TECH HOSPITAL job-- new hire ADVICE!!

[coolbna]

Hey guys,

I just landed a pharm. tech position at a hospital. yay! However, I have never worked in a hospital pharmacy before. I'm scared beyond imagination. More over, I've been out of job for the past few years (college) so I don't remember anything I learned while working in retail.

So, If you could take your time and share your experiences, I greatly appreciate it! Also, should I start memorizing prescription drugs? BTW funny stories welcome too!

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[delano2000]

The hospital and retail settings are very different from each other. In hospital, you don't have to type labels, deal with issurance companies, deal with patients, or any of that. In the hospital setting you will be exposed to a much wider variety of drugs, narcotics will be handled differently from the retail setting, you will have to deal with pyxis machines, annoying nurses trying to yell at you all day about missing meds, go on delivery runs, may or may not have to compound ointments, GI cocktails, enemas, irrigations, etc. You will also be taught how to make IV solutions, TPNs and depending on whether or not you have an Oncology unit, you might learn how to make chemos too. You will also learn how to operate the robot (we had one called an Omnicell), run lots of batches (cartfill, pyxis, narcs, IVs, oral syringes, etc) and reports throughout the day, stock and replenish drugs. You will deal with a lot of bulk drugs that are super heavy. Nurses are gonna screw up with narcs and create discrepancies that you may or may not (depending on your institution) have to fix. You will come across lots of very expensive drugs (some in the price range of over $10K so you'll have to be very careful when delivering), very powerful narcs, drugs with very short stabilities so they have to be delivered STAT and lots of drugs that will need to be refridgerated once they are sent to the different units. If your institution has a tubing system, you will learn which drugs can and cannot be tubed (never tube narcs and insulin) and you will sometimes see specimen that are meant to be sent to the lab and not pharmacy (and yes that also includes stool samples so handle with care). You might also be required to pre-pack drugs for unit dosing (if they are in bulk bottles). You will also be required to pick up credits from the different units and you must know how to prioritize (anything that has to do with regulating the heart will get priority over a reg med). You might also be in charge of dealing with crash cart trays, anesthesia boxes and so on. Be wary of codes and stay out of the way if you are not needed during a code.

You will also want to brush up on your drugs. You are not required to know everything before hand, so don't stress out too much. They'll teach you as you go along and you'll start to pick up on different things.

That's about it in a nutshell. Have fun. I enjoyed it (for the most part).

 

[xtsukiyox]

delano, that was a pretty cool post. Thanks.

 

[delano2000]

delano, that was a pretty cool post. Thanks.

I'm pretty sure that I left some things out but that was all I could remember from my time in hospital.

 

[coolbna]

Well articulated, thanks man. I notice our pharmacy has the omnicel thing and the lady said, it minimizes physical labor. I mean i don't mind lifting boxes but let the machine do it. Also I don't have IV certification so like u said I'm gone try to look into that. Is there a website were I can learn more about IVs? BTW I agree about the nurses.

 

[delano2000]

Well articulated, thanks man. I notice our pharmacy has the omnicel thing and the lady said, it minimizes physical labor. I mean i don't mind lifting boxes but let the machine do it. Also I don't have IV certification so like u said I'm gone try to look into that. Is there a website were I can learn more about IVs? BTW I agree about the nurses.

The Omnicell at my hospital was only used for easy retrieval of meds (not IV bags though). So pretty much if we get a label for lets say Zocor, the Omnicell will rotate and indicate the exact location of the drug so that you can retrieve the med instead of walking around looking through all the different drug bins to find it. It is technically not a robot per se (though this may be different in various institutions). The lifting of the boxes with the 24 liter bags of NS will be done by the techs, unfortunately.

Oh, just a word of advice, a lot of hospitals have locations for drugs, hospital wide, using their generic names. So even though a generic may not be available, you might see it listed under its generic name. This might be the case with pyxis machines too, so definitely get familiar with the brand/generic names.


EDIT: If you haven't had a formal training through a specific program then more than likely they will train you on-site.

 

[R2pharmD2]

The Omnicell at my hospital was only used for easy retrieval of meds (not IV bags though). So pretty much if we get a label for lets say Zocor, the Omnicell will rotate and indicate the exact location of the drug so that you can retrieve the med instead of walking around looking through all the different drug bins to find it. It is technically not a robot per se (though this may be different in various institutions). The lifting of the boxes with the 24 liter bags of NS will be done by the techs, unfortunately.

My new hospital has something similar and I'm not a fan. It might be faster when you're new and don't know where anything is, but it seems like waiting for the stupid thing to rotate to the right position is slower than just walking to the shelf and grabbing the drug (once you know the layout that is). I'm only in my second week there though, so maybe it'll win me over eventually.

 

[delano2000]

My new hospital has something similar and I'm not a fan. It might be faster when you're new and don't know where anything is, but it seems like waiting for the stupid thing to rotate to the right position is slower than just walking to the shelf and grabbing the drug (once you know the layout that is). I'm only in my second week there though, so maybe it'll win me over eventually.

You'll appreciate it eventually. Sometimes it might seem like it's slower but when you are pulling the batches, it will be your best friend. Just know that you can multitask while you wait for it to rotate to the right location.

 

[owlegrad]

I respectfully disagree with d on some of those points.

I type labels at the hospital all the time. We print labels to put on the baggies that we deliver (no tube system, no CPOE). We don't have a robot, so I am not familiar with that part at all. Also, there are drugs you will never see in the hospital that you will see in retail, so it is just a matter of them having different sets of drugs, not necessarily that one has a wider selection of drugs. In fact your hospital will have a formulary, and those are the only drugs you will ever see, so in that sense it is actually much more confined.

Other than that, I agreed with everything d said. I must work in some magical hospital where nurses and pharmacy get along though; I have had very few interactions with nurses that were negative.

 

[delano2000]

I respectfully disagree with d on some of those points.

I type labels at the hospital all the time. We print labels to put on the baggies that we deliver (no tube system, no CPOE). We don't have a robot, so I am not familiar with that part at all. Also, there are drugs you will never see in the hospital that you will see in retail, so it is just a matter of them having different sets of drugs, not necessarily that one has a wider selection of drugs. In fact your hospital will have a formulary, and those are the only drugs you will ever see, so in that sense it is actually much more confined.

Other than that, I agreed with everything d said. I must work in some magical hospital where nurses and pharmacy get along though; I have had very few interactions with nurses that were negative.

I'm assuming you work in a smaller hospital with fewer staff. I have never ever seen a pharm tech enter orders in a hospital setting. I've seen some interns do it with supervision, but never a tech.

FYI I worked in a medium-large hospital and our inpatient pharmacy services both the adult hospital and the children's hospital (they are combined under one big hospital). Also, I think I've stated earlier that a lot of the different ops will depend on the institution you are working in. Some will apply and some won't. I do agree about the formulary thing though. I was just eluding to the fact that there will be a wider variety of drugs used in the hospital setting than in retail. For example, how often do you see IV drugs in retail? Rarely, if ever, right?

Out of curiosity, how many beds does your hospital have, Owle?

 

[owlegrad]

I'm assuming you work in a smaller hospital with fewer staff. I have never ever seen a pharm tech enter orders in a hospital setting. I've seen some interns do it with supervision, but never a tech.

FYI I worked in a medium-large hospital and our inpatient pharmacy services both the adult hospital and the children's hospital (they are combined under one big hospital). Also, I think I've stated earlier that a lot of the different ops will depend on the institution you are working in. Some will apply and some won't. I do agree about the formulary thing though. I was just eluding to the fact that there will be a wider variety of drugs used in the hospital setting than in retail. For example, how often do you see IV drugs in retail? Rarely, if ever, right?

Out of curiosity, how many beds does your hospital have, Owle?

Yeah we let techs enter orders and then the orders are checked, not so different from CVS or whatever. I have heard that is very rare though. To be completely honest, I forgot we were talking about a non-intern here.



I disagree that you see a wider variety in the hospital. It is true I never work with IV's at CVS, but I never deal with most OTC's (and other drug classes) at the hospital. It isn't wider, it's just a different set (IMO). The only way to be exposed to both sets is to work in both settings.



It's not how many beds you have, it's how you use them.
(90)

 

[delano2000]

Yeah we let techs enter orders and then the orders are checked, not so different from CVS or whatever. I have heard that is very rare though. To be completely honest, I forgot we were talking about a non-intern here.



I disagree that you see a wider variety in the hospital. It is true I never work with IV's at CVS, but I never deal with most OTC's (and other drug classes) at the hospital. It isn't wider, it's just a different set (IMO). The only way to be exposed to both sets is to work in both settings.



It's not how many beds you have, it's how you use them.
(90)

Dude we used quite a few OTC drugs in my hospital. Afrin, Tylenol, Motrin, Mucinex, aspirin to name a few. Again I guess it all boils down to formulary.

Our hospital has around 500+ beds and average daily census is usually over 300. Maybe that's why you get to do some of the stuff you do (and the techs too).

 

[dancingallday]

It's not how many beds you have, it's how you use them.
(90)

I work in an 800 bed hospital as a technician. No technician ever enters orders here, and we definitely deal with a MUCH larger formulary than when I worked in retail--you work in a small hospital, and I think your small formulary may be related to that. I mean, I had no idea half of the medications I work with every day now even existed before I started here.

 

[owlegrad]

Dude we used quite a few OTC drugs in my hospital. Afrin, Tylenol, Motrin, Mucinex, aspirin to name a few. Again I guess it all boils down to formulary.

Our hospital has around 500+ beds and average daily census is usually over 300. Maybe that's why you get to do some of the stuff you do (and the techs too).

I didn't mean that my hospital has no OTC's, but there are thousands of OTC products, I doubt your hospital has all of them (or even most of them).

You see different products depending on where you work. I don't think that is an odd concept.

I work in an 800 bed hospital as a technician. No technician ever enters orders here, and we definitely deal with a MUCH larger formulary than when I worked in retail--you work in a small hospital, and I think your small formulary may be related to that. I mean, I had no idea half of the medications I work with every day now even existed before I started here.

Yes I am sure that is true. I have a hard time believing you have a larger formulary than when you worked in retail though. In retail your formulary is every drug product available through Cardinal (or whoever you use). And then you add OTC's so your formulary is every drug product available on the market. How can your hospital beat every drug product on the market?

 

[dancingallday]

Yes I am sure that is true. I have a hard time believing you have a larger formulary than when you worked in retail though. In retail your formulary is every drug product available through Cardinal (or whoever you use). And then you add OTC's so your formulary is every drug product available on the market. How can your hospital beat every drug product on the market?

I guess I was just thinking about the myriad of IV antibiotics, anesthetics, chemotherapy agents, etc. that I wasn't exposed to in retail. But I suppose, yes, if you're strictly thinking about the PO section, retail will always kick butt there.

 

[delano2000]

Yes I am sure that is true. I have a hard time believing you have a larger formulary than when you worked in retail though. In retail your formulary is every drug product available through Cardinal (or whoever you use). And then you add OTC's so your formulary is every drug product available on the market. How can your hospital beat every drug product on the market?

You can get drugs that are not on formulary for inpatients too. I've seen it done quite a few times but you have to go through a bunch of loopholes to get it done and a lot of pharmacists don't like doing that. When I say that you are exposed to more drugs in hospital than retail, I mean we stock more of those drugs on-site than retail will. Plus, drugs in hospital are used for virtually all routes of administrations while in retail that is limited.

So in essence, you might have access to more drugs but you are not necessarily exposed to more drugs on a daily basis.

 

[owlegrad]

I admit defeat. I guess I am hopelessly biased due to being used to a limited formulary vs the hundreds of thousands of drugs we sell in retail.

The more I think about the more I think I was wrong to begin with though. Sure there are thousands of OTC's but they are based on maybe 100 different active ingredients or so? Then you figure that most RX drugs you don't see in the hospital it is because they are copycat drugs or the benefit doesn't outweigh the price...maybe I was off base to begin with. I would have to really think about it.

I guess my main point is that both places have drugs you will not see at the other.

 

[delano2000]

I admit defeat. I guess I am hopelessly biased due to being used to a limited formulary vs the hundreds of thousands of drugs we sell in retail.

The more I think about the more I think I was wrong to begin with though. Sure there are thousands of OTC's but they are based on maybe 100 different active ingredients or so? Then you figure that most RX drugs you don't see in the hospital it is because they are copycat drugs or the benefit doesn't outweigh the price...maybe I was off base to begin with. I would have to really think about it.

I guess my main point is that both places have drugs you will not see at the other.

Duly noted.