Hospital pharmacy is nuts.

Discussion in 'Pharmacy' started by WVUPharm2007, Dec 27, 2008.

  1. WVUPharm2007

    WVUPharm2007 imagine sisyphus happy
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    Damn...

    I'm just now getting de-stressed from my night.

    I was all alone tonight...just me and 220 patients...had three codes within the course of 20 minutes. One in PACU, one in ICU, and one in the CT scanner of all places.

    You people don't know jack about stress until you've literally got a surgeon, an internal medicine doc, and an ER doc on the line simultaneously screaming at you wanting stat levophed, Neo drips, and fentanyl drips all at the same time. You want to talk about confusion? I'm working off of verbal orders and a cordless phone in an IV hood. Who gets the Levophed or phenylephrine again (...does it really matter...)?

    Halfway through one of them wants to know if you have inactivated factor VIIa...who the hell knows...I have to call my director...he's all pissed off because his budget wouldn't let him have it or some crap...hell I don't know...then that physician is pissed because we didn't have it...hell...got all three docs all pissed off because THEIR code doesn't automatically come first...my techs are running around the hospital like chickens with their heads cut off...all the while I'm getting calls every 3 minutes from nurses everywhere else in the hospital wondering where their precious now dose Maalox is I've buried underneath the orders for the codes and has sat there for 30 minutes...a damned recruiter for RPHontheGo calls me at one point...the surgeon is calling me to ask if vecuronium and Zemuron are the same thing (yeah, a surgeon)...somehow I withheld my desire to call him a *******...I'm then informed that he doesn't want to use the Zemuron that's in his freakin' Pyxis because he's used to vecuronium...so I literally start sprinting around the pharmacy trying to find where the hell our buyer hides the damned neuromuscular blockers...by the end of the night you could see where my black boots had left marks all over the floor from me running everywhere. :)laugh:) The night pharmacist comes in to find me as a pathetic lump of humanity, slumped in my office chair, muttering nonsensical phrases to myself...

    Ah...good times...I love this ****...
     
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  2. UNMorBUST

    UNMorBUST Mystery Man
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    Fun night, reminds me of the youtube video posed smewhere here the other day where everyone is saying" Stat".
     
  3. SpirivaSunrise

    SpirivaSunrise Go Gators!
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    Hah!

    Sounds like fun!

    You should see my place when it gets crazy too...only when we get a barrage of stats, the patient isn't 300 feet away. More like 15 miles away in bumper-to-bumper traffic. I think we should look into getting a helicopter.
     
  4. ItsOverZyvox

    ItsOverZyvox Retired
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    Best post ever by Mikey! :thumbup:

    :smuggrin:



     
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  5. ItsOverZyvox

    ItsOverZyvox Retired
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    So sez the glorified retail druggist.. :smuggrin:
     
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  6. ItsOverZyvox

    ItsOverZyvox Retired
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    Another thing WVU.. Zemuron be available generic now yo.. check with ur purchaser to make sure you're getting some savings!
     
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  7. tussionex

    tussionex Pharmacist
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    awesome!

    i actually miss that, what with working in my IT dungeon and all.
    sounds like you did well....when i have nights like that, i just remember what i read on a paramedic blog one time "smooth is fast"....don't rush, just be real smooooooth and you'll get stuff done efficiently and not kill anyone!
     
    #7 tussionex, Dec 27, 2008
    Last edited: Dec 27, 2008
  8. ItsOverZyvox

    ItsOverZyvox Retired
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    BTW, an evening shift (2:30pm - 11pm) with that kind of census (220 inpatient) requires 2 pharmacists not one. Patient care is compromised... want me to kick your DOP's ass?
     
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  9. njac

    njac Senior Member
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    I think the CT scanner is actually a relatively common place for codes.
    I don't know what your ER is like but they try to die over in radiology all the time here.

    sounds like you handled it well - do you not have an IV tech at night?
     
  10. ItsOverZyvox

    ItsOverZyvox Retired
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    Why do you suppose?
     
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  11. SpirivaSunrise

    SpirivaSunrise Go Gators!
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    Uh huh! Join me at work one day. I'll have you weeping like a little boy by the end of the evening.
    :smuggrin:

    Posted via Mobile BlackBerry Device
     
  12. SpirivaSunrise

    SpirivaSunrise Go Gators!
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    I suppose! I suppose!!


    Posted via Mobile BlackBerry Device
     
  13. Priapism321

    Priapism321 Bursting with enthusiasm
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    Because they are trying to figure out where the bleed or clot is causing hemodynamic instability.
     
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  14. ItsOverZyvox

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    I refuse to work til the end of the evening.
     
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  15. ItsOverZyvox

    ItsOverZyvox Retired
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    I was thinking cuz we tend to induce ischemia through dob/adeno stress test... which is read by CT. Poor patient laying there with racing heart!
     
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  16. njac

    njac Senior Member
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    I usually see ICU or (current) trauma patients code in the CT scanner. (and by "see" that mostly means I go down and replace the crash cart)

    I don't believe that any of the ones that I've witnessed had undergone a recent stress test.

    It's more along the lines of what Priapism said - we're busy looking for what the issue is and in the 5-10 minutes they're in there while they're still unstable a lot seems to happen hemodynamically. Usually trauma patients finding a new place to bleed from.
     
  17. Storm90

    Storm90 Accepted Pharmacy Student
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    You are hardcore and dedicated to the craft. Good on you!
     
  18. WhiteSnows

    WhiteSnows Think Right and Grow Rich
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    Sound stressful, but fun things to do. Many people in america now do not even have job to do. They sit home an watch some crap TV shows and waiting for a call from somebody to hire them.
     
  19. WVUPharm2007

    WVUPharm2007 imagine sisyphus happy
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    Psssh? 8 hours? Nah man, we work 10s. I only have to go to work 4 days a week. I was there 1-11....just as I was there 1-11 the three nights prior. I love evening shift. No management, it's quiet, I have more ability to freestyle...it's nice.
     
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  20. loo

    loo Always Sleepy
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    I'm sooo excited!

    I got a superduper GPS for X-mas!

    Bluetooth, real-time traffic reports, etc. Shoot, I can find Ms. Lorraine's house off an unnamed dirt road!!!!

    Sorta like you getting a superduper sniper rifle with a state of the art scope.

    10 hour shifts? *****.
     
  21. aphistis

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    I'll probably regret asking this, but what is a surgeon wanting to do with a stick of roc or vec?
     
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  22. museabuse

    museabuse Senior Member
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    So is the grass still greener in hospital pharmacy?
     
  23. tussionex

    tussionex Pharmacist
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    evening shift rocks!:cool:
     
  24. WVUPharm2007

    WVUPharm2007 imagine sisyphus happy
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    Versus retail? Yes. Without question. It was freakin' awesome. I hope I have 100 more nights just like it.
     
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  25. browneyes021

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    I love working the evening shift at my hospital until pyxis drawers break or nurses call pharamcy and say, "I can't find the medication" and it turns out they never even looked in the tube system. Other than that, it's cool. It's just on certain nights you need more than one pharmacist and tech working.
     
  26. JeremyE30

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    Do your techs not mix those drips for you? We mix everything at my place, pharmacists never go in the hood to mix.
     
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  27. WVUPharm2007

    WVUPharm2007 imagine sisyphus happy
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    Usually, yes, but when you have one on the hourly round and the other running things everywhere...something's got to give...this was just an unusually crazy situation.
     
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  28. njac

    njac Senior Member
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    well thank you for being one of the pharmacists who will go in the hood and make it.
     
  29. ItsOverZyvox

    ItsOverZyvox Retired
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    Not only should pharmacist mix and fill, they should deliver when necessary! I actually miss running down the hallways to ER...with freshly prepared Activase drip!!!
     
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  30. ItsOverZyvox

    ItsOverZyvox Retired
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    Again, with a census of 220, you need 2 pharmacists and 2 techs.
     
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  31. njac

    njac Senior Member
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    That's why we have a pharmacist in the ED 12 hours a day. But I agree 100 percent. You just don't always see it!
     
  32. WVUPharm2007

    WVUPharm2007 imagine sisyphus happy
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    Well, if you can magically *poof* two more pharmacists into existence that want to live in the outer Pittsburgh metropolitan area and take the job openings we have, maybe we would have two pharmacists in the evening. :laugh:
     
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  33. tussionex

    tussionex Pharmacist
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    i will make or deliver whatever needs to be done.
    i dont roll with the "i pharmacist, you technician" mentality.
     
  34. njac

    njac Senior Member
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    I think it helps that he's got a cordless phone in his pharmacy... we do not, so they are sort of stuck at the computer. But our census is closer to 500 so on a Saturday night we have 4 pharmacists in inpatient, 1 in the ER, and at least 5 techs.
     
  35. Omegadramon

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    If those norepinephrine were in those god forsaken ampules, I will shed a tear on your behalf. For some reason at our place, they stopped ordering the vials and gave us those blasted ampules.

    Fent drips are never fun to make either.


    BTW, Zyvox/Epic, what manufacturer supplies generic roc. I'm trying to figure out using the orange book and it tells me Hospira and Teva have filed applications.
     
  36. ItsOverZyvox

    ItsOverZyvox Retired
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    It just went generic and you won't find it in the Orange Book or Red Book yet. Your DOP and the purchaser should know.

    Sicor, Generamedix, and Sandoz.
     
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  37. WVUPharm2007

    WVUPharm2007 imagine sisyphus happy
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    Yup. The little green Levophed branded ones. I'm fine with ampules though. I have a method that involved tons of ethanol and gauze. Speaking of sedation...there's this dude in our ICU that's been on 50mL/hr of our standard Versed drip for a week now. What's balls is that our department policy is to send them down in 100mL bags. Every other hour I get the same phone call. I tried to use common sense and make a liter bag of the stuff but I got yelled at and the policies/procedures book thrown at me for it. No, no..I shall send the 100mL bag. Never mind the stuff is stable for days in saline...oh well. Of course the procrastinating ICU nurses always say the same thing, "He's DRY and I need it NOW." They never EVER think of calling ahead.
     
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    #37 WVUPharm2007, Dec 29, 2008
    Last edited: Dec 29, 2008
  38. njac

    njac Senior Member
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    ick. levophed amps. we have the little vials, 4mg/2mL maybe? can't remember. the only things I regularly have to use ampules for are cardene and morphine. we've gone to the cardene RTUs so no generic nicardipine for us yet as we don't have to use it nearly as much as we used to.
     
  39. Omegadramon

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    797 took away my gauze. Now we're getting ripped off by purchasing crappy, presaturated alcohol wipes to replace them (because they produce less "particulate matter"). what a load of bull.
     
  40. Omegadramon

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    Nicardipine now comes in awesome premixed 20mg/200ml boxes.
     
  41. njac

    njac Senior Member
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    those would be the "RTUs" I referenced. They are quite nice. and good for more than 48 hours!

    now that we don't get to use gauze we buy some lint-free paper stuff that we cut down to 4x4 squares and soak in isopropyl.
     
  42. njac

    njac Senior Member
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    why not make 6 or 12 bags at a time then? at least 3 or 4. It's easier on your IV staff to batch it anyway, no?
     
  43. WVUPharm2007

    WVUPharm2007 imagine sisyphus happy
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    Well...we use 'em...and JCAHO just came through. They are obsessed with that frickin' anticoag thing they are mandating...
     
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  44. WVUPharm2007

    WVUPharm2007 imagine sisyphus happy
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    Oh, no...he might go off of it and we'd have to waste $1.65 worth of ingredients. And I do make 4 at a time when I'm there...alone, anyway...
     
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  45. SpirivaSunrise

    SpirivaSunrise Go Gators!
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    What other adjustments have you guys made since the new <797> changes went into effect? I know how it's affected nuc med departments in the hospitals (leading to more after-hour call outs on my pager :rolleyes:)...but curious how you guys are dealing with it in the pharmacies.
     
  46. WVUPharm2007

    WVUPharm2007 imagine sisyphus happy
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    I think our procedures is to tell them to go to WVUH or UPMC.
     
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  47. njac

    njac Senior Member
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    well now instead of just gloves/booties/hair net I have to wear a stupid facemask too. I do not recommend that if you had doritos with lunch, btw. :scared:

    as far as I can tell it's a giant pain in the butt. but I also work evenings so I tend to revert back to "the old ways" :smuggrin: things may be different during the day.
     
  48. SpirivaSunrise

    SpirivaSunrise Go Gators!
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    Good for them...this was actually one safety goal I really wanted to see them enforce. Sometimes I think TJC's a little out there...and a lot of their policies don't jive with how patient care is provided in the real world. But I liked 3E. It goes into full effect soon, no? January?
     
  49. tussionex

    tussionex Pharmacist
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    oh, to hell with that!
    now, i want to kick your DOP's ass.....policies should be revised when common sense intervenes!
     
  50. 67echo

    67echo Hooah!
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    you're always the fiesty one...
     

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