Is it a pharmacists responsibility to check dosage?

[b16]

Hi pharmacist friends,
Quick question here from a 3rd year medical student colleague. So long story short, I had a script filled at a CVS over the weekend near my house. I started taking the medication as directed on the bottle label ("take 2 tablets twice a day"), and the next day got all kinds of diarrhea, so I decided to check the dosing on epocrates and found out that the pharmacy directions were instructing me to take 2 times the highest dose of this drug that is currently in the guidelines; the correct dose of this drug for my indication is 1000mg BID. So I call the pharmacist at the CVS to ask why the instructions are telling me to take 2x more than the highest recc dose of this drug for any indication, and she basically got irritated that I called her and pulled out the script I had brought in and said that the script said the same dosing that they put on the label and that it was my doctors fault for writing the wrong dose (I think there was some confusion between 2 500mg tabs BID vs. 2 1000mg tabs BID on the script). Either way, the question I have is, isnt there some responsibility on the pharmacist who filled a script for a dose of a drug that isnt indicated for anything? if the script is ambiguous about the dosing, shouldn't that require verification from the physician (especially because regardless of the schedule the dispense# didn't even agree with their label instructions?) I was very irritated that I was essentially being told, "we assumed that what the script said was a dose that doesn't exist for any indication, but we filled it anyway without any confirmation, and oh, by the way, its your doctors fault, not ours." Now, not being from the pharmacy world, something really irritated me about that general idea, and I wanted to ask if this is essentially a ****ty and incorrect pharmacist, or if its actually true that the pharmacy will fill any dose written on a script by a doc without liability, even if its a wrong dose? I mean, if someone leaves out a decimal, 7.5 mg of coumain is now 75mg; will a pharmacy still fill a script for a 75mg dose of coumdin because thats what it said on the script? (ridiculous example, but you get the point). Am I crazy here, or is this pharmacist I talked to incorrect?

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[FruitFly]

Good question. Pharmacists always have a corresponding professional responsibility to check the doses of medications dispensed. Pharmacists are required to be active in a patient's health care as it relates to medicine. If anything is questionable on an Rx, it is a professional imperative to call the prescriber.

With that said, sometimes doses exceed the normal dosing ranges and are not exactly the maximum doses one could take. Some medications require professional judgment and practitioners may elect to prescribe on the higher doses. But there needs to be a rational reason for this. And, btw, generally speaking- at higher doses, there's usually greater chances of experiencing the same sorts of common side effects you may have seen in the regular interval. It depends on the medication. Since we don't give out medical advice on SDN, we're keeping the discussion general to what pharmacy entails.

Pharmacists, in most states, and Federally for Medicaid/Medicare patients, are required to counsel patients on all new prescriptions. Patient counseling usually addresses issues of dose and side effects. Anyways, don't let one, perhaps lazy, pharmacist taint your image of pharmacy.

 

[b16]

Good question. Pharmacists always have a corresponding professional responsibility to check the doses of medications dispensed. Pharmacists are required to be active in a patient's health care as it relates to medicine. If anything is questionable on an Rx, it is a professional imperative to call the prescriber.

With that said, sometimes doses exceed the normal dosing ranges and are not exactly the maximum doses one could take. Some medications require professional judgment and practitioners may elect to prescribe on the higher doses. But there needs to be a rational reason for this. And, btw, generally speaking- at higher doses, there's usually greater chances of experiencing the same sorts of common side effects you may have seen in the regular interval. It depends on the medication. Since we don't give out medical advice on SDN, we're keeping the discussion general to what pharmacy entails.

Pharmacists, in most states, and Federally for Medicaid/Medicare patients, are required to counsel patients on all new prescriptions. Patient counseling usually addresses issues of dose and side effects. Anyways, don't let one, perhaps lazy, pharmacist taint your image of pharmacy.

Hi Fruitfly,
Thanks for the info. I was pretty sure that there were requirements for the pharmacist to review the medication, dosing instructions, schedule, ect.. before giving it to the patient. While I certainly know there are off-label doses for many medications and often heightened side-effect risks, I just thought that an off-label range dose would trigger a computer flag or a pharmacist review or something, not to mention in my case the dosing instructions and dispensed # of tabs didn't even match up to cover the 10 day course. I certainly don't think ill of pharmacists in general, and in fact work with many good ones everyday on inpatient services. It was just this one particular person telling me I was wrong to call the pharmacy and accuse them of having any responsibility in the dosing of my Rx being incorrect. It was just irritating, that's all, and I just wanted to be reassured that I was correctly understanding everyone's responsibilities in the situation. A simple apology from this lady would have done, geeze.

 

[BMBiology]

If a physician writes coumadin 75mg then it is obviously wrong and if a pharmacist fills the prescription, then she would be in trouble with the Board since it falls below the professional standard of a pharmacist. But legally speaking, the court has generally ruled that the pharmacist only has a duty to accurately fill a prescription based on what is written on the prescription. The duty of care belongs to the physician. The court felt that if pharmacists are also held liable for what the physicians write, then the pharmacists may interfer with the physician-patient relationship and therefore, may prevent many patients from receiving their medications.

Many cases, however, are not clear. For example, if your physician writes starting metformin dose 1000mg bid instead of 500mg bid then, it is not so obvious and most pharmacists would not question the script since they wouldn't know if you are on a starting dose or maintenance dose of metformin. Another example is gabapentin. The manufacture's max dose is 3600mg/d but studies have shown that 4800mg/d can be prescribed as off label.

I suggest you go back to the pharmacy and ask for the original script. If the sigs are written incorrectly by your physician, then I would take it up with your physcian. But if the pharmacist misfilled, then talk to the pharmacy manager.

 

[Pharmavixen]

What Fruitfly said, and I would add that the unfortunate reality for many retail pharmacists is a ridiculous workload level. Which doesn't excuse the level of service you got, but when you're filling several hundred scripts a day, sometimes you look at oddball scripts and make a judgement call, assuming it's okay, because if you take the time to check it, you can get hopelessly behind, and then you start rushing, which increases the possibility of making a mistake.

I've stopped to check scripts I wasn't sure about, and the next day, boss phones me at home to tell me about "serious complaints," that is, some unusually b*tchy regular customers came in and didn't get served instantly because I was leery of dispensing nitrofurantoin to a 5-day-old.

Just one of the reasons I don't work retail anymore.

 

[Jeddevil]

Let us know what drug you are talking about. Hard to say who is at fault when we don't know what you are talking about. When you said 2 bid, then talked about 1000 mg and diarrhea, my first thought is Augmentin xr, which would do that. But, there are plently of indications for that dose.

 

[BMBiology]

I have seen some distrubing things when I worked in retail like a elderly patient had a seizure because the physician writes max dose of darvocet. Another patient had respiratory depression because he wasn't told to avoid prolonged sun exposure while on the fentanyl patch.

 

[rxlynn]

What Fruitfly said, and I would add that the unfortunate reality for many retail pharmacists is a ridiculous workload level. Which doesn't excuse the level of service you got, but when you're filling several hundred scripts a day, sometimes you look at oddball scripts and make a judgement call, assuming it's okay, because if you take the time to check it, you can get hopelessly behind, and then you start rushing, which increases the possibility of making a mistake.

I've stopped to check scripts I wasn't sure about, and the next day, boss phones me at home to tell me about "serious complaints," that is, some unusually b*tchy regular customers came in and didn't get served instantly because I was leery of dispensing nitrofurantoin to a 5-day-old.

Just one of the reasons I don't work retail anymore.

another point to go along with this - I always advise people that I know to actively search out pharmacies that aren't as busy. A CVS that fills 150 - 200 a day is a very different pharmacy than one that fills 500-600 a day. I think the OP probably just got a particularly poor pharmacist, but the likelyhood of problems occurring along with less opportunity to counsel increases in the high volume stores.

 

[BMBiology]

When you said 2 bid, then talked about 1000 mg and diarrhea, my first thought is Augmentin xr, which would do that. But, there are plently of indications for that dose.

You are right. If it is Augmentin XR, then two tabs of 1000mg bid is the FDA approved indication for CAP.

 

[b16]

First off...I'd prefer to talk in the hypothetical about which particular drug it was. Its just something about me, but I prefer to keep my personal medical information to myself when it comes to the internet, hopefully you understand. Although I'll say its a commonly prescribed drug. I can say that while a internet search and pubmed search I've done haven't shown any indication for this drug at the dose/schedule that was written on the dosage instructions on the label, I certainly can't definitively rule out that someone has written for it somewhere for some off-label reason, but I still think it would be a rare enough of a scenario that it might warrant a second glance, but I understand that something that small might slip by unnoticed. The store I was at was a fairly busy CVS, but it was a 24 hour store and I filled it at like 10 PM and people were mostly chatting and restocking so it appeared to be a relatively slow night. I saw the physician today who wrote the script and while I havent seen the original script in person, I think the issue was that he wrote on the script " :/= 1000 mg PO BID x10 days dispense # 20", so I admit that the script was ambiguous and the use of the whole "roman numeral and dot notation thing" was unnecessary and confusing, but if you were to interpret the script as the pharmacist at the CVS did (2 1000mg tabs two times a day x10 days) the dispense # would have to be 40 to cover a 10 day course, not 20 which was what was written on the script. Again, I can understand that something like that could slip by every now and then, but the issue I had was more that when I called the pharmacy to ask about it I was basically told "its not our problem" and was left without the slightest sense that they regretted the mistake. Anyway, I'm just glad I had enough motivation to double check the indicated dose myself or I probably would have had some wicked diarrhea for 9 more days. Anyway, thanks to everyone for their input.

 

[b16]

You are right. If it is Augmentin XR, then two tabs of 1000mg bid is the FDA approved indication for CAP.

While its not Augmentin, I do promise that the dose I was given by the pharmacy was not indicated by any search tool I used (Epocrates/FDA website/Micromedix/pubmed/ect...). When I talked to the prescribing physician today he also agreed that it was not a dose that he would ever write.

 

[BMBiology]

I saw the physician today who wrote the script and while I havent seen the original script in person, I think the issue was that he wrote on the script " :/= 1000 mg PO BID x10 days dispense # 20"

Wait a minute, you are a 3rd year medical student and you don't remember what the physician told you about the direction and you did not read the script before handing it to the pharmacist?

Not saying you are jumping to conclusion that the pharmacist made a mistake but this happens far more than you think. It is never the physician fault. I still say go to the CVS and ask for a copy of the script. If the pharmacist made a mistake, take it up with the pharmacy manager. If the pharmacist didn't, I think you should do the right thing and apologize.

 

[WVUPharm2007]

..
П 1000mg po BID

That would be a very standard way of writing "Take 2 1000mg tabs by mouth twice daily." It's how everyone writes out in the real world...but I can feel for you. All of the pharmacists that don't give a damn wind up in retail because it's the only thing they can handle. I imagine that you unfortunately got one of those types.

 

[Megas]

Pharmacists have a corresponding liability and obligation. For every Rx I call on where I look stupid ("oh!, that new rx for Ativan at the insanely high dose was for alcohol withdrawal treatment at home,oops, sorry"), there's another one where the script was in error. It takes less than one minute to call or FAX (for each incident) on a few scripts a day.

 

[Aznfarmerboi]

Hi pharmacist friends,
Quick question here from a 3rd year medical student colleague. So long story short, I had a script filled at a CVS over the weekend near my house. I started taking the medication as directed on the bottle label ("take 2 tablets twice a day"), and the next day got all kinds of diarrhea, so I decided to check the dosing on epocrates and found out that the pharmacy directions were instructing me to take 2 times the highest dose of this drug that is currently in the guidelines; the correct dose of this drug for my indication is 1000mg BID. So I call the pharmacist at the CVS to ask why the instructions are telling me to take 2x more than the highest recc dose of this drug for any indication, and she basically got irritated that I called her and pulled out the script I had brought in and said that the script said the same dosing that they put on the label and that it was my doctors fault for writing the wrong dose (I think there was some confusion between 2 500mg tabs BID vs. 2 1000mg tabs BID on the script). Either way, the question I have is, isnt there some responsibility on the pharmacist who filled a script for a dose of a drug that isnt indicated for anything? if the script is ambiguous about the dosing, shouldn't that require verification from the physician (especially because regardless of the schedule the dispense# didn't even agree with their label instructions?) I was very irritated that I was essentially being told, "we assumed that what the script said was a dose that doesn't exist for any indication, but we filled it anyway without any confirmation, and oh, by the way, its your doctors fault, not ours." Now, not being from the pharmacy world, something really irritated me about that general idea, and I wanted to ask if this is essentially a ****ty and incorrect pharmacist, or if its actually true that the pharmacy will fill any dose written on a script by a doc without liability, even if its a wrong dose? I mean, if someone leaves out a decimal, 7.5 mg of coumain is now 75mg; will a pharmacy still fill a script for a 75mg dose of coumdin because thats what it said on the script? (ridiculous example, but you get the point). Am I crazy here, or is this pharmacist I talked to incorrect?

The pharmacist have a corresponding duty to check dosage. I wouldn't say the pharmacist here is wrong until you can tell us what drug it is so we can tell you the situation. For example. . . if the drug was for Metformin, take 2000 mg twice daily for 10 days, I would definitely flag it down as a call doctor if you never taken it before in your medical profile.

Concerning the pharmacist being rude, there is no excuse to act unprofessionally especially to another person in health profession. However, it depends as you know from communication class how you approach her. The pharmacist might be defensive especially if shes being accused of something. There's also the matter that while she might be pharmacist on duty at that time, she did not fill your script.

 

[Old Timer]

The answer to your hypothetical questions are:

1. Yes, the pharmacist has an ethical and in some states a legal obligation when dispensing a medication to ensure the dosage dispensed is within normal guidelines and he or she should document on the Rx any conversations with the prescriber about the prescriber's reason for prescribing outside of the normal dosage range. I once filled a prescription for a cancer patient for MS-Contin 1800mg q12h. When I called the physician, I was informed the patient was a heroin addict and that was the required dosage for this patient. While that dosage might have killed you or me and was way outside the normal dosing guidlines, I felt fine dispensing once I had documented the reason for the dosage and noted this on the prescription.
2. The next issue is the attitude of the pharmacist. I encourage patients to question anything I have done. If something slips past me and a patient's questioning makes me look at it again and I see something I missed, than that is a good thing. If my patient's can't feel free to question me, than I can't count on getting all of the information I need to help the patient with their drug therapy.

The problem with your post is it is neither here nor there. You should have posted everything or made it totally hypothetical. In other words without knowing:

• The Name of the drug
• The diagnosis
• Other concomitant drug therapy

I cannot accurately asses how the pharmacist performed and what I would have done in that case. I suggest you arrange a time to go in and speak with the pharmacist and if not ask for the name of the pharmacy supervisor and have a discussion about your incident. You really need to see the hard copy of the prescription. You also need to ask if the system gave them a hard stop to DUR review the dosage.

 

[monsterbrain]

I'm just a pharmacy student (tech) and even I would have questioned the #20 vs. #40 if I saw that while typing the script. Any of the pharmacists I work with would have made a call to the physician on that one. Sorry to hear that your experience was not handled professionally.

 

[loo]

All of the pharmacists that don't give a damn wind up in retail because it's the only thing they can handle.

Be careful with your broad generalizations...they're not always true. There's hospital, LTC, mail order, etc. pharmacists who don't "give a damn" either.

 

[b16]

Wait a minute, you are a 3rd year medical student and you don't remember what the physician told you about the direction and you did not read the script before handing it to the pharmacist?

Not saying you are jumping to conclusion that the pharmacist made a mistake but this happens far more than you think. It is never the physician fault. I still say go to the CVS and ask for a copy of the script. If the pharmacist made a mistake, take it up with the pharmacy manager. If the pharmacist didn't, I think you should do the right thing and apologize.

I did glance down at the script and basically remember what it said from a glance, enough to get the gist of what he wrote but this is a very competent senior physician who I trust greatly so I didn't spend significant time scrutinizing each letter. Who memorizes each character and pen stroke, just in case there is a problem anyway? I was sick, and my only priority was putting it in my pocket and heading to the pharmacy and getting it filled ASAP.

Also, thank you to everyone else for your informative comments. To keep things simple, I should have just asked the question in the topic headline without injecting all of the details of my personal experience; I just thought I would try to explain why the question came up in my mind. I appreciate everyone's input and think I have a good idea of the answer to my question now. Thanks again.

 

[WVUPharm2007]

Be careful with your broad generalizations...they're not always true. There's hospital, LTC, mail order, etc. pharmacists who don't "give a damn" either.

Ok....I"ll give you LTC and mail order....because those are even more pathetic and mindless than retail. You sit there and literally make sure the right drug is in the right box for 40 hours a week...and nothing else...

 

[BMBiology]

Ok....I"ll give you LTC and mail order....because those are even more pathetic and mindless than retail.

When did you become priapism? Is that your new year's resolution?

 

[VCU07]

If a physician writes coumadin 75mg then it is obviously wrong and if a pharmacist fills the prescription, then she would be in trouble with the Board since it falls below the professional standard of a pharmacist. But legally speaking, the court has generally ruled that the pharmacist only has a duty to accurately fill a prescription based on what is written on the prescription. The duty of care belongs to the physician. The court felt that if pharmacists are also held liable for what the physicians write, then the pharmacists may interfer with the physician-patient relationship and therefore, may prevent many patients from receiving their medications.

Many cases, however, are not clear. For example, if your physician writes starting metformin dose 1000mg bid instead of 500mg bid then, it is not so obvious and most pharmacists would not question the script since they wouldn't know if you are on a starting dose or maintenance dose of metformin. Another example is gabapentin. The manufacture's max dose is 3600mg/d but studies have shown that 4800mg/d can be prescribed as off label.

I suggest you go back to the pharmacy and ask for the original script. If the sigs are written incorrectly by your physician, then I would take it up with your physcian. But if the pharmacist misfilled, then talk to the pharmacy manager.

While I agree that 75mg is highly unlikely, there is no max. dose for warfarin. So, it is technically possible. Recently, we had a pt. that was on 50mg and still subtherapeutic! Anyway, there was another deficiency and so hem/onc was consulted.
In response to the OP...just b/c no reference states a dose with which you were prescribed, does not mean it was an error on dosing per the md or dose check per the pharmacist. There are drugs which fall above max. dose recommendations and diarrhea is certainly a possible side effect to any medication (even at referenced doses).

 

[MountainPharmD]

Ok....I"ll give you LTC and mail order....because those are even more pathetic and mindless than retail. You sit there and literally make sure the right drug is in the right box for 40 hours a week...and nothing else...

Ha ha....And sitting in the dungeon basement of a hospital pharmacy doing order enrty all day while getting fat is a great job..... There are many more hospital pharmacist doing that than the clincal super nerd wanna bes......

The funniest thing I ever saw was at the hospital pharmacy in my home town. A group of fat women sitting on thier fat *****es doing order entry all day talking about how terrible retail pharmacy was. I literally wanted to puke every time I walked in there it was so depressing.

 

[Omegadramon]

Order Entry is so 20th century.

CPOE, kthxbai

 

[Aznfarmerboi]

Ha ha....And sitting in the dungeon basement of a hospital pharmacy doing order enrty all day while getting fat is a great job..... There are many more hospital pharmacist doing that than the clincal super nerd wanna bes......

The funniest thing I ever saw was at the hospital pharmacy in my home town. A group of fat women sitting on thier fat *****es doing order entry all day talking about how terrible retail pharmacy was. I literally wanted to puke every time I walked in there it was so depressing.

lets admit it, there are way more hospital pharmacists who does hospital because they couldn't hack it in retail than because they want to use their brains.

 

[genesis09]

This is a true problem in pharmacy that different specialities are fighting each other rather than working with each other. Each area has its own positives and negatives. If you do not have people skills, I would recommend looking for a job in a closed pharmacy or staff hospital position. If you want to be with people all day, than community is for you. The list goes on and on. You'll have to pick what area is best for you. No one area is superior to the other; they are just different.
Currently, the majority of pharmacists work in a community position. I can't imagine that changing in the near future. The next biggest group are pharmacists who work in hospitals. Most pharmacists who work in hospitals work as a staff pharmacist verifying orders. After that, probably comes PBMs, and after that, are other small areas i.e. LTC, home infusion, etc.

 

[WVUPharm2007]

lets admit it, there are way more hospital pharmacists who does hospital because they couldn't hack it in retail than because they want to use their brains.

The world of retail pharmacists trying to legitimatize their mindless, yet financially rewarding, career choice is fun to watch. Just be honest. I'd wager, at minimum, 90% of retail pharmacists are there because it pays more and is less work to get into and keep up with than that they really like doing it. There is a reason it takes MONTHS to fully train at a hospital and HOURS to fully train at CVS. Don't get me wrong...the profession needs dispensers. But you also have to admit how demeaning and embarrassing to the pharmacy profession as a whole retail pharmacy is. Dude...you have drive-throughs, gift cards for transfers, and store managers with maybe an associates' in business telling you, a health professional with a doctorate, what to do.

But even the boring order entry isn't easy. Even when I'm just doing the order entry shift for the day, I'm still using my brain much more than I did in retail. In fact, we have an out-patient pharmacy. Its staffed by the older pharmacists that want to take it easy or by other folks that want a nice, mindless day after a stressful day...or maybe they have a headache and don't feel like thinking. But, I do agree...the order entry part is easy. It's the off-the-wall questions from physicians and on-the-spot problem solving I'm expected to handle in between orders that keeps it interesting. The most fun, interesting night of my short career happened in the order entry hot seat one lonesome night by myself. I made a post about it last week. Then when I'm doing the clinical shift...my god, it's not even a contest.

Give it a rest...your job at Wags is a joke and you are contributing to the destruction of the once great community pharmacy profession one gift card at a time.

 

[WVUPharm2007]

If you do not have people skills, I would recommend looking for a job in a closed pharmacy or staff hospital.

If you don't have people skills at my job, you are f'd. You need the nurses, technicians, and physicians all liking you as a person or you will fail...or be miserable...and, really, how often does a retail pharmacist really deal with the public. In my experiences, every retail pharmacist I've ever been around avoids talking to the public and sends techs/interns out to retrieve scripts/check-out customers...er I mean patients...

 

[WVUPharm2007]

When did you become priapism? Is that your new year's resolution?

Maybe we are one in the same. You've noticed he's coming around to my theory of BCS worthlessness as I've come to the conclusion that his theory of retail pharmacy pointlessness is valid, no? Odd...

 

[SpirivaSunrise]

The world of retail pharmacists trying to legitimatize their mindless, yet financially rewarding, career choice is fun to watch. Just be honest. I'd wager, at minimum, 90% of retail pharmacists are there because it pays more and is less work to get into and keep up with than that they really like doing it. There is a reason it takes MONTHS to fully train at a hospital and HOURS to fully train at CVS. Don't get me wrong...the profession needs dispensers. But you also have to admit how demeaning and embarrassing to the pharmacy profession as a whole retail pharmacy is. Dude...you have drive-throughs, gift cards for transfers, and store managers with maybe an associates' in business telling you, a health professional with a doctorate, what to do.

But even the boring order entry isn't easy. Even when I'm just doing the order entry shift for the day, I'm still using my brain much more than I did in retail. In fact, we have an out-patient pharmacy. Its staffed by the older pharmacists that want to take it easy or by other folks that want a nice, mindless day after a stressful day...or maybe they have a headache and don't feel like thinking. But, I do agree...the order entry part is easy. It's the off-the-wall questions from physicians and on-the-spot problem solving I'm expected to handle in between orders that keeps it interesting. The most fun, interesting night of my short career happened in the order entry hot seat one lonesome night by myself. I made a post about it last week. Then when I'm doing the clinical shift...my god, it's not even a contest.

Give it a rest...your job at Wags is a joke and you are contributing to the destruction of the once great community pharmacy profession one gift card at a time.

Ehhh..come on Mikey. Goodness knows I'd be working inpatient too (as opposed to retail) if I didn't enjoy my specialty. But that's a personal choice we each make, and the elitist attitude is silly. What good comes of p***ing all over your colleagues?

 

[MountainPharmD]

If you don't have people skills at my job, you are f'd. You need the nurses, technicians, and physicians all liking you as a person or you will fail...or be miserable...and, really, how often does a retail pharmacist really deal with the public. In my experiences, every retail pharmacist I've ever been around avoids talking to the public and sends techs/interns out to retrieve scripts/check-out customers...er I mean patients...

How often does a retail pharmacist deal with the public. Did you serious;y just say that!?!?!?

Oh lord dude you are hilarious!!! Two months on the job and you are spouting off as if you are seasoned vetern. So tell me pharmacy guru...How many patients do YOU talk to in a given day? How many patients do you counsel? Oh what how many patients do you actually see let alone talk to?

Staring at that computer screen and talking on the phone...wow you really are the man!

 

[Priapism321]

Ehhh..come on Mikey. Goodness knows I'd be working inpatient too (as opposed to retail) if I didn't enjoy my specialty. But that's a personal choice we each make, and the elitist attitude is silly. What good comes of p***ing all over your colleagues?

Hey, give the guy a break. He adequately commented on the personal decisions that go into choosing to man the drive thru for a living: complacency, apathy, and, never are we to leave out, SIGN ON BONUSES (for a brand new laptop, of course). That takes care of most of them, I think.

 

[BMBiology]

There is a reason it takes MONTHS to fully train at a hospital and HOURS to fully train at CVS.

All due respect, I think you are trying way too hard to glorify a hospital pharmacist.

I have worked in both retails and hospital. I can tell you the job is much more similar than most pharmacists would like to admit. In retail, pharmacists love to whine about customers (also known as "patients") and in hospital, pharmacists love to whine about nurses and physicians.

Don't think you are a all high and migthy pharmacist because you work in a hospital. In the peaking order, a nurse still outranked a pharmacist. Some physicians may ask a pharmacist for an advice but honestly, most of the questions they asked are very similar to the mindless questions customers ask their retail pharmacists (you know what I mean if you worked as a drug information pharmacist!). God forbid if the hospital is kind enough to actually hire a full time clinical pharmacist and pay pharmacists for their clinical skills.

Retail is a joke and it is demeaning to the profession but if it weren't for JCAHO and their strict standards, the hospital administrators would eat the pharmacists for breakfast so it is not because hospital pharmacists love the pharmacy profession so much that they would defend it until their last breath.

I know a few pharmacist who worked in retails for years and finally snapped and are currently working in a hospital. They are not having a difficult time adjusting and actually like the less stressful (and less bullsh*t) work.

Pharmacists love to whine and say how horrible other pharmacists are but the truth is that they are more similar to each other than they would like to admit.

 

[Priapism321]

Don't think you are a all high and migthy pharmacist because you work in a hospital. In the peaking order, a nurse still outranked a pharmacist.

Can you provide something to substantiate such a claim? And what is a "peaking" order?

 

[TCB]

To each his own, we are all working for a common goal.

 

[BMBiology]

Can you provide something to substantiate such a claim? And what is a "peaking" order?

Sorry I mean pecking order. Just look at how often nurses raised their voices at pharmacists. Physicians don't want to mess with them and their union power. Hell, even the hospital administrators don't want to cross their path.

 

[WVUPharm2007]

How often does a retail pharmacist deal with the public. Did you serious;y just say that!?!?!?

Oh lord dude you are hilarious!!! Two months on the job and you are spouting off as if you are seasoned vetern. So tell me pharmacy guru...How many patients do YOU talk to in a given day? How many patients do you counsel? Oh what how many patients do you actually see let alone talk to?

Dude...in the 4 years I worked in retail, the damned pharmacists never talked to the patients...they avoided it like the plague. And this reflects every retail pharmacy i've ever set foot in. It's all about pushing scripts with $$$ leading the way. They'd send out the interns because they were an hour behind. Now if this is INDEPENDENT pharmacy, it's totally different. But that's another horse of another color that I actually respect. And I talk to maybe two or three patients a day with Coumadin teaching when I do clinical....which is, of course, several times more involved than the counseling done in retail joints. You sit down and talk to them for 15 minutes. Imagine trying to do that at CVS. Your DM would have your head.

Staring at that computer screen and talking on the phone...wow you really are the man!

Hahaha. It's like a secretary making fun of a guy with any some other job because it might involve typing. Seriously...think about what you are saying. A retail pharmacist's ENTIRE job revolves around dispensing with maybe 15 minutes of something interesting thrown in there from time to time. How lame...I know you're pissed at me. I'd be pissed at me, too...I'm making you realize how pathetic the career choice of retail pharmacist is. I truly mean this. Everyone that works for a major retail pharmacy chain is contributing to the dilution of the quality of pharmacy practice. And they NEED to be called out on it. Times are a-changing. We need to drop the spatula and start doing more clinical work. It took me years to realize this, but it's true. It's the future. It's inevitable.

 

[SpirivaSunrise]

Hey, give the guy a break. He adequately commented on the personal decisions that go into choosing to man the drive thru for a living: complacency, apathy, and, never are we to leave out, SIGN ON BONUSES (for a brand new laptop, of course). That takes care of most of them, I think.

Oh gosh, I wouldn't disagree there...a good majority of the reasons pharmacists decide to go into retail are absolutely absurd (including those listed). But these over generalizations are getting a little out of hand...and I think a little insulting to many of the community pharmacists out there who do it for the right reason.

If you guys happened to stumble into Z's pharmacy in 10 years...and didn't know his background or that it was him, would you look down on this pharmacist?

And let us not forget that you and I are able to specialize in areas we enjoy, because most of our colleagues don't want to.

 

[WVUPharm2007]

All due respect, I think you are trying way too hard to glorify a hospital pharmacist.

I have worked in both retails and hospital. I can tell you the job is much more similar than most pharmacists would like to admit. In retail, pharmacists love to whine about customers (also known as "patients") and in hospital, pharmacists love to whine about nurses and physicians.

I love the nurses. They are nice to me. I see them all the time and we know each other. See...you are reflecting on OLD hospital pharmacy. When you sit in the basement and type in orders all day. That's 1990s brand pharmacy. The ONLY reason 1 out of 4 pharmacists we staff on a given day do this is because we aren't rolling out physician order entry until next year. This is rural PA...it's 10 years behind the bleeding edge. Around 2011, we are going to take up residency on the floor and will work right there. If an order is f'd up...no more phone tag...the physician is right there next to you. The physicians ask you more questions....the nurses ask you more questions...and they all respect you more.

Hospital pharmacy is improving.

Then you have retail. I don't even have to say anythingy...but I will. Suffice it to say, it's an embarrassment. Central fill pharmacies...gift cards...drive-throughs...DMs with $$$ in their eyes...every day it gets worse. Every day, you are more and more just there because you have to be legally. And everyone who agrees to work there without either demanding change or refusing to work under idiotic conditions like 12-hour shifts without a lunch break is just helping to perpetuate the destruction of a once proud and meaningful profession - community pharmacy.

It's not that hospital is INTRINSICALLY better than community - it isn't. It's what selling out the profession to huge corporate masters with loss-leader $4 scripts has done to the profession. Community pharmacy has so much potential - medication management, disease-state counseling specialists...and many others...but so many pharmacists and pharmacies are pissing it away for shareholders. Selling out your brain and your quality of work for a tiny bit more per paycheck. And, frankly, you are damned straight I'll call you out on it if you work for the CVSs of the world. You are a sellout.

 

[BMBiology]

And, frankly, you are damned straight I'll call you out on it if you work for the CVSs of the world. You are a sellout.

I am not replying to you specifically but your comment reminds me of my friend.

I know a pharmacist who worked in retail before and during pharmacy school, and know how crappy it is. Now that he works in a hospital, he thinks retail pharmacists are a "sellout". He was more than willing to sell out the profession before he applied to pharmacy school and during pharmacy school but I guess now that he works in a hospital, he started to love the profession so much that he refused to let the corp shove hundred dollar bills into his pocket.

 

[Sosumi]

I really don't like this constant condescending attitude toward retail pharmacy. I quite enjoy it much more than hospital pharmacy -- locked up in some corner where the only contact are the whiney technicians and pharmacists complaining about nurses. 90% of calls were from nurses complaining about where the medications were. Clinical pharmacy isn't much better. I loved rounding with physician teams, but really, how often were you really needed?

Community pharmacy has its fair share of "embarrassing" things, but it's also where I feel I make MUCH more of a difference in patients' lives. If you make it a point of mastering efficiency in the dispensing part and scheduling of your technicians, it gives you time to do clinical reviews of each medication, patient counseling, immunizations, making OTC recommendations, answering and reassuring patients about side effects, following up on how they do on their meciations, and MTM consults. One of my old pharmacy professors stopped by once trying to encourage me to preceptor because my practice is considered "advanced" for a community setting. It's not really advanced but something I think far too many pharmacists are too apathetic toward doing because they're too lazy to spend a few off days to take additional training to do immunizations or MTM, especially if they don't get paid for it.

 

[MountainPharmD]

A retail pharmacist's ENTIRE job revolves around dispensing.

Gee no ****? Pharmacists dispense medications? So I guess that no medication gets dispensed at your hospital. Your job revolves around the exact same thing.

How lame...I know you're pissed at me. I'd be pissed at me, too...I'm making you realize how pathetic the career choice of retail pharmacist is. I truly mean this. Everyone that works for a major retail pharmacy chain is contributing to the dilution of the quality of pharmacy practice..

Why would I be pissed at you? You have no idea what you are talking about. Whats to be pissed about? Retail pharmacy IS pharmacy and has been ever since its inception. Oh, I guess every pharmacist for the last hundred years has wasted thier time by your assesment.

When people think of a pharmacist they think of the guy in the white coat standing behind the retail pharmacy counter. The one they trust to ask questions about not only thier prescriptions but every other aspect of thier health care.

Retail pharmacy could be the best job in the world if it were not for the corporate chains destroying the profession. The only thing that is pathetic is the fact we have allowed them to do it. Every retail pharmacist today has to shoulder some of the blame. We traded out dignity, integrety and self respect for high salaries and big sign on bonus.

 

[WVUPharm2007]

Gee no ****? Pharmacists dispense medications? So I guess that no medication gets dispensed at your hospital. Your job revolves around the exact same thing.

Depends which day it is. Some days it does...but only because it's a neccessity. The other, happier days, I dispense nothing. And I'm not trying to be condescending to all community pharmacists...just the ones that work for faceless retail giants who are perpetuating the death of a once proud profession. And, frankly, you deserve to be looked down upon.

 

[BidingMyTime]

There is a reason it takes MONTHS to fully train at a hospital and HOURS to fully train at CVS. Don't get me wrong...the profession needs dispensers. But you also have to admit how demeaning and embarrassing to the pharmacy profession as a whole retail pharmacy is

Months to fully train at a hospital? I've worked at several hospitals and all of them just threw the pharmacist in and expected them to learn running. One hospital I was at would often schedule pharmacists on the first-day by themselves and expect the tech to show them the computer system.

On the other hand the retail pharmacies I have worked would often schedule the pharmacist with another pharmacist for 1 - 2 weeks to learn the system.

I've spent the bulk of my career in hospital, and am currently in retail. Both are taxing in pharamaceutical knowledge in different ways. It's amazing how quick I've forgotten all about dopamine & dobutamine drips since leaving hospital. On the other hand, I had to work to get up to speed on all the numberous drugs in each class that all available (since the hospitals I worked at had extremely limited formularies.)

There are great things for a professional pharmacist in either retail or hospital (and I'm sure in any of the other practice settings, although I'm only personally familiar with these two.) I've known horrible pharmacists and super-superb pharmacists in both practice settings.

You are wrong to disparage a pharmacy practice setting. Undoubtedly there are bad individual pharmacy settings, but both retail and hospital pharmacies require pharmacy skills and pharmaceutical knowledge.

 

[MountainPharmD]

I really don't like this constant condescending attitude toward retail pharmacy. I quite enjoy it much more than hospital pharmacy -- locked up in some corner where the only contact are the whiney technicians and pharmacists complaining about nurses. 90% of calls were from nurses complaining about where the medications were. Clinical pharmacy isn't much better. I loved rounding with physician teams, but really, how often were you really needed?

Nice summary of hospital pharmacy.

I have this recurring nightmare of being chained to a chair in the basement of a hospital pharmacy. I have a phone taped to my ear and alll I hear is one nurse after another bitch about how they sent in an order 5 minutes ago and they do not have it yet. Then a drug rep brings in lunch and I cannot go because I am chained to the bank of order entry computers.

Don't let priapism and WVUu get to ya. They both combined have been practicing for about 5 minutes.

 

[BMBiology]

-

 

[All4MyDaughter]

I don't think it is inconceivable that there are retail pharmacists who enjoy their job and have perfectly legitimate reasons for working in that practice setting. I also don't think they should have to justify their choices to anyone.

I worked several years in retail and now work in a hospital setting. There are happy pharmacists, miserable pharmacists, good pharmacists, bad pharmacists and "I'm just here for the money" pharmacists in both settings.

I also disagree that it takes "hours" to train in retail. The major learning curve in BOTH settings, IMO, revolves around using the particular computer system. And that takes more than "hours" anywhere you go.

 

[BMBiology]

Months to fully train at a hospital?

Well you see, WVU only worked in retail when he was a pharmacy student so now that he works in a hospital, he needs a little more training. Just saying...

 

[MountainPharmD]

So let me bring this back to what the OP originally asked.

Legally our job is to dispense the medication as it is wriiten by the doctor. We can be held responsible if it is determed that a resonable and prudent pharmacist should have known what was dispensed was incorrect.

In my world...Yes it is the pharmacist responsibility to check the dosage. At my pharmacy we get the weight of all children so we can double check the dose. We call on every non standard dose that we cannot find some kind of documentation to support. I am a wiz at finding things quickly on the computer.

Have I worked with pharmacists that would fill a prescription for Levaquin BID and never even pause....Yes I have. I have seen two prescriptions for this in the last two months and called...Yes I have.

 

[WVUPharm2007]

Well you see, WVU only worked in retail when he was a pharmacy student so now that he works in a hospital, he needs a little more training. Just saying...

I worked summers back home at the local hospital, too. Haha. Putz.

And, yes, it takes months to learn my job. At least to get to the point where you can work alone with no other pharmacists around. If you think otherwise, you are delusional. The mandated training and painstaking getting-used-to of policies is time consuming. They had one pharmacist work 8 months before she was allowed to work on her own. The let me go solo after about 3 months. A kid that graduated in December from Pitt did retail for 8 months, came to us in late September, and is still a few months from going solo...and he tells me every day how much more involved it is than his old gig at CVS. He was a member of Rho Chi, too. He isn't dim at all. It could just be because he's a Pitt grad though...lol...