Drama in my pharmacy.

[undertow]

Today was my last day working as a tech before i start school. Its a 24 pharmacy store that does about 300-350 scprits daily.

Anyhow, our overnight pharmacist is a 65 year old pharmacist who has been in the business for like 30 years. Everyone else thinks that he sucks as a pharmacist. He usually averages about 20-25 scripts over 8 hours. Quite slow imo.

So this morning the morning pharmacist,a 25 year old woman who recently got her licence and isn't afraid to speak her mind, comes in and sees that the overnight guy only did 16 scripts and left about 35 rx's undone. She was pissed to say that least. She picked up the stack of scripts that needed to be typed and told him thats he's pathetic and that he does absolutely nothing all night. After he left she took out her phone cam and started takin pics of the scripts that he left as evidence as if it were some kind of crime scene investigation. Unfortunately, i came late to work and missed the whole scene.

I was wonderin if any of you had similar situations and how you handled it

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[sdn1977]

Today was my last day working as a tech before i start school. Its a 24 pharmacy store that does about 300-350 scprits daily.

Anyhow, our overnight pharmacist is a 65 year old pharmacist who has been in the business for like 30 years. Everyone else thinks that he sucks as a pharmacist. He usually averages about 20-25 scripts over 8 hours. Quite slow imo.

So this morning the morning pharmacist,a 25 year old woman who recently got her licence and isn't afraid to speak her mind, comes in and sees that the overnight guy only did 16 scripts and left about 35 rx's undone. She was pissed to say that least. She picked up the stack of scripts that needed to be typed and told him thats he's pathetic and that he does absolutely nothing all night. After he left she took out her phone cam and started takin pics of the scripts that he left as evidence as if it were some kind of crime scene investigation. Unfortunately, i came late to work and missed the whole scene.

I was wonderin if any of you had similar situations and how you handled it

Poor form on the part of your Am pharmacist for sure! I've been in this situation...you handle it discreetly - don't involve the ancillary personnel at all. You document - no - you don't take pictures - that is ridiculous. The computer know what time the rx was put into the fill queue, what time the label was generated & the rx filling record shows who filled it - if it was the Am pharmacist - its her initials. Were there really 35 rxs which were dropped off between 11PM & 9Am & nobody wanted filled? That is actually hard for me to believe unless you are two blocks from an ER.....I'm guessing they were left for him from the evening shift...in which case..it doesn't matter - the pts were told the rx wouldn't be available until the day after since the drug had to be ordered & the rx was put in after the auto order went thru.

This is not atypical at all. Someone has to do the night shift & I'm betting she is not wanting to do it! So.....he does - he sits there all night & sends folks down to the aisle with the condoms, tells folks where to find the acetaminophen for their kid with the fever....all those things we don't want to do because we'd rather be snuggled up with our SO in our own beds.

So...its a trade off. You choose what you want to fuss about. What did it matter? Were there enough techs to get the work done during the day? Does he have a tech during the night shift? How hard is it to staff nights? Its pretty hard in my area.

You make your own reality - if you want to get pissed off - someone will do it. In this case...the 25yo RPh got pissed off at the night shift guy. It happens all the time - he doesn't care & her pictures won't mean anything. But...she had the satisfaction of taking them & talking about it - gossip is a poor friend!

 

[tartaufraise]

Just a fact of life: people shifting tasks to each other, people avoiding work, people trying to make others do the work, people got pissed because co-workers are not up to their std., etc.

It happens all the time, in any work place, and not just in Pharmacy. Get used to it, and pick your own way to handle it; be it drama, or sulking, or suffering in silence, or putting things in persepective. Imho, the best part about being a pharmacist is, once I go home, the job stays at work (except if I'm on-call, in which case I'll avoid at all cost).

 

[Doctor M]

As a pharmacy manager, i have given my overnights one warning before a write up occurs. I lead by example. We do about 400-500 per day and i try my hardest to have all rx's typed in before i leave. Normally i have all typed in and all the overnight has to do is fill and fill. As far as taking pictures that is kind of ridiculous. I believe documentation is the way to go. Document document!!! One of my overnight will have everything done when i walk in but when my partner is working she slacks. i do surprise visits on her so she never knows when i will be in. Anyway, it looks as if though your daytime rph needs some management classes. Take care

carlos

 

[WVUPharm2007]

Welcome to the world of pharmacy. The whinning never stops. I've never had a job where someone didn't whine about something or someone. I guarantee you someone has already said something bad about you behind your back. I generally cut right to the chase and get an up front discussion going on whenever I'm badmouthed. You know, they try to say stuff about you literally behind your back when you are busy doing something. That happened today and I snapped my neck and gave this wicked stare at the person for a good 10 seconds. It was hilarious. I'll just nod when other people do it and let the idiotic office politics go on around me.

Sometimes it can cause bad stuff to happen, too. The most intelligent, but not most experienced, though sufficiently experienced, technician we have (works evenings with me) is leaving because the day shift techs were constantly talking **** and he got tired of it. He'll be getting paid twice as much at WVU hospital...good for him. The kid kept the place running. He always tidied up the place, kept everything stocked, and worked very fast and accurately. But due to politics, he's leaving and my pharmacy will suffer. I'm leaving in October and he's leaving next week, so the pharmacy may have a lack of talent for the evenings and could go to hell. Or not.

 

[pharmaz88]

After he left she took out her phone cam and started takin pics of the scripts that he left as evidence as if it were some kind of crime scene investigation.

hippa violation

...blackmail her for extra-long lunches and breaks.

 

[rxlynn]

This is the perfect illustration of why I will never work in a 24 hour pharmacy after I'm licensed. It is so difficult to staff the night Rph that they can get away with anything short of murder, and nobody does anything about it. A good night pharmacist can makes the days so much easier, but a bad one can cause all sorts of problems.

The last time I floated over to the 24 hour pharmacy close to my house, we had a mother who came in a 8:30 am on Sat. morning to pick up the compound that a) the night pharmacist was supposed to do overnight and b) that he didn't bother to tell the day pharmacist about before he left - just left the script in the pile of 6 or so he hadn't completed before he left. The pharmacist was a floater too, so we told her to call the DM and complain. I truly don't understand why people who have no more work ethic than that ever became pharmacists in the first place!

sdn1977 is right - you should be able to get adequate documentation from the pharmacy computer. We used that when our night pharmacist (I used to tech in a 24 hour store) started whining that she needed tech help until 11 pm.

 

[DHG]

hippa violation

...blackmail her for extra-long lunches and breaks.

HIPAA.


I agree that was pretty unprofessional behavior. And what the hell is she going to do with pictures?

 

[tupac_don]

Just a fact of life: people shifting tasks to each other, people avoiding work, people trying to make others do the work, people got pissed because co-workers are not up to their std., etc.

It happens all the time, in any work place, and not just in Pharmacy. Get used to it, and pick your own way to handle it; be it drama, or sulking, or suffering in silence, or putting things in persepective. Imho, the best part about being a pharmacist is, once I go home, the job stays at work (except if I'm on-call, in which case I'll avoid at all cost).

You actually do on-call as a pharmacist??? Wow

 

[pharmaz88]

HIPAA.

 

[tartaufraise]

You actually do on-call as a pharmacist??? Wow

Yes, in the hospital that I worked, there are at least 6 pharmacists on-call. They mostly work full-time retail and on-call at the hospital for graveyard shifts, weekends, holidays, or whenever the hospital need an extra RPh (such as when we changed our comp. system, which was a complete chaos). The staff pharmacists are also have their on-call rotation in case someone decided last minute they want to enjoy labor day weekend and call in sick & use their PTO.

In fact, I believe you can join this place and work solely on-call. There's one in TX for sure, you call this hotline number to schedule a RPh and one will come.. the name of the organization escape my head just now, but someone can probably fill in.

 

[ZpackSux]

Yes, in the hospital that I worked, there are at least 6 pharmacists on-call. They mostly work full-time retail and on-call at the hospital for graveyard shifts, weekends, holidays, or whenever the hospital need an extra RPh (such as when we changed our comp. system, which was a complete chaos). The staff pharmacists are also have their on-call rotation in case someone decided last minute they want to enjoy labor day weekend and call in sick & use their PTO.

In fact, I believe you can join this place and work solely on-call. There's one in TX for sure, you call this hotline number to schedule a RPh and one will come.. the name of the organization escape my head just now, but someone can probably fill in.

What you're referring to is not "on call" per se. Those pharmacists who fill in are called "PRN" or "Per Diem" meaning they fill in as needed.

On call pharmacists usually are hospital pharmacists who are on call when the pharmacy is closed.. like between 11pm till 7 am. And when a patient requires medications that's not available througout the hospital, then the house supervisor calls the on call pharmacist to come out and dispense it...usually complex mixture of electrolyte IV solutions or narcotic medications in the pharmacy which no one has access to.

 

[tartaufraise]

What you're referring to is not "on call" per se. Those pharmacists who fill in are called "PRN" or "Per Diem" meaning they fill in as needed.

On call pharmacists usually are hospital pharmacists who are on call when the pharmacy is closed.. like between 11pm till 7 am. And when a patient requires medications that's not available througout the hospital, then the house supervisor calls the on call pharmacist to come out and dispense it...usually complex mixture of electrolyte IV solutions or narcotic medications in the pharmacy which no one has access to.

No, they are strictly on-call. They're not PRN. There are PRN pharmacists who are called ahead of time, before the boss draws the final the schedule, to see if they can work that week & fill in the gap on the shifts.

After the schedule is set up, if there are gaps (due to emergencies like RPh is sick last-minute, or if a system break down and need more staffing), then we call the on-call pharmacists; whomever the staff that are assigned that week to cover, or, if they're not available, that hotline number. Hope this makes sense?

That's how my hospital staff the pharmacy, that way, we never have any down-time and patients can always have access to any custom drips, including narcs (like for hospice patients). On top of that, we also have on-call oncology pharmacist to do after-hour chemo meds etc. if needed.

 

[ZpackSux]

No, they are strictly on-call. They're not PRN. There are PRN pharmacists who are called ahead of time, before the boss draws the final the schedule, to see if they can work that week & fill in the gap on the shifts.

After the schedule is set up, if there are gaps (due to emergencies like RPh is sick last-minute, or if a system break down and need more staffing), then we call the on-call pharmacists; whomever the staff that are assigned that week to cover, or, if they're not available, that hotline number. Hope this makes sense?

That's how my hospital staff the pharmacy, that way, we never have any down-time and patients can always have access to any custom drips, including narcs (like for hospice patients). On top of that, we also have on-call oncology pharmacist to do after-hour chemo meds etc. if needed.

And you're trying to give me lessons on how a hospital pharmacy is staffed?

If your boss has to rely on "on call pharmacist" who is on standby to staff the pharmacy..along with having to use the "hotline" I can tell you it's not the most efficiently operated hospital pharmacy.

After hour chemo? Does your pharmacy close at night? If not, I don't know why a pharmacist would need to mix chemos.. And if the pharmacy is closed..then why is there an "oncology pharmacist" on call...your other pharmacists can process a chemo order? And why do chemos at afterhours? It's not an emergency..

By the way, your "on call pharmacists" aren't full time or part time employee of the hospital. So, they are classified as "PRN" or "Per Diem" or "Contract" according to your HR classification.

 

[WVUPharm2007]

And why do chemos at afterhours? It's not an emergency..

Haha. I could imagine how pissed off the night RPh I used to work with would be if they tried to have her make a chemo at 3AM. She'd throw a tantrum if a guy found unconscious that hadn't eaten in 3 days came in the ER and needed a TPN made.

"The IV tech comes in at 8AM. He doesn't know he's hungry!"
*Slams down phone*
*Continues playing on internet*

 

[sdn1977]

I gotta agree with Zpack here.....on call is used for those folks who are availble by phone after hours & will come in to mix or get an emergent drug which can't be obtained by the nursing supervisor (which means in real life - you can't drink that night!!!!). Almost every drug is available in some pyxis somewhere in the hospital. The supervisor may just need direction to which one - OR or ICU or whatever...but very rarely do they need something from the pharmacy (I can think of just a few - snake bite antivenom, rabies antivenom, etc...)

Any hospital IMO that does after hours chemo has a poor dop!!!! There is absolutely no medical & certainly no pharmaceutical sense for a chemo mixture after hours & in fact its dangerous! Now...if your chemo person also did pain management...yes..sometimes those folks are on call at night. They sometimes need to write orders for changing a route of administration if the pts situation requires it. As for tpns - I wrote the first standardized tpn orders my hospital had & rewrote them many, many times over the years. We ABSOLUTELY NEVER made a tpn after hours. There is no case in which a D10 can't be hung for 7 hours without harm.

In my neck of the woods....we have a few per diems, but over the years we've had occasion to use "registry" pharmacists. Could that be what you're referring to - a registry person? One who actually works for a company who hires the pharmacist & basically "sells them by the day" to an individual pharmacy. Thats done all the time in retail. It used to be done frequently in hospitals too (the 1980's) but never when they worked alone. Hospital systems are too complex for a registry person to come in just for one shift & never, ever alone. That's just a receipe for trouble!

 

[sdn1977]

Haha. I could imagine how pissed off the night RPh I used to work with would be if they tried to have her make a chemo at 3AM. She'd throw a tantrum if a guy found unconscious that hadn't eaten in 3 days came in the ER and needed a TPN made.

"The IV tech comes in at 8AM. He doesn't know he's hungry!"
*Slams down phone*
*Continues playing on internet*

One of the last things a guy found unconscious who hadn't eaten in 3 days would be a tpn & good for her if she told them the chemo wouldn't be handled until the AM. Its just bad for everyone - pharmacy, nursing & lab to have a middle of the night chemo!

 

[ZpackSux]

One of the last things a guy found unconscious who hadn't eaten in 3 days would be a tpn & good for her if she told them the chemo wouldn't be handled until the AM. Its just bad for everyone - pharmacy, nursing & lab to have a middle of the night chemo!

That's right... a patient who's unconsicous from starvation needs hydration and some Dextrose.. then Psych eval..

Then let's go with TPN only if pt is NPO or have other underlying disease state that will require the pt to receive TPN. Which means more diagnostic evaluations.. which takes time. TPN can wait.

Chemo and TPN are never STAT.

 

[tartaufraise]

And you're trying to give me lessons on how a hospital pharmacy is staffed?

Well, certainly thank you ZpackSux and snd1977 for your enlightening lesson on how hospital pharmacy is run I would certainly seek employers like you after I graduated, considering you both have an idea how to run an efficient pharmacies. Many thanks for the info indeed & I'll look forward for more of your posts

 

[WVUPharm2007]

That's right... a patient who's unconsicous from starvation needs hydration and some Dextrose.. then Psych eval..

... I actually know that, I'm just saying something to be saying something...geeez. One of the few things I remember from the Pathophys section on electrolytes/nutrition/etc.

 

[caroladybelle]

After hour chemo? Does your pharmacy close at night? If not, I don't know why a pharmacist would need to mix chemos.. And if the pharmacy is closed..then why is there an "oncology pharmacist" on call...your other pharmacists can process a chemo order? And why do chemos at afterhours? It's not an emergency.

As a matter of note:

I agree that chemo should never have to be started at night. However, in the custom of hospitals that treat their onco/hemos like "customers" that they seek to cater to, at the expense of all staff (nursing/pharmacy/lab/radiology), there are times when chemo will be mixed at inappropriate hours "as an emergency" (Quite, frankly, the MDs failure to properly plan, should not equal another department's "emergency" but whatever.)

And I have come across (over 13 years and over a dozen facilities, of varying size) several pharmacists that declined/delayed mixing chemo, as they reported that they had inadequate experience. I have also received improperly prepared chemo, mixed at night.

Whenever you create a policy of "no new chemo orders after 1700" or "all TPN orders must be done by 1500", there will be at least one high powered MD that insists that they have a case that supercedes that, and administrators that cater to them. Repeatedly.

(I always love reading the policies dealing with properly prepping a patient to receive chemo in an appropriate manner, w/adequate education....then dealing with MDs that admit them at 2000 without a line or labs, and want chemo started by 2200.)

Carolina
(hemo/onco RN)

 

[sdn1977]

As a matter of note:

I agree that chemo should never have to be started at night. However, in the custom of hospitals that treat their onco/hemos like "customers" that they seek to cater to, at the expense of all staff (nursing/pharmacy/lab/radiology), there are times when chemo will be mixed at inappropriate hours "as an emergency" (Quite, frankly, the MDs failure to properly plan, should not equal another department's "emergency" but whatever.)

And I have come across (over 13 years and over a dozen facilities, of varying size) several pharmacists that declined/delayed mixing chemo, as they reported that they had inadequate experience. I have also received improperly prepared chemo, mixed at night.

Whenever you create a policy of "no new chemo orders after 1700" or "all TPN orders must be done by 1500", there will be at least one high powered MD that insists that they have a case that supercedes that, and administrators that cater to them. Repeatedly.

(I always love reading the policies dealing with properly prepping a patient to receive chemo in an appropriate manner, w/adequate education....then dealing with MDs that admit them at 2000 without a line or labs, and want chemo started by 2200.)

Carolina
(hemo/onco RN)

Carolina,

That's why we have policies - no emergency chemos - EVER! I've had physicians rant & rave & nurses yell at me because we won't do it. No problem....we let them all vent. I understand those physician's are in your face. Just send them down to the pharmacy. When they get in my face....I calmly & politely tell them no. When they want my supervisor's name....I give them the dop's name - no phone # mind you, but the name. (oh...& i've already called the dop...so folks like Zpack already have a heads up).

When the S*%^ hits the fan, & this pissed off physician calls the head of his dept or Chief of Staff, everyone from the hospital administrator down to the guy who cleans the floor of the pharmacy already knows the chemo is not being mixed because it has already been discussed.

If your policies aren't working, its because your supervisors aren't behind them. In our case....its our dop. For nursing, it would be the director of nursing who gives direction to the evening or night shift nursing supervisor. I, honestly, in 29+ years have never had an administrator try to overrule a policy which is in place (well....once....one tried to make me dispense Percodan...you can tell how long ago that was! without a triplicate - CA remember??? I told them flat out no one makes me break a federal law. The physician sought me out two days later to apologize for putting me in an untenable situation).

Its very hard to imagine a dop giving into physician pressure when a policy which was clearly thought out with multidisciplinary input & affirmed by the medical section which it covers, the P&T committee & the Executive committee specifies what can and cannot be done. So.....send them to us - we can be the bad guy. If you can't get the drug, you can't give the drug.

 

[caroladybelle]

Actually in said hospital, good luck with passing such a policy, the MDs would bring such pressure to bear that it would not get passed by the multidisciplinary.

The administration kisses MD tuchis...to hell with the pharmacy, nursing or the lab or safety of the patient for that matter. And, yes, we did send said MD to pharmacy.

The chemo continues to get ordered a inapropriate times, regardless. It tends to be a fact of life in many community hospitals.

Thankfully, I stick to teaching hospitals, with only occasional community work.

But I was just letting you know that some facilities do require chemo at night, and some night pharmacists tell us that they do not know how to prepare it on that shift. Don't shoot the messenger.

 

[sdn1977]

Actually in said hospital, good luck with passing such a policy, the MDs would bring such pressure to bear that it would not get passed by the multidisciplinary.

The administration kisses MD tuchis...to hell with the pharmacy, nursing or the lab or safety of the patient for that matter. And, yes, we did send said MD to pharmacy.

The chemo continues to get ordered a inapropriate times, regardless. It tends to be a fact of life in many community hospitals.

Thankfully, I stick to teaching hospitals, with only occasional community work.

But I was just letting you know that some facilities do require chemo at night, and some night pharmacists tell us that they do not know how to prepare it on that shift. Don't shoot the messenger.

Sorry - my comments were not meant to criticize you - absolutely not!!

I'm actually surprised there are any hospitals left which allow this. Most of my years in hospital pharmacy was in community hospitals & we stopped allowing this years and years ago. I can't think of a community hospital in the SF bay area which allows it...perhaps there are some I'm not aware of...thanks for sharing your experience.

I'm sure Zpack would have somthing to say about the dop in this situation!

 

[sdn1977]

Sorry - that was terrible english!

Should have read: Most of my years in hospital pharmacy WERE in...

sorry!

 

[ZpackSux]

Actually in said hospital, good luck with passing such a policy, the MDs would bring such pressure to bear that it would not get passed by the multidisciplinary.

The administration kisses MD tuchis...to hell with the pharmacy, nursing or the lab or safety of the patient for that matter. And, yes, we did send said MD to pharmacy.

The chemo continues to get ordered a inapropriate times, regardless. It tends to be a fact of life in many community hospitals.

Thankfully, I stick to teaching hospitals, with only occasional community work.

But I was just letting you know that some facilities do require chemo at night, and some night pharmacists tell us that they do not know how to prepare it on that shift. Don't shoot the messenger.

Why would any hospital kiss Heme/Onc physician's arse... days of those docs brining in big revenues are over. Heme/Onc guys are too busy trying to dump non paying chemo patients ... and we politely decline or request payment upfront for outpatient chemo.

High Profile Surgeons who bring in big revenue are different... then again those guys could careless about chemos at night...or TPNs at night. If hospital adminstration caters to physicians who break Policies... for the sake of your liability, stay far far away.. Policies are in place for reasons. Mostly for safety of patients. That must be a rink dink small town country hospital.