 150 rx of ready fills (filling and QA) , sending faxes to doctors, C2 & compound from daytime, temp check, C2 audit once a month.... plus, all those drug addict people with crappy oxycodone 30mg rx from 30 miles from pharmacy.
Low stress level? yeah.. but it depends. When it is flu season, I see 10 people in each drop-off AND pick up (That store had 3 big hospital around) while there are 5 phones on hold at 2:30am. = dealing with 25 people at the same time by myself. If I have insurance issue or one crazy customer, the line gets long in no time.
I closed pharmacy to have 30 minutes lunch break at 3 am, and customers complain that why we are not 24 hours pharmacy but "23 1/2 hour pharmacy". lol.

Now I am working day time. It is busier for sure, but I would be dealing with all crazy things with other staffs & techs rather working at night by myself.

 

[BidingMyTime]

Now I am working day time. It is busier for sure, but I would be dealing with all crazy things with other staffs & techs rather working at night by myself.

I guess its a difference in personality. I would rather work by myself, than deal with the constant interruptions by technicians. If I'm the only one, then even when its busy with the phones ringing and/or 5 people at checkout, I can still concentrate on 1 person or 1 problem at a time before moving on to the next.

 

[HelpfulPharmer1]

I've noticed some floaters who cover overnights sometimes and when there are compounds in our queue pointed out to them they say they don't do compounds because they aren't certified.


I had pharmacist refusing to compound with the reason that the pharmacy does not have "License to Compound" posted on the wall.

Is that a valid reason?
Question to all: In retail pharmacy in California, do we need to have store compounding license and personal compounding license to compound non-sterile product like Magic Mouthwash by mixing Benadryl and Lidocaine together?

During my rotation as student, I learned compounding skills from making sterile IV to making liquid Tamiflu from capsule to mixing Magic Mouthwash to making capsules, creams, ointments, jars, tubes, labels and even shipping !!!

I work for a national chain that is very strict at keeping track and requesting current photocopy for immunization, CPR, pharmacist licence, tech license and they have never asked me to provide compounding license. That suggests we have no need for personal compounding license for simple retail compounded products. Computer also has formula for compounding inside the software, ready to make create any compound and we even have mortar and pestle at any branch. Therefore, I have reasons to believe we are okay to compound non-sterile products without store compounding license and also without personal compounding license and hence, I have been compounding simple Magic Mouthwash, liquid Tamiflu, liquid muscle relaxer for disabled patients who can not swallow pill and must take med by G-tube.

Any one has law that shows store must have store compounding license for non-sterile product? Please share.

Thank you very much for your helpful thoughts.

 

[SClENCE]

I guess its a difference in personality. I would rather work by myself, than deal with the constant interruptions by technicians. If I'm the only one, then even when its busy with the phones ringing and/or 5 people at checkout, I can still concentrate on 1 person or 1 problem at a time before moving on to the next.

I think I would much rather work at night, simply because I can focus on filling scripts and not as often be interrupted by customers at pick-up. The only thing that intimidates me is if I run into an issue that I don't know how to resolve, then I'm basically screwed since I'm by myself lol.

 

[owlegrad]

I love working overnight. You can always call another store in your chain if you get stuck on something.

 

[farmadiazepine]

If a pharmacist feels uncomfortable compound a prescription, he or she should not do it. Why would they compound something they are not comfortable dispensing? That's the answer to "Can a pharmacist refuse to compound?"

But.. compounding is a skill pharmacists should have. So if your pharmacist cannot compound, then you have, and I'm sorry to say, a wack a** pharmacist working the overnight.

Here I am compounding tacrolimus suspension, caffeine citrate, sildenafil, and a ton of drugs for kids during my day shifts, and you have an overnight who can't compound a simple non-sterile compound? That sucks.

 

[trailerpark]

If a pharmacist feels uncomfortable compound a prescription, he or she should not do it. Why would they compound something they are not comfortable dispensing? That's the answer to "Can a pharmacist refuse to compound?"

But.. compounding is a skill pharmacists should have. So if your pharmacist cannot compound, then you have, and I'm sorry to say, a wack a** pharmacist working the overnight.

Here I am compounding tacrolimus suspension, caffeine citrate, sildenafil, and a ton of drugs for kids during my day shifts, and you have an overnight who can't compound a simple non-sterile compound? That sucks.

Who has time for that? I can't even stand mixing the pantoprazole suspension. Shake for 60 seconds!? I don't have time for that!!!!!

 

[wucool33]

Wait, some of you guys have to do c2 cycle counts and other inventory stuff for overnight? How do you even have time for that stuff? I'm doing 150-200 rx every night, that plus doing 14 days RTS and refilling the robot for day time ppl would already take up my whole night... Not to mention all the periodic interruptions with customers coming in...

 

[farmadiazepine]

Wait, some of you guys have to do c2 cycle counts and other inventory stuff for overnight? How do you even have time for that stuff? I'm doing 150-200 rx every night, that plus doing 14 days RTS and refilling the robot for day time ppl would already take up my whole night... Not to mention all the periodic interruptions with customers coming in...

Then what does your daytime do? Fill at least 1000 scripts during their shift?

 

[wucool33]

Then what does your daytime do? Fill at least 1000 scripts during their shift?

You mean what I do is not the norm?