What do interns get to do at your place?

[owlegrad]

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The question is in the title. I am just curious what the pharmacists here let their students do. I have noticed a tremendous difference between different pharmacists in terms of what I am permitted to do at work. Some let me do nearly everything, one pharmacist had me waste an amox because he didn't want me to reconstitute, which frankly shocked me. It didn't even occur to me to ask first, I didn't think anyone would mind that much. Lesson learned.



Alternatively, what have the students on here been allowed to do (or been limited to) at varies sites? Either through school or at work. So far I have been allowed to do much more at work than I have through any school experiences, which makes sense to me.

 

[Old Timer]

The question is in the title. I am just curious what the pharmacists here let their students do. I have noticed a tremendous difference between different pharmacists in terms of what I am permitted to do at work. Some let me do nearly everything, one pharmacist had me waste an amox because he didn't want me to reconstitute, which frankly shocked me. It didn't even occur to me to ask first, I didn't think anyone would mind that much. Lesson learned.



Alternatively, what have the students on here been allowed to do (or been limited to) at varies sites? Either through school or at work. So far I have been allowed to do much more at work than I have through any school experiences, which makes sense to me.

As much as they are able.

I let them take phone messages from doctors once they demonstrate proficiency. They have to take the messages, transcribe and save them so I can check. Once they have it down, they can take doctor calls. They can reconstitute. They can do anything I do except counsel (not permitted in PA) and do final verification.

I teach them how to do otc recommendations after they observe me and and I observe them and they limit themselves to things we have gone over. I'm always listening.

 

[phathead]

Varies depending on state, company and pharmacist.

At WAGs they pretty much sit at the drive-thru doing consults 24/7

 

[owlegrad]

As much as they are able.

I let them take phone messages from doctors once they demonstrate proficiency. They have to take the messages, transcribe and save them so I can check. Once they have it down, they can take doctor calls. They can reconstitute. They can do anything I do except counsel (not permitted in PA) and do final verification.

I teach them how to do otc recommendations after they observe me and and I observe them and they limit themselves to things we have gone over. I'm always listening.

Sounds reasonable to me, although PA law sounds terrible in that regard. For some reason I thought you were in Cali. Do you have different standards for employee interns vs students on rotation (assuming you have both)?

Varies depending on state, company and pharmacist.

At WAGs they pretty much sit at the drive-thru doing consults 24/7

That sounds like hell. Counseling through drivethru window all day? Is that some kind of punishment for being a student?

 

[phathead]

That sounds like hell. Counseling through drivethru window all day? Is that some kind of punishment for being a student?

I like to think of it as hazing... but without the ass paddling

 

[owlegrad]

I'll take the paddle, TYVM. Do most people even want to be counciled at drivethru? I envision cars driving off with me in midsentense.

Say what you will about CVS, they would never do this. Drivethru time is tracked, and no activity like counciling should be permitted to allow us to blow a metric.

I like to think of it as hazing... but without the ass paddling

 

[Theta16]

I was planning on starting a thread about this once I had a few more days of experience at my hospital. So far I've done mostly tech work (filling Pyxis carts and running orders). I've made some IV bags and even did some order entry (double checked by a pharmacist). My hospital only has 1 quasi-clinical pharmacist but I haven't had a chance to follow them around yet.

So far, I feel like I'm basically a tech who gets a little extra freedom because I can decide when I want to work as well as where (central pharmacy or a satellite). I'm not sure what else I can really do as most of the pharmacists in the hospital do order-entry all day. We're supposed to start a journal club this week, so I'll see how that pans out. I'm curious to know what other interns are doing in hospitals.

The question is in the title. I am just curious what the pharmacists here let their students do. I have noticed a tremendous difference between different pharmacists in terms of what I am permitted to do at work. Some let me do nearly everything, one pharmacist had me waste an amox because he didn't want me to reconstitute, which frankly shocked me. It didn't even occur to me to ask first, I didn't think anyone would mind that much. Lesson learned.



Alternatively, what have the students on here been allowed to do (or been limited to) at varies sites? Either through school or at work. So far I have been allowed to do much more at work than I have through any school experiences, which makes sense to me.

 

[owlegrad]

I was planning on starting a thread about this once I had a few more days of experience at my hospital. So far I've done mostly tech work (filling Pyxis carts and running orders). I've made some IV bags and even did some order entry (double checked by a pharmacist). My hospital only has 1 quasi-clinical pharmacist but I haven't had a chance to follow them around yet.

So far, I feel like I'm basically a tech who gets a little extra freedom because I can decide when I want to work as well as where (central pharmacy or a satellite). I'm not sure what else I can really do as most of the pharmacists in the hospital do order-entry all day. We're supposed to start a journal club this week, so I'll see how that pans out. I'm curious to know what other interns are doing in hospitals.

Oh geez at the hospital I get a lot of latitude. Order-entry, IV's, clarifying orders, reviewing meds, plus all the tech work I can handle. The only things I can't do are writing orders (not sure if I am not allowed or they just don't have me do it), final check (duh), or controls. The controls I hypothetically could do, but they have never delegated that task to me and I don't expect them to start.

I should specify that we are a small hospital though, so when I say I get a lot of latitude, I mean I get to do anything (everything) that a tech would do, plus some intern-y stuff like order entry. I don't round or anything like that (none of our pharmacists do).

 

[rxlea]

IPPE: Take scripts, counsel, counsel/recommend OTC, everything tech does, count controls, inventory controls, compound, make IVs/TPN for home infusion. Everything but the final check except one pharmacist said I could if I wanted to.

Work: go to codes with the rph, round with rph, IVs, chemo, compound, check TPNs, everything techs do and (hopefully) they will let me do final checks on pyxis fills and code cart trays/anesthesia trays/etc. We don't have order entry because of CPOE but the rphs quiz me on stuff and ask me what's wrong with orders and what I would do.

 

[CUpharmD2013]

It varies from pharmacist to pharmacist, but generally I do tech work, inventory controls, compound, counsel/recommend OTCs, counsel patients on Rxs (with the help of the pharmacist many times because I want to be sure), doctor calls, transfer in/outs, reconstitute, and verify rebills. Pretty much everything except for final verification. I heard that I will be able to do this in my 4th year.

 

[bacillus1]

In PA, aside from being able to take dr. calls, intern don't really have any more "scope of practice" than techs. I do take dr. calls, and I counsel on OTC meds (and Rx meds if I'm comfortable enough with them) when the PDM's not there. The PDM doesn't like me counseling. I'm a P4, so you'd think I'd be able to counsel.

Not sure yet what I'll be allowed to do on my practice-based rotations, as I'm on an industry rotation right now.

 

[taken2]

It depends on the preceptor/pharmacist you are working with. When I did hospital rotation, I didn't do a lot of tech work. I was always on the floor with the pharmacist. I did a lot of coumadin education, documentations (the pharmacist will co-sign after me), made IVs, reviewed med, called doctors office for refills, called doctors to make recommendations etc. I did everything the pharmacist I'm working with for the day is doing. The hospital uses CPOE so I didn't get to do order-entry. Sometimes, I helped the pyxis tech pull med in the central pharmacy.
My compounding rotation was different. I did mostly compounding. I wasn't allowed to take doctors call or transfer orders. I did take a couple of refill calls only when the pharmacist and tech are busy.

 

[pharm B]

I'm waiting to see what kind of stuff we're allowed to do in the coming weeks at my hospital. Right now, I'm doing an MUE on one drug and a monograph on another for presentation at P&T. Basically, someone's requesting that a drug be added to our formulary, and I'm presenting some info on it.

I just did my "aseptic technique" test today. They had me do numerous transfers of fluids from bag to bag and finally to vials, and the vials will be incubated for the next 2 weeks. If anything grows, I fail. If not, I pass!

We've filled the machines on different floors, wasted some meds, and collected info on some adverse drug events.

Interesting to say the least, especially since I'm just about to be a P2.

 

[ChasingMyDreams]

I work in hospital and get to do pretty much everything except verify. My primary responsibility each shift is tech stuff (pyxis refills, iv compounding etc) but once that is taken care of I do some order entry (we also have techs for this) and solve random problems (phone calls about missing meds from mar or "grayed out" pyxis meds, etc).

I have and do write orders in charts (usually VORBs or TORBs from MDs) which are signed by a pharmacist after I write them. This is usually the result of an order clarification I was after.

I have recently gotten a "special" assignment to do a med rec study. (Basically I interviewed 100 pts and compared their med recs with what they say they were taking at home and also looked for errors in dose, frequency, etc.) That was actually pretty cool as I got to know a lot of the attending physicians.

I have also done some coumadin counseling/monitoring as well as vanc monitioring/dosing...

It really just depends on the pharmacist....

 

[Sparda29]

I'm waiting to see what kind of stuff we're allowed to do in the coming weeks at my hospital. Right now, I'm doing an MUE on one drug and a monograph on another for presentation at P&T. Basically, someone's requesting that a drug be added to our formulary, and I'm presenting some info on it.

I just did my "aseptic technique" test today. They had me do numerous transfers of fluids from bag to bag and finally to vials, and the vials will be incubated for the next 2 weeks. If anything grows, I fail. If not, I pass!

We've filled the machines on different floors, wasted some meds, and collected info on some adverse drug events.

Interesting to say the least, especially since I'm just about to be a P2.

I'd fail that probably. I've developed so many bad habits when it comes to making IVs. (Making contact with critical areas on the syringe, not bombarding the place with alcohol, holding things/placing things in a way that blocks airflow.)

 

[Stoichiometry]

So how much of what you get to do was taught by the preceptor vs the school? I am starting my IPPE hours this week and wondering what I get to do. I don't officially start school until this fall...but legally in my state now that I have my license I can do everything a pharmacist does but the final check as long as I am supervised.

 

[joetrisman]

I'd fail that probably. I've developed so many bad habits when it comes to making IVs. (Making contact with critical areas on the syringe, not bombarding the place with alcohol, holding things/placing things in a way that blocks airflow.)

At my IPPE hospital rotation site, we didn't have to do a sterile technique test. They just threw me in there and had me started making batches.

 

[owlegrad]

So how much of what you get to do was taught by the preceptor vs the school? I am starting my IPPE hours this week and wondering what I get to do. I don't officially start school until this fall...but legally in my state now that I have my license I can do everything a pharmacist does but the final check as long as I am supervised.

Almost everything I do, I learned on site. School does not teach how to take messages, call doctors, enter orders, etc. We do practice counciling patients though, and sterile technique, although I don't think most people can learn this from one practice setting, it takes time and practice. I think we practiced reconstatuting in our first year, but I am not 100% on that. Anyway my preceptor did on the job training for that either way for sure.

At my IPPE hospital rotation site, we didn't have to do a sterile technique test. They just threw me in there and had me started making batches.

No offense, but that's kinda scary.

 

[joetrisman]

No offense, but that's kinda scary.

Agreed. I've done and passed a sterile technique test before but I was still kinda like "really?!?" when they brought me in there and cut me loose with rxs to fill.

 

[PharMed2016]

The question is in the title. I am just curious what the pharmacists here let their students do. I have noticed a tremendous difference between different pharmacists in terms of what I am permitted to do at work. Some let me do nearly everything, one pharmacist had me waste an amox because he didn't want me to reconstitute, which frankly shocked me. It didn't even occur to me to ask first, I didn't think anyone would mind that much. Lesson learned.



Alternatively, what have the students on here been allowed to do (or been limited to) at varies sites? Either through school or at work. So far I have been allowed to do much more at work than I have through any school experiences, which makes sense to me.

I'm pretty much limited to tech work minus reconstituting, recommending OTC, and counseling. I'm still not allowed to take any calls yet but then again I work predominately weekends, eh.

 

[nrsair]

I'm pretty much limited to tech work minus reconstituting, recommending OTC, and counseling. I'm still not allowed to take any calls yet but then again I work predominately weekends, eh.

That's me except I get to reconstitute when they come in (rarely). I also get to put cream in jars so long as it doesn't involve any compounding. Those are kind of nerve racking the first few times. I get to deliver every once in a while, which is really cool.

 

[Jabberwocky12]

I'm pretty much limited to tech work minus reconstituting, recommending OTC, and counseling. I'm still not allowed to take any calls yet but then again I work predominately weekends, eh.

Wait interns aren't allowed to reconstitute in retail settings?

As a non-certified tech I was allowed to compound basic creams (Hydrocorsitone and a cream or other OTC combos) duac, antibiotics, magic mouthwash, and the like.

Interns, who have 2-4 years of college, can't put water in a powder or 2 creams together?

 

[crazybob]

Wait interns aren't allowed to reconstitute in retail settings?

As a non-certified tech I was allowed to compound basic creams (Hydrocorsitone and a cream or other OTC combos) duac, antibiotics, magic mouthwash, and the like.

Interns, who have 2-4 years of college, can't put water in a powder or 2 creams together?

It usually depends on the preceptor on what he/she will let you do. They're ultimately responsible for what you do, so if they would feel nervous about you doing something, you probably wouldn't be allowed until the preceptor feels comfortable with what you can do.

 

[owlegrad]

Wait interns aren't allowed to reconstitute in retail settings?

As a non-certified tech I was allowed to compound basic creams (Hydrocorsitone and a cream or other OTC combos) duac, antibiotics, magic mouthwash, and the like.

Interns, who have 2-4 years of college, can't put water in a powder or 2 creams together?

We absolutely can do those things, as long as the pharmacist permits it. I think that poster meant to say tech work PLUS blah, blah, blah.


EDIT: In a retail environment we can do anything the pharmacist can do, except final check, under the supervision of the pharmacist. Varies by state. I understand in PA we cannot council, which is just pathetic.

 

[rxlea]

In AZ, interns can do final check. They might let me start checking the refills.

 

[pfaction]

rxlea, you have the best work experience I have EVER come across.

My hospital: Please shut off your brain and fill. No, no IV's. No shadowing IV's. Going on the floors? There's nothing to fill on the floors, so you're going to fill here for 8 hours a day. Learn? HAHAHA. I subsequently quit. 14$ an hour, when retail gives me 13$. They treated me like a paid volunteer, I would have taken minimum wage if I could do what you did. ENVIOUS.

My retail: Awesome, since I work nights. I just browse the drug data base all night after clocking out. I've reconned since 2nd year, some minor OTC within shot of pharmacist, some counseling in shot of pharmacist (even though I was reading off the goddamn label).

 

[PharMed2016]

That's me except I get to reconstitute when they come in (rarely). I also get to put cream in jars so long as it doesn't involve any compounding. Those are kind of nerve racking the first few times. I get to deliver every once in a while, which is really cool.

Looking back, I didn't word it as best as I can. I am allowed to counsel, recommend OTC, and compound. I've done maybe 2 deliveries during my time with the company, lol.

 

[owlegrad]

Looking back, I didn't word it as best as I can. I am allowed to counsel, recommend OTC, and compound. I've done maybe 2 deliveries during my time with the company, lol.

No worries friend, we knew what you meant. 😉

 

[rxlea]

I don't understand why some people can't reconstitute solutions/suspensions. Even the techs do that every place I have ever worked. That just seems weird to me.. It tells you on the bottle what to do!

and pfaction, as far as my work experience, I've just been lucky I guess, but I never take it for granted. I absorb as much as possible and do the best I can to help out the department. I've worked at the hospital long enough and been such a good worker that the pharmacists trust me and they know I have their back. Believe me, I have "done my time" so to speak. I never complain about what they want me to do.. I might bitch/moan to friends or on SDN but at work, I just do what they tell me. In the end, I benefit because they are more than willing to teach. It helps that many of the pharmacists have precepted students in the past. We only stopped taking students last year because of our remodel. As for IPPE, I am INCREDIBLY lucky- especially after I have heard what some of my classmates are doing. I am SO grateful that I could never adequately express it on here.

 

[pfaction]

No. Trust me when I tell you, you're damn f-ing lucky. For a PAID job to get to do all that is amazing! In the IPPE/APPE, it's hit or miss but since you're not being paid they can let you do whatever or nothing. I had a similar experience in my IPPE hospital (and retail, but only one...the other was a CVS where I worked for free) and am going back there this fall. I could be an intern from my 1st year and the hospital I worked at wouldn't give a s-, they'd have me just filling. Funny story, I've been volunteering there since 2004 (10th? grade) and I stopped only because I got hired. And boy I'm glad I got paid to do the same exact things.

Really cool that you get to do what you do though. And yeah, for hospital IPPEs some people left after 3 hours, some people did IV's with sterile water...when I walked in, we went under a sterile hood in the 1st 3 hours, did DUEs, all this amazing stuff. Can't WAIT to go back.

EDIT:

Off topic...How do you join NCPA? I'm on their site, but I don't know what to put for title.

 

[sakigt]

If I has just met a tech I wouldnt let them compound, either. Everyone's experiences are different, so who knows.

As an intern I do everything the techs do. Make IVs, TPNs, reconstitute drugs worth more than my car (you know they trust you when you can do that...lol), make narcotic PCAs, drips, epidurals, fill the Accudose (our Pyxis). Among other things, make calls, find lost meds, etc etc.

 

[Praziquantel86]

Technical work: IVs, compounding, medication delivery.

Intern work: Codes, rounding, verbal orders (with preceptor oversight), Q/A projects, topic presentations, P&T monographs.

Our hospital treated interns like residents. One of the most useful experiences I've ever had...if you can find a place that does this, take the job.

 

[owlegrad]

I don't understand why some people can't reconstitute solutions/suspensions. Even the techs do that every place I have ever worked. That just seems weird to me.. It tells you on the bottle what to do!

I know right?!

Although I have never worked in a retail pharmacy that allows techs to reconstitute - I don't think they are allowed to in FL, but I know they can't at CVS in FL. It actually says that on our pickup workflow guide thingy: "Pharmacist to reconstitute all meds that require it" or something like that. I am pretty sure they are not allowed to, legally. Or else it is a very strict company policy. Florida is very strict about what techs are allowed to do though.

But I can beat that even - I know a pharmacist who does all his own counting because he doesn't trust his techs to count right. I think he may have OCD, he is very particular about stuff. He is a monster at production though, he can crank out scripts like it is going out of style. I like working with him (and not just because it means no counting for me).

 

[rxlea]

I did compounding today at my IPPE- made some capsules, a few oral suspensions that go in the J tube, and a vit k oral solution. I even learned how to use a motorized "mortar"- awesome!

 

[Jabberwocky12]

I know right?!

Although I have never worked in a retail pharmacy that allows techs to reconstitute - I don't think they are allowed to in FL, but I know they can't at CVS in FL. It actually says that on our pickup workflow guide thingy: "Pharmacist to reconstitute all meds that require it" or something like that. I am pretty sure they are not allowed to, legally. Or else it is a very strict company policy. Florida is very strict about what techs are allowed to do though.

What I heard was that CVS had a lawsuit long ago that made it so pharmacists have to do it. However, I think most people let it slide. I think it was like, years ago someone from up front reconstituted something for an infant using isopropyl or something like that and the child died. CVS changed their guidelines after that.

Of course that was what a CVS pharmacy manager told me, I never really followed up to see if that was true or not... I think it's BS because I'm sure most parents/pharmacist would smell that and think something was up.

 

[owlegrad]

What I heard was that CVS had a lawsuit long ago that made it so pharmacists have to do it. However, I think most people let it slide. I think it was like, years ago someone from up front reconstituted something for an infant using isopropyl or something like that and the child died. CVS changed their guidelines after that.

Of course that was what a CVS pharmacy manager told me, I never really followed up to see if that was true or not... I think it's BS because I'm sure most parents/pharmacist would smell that and think something was up.

That is entirely possible, except that I know of no pharmacists who let it slide - they all reconstitute themselves, or have me do it. And all this time I thought I was doing intern work to boot. sigh.

We also have those damn pickup logs, which it is my understanding also stemmed from a lawsuit from years ago.

 

[Tinkerbell22]

EDIT: In a retail environment we can do anything the pharmacist can do, except final check, under the supervision of the pharmacist. Varies by state. I understand in PA we cannot council, which is just pathetic.

I think it is weird that in some states interns can do final check, but not reconstitute or counsel. I have only worked in FL and GA, but it seems like those two states actually have less strict laws. I always thought the only difference between interns and techs are that interns can counsel under supervision and take verbal prescriptions. Could be totally wrong though, and probably missing a few other things.

I know right?!

Although I have never worked in a retail pharmacy that allows techs to reconstitute - I don't think they are allowed to in FL, but I know they can't at CVS in FL. It actually says that on our pickup workflow guide thingy: "Pharmacist to reconstitute all meds that require it" or something like that. I am pretty sure they are not allowed to, legally. Or else it is a very strict company policy. Florida is very strict about what techs are allowed to do though.

I reconstituted as a tech... with a graduated cylinder. lol we didn't have the fancy machines like CVS. beat that. 😛

I never worked at CVS until I was in intern in GA, but I did reconstitute at my IPPE.

Something funny I noticed though... in GA a lot of pharmacists prefer to count CIIs themselves (especially if they work with a lot of floating techs/interns, and I don't blame them), but I met one who just met me and let me count CIIs, but prefered to reconstitute themselves (but I think that was mainly a time-issue since I can be slow at that). lol

 

[IndustryPharmD]

While you interns say "varies by site", I can say "varies by intern".

I had some interns who I let do pretty much everything but the final verification (I wouldn't let another pharmacist verify under my login either, because should they make an error, my license would be on the line! and everyone makes errors, even if very, very rarely). I had some interns who I watched like a hawk all the time they were in a position where they were able to converse with patients because they were saying things so inane it made me genuinely scared for the patients' well-being.

Generally, if I believed they knew what they were doing, I would try to steer them towards answering OTC questions and counseling. And also ring the register, while they were at it. If I felt they were inept, I made them fill and read books and answer my questions - basically, keep them away from real, live patients.

Whether they were good or not, if they had no prior retail experience, I also made sure they knew how it all works in general, but they rarely did much typing simply because they were too slow and knew not nearly enough about insurance issues to be useful in that role.

 

[owlegrad]

I think it is weird that in some states interns can do final check, but not reconstitute or counsel. I have only worked in FL and GA, but it seems like those two states actually have less strict laws. I always thought the only difference between interns and techs are that interns can counsel under supervision and take verbal prescriptions. Could be totally wrong though, and probably missing a few other things.

It is my understanding that in some states techs can take messages or doctor calls, but not in FL. I also thought they couldn't reconstatite, but I was wrong about that, it is just a CVS thing apparently. That was what I meant by strict laws for techs. I agree that at least in FL the laws for inters are very lax - our licences do not expire while we are in school, we can do almost everything, etc. It's a sweet state for interns.

 

[Tinkerbell22]

It is my understanding that in some states techs can take messages or doctor calls, but not in FL. I also thought they couldn't reconstatite, but I was wrong about that, it is just a CVS thing apparently. That was what I meant by strict laws for techs. I agree that at least in FL the laws for inters are very lax - our licences do not expire while we are in school, we can do almost everything, etc. It's a sweet state for interns.

I guess that's what I meant (less strict for interns)... I don't really know too much about other state laws for techs... that is weird that some can take verbal prescriptions... but then again it's probably better for an experienced tech who knows drugs/dosages/sigs than a new intern who has never worked in a pharmacy before they started IPPE.

Our licenses don't expire for 5 years here either... but I never filled out my application for Florida because it's like 14 pages long versus 1-2. lol I am praying I don't have to go home next summer to get the rest of my hours. 🙁

 

[owlegrad]

I guess that's what I meant (less strict for interns)... I don't really know too much about other state laws for techs... that is weird that some can take verbal prescriptions... but then again it's probably better for an experienced tech who knows drugs/dosages/sigs than a new intern who has never worked in a pharmacy before they started IPPE.

Our licenses don't expire for 5 years here either... but I never filled out my application for Florida because it's like 14 pages long versus 1-2. lol I am praying I don't have to go home next summer to get the rest of my hours. 🙁

That must be the out of state version or something. Mine was one page.

Or maybe my school took care of the first 13 pages and I just had to sign the last page? Who can remember, that was years ago. 😉 I feel weird saying that.

EDIT: No charge though, right? I always thought that was cool.

 

[rxlea]

The only thing I hate about taking verbal orders is when they spill it out so fast that I can barely understand what they are saying- especially if they have an accent. Then they get mad if I ask them to repeat the sig.

But, whenever I call to "clarify" a script where they made an error, they are extremely grateful. I have had some apologize.

 

[owlegrad]

While you interns say "varies by site", I can say "varies by intern".

I had some interns who I let do pretty much everything but the final verification (I wouldn't let another pharmacist verify under my login either, because should they make an error, my license would be on the line! and everyone makes errors, even if very, very rarely). I had some interns who I watched like a hawk all the time they were in a position where they were able to converse with patients because they were saying things so inane it made me genuinely scared for the patients' well-being.

Generally, if I believed they knew what they were doing, I would try to steer them towards answering OTC questions and counseling. And also ring the register, while they were at it. If I felt they were inept, I made them fill and read books and answer my questions - basically, keep them away from real, live patients.

Whether they were good or not, if they had no prior retail experience, I also made sure they knew how it all works in general, but they rarely did much typing simply because they were too slow and knew not nearly enough about insurance issues to be useful in that role.

I like that.

Counciling and OTC recommendations still scare me. Everything else I do is checked by the pharmacist, so I can be confident that no harm will come to a patient (of course I try not to make mistakes at all) but my pharmacists don't normally double check my recommendations so I basically don't make them. It is by far my weakest area for sure. I just get really nervous about saying something wrong, so I usually refer all questions to the pharmacist. I have gotten better though.

I agree, it takes a lot of time to become proficient at typing. Besides resolving ins issues, it just takes skill/practice to be good at typing quickly and accurately. And it sets the tone for the whole workflow - if your dropoff is struggling, you can bet the rest of the pharmacy is going to start feeling the effects. Not to mention if you don't select the right NDC at dropoff, that's more work at production to change NDC's. And if you make mistakes typing that is more work for the pharmacist to either send it back or correct it, holding up workflow even more. I think you learn the most at dropoff though because you have to check every aspect of every prescription.

The only thing I hate about taking verbal orders is when they spill it out so fast that I can barely understand what they are saying- especially if they have an accent. Then they get mad if I ask them to repeat the sig.

But, whenever I call to "clarify" a script where they made an error, they are extremely grateful. I have had some apologize.

Haha, I agree. I don't mind so much if they are on the phone because I have gotten used to just reading back all prescriptions after receiving them, although at first I felt a little dorky doing it. I have caught myself though so now I just do it automatically no matter how simple the rx is. "That's John Smith, DOB 1/1/70, ZPAK, dispense #1, UAD, no refills, from Dr. Cox? OK Thanks."

But taking messages is just the pits. It's like their goal is to not take a single breath during the message.
I have gotten better, but I still press 1 to repeat several times during the message.

And I agree about them being thankful as well. I haven't had too many negative experiences calling for clarification in my limited experience. Most are pretty gracious about it. 👍

 

[Tinkerbell22]

That must be the out of state version or something. Mine was one page.

Or maybe my school took care of the first 13 pages and I just had to sign the last page? Who can remember, that was years ago. 😉 I feel weird saying that.

EDIT: No charge though, right? I always thought that was cool.

It was the only version they had up... I'm still a Florida resident. lol

They have this health history form that takes up a couple of pages... why they gotta be so nosy?

 

[rxlea]

Today, a MA calls in Risperdal 0.5mg "1 PO PRN" on a 76 y/o pt with alzheimers.. I called back and said we needed some sort of schedule and asked if they were using it for agitation. Patient had never been on it before... The MA was very confused. Talked to the doc. He changed it to ativan... Not covered by medicare. Sometimes you can't win 🙄

 

[IndustryPharmD]

Counciling and OTC recommendations still scare me.

Well, in New Jersey there is no such thing as a pharmacy intern, so the only interns I have directly supervised are those who are on rotations. And if you are on rotations and you are afraid of counseling - that really, really bad. Because you should have already learned everything science and therapeutics-wise you need to know to independently function, and in a few short months you WILL BE the pharmacist.

I went to school in Nebraska, where interns can counsel from the first day of pharmacy school (and I went to school before the pharmacy act was amended, so back in my days pharmacy students were considered credentialed for many different purposes, talk about added pressure! it was changed just as I was graduating, if I remember correctly). And my boss was an older pharmacist, so when he saw that I only talked about things I KNEW, and asked about anything I did not know, he let me loose. So I had all the endless cough-and-cold and allergy questions from the second half of my first year of pharmacy school. 🙂

I think you learn the most at dropoff though because you have to check every aspect of every prescription.

I disagree about the learning aspect. You learn only how prescriptions usually look, and what brand/generic equivalents are. You don't really apply any clinical or scientific knowledge at that point, and hardly use analytical skills. Essentially, you are a high-functioning image recognition software. 😀

Though when I was in school, silly me also wanted to type rather than be at the drive through. Now I would rather talk to patients than type and verify. 😀

 

[owlegrad]

Well, in New Jersey there is no such thing as a pharmacy intern, so the only interns I have directly supervised are those who are on rotations. And if you are on rotations and you are afraid of counseling - that really, really bad. Because you should have already learned everything science and therapeutics-wise you need to know to independently function, and in a few short months you WILL BE the pharmacist.

You didn't think it was scary to council at first? Learning science and therapeutics is different from knowing how to communicate with patients. I think I just need more practice doing it. Experience and all that, ya'know? I can't imagine not being nervous your first time or until you have plenty of experience doing it. 😉

I disagree about the learning aspect. You learn only how prescriptions usually look, and what brand/generic equivalents are. You don't really apply any clinical or scientific knowledge at that point, and hardly use analytical skills. Essentially, you are a high-functioning image recognition software. 😀

Though when I was in school, silly me also wanted to type rather than be at the drive through. Now I would rather talk to patients than type and verify.

I am going to go ahead and disagree. You learn normal doses and schedules, dosage forms, brand/generic, and you pick up various miscellaneous odds and ends, like how long prescriptions are valid for and such. Plus some stuff that is not really helpful for school, like which medications are ridiculously expensive.

You can also use some clinical judgment while typing. For example, if you get a prescription for a child you can ask for their wieght and double check the dosage for them. Or if something just seems wrong (dose, schedule, whatever) you can check it out. I think I use quite a bit more knowledge at drop off than say production. You have to evaluate every part of the prescription because you are typing it in. In fact, except for counseling, I can't think of where I would use more knowledge than drop off?

I see your point about drive through, but I rarely have a meaningful conversation with anyone in the drive through window. They specifically want to get their meds and go, in my experience at least. I do like that you can talk to people a little more at pickup than the other stations (although you can also talk to people at drop off as well), but usually people just want to purchase their meds and go. Pickup (and especially drive through) is really just running a register most of the time, for me at least.

Can't speak to verifying of course - I still have a ways to go before I get to that one. 😎

These are just my thoughts on the matter though, don't mean to imply that they are the absolute truth or anything. 😀

 

[pfaction]

I have yet to meet someone that isn't afraid of counseling. You will most likely always leave something out you wish you had told the patient. Or you can be the bold one that steps up, counsels, and says something incorrect.

 

[Sparda29]

Today, a MA calls in Risperdal 0.5mg "1 PO PRN" on a 76 y/o pt with alzheimers.. I called back and said we needed some sort of schedule and asked if they were using it for agitation. Patient had never been on it before... The MA was very confused. Talked to the doc. He changed it to ativan... Not covered by medicare. Sometimes you can't win 🙄

Should be bypassable to Medicaid if they have it. Aren't most benzos dirt cheap anyway?

 

[IndustryPharmD]

You didn't think it was scary to council at first? Learning science and therapeutics is different from knowing how to communicate with patients. I think I just need more practice doing it. Experience and all that, ya'know? I can't imagine not being nervous your first time or until you have plenty of experience doing it. 😉

Telling people where to go and what to do is in my blood. 😀 No, I have never been nervous about counseling. If I know something - I KNOW something, so why be nervous. And if I don't know something - I say so, and offer to look it up (when I was an intern, asking the pharmacist was also on the list).

Perhaps it helped that long before I first set foot behind the pharmacy counter, my first job was working in a call center for then-nascent cell phone industry. Walking someone through brand-new technology over the phone beats any kind of face-to-face medication counseling in terms of difficulty.

I am going to go ahead and disagree. You learn normal doses and schedules, dosage forms, brand/generic, and you pick up various miscellaneous odds and ends, like how long prescriptions are valid for and such. Plus some stuff that is not really helpful for school, like which medications are ridiculously expensive.

Now, I would be scared of a pharmacist whose idea of what "normal" doses and dosage schedules are comes from what physicians write. Sure, it works sometimes - but not nearly always. Some drugs are particularly prone to weird errors. I am not saying it's useless, I am just saying that it won't let you learn as much as counseling will (by the way, while counseling, dosing IS one of the most frequently asked questions, and that includes not just "three times a day" but also things like "with food", "avoid dairy products within a couple hours of taking this drug", etc.)

Every function in the pharmacy has some learning value. That's why I always urged students to work during school. Even one shift - that's just 8 hours out of 168 hour week - will make a difference in terms of learning but won't take that much time out of one's life. Besides, it helps when you are used to working weekends before you HAVE TO work weekends.

My (non-pharmacist) colleagues are often surprised that I still work in a pharmacy every other Saturday. But I explain that since the age of 9, I have always had either school or work on Saturdays, so for me having every other Saturday OFF is already an improvement.