CPhT Administrator Vs Staff Pharmacists

[Sparda29]

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Was just wondering if this weird dynamic exists at other hospitals or just at mine. Had a recent issue where a resident contacted me overnight about a difficult case, I recommended a drug, he talked to his attending. Attending got the department head's approval. The issue was that the drug I recommended was rather expensive.

So now, the administrator in charge of ordering and inventory is upset that I recommended something expensive and wants me to keep cost in mind when making recommendations. I get that, but that's obvious, and sometimes the best thing happens to be expensive.

Am I right to feel that a pharmacy tech has no authority over me just because they are in an administrative role? Other pharmacists told me that this particular person is well connected. Example, when the pharmacy supervisor wrote our pharmacy contact directory, she organized the list via hiearchy as DOP -> Pharmacy Supervisor -> Staff Pharmacists -> Technicians. The administrator who is a tech ended up raising a big stink to the point about her low place on the list until the pharmacy supervisor just gave up and did it in alphabetical order.

Anybody else work at hospitals where there are techs in administrative roles, and if they are in an administrative role, do they have any power over the staff pharmacist?

One thing that really bugs me is,. why do we need an inventory manager? That's a job the staff pharmacists can collectively do. Give all the pharmacists the logiin info for Amerisource, and that's it, when something is out of stock, we can just order it right away instead of writing it into a list and waiting for the inventory manager to order it.

 

[awval999]

I have worked in an inpatient setting where there is a technician supervisor. The technician supervisor is usually smart enough to not question a pharmacist's professional judgment. I'm sure in your situation the technician supervisor probably has a drug budget monthly target to hit and you just blew a wide hole in it, so I'm sure that's where this came from.

I would just smile and nod and say something along the lines of, "Of course I keep in mind the cost to health system of every recommendation I make, I understand the drug budget is very important to the pharmacy leadership, in this particular circumstance, in my clinical judgement the patient required X due to Y, there was no alternative."

Getting into a pissing match where you will probably have to say the same thing to the pharmacist supervisor if you come across arrogant isn't worth it.

 

[PharmDBro2017]

Was just wondering if this weird dynamic exists at other hospitals or just at mine. Had a recent issue where a resident contacted me overnight about a difficult case, I recommended a drug, he talked to his attending. Attending got the department head's approval. The issue was that the drug I recommended was rather expensive.

So now, the administrator in charge of ordering and inventory is upset that I recommended something expensive and wants me to keep cost in mind when making recommendations. I get that, but that's obvious, and sometimes the best thing happens to be expensive.

Am I right to feel that a pharmacy tech has no authority over me just because they are in an administrative role? Other pharmacists told me that this particular person is well connected. Example, when the pharmacy supervisor wrote our pharmacy contact directory, she organized the list via hiearchy as DOP -> Pharmacy Supervisor -> Staff Pharmacists -> Technicians. The administrator who is a tech ended up raising a big stink to the point about her low place on the list until the pharmacy supervisor just gave up and did it in alphabetical order.

Anybody else work at hospitals where there are techs in administrative roles, and if they are in an administrative role, do they have any power over the staff pharmacist?

One thing that really bugs me is,. why do we need an inventory manager? That's a job the staff pharmacists can collectively do. Give all the pharmacists the logiin info for Amerisource, and that's it, when something is out of stock, we can just order it right away instead of writing it into a list and waiting for the inventory manager to order it.

Specific example of the case and drug you recommended for treatment would be beneficial here.

Coming from working at a 200-300 bed hospital where we lost our best technician (the one who did all the ordering), it is not a good idea to have pharmacists do the ordering because half of them are lazy POS and won't order a damn thing and don't care. You end up getting screwed on nightshift and weekends because no one ordered anything. Half the people work hard and do great, the other half dick off all day.

 

[BidingMyTime]

Oh, you definitely want an inventory manager. I don't think I've ever worked at a hospital that didn't have one. And no reason a technician can't be one. It's one thing for the tech to mention cost to you, but no, s/he should not be 2nd guessing your decision or acting up by it.

 

[Rockinacoustic]

What was the difficult case?

 

[Sparda29]

What was the difficult case?

We do not have any Kcentra or antidotes for Pradaxa. Eliquis, etc.

 

[PharmDBro2017]

We do not have any Kcentra or antidotes for Pradaxa. Eliquis, etc.

Don't y'all have a policy to go off of in times like this? No praxbind or AndexXa in stock?

And so what did you recommend

 

[deleted945127]

i am a tech and i do not do inventory but as i heard , ordering meds and keep it within or lower than the budget will get the pharmacy a good bonus....


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[Pharmacy is a Scam]

One thing that really bugs me is,. why do we need an inventory manager? That's a job the staff pharmacists can collectively do. Give all the pharmacists the logiin info for Amerisource, and that's it, when something is out of stock, we can just order it right away instead of writing it into a list and waiting for the inventory manager to order it.

Probably because they can save more money by paying someone $10-20/hr to do administrative work like this rather than pay a pharmacist $50/hr to do the same thing. In case you haven’t noticed, every practice setting that employs both pharmacists and pharmacy techs are constantly looking for ways to:
1) Cut costs
2) Increase the scope of practice of techs because they cost less
3) Decrease the work that pharmacists do that anyone else can also do (oftentimes framed as “pharmacists should focus on providing clinical/cognitive services”) because pharmacists cost too much
4) Cut more costs

 

[Sparda29]

Don't y'all have a policy to go off of in times like this? No praxbind or AndexXa in stock?

And so what did you recommend

No Praxbind, no Andexxa, no Kcentra,. It's some scary **** if you're a patient on Eliquis, Pradaxa, Xarelto with a uncontrolled bleed and you're here.

Apparently the only option we have here is FFP.

 

[Rockinacoustic]

No Praxbind, no Andexxa, no Kcentra,. It's some scary **** if you're a patient on Eliquis, Pradaxa, Xarelto with a uncontrolled bleed and you're here.

Apparently the only option we have here is FFP.

That sounds like a lawsuit waiting to happen.

So what was the anticoagulant and the recommendation you made?

 

[confettiflyer]

No Praxbind, no Andexxa, no Kcentra,. It's some scary **** if you're a patient on Eliquis, Pradaxa, Xarelto with a uncontrolled bleed and you're here.

Apparently the only option we have here is FFP.

What the hell really?

And Andexxa is a ****e drug anyway.

Back to your original question, your institution should trust you enough that you did your due diligence in selecting the right agent for the right patient, even if it’s expensive. A non-pharmacist suggesting otherwise and only concerning themselves about cost is overstepping the line.


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[owlegrad]

I would ask myself which my director cares about more, patient care or cost containment. Then I would try to decide who the director cares about more, a random staff pharmacist or the person who controls if the pharmacy meets inventory goals.

Really I would probably just ask the tech what they want me to recommend next time it comes up and go from there.

 

[Sparda29]

That sounds like a lawsuit waiting to happen.

So what was the anticoagulant and the recommendation you made?

I had recommended Praxbind which yeah is pretty damn expensive but also very useful and life saving in a

What the hell really?

And Andexxa is a ****e drug anyway.

Back to your original question, your institution should trust you enough that you did your due diligence in selecting the right agent for the right patient, even if it’s expensive. A non-pharmacist suggesting otherwise and only concerning themselves about cost is overstepping the line.


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There is another major medical center nearby, I guess they are thinking that they can just send the patient over there, but in an emergency situation they should have it in stock.

 

[owlegrad]

Come to think of it, this reminds me of a board we have at work. Whenever something goes on backorder we put it on the board and underneath we put whatever we are going to recommend instead. I sometimes wonder who puts the recommendations for alternatives on the board. As far as I can tell it is always whatever is cheapest.

Anyway something somewhat similar happened to me. When atropine drops were backordered I told a nurse that scopolamine patches can be used for excess secretions. Turns out I was supposed to recommend hyoscyamine. Whomp whomp. While I was annoyed at the time I have come to like the board. It's one less thing I have to think of - nurse calls to complain SPS isn't available and asks what she should do - the board says: "recommend Veltassa". Ok, got it.

 

[BC_89]

Supervisory tech calling the shots? Something I never dared to do.

When I was in charge of inventory control at a hospital I would merely tell our staff pharmacists just fill a white board as the day goes of meds we are running low on. I'd use the ABC passport online to fill the orders and update our monthly budget. If something was crazy expensive I would bring it up to our pharmacist that may or may not know the overall cost of what was recommended. I only take it that far and still input the special order to be delivered. Couple of times I was 3% over the budget but made up for it once flu season was past.

When my chain of command would ask on the particular drugs I would shrug and say "that's the only recommendation at this time" And leave it at that.

 

[PolarPop]

I had recommended Praxbind which yeah is pretty damn expensive but also very useful and life saving in a


There is another major medical center nearby, I guess they are thinking that they can just send the patient over there, but in an emergency situation they should have it in stock.

Or borrow the drug from the hospital? Aren’t you in NYC? A few of the smaller hospitals around where I work don’t stock these drugs either but they will ask us to borrow them every once in awhile (usually kcentra). With Uber or the hospital’s driver they can get it within 1-2 hours or so.

We also have two techs do most of the ordering and they do get flustered when I ask for expensive drugs. All they see are drug names and $ signs. But they just need a little context and they settle down.

 

[JustFillIt]

Was just wondering if this weird dynamic exists at other hospitals or just at mine. Had a recent issue where a resident contacted me overnight about a difficult case, I recommended a drug, he talked to his attending. Attending got the department head's approval. The issue was that the drug I recommended was rather expensive.

So now, the administrator in charge of ordering and inventory is upset that I recommended something expensive and wants me to keep cost in mind when making recommendations. I get that, but that's obvious, and sometimes the best thing happens to be expensive.

Am I right to feel that a pharmacy tech has no authority over me just because they are in an administrative role? Other pharmacists told me that this particular person is well connected. Example, when the pharmacy supervisor wrote our pharmacy contact directory, she organized the list via hiearchy as DOP -> Pharmacy Supervisor -> Staff Pharmacists -> Technicians. The administrator who is a tech ended up raising a big stink to the point about her low place on the list until the pharmacy supervisor just gave up and did it in alphabetical order.

Anybody else work at hospitals where there are techs in administrative roles, and if they are in an administrative role, do they have any power over the staff pharmacist?

One thing that really bugs me is,. why do we need an inventory manager? That's a job the staff pharmacists can collectively do. Give all the pharmacists the logiin info for Amerisource, and that's it, when something is out of stock, we can just order it right away instead of writing it into a list and waiting for the inventory manager to order it.

All those blunts you been smoking didn’t make you paranoid did it?

 

[Sparda29]

Or borrow the drug from the hospital? Aren’t you in NYC? A few of the smaller hospitals around where I work don’t stock these drugs either but they will ask us to borrow them every once in awhile (usually kcentra). With Uber or the hospital’s driver they can get it within 1-2 hours or so.

We also have two techs do most of the ordering and they do get flustered when I ask for expensive drugs. All they see are drug names and $ signs. But they just need a little context and they settle down.

Suburbs but still closest hospital that stocks it is 10 miles away,, not too far. IMO, still too long, that **** should be in the OR, and ER and ICU pyxis ready to roll.

 

[Rockinacoustic]

I had recommended Praxbind which yeah is pretty damn expensive but also very useful and life saving in a

What did this tech propose instead, vitamin K?

I would nicely tell the tech to stay in their lane. If they truly don't want to stock a timely antidote (see: https://www.annemergmed.com/article/S0196-0644(17)30657-1/pdf) then make them work with the DOP on a policy on how to immediately triage these patient's to places that do stock them.

 

[lane one]

I totally get not stocking Andexxa for cost purposes (and because it sucks). But no prothrombin complex? not even the cheaper 3 factor stuff? That's just reckless.

 

[rxkrafted]

As others have already mentioned, this is a lawsuit waiting to happen.
Your institution should at least carry Kcentra on hand for emergencies. I'm curious, but can you find your hospital policy on reversal protocol for anticoagulants and tell us what it says?

Inventory managers are important in my opinion because we need someone who is needs to regulate the budget and prevent overbuying, which I have witnessed before with pharmacists who had privileges to order. You have to understand that a lot of money comes out of the pharmacy in the overall hospital operation and if there is no one overseeing the budget, you'll have stocks of expensive meds on hand that may or may not be used before they expire.

Instead of trying to fight for dominance in this so-called hierarchy, you guys should communicate efficiently and get on the same page. Voice your concern with the director, clinical manager, and the buyer and let them know that this is a safety issue for the patients, so getting kcentra (and maybe praxbind) on the formulary for emergency situations should be considered.

 

[Sabril]

How does it usually work in a hospital? I thought you make a recommendation, the clinical coordinator decides whether or not to approve it, and then the tech orders it? In which case, it is between the tech and the coordinator? Or is the tech the coordinator in this case?

what if you make recommendations that "they" do not like? do you get written up for that?

 

[confettiflyer]

How does it usually work in a hospital? I thought you make a recommendation, the clinical coordinator decides whether or not to approve it, and then the tech orders it? In which case, it is between the tech and the coordinator? Or is the tech the coordinator in this case?

what if you make recommendations that "they" do not like? do you get written up for that?

It sounds like sparda doesn’t have a clinical coordinator/administrator, who would make the clinical decision and isolate the staff from the budgetary aspect of this.


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[sakigt]

How are you legally allowed not to stock Kcentra? Who is on P&T?

Also Praxbind is only like $3500..... they must be attempting to run a tight ship. 😕

 

[UofK]

I have worked in an inpatient setting where there is a technician supervisor. The technician supervisor is usually smart enough to not question a pharmacist's professional judgment. I'm sure in your situation the technician supervisor probably has a drug budget monthly target to hit and you just blew a wide hole in it, so I'm sure that's where this came from.

I would just smile and nod and say something along the lines of, "Of course I keep in mind the cost to health system of every recommendation I make, I understand the drug budget is very important to the pharmacy leadership, in this particular circumstance, in my clinical judgement the patient required X due to Y, there was no alternative."

Getting into a pissing match where you will probably have to say the same thing to the pharmacist supervisor if you come across arrogant isn't worth it.

You need an inventory manager --> Director/ AD of Pharmacy Supply Chain and 340B (who is a pharmacist, and this is assuming you are at a large facility). I'm not giving access to my wholesaler accounts to every pharmacist on staff. That is a formulary management nightmare.

Technicians need leadership roles in an organization, but ultimately they should only be over technicians and report directly to a Director/AD of Pharmacy Operations (if we are talking central pharmacy operations).

Your P&T process should outline what is on formulary, what is not, have a policy established for non-formulary med use including assessing patient home supply if possible. There will always be one offs, but a technician should not be "overseeing" these decisions retroactively.

 

[UofK]

We do not have any Kcentra or antidotes for Pradaxa. Eliquis, etc.

WTF 😕😕

 

[Sparda29]

It sounds like sparda doesn’t have a clinical coordinator/administrator, who would make the clinical decision and isolate the staff from the budgetary aspect of this.


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Not really to be honest.