future of pharmacy

[Da Alchemist]

These are just curious questions that i have, since im not in pharm school yet. Can anyone school me? Sdn?

For the future smartazzes I never claimed that Retail pharmacy can run without Pharm.D or claimed that i know everything. All I said was can anyone school me?

I wonder what that English guy is talking about.

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[StringTheorist]

i talked to my pharmacy manager about this, and she said no way in hell this would ever happen. you're not paid 90k+ a year to just count pills, youre paid because you are liable for people's wellbeing... and their dosage. you cant ever trust someone with just a tech's experience with dosaging and the like...you need a human being there with the knowledge of interactions. no robot or tech will replace the role of the pharmacist... its too risky.

 

[sdn1977]

OK - so, I'm back from work - not such a long or bad day !

Now....why a pharmacist & not just a tech reading a database?

Well....because there are exceptions to every rule. Thats part of medicine (in which I mean the treatment of ailments which encompasses both diagnosis, treatment & education).

Let me give you a few examples....

The asa/warfarin combination. First Data Bank (which is the company which provides all the drug interaction data for all pharmacy software companies) will give this interaction a "top" or "high" priority. Likewise, ciprofloxacin & warfarin will also have a "high" drug interaction.

But - this does not mean you can't give them both together. In fact, they are frequently given together......but both the prescriber & the dispenser know what they are used for & have counseled the patient on what to expect, what to look for & if they need counseling at all (the pt who is taking ciprofloxacin for 3 days for a uti & is due to have an INR drawn in 10 days anyway won't need counseling beyond what was initially given - just a simple reminder...)

Then...we can take the pt who is taking clarithromycin & amoxicillin together. Therapeutically....this would come up as a drug interaction - two drugs with similar, altho not identical spectrums.

However, you'd have to know.....that after asking the pt if they were being treated for an ulcer (H. pylorii - altho they may not know it by that name), we would know that this is a normal & expected therapeutic treatment modality (in fact, these are two components of Prevpak).

Likewise...an rx for promethazine 12.5mg q8h prn for a 6 yo for n/v doesn't seem so bad - right? However, in the last year, there has been an additional black box warning for promethazine for use in children. This black box warning basically says it should not be used at all...but, there are some circumstances in which it can & should be used. But, it needs a pharmacist to know if the circumstance is sufficient to call the prescriber or to let it ride, how much to tell the pt/caregiver, etc...

So....the whole purpose of a pharmacist (forget the degree - it can be a PharmD or a BS pharmacist) is to know what to take seriously & what not to take seriously.

Finally, we get to the law. Although each state has its own pharmacy practice statues, nearly all of them have some statement that a pharmacist shares responsibility for the appropriate dispensing of a drug. In the pharmacist terminology, dispensing involves not just counting, pouring, licking & sticking - it means evaluating if it is the appropriate drug, the appropriate dose, with counseling for the appropriate individuals.

I hope that provided some insight.

For myself, I don't worry at all about my job. There are some physicians who "dispense" from machines designed for this. They really haven't taken off & frankly, they can't keep too much stock because having the sufficient variety & quantity of drugs on hand is expensive (just ask your manager what the last inventory dollar amount was!). In some states, these machines are not legal because a prescriber cannot be a dispenser.

So....no, I'm not worried at all. I won't be working in 30 years, but some of you will be! The sky is really not falling.

Good luck!

 

[Da Alchemist]

OK - so, I'm back from work - not such a long or bad day !

Now....why a pharmacist & not just a tech reading a database?

Well....because there are exceptions to every rule. Thats part of medicine (in which I mean the treatment of ailments which encompasses both diagnosis, treatment & education).

Let me give you a few examples....

The asa/warfarin combination. First Data Bank (which is the company which provides all the drug interaction data for all pharmacy software companies) will give this interaction a "top" or "high" priority. Likewise, ciprofloxacin & warfarin will also have a "high" drug interaction.

But - this does not mean you can't give them both together. In fact, they are frequently given together......but both the prescriber & the dispenser know what they are used for & have counseled the patient on what to expect, what to look for & if they need counseling at all (the pt who is taking ciprofloxacin for 3 days for a uti & is due to have an INR drawn in 10 days anyway won't need counseling beyond what was initially given - just a simple reminder...)

Then...we can take the pt who is taking clarithromycin & amoxicillin together. Therapeutically....this would come up as a drug interaction - two drugs with similar, altho not identical spectrums.

However, you'd have to know.....that after asking the pt if they were being treated for an ulcer (H. pylorii - altho they may not know it by that name), we would know that this is a normal & expected therapeutic treatment modality (in fact, these are two components of Prevpak).

Likewise...an rx for promethazine 12.5mg q8h prn for a 6 yo for n/v doesn't seem so bad - right? However, in the last year, there has been an additional black box warning for promethazine for use in children. This black box warning basically says it should not be used at all...but, there are some circumstances in which it can & should be used. But, it needs a pharmacist to know if the circumstance is sufficient to call the prescriber or to let it ride, how much to tell the pt/caregiver, etc...

So....the whole purpose of a pharmacist (forget the degree - it can be a PharmD or a BS pharmacist) is to know what to take seriously & what not to take seriously.

Finally, we get to the law. Although each state has its own pharmacy practice statues, nearly all of them have some statement that a pharmacist shares responsibility for the appropriate dispensing of a drug. In the pharmacist terminology, dispensing involves not just counting, pouring, licking & sticking - it means evaluating if it is the appropriate drug, the appropriate dose, with counseling for the appropriate individuals.

I hope that provided some insight.

For myself, I don't worry at all about my job. There are some physicians who "dispense" from machines designed for this. They really haven't taken off & frankly, they can't keep too much stock because having the sufficient variety & quantity of drugs on hand is expensive (just ask your manager what the last inventory dollar amount was!). In some states, these machines are not legal because a prescriber cannot be a dispenser.

So....no, I'm not worried at all. I won't be working in 30 years, but some of you will be! The sky is really not falling.

Good luck!

Wow. So that explains it... I have a question for you though. Have you ever called the prescriber to disapprove an rx order or to adjust the rx? How often in your pharmacy does it happen?

 

[Lisochka]

One girl in the gym told me that they are trying to pass laws which would enable physician assistants to do physician jobs and nursing assistants - nurse jobs.

so you think it is bull?
Actually, I have heard it from 2 different unrelated people.
I don't know... I do hope it is a bull... Because I would not want to go to a pharmacy without a pharmacyst.
But how many people would go for cheaper price? And just because they do not know the difference between a pharmacy with a pharmacist and a pharmacy without a pharmacist...

 

[Dustbunny]

Your post is quite interesting. I'm surprised that for such a small practice that they are able to offer all of those services, namely the onsite lab and medication dispensary. Are their any limitations on what they can dispense besides the obvious; controlled substances?

Not AFAIK. It's a bit more sophisticated than what you see. Said doctor has been e-prescribing longer than anyone else in the country (literally) and is a beta-tester for all of AllScripts newest and greatest toys and software.

The guy's formulary checking is absolutely outstanding. I was completely blown away by it.

In terms of profitability, he and his partner split an extra $20K between them, so, say, $10K each. Not much, but it's something. He's an amazing businessman.

I have a question for you though. Have you ever called the prescriber to disapprove an rx order or to adjust the rx? How often in your pharmacy does it happen?

Not often, but yes. Adjustments vary based on volume. I would say one every 200-500 prescriptions or so, on average, need to be changed in some fashion.

 

[jmkraus]

geez guys, dont you get it? he obviously learned everything he knows from watching Dr. House on channel FOX lol.

oh and coincidentally, it would take exactly six years to properly train technicians to dispense medicine.

 

[sdn1977]

Wow. So that explains it... I have a question for you though. Have you ever called the prescriber to disapprove an rx order or to adjust the rx? How often in your pharmacy does it happen?

"disapprove" - not sure I'd use that term....

But, do I call (not often) or fax for clarification or dose adjustment? Yes, frequently - when I'm working retail 3-4 times per day. When I work in the hospital, perhaps 1-2 times per day, but I just stop the prescriber in the hall or call & leave a msg at the office. If I'm working off a protocol, I don't have to call - I just change it & write the order in the chart. The prescriber sees it the next day.

 

[Farmercyst]

I do appreciate the movement back toward a civil discussion. Thanks all for your input thus far. Some of us soon-to-be P1's are actually getting something out of it.

 

[tussionex]

Wow. So that explains it... I have a question for you though. Have you ever called the prescriber to disapprove an rx order or to adjust the rx? How often in your pharmacy does it happen?

almost every day. though we usually call the floor, and nursing does an excellent job of following up.

 

[ZpackSux]

SDN should compile everything she has written on the forum and turn it into a book... "Life as a nice legged Pharmist.."

 

[sdn1977]

SDN should compile everything she has written on the forum and turn it into a book... "Life as a nice legged Pharmist.."

A picture book???

I'd look a lot d*mn better than that pharmacist you posted in military gear working outside of a hood - thats for sure !

 

[ZpackSux]

A picture book???

I'd look a lot d*mn better than that pharmacist you posted in military gear working outside of a hood - thats for sure !

This post is useless without a picture!

 

[Hibiclens]

Wow. So that explains it... I have a question for you though. Have you ever called the prescriber to disapprove an rx order or to adjust the rx? How often in your pharmacy does it happen?

Happens all the time. "Mrs. X, so your dose of drug Y has increased?"..."No she says"....then we call and Nurse/Dr. Z says whoops. Stuff like that happens all the time. Drs and Nurses know what they are doing...no question about it. But when it comes to the individual patient at the community level, having a good relationship can really make a difference.

 

[VCU07]

Yea I said "aren't otc meds self explanatory(not sure)" meaning i do not know? why not train the technician to explain to the customer what 3-5 days at a time mean? without giving med decision advice. Oh and I do agree that pharmacist should stay in retail. If u look at my first post i said i was just curious.

People are getting mad b/c, quite frankly, you are asking too many questions. Many technicians are high school students or individuals w/o degrees that have no real sense of drug knowledge. They may be familiar with medication names. Nevertheless, they have no insight into the proper use of these meds. So, how about a scenario? My 1 year old has a fever and needs some medication. The box doesn't give administration info. for kids under 2 years of age. Would the tech just say tough ****? What would happen if a pharmacist wasn't there to assess the situation? I suppose they could go to the pediatrician, but why pay a copay for something a pharmacist can handle? I believe that many of your ideas (or questions) are much more complicated than you think.

 

[Da Alchemist]

People are getting mad b/c, quite frankly, you are asking too many questions. Many technicians are high school students or individuals w/o degrees that have no real sense of drug knowledge. They may be familiar with medication names. Nevertheless, they have no insight into the proper use of these meds. So, how about a scenario? My 1 year old has a fever and needs some medication. The box doesn't give administration info. for kids under 2 years of age. Would the tech just say tough ****? What would happen if a pharmacist wasn't there to assess the situation? I suppose they could go to the pediatrician, but why pay a copay for something a pharmacist can handle? I believe that many of your ideas (or questions) are much more complicated than you think.

I apologize for the questions(if google can answer it, i wouldve asked google). I stated early on though that I don't have a degree and not in pharm school yet so you know where I'm coming from. Take it easy.

If there was no Pharm.D, I would recommend Infant's tylenol. What is the right dose? It is illegal to give advice, you must consult with the pediatrician/MD lol j/k


p.s if people get mad over internet questions, I advice anger management classes or maybe a hug? I can understand getting mad over what they call a "troll" but my questions were'nt that bad? I actually did learn something with Sdn's explanation. In conclusion, people who get mad easily shouldn't pursue in pharmacy because you will come across patients who ask more "interesting" questions than I did in person. This is only internet and some are already getting high blood pressure, almost heart attack, or stroke.

 

[Jbuprepharm]

yeah, but I think the average person going into pharmacy half expects ******ed questions from patients/customers, it's the nature of the job.

Similar questions (I'm not calling you ******ed) from a member of this board who is about to enter pharmacy school seem a bit more inflammatory.
I found your OTC question amusing because at Tech, and I imagine every other school in the country, we have a class devoted to OTCs, with numerous examples of people who have NO IDEA of how to use an OTC. Even if people were generally smart enough to read the box and understand it, it doesn't cover all the bases.

I've worked retail for 2 years now, and you'd be amazed at how little people know or want to know. They want to tell you what's wrong and for you to pick something out for them, they feel better having you tell them, than themselves picking it out.

I don't imagine you have much/any pharmacy experience (retail anyway) based on your questions. Why don't you go to your local pharmacy, whoever it may be, and tell them your situation, and ask to shadow/observe/volunteer for a few days, you'd be surprised at how much you'll learn in so little time.
(Note: this is one of the reasons I'm glad my undergrad required that pre-health students (med, pharm, RN, Dental) shadow for at least 40 hours one semester, it really helps you know what to expect).

I hope you find my comments helpful rather than hurtful, I mean it sincerely, go spend some time in a pharmacy. You'll have a lot of your own questions answered without ever verbalizing them

 

[imperial frog]

the main big difference is techs cant counsel? but counsel what? Didnt the MD already counsel the patient.

Hahaha...NO!!!!

 

[imperial frog]

When the warning label read “Do Not Chew or Crush, Swallow Whole,” misinterpretations included “Chew it up, so it will dissolve” and “Don’t swallow whole or you might choke.”

Actually, gramatically, that warning label does say not to swallow whole so it's not really a misinterpretation.

 

[Da Alchemist]

Yes, I will be getting pharm experience soon. I already passed the ptce exam a couple of months ago but I havent looked for a job yet. Thanks for the advice

 

[Caverject]

A picture book???

I'd look a lot d*mn better than that pharmacist you posted in military gear working outside of a hood - thats for sure !

I think a pop-up book would be better suited for you...

 

[Da Alchemist]

Hahaha...NO!!!!

lol

 

[ButlerPharm.D.]

I didn't adjust the grammar of any of these, this was simply a copy and paste job from the article cited. I agree, perhaps they should have used a semicolon instead.

Actually, gramatically, that warning label does say not to swallow whole so it's not really a misinterpretation.

 

[ForcedEntry]

why not train the technician to explain to the customer what 3-5 days at a time mean?

technician, not reading teacher.

 

[lee0539]

interesting subject... however I wonder why there isn't a median of the job between tech and pharmD? Take a college student who has majored in medical field like biology/chem/biochem/etc and give them 1 year training and a test and pay them around double a tech but half the pharmD to do much of the counting and labeling and any problems or possible questions can be asked to a pharmacist overseeing several retail stores within the local area.

 

[Farmercyst]

interesting subject... however I wonder why there isn't a median of the job between tech and pharmD? Take a college student who has majored in medical field like biology/chem/biochem/etc and give them 1 year training and a test and pay them around double a tech but half the pharmD to do much of the counting and labeling and any problems or possible questions can be asked to a pharmacist overseeing several retail stores within the local area.

I'm thinking easier said than done. I work in a Call Center and answer ~100 calls/day. If you located a pharmacist centrally to a given region the answers would almost have to come by phone. I certainly wouldn't want to reroute any questions to the next available pharmacy X blocks/miles away everytime a question was beyond the training of the PhA. (pharmacist assistant although what you've described is a pharmacy intern. )
From a customer service standpoint alone this would be bad PR. The other problem would be patient non-compliance. You get a question you can't answer and the patient can either call the pharmacist, or just go home with their question unanswered. They wait for 5 minutes for the central pharmacist to pick up, go home, and their possibly life/death question about new side affects, new dosage, allergic reaction, etc. goes unanwered, leaving them at risk. I suppose the poison control center runs a similar operation, but most people stay on the line because they know they're dealing with a poisoning issue, or they just go to the ER. I doubt that would be the case in a situation where the pt knows something is wrong, but doesn't know how bad the situation can potentially be. Anyway just a few thoughts to consider.

 

[andrewattheU]

it doesnt really answer my main questions. why is it that peoples lives are in their hands? (retail pharmacist) because they dispensed the prescribers order or because they counsel the patients about side effects? let the licensed tech with compounding skills dispense it. patients with drug info questions? let the tech look it up in the computer pharm database.

techs dont have the knowledge or training to know if what they are prescribing is incorrect or how most of the drugs actually affect the body. techs dont have to take biochem or understand drug interactions like pharmacists do

 

[tussionex]

pharmacists hold people's lives in their hands not because they counsel patients, or because they dispense the drug ordered.

they hold people's lives in their hands because they SAFELY dispense the drug ordered while taking into account the disease state of the patient, the concurrent drug therapy that the patient may be taking, the potential interactions and allergies, and the correct dose.
in a hospital, this includes critically ill adults and babies...with drugs such as precisely dosed antibiotics, narcotic and benzo infusions for sedation, epidurals, TPNs, CVVH and CRRT dialysis solutions...the list goes on....

in retail, the patients that come through the door have at least 5-6 different diagnoses/drug therapies that the respective MDs may or may not be aware of, may have compliance and education issues, and many have their therapies changed with little knowledge or understanding of their condition.

in either case, how can you wonder how the pharmacist holds a patient's life in their hands?

 

[Caverject]

Originally Posted by sdn1977
A picture book???

I'd look a lot d*mn better than that pharmacist you posted in military gear working outside of a hood - thats for sure !

This post is useless without a picture!

Ask and ye shall receive...

 

[Lisochka]

I have talked to 2 pharmacists at the place I work.
One said that she sees machines substituting pharmD's in retail.
The other guy said that he worries about the job security himself because in some rural areas, some hospitals have just a tech who puts orders together and then through a video camera a pharmacist in another city checks the order. I don't know how it is possible, but I guess it is possible.
So, there is a chance that we will be out of job one day

 

[sdn1977]

Ask and ye shall receive...

How'd you know I wear glasses??? Have you been stalking me

 

[sdn1977]

I have talked to 2 pharmacists at the place I work.
One said that she sees machines substituting pharmD's in retail.
The other guy said that he worries about the job security himself because in some rural areas, some hospitals have just a tech who puts orders together and then through a video camera a pharmacist in another city checks the order. I don't know how it is possible, but I guess it is possible.
So, there is a chance that we will be out of job one day

Don't worry - the sky really is not falling.

Robotics really are in place in many places in retail (fortunately not where I work - its just one more check you have to make....and that means you're doing lots of rxs!!!)

Lots of hospitals have remote pharmacists checking orders during the hours the pharmacy is not open, altho not with a remote camera. Its just sent electronically & the individual pharmacist's computer at home (usually provided by the hospital) is "turned on" when the last pharmacist leaves. This allows orders to be entered & authenticated so the nurses can access pyxis. The pharmacist is paid to do this,, but not the same as if he/she were doing a full shift.

Both these things are in place - look at it this way - they don't "threaten" your job - they just expand your job to better patient care with the least money spent - either capital or personnel budget.

Perhaps Zpak can expand further on this monetarily. But, it doesn't lessen your need - it reinforces your need.

 

[tussionex]

sdn, you are correct, as always

robotics and remote access does not eliminate pharmacists [or techs, for that matter]
if you read any of the studies about pharmacy automation, you will see that the majority of sites that installed these technologies actually needed to expand ALL personnels' FTE's [full-time equivalents]

automation just changes the way staff is allocated, it does not eliminate staff, and in many cases....causes the need for more staff...but used in different ways

 

[OrganicPharmer1]

How'd you know I wear glasses??? Have you been stalking me