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That's probably why they pay you that much money.
Why do people care so much about politics?
Started by BMBiology
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I have experienced this personally so, no you're wrong.
The techs at my full time job are exceptional. Every time a pharmacist moves on they lament the transition.
So I can definitely see that not all workplaces are ready for tech check tech.
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I like TCT, frees up my time to do other things. We have a competent tech staff and a lot of barcoding (every time the drug moves...from arrival, to storage, queue for dispensing, at the dispensing cabinet, and at bedside) + we audit like 5-10%.
I can see how a place with crappy training and high turnover wouldn't be a good candidate for TCT.
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I can see how a place with crappy training and high turnover wouldn't be a good candidate for TCT.
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I hope it never becomes the standard because, like you, I get paid very well to check Pyxis fills at my per diem job. I took that job because it was basically no stress. Check Pyxis, do a few kinetic consults, make a few IV bags. No responding to codes or dealing with rounds.
Anyway, I can see TCT taking a huge burden off of central pharmacists. It's just that once you take that workload off of them, maybe you can't justify as many FTEs. Call my cynical, but I can picture an environment where you have the absolute minimum amount of staffing present to meet your tech ratio, which many states allow hospitals to send requests to expand, then a budget cut removes your "luxury" clinical pharmacists. That's a lot of people out of a job.
If the tech misses something on the final check are you liable? I'm not sure I would be comfortable with this, same thing with techs mixing IVs. It's not that I don't believe that techs are capable, because they are, it's just the fact that I'm potentially liable for something that is literally out of my control. How does that make any sense? How am I supposed to know if the IV has 100g or 1000mg of drug in it? It's going to look the same lol.
Yeah in school they say that TCT is so great because it allows pharmacists to do more important clinical stuff. The problem is that since they can't bill for these services (at least at a fair rate) it could ultimately end up in a reduction of total pharmacist hours. Of course they will argue that even when pharmacists aren't billing they are still saving costs by reducing re-admittance but I'm not totally buying it... someone making 6 figures who brings in 0 revenue has to be at the top of the list of cuts.
Programs like DoseEdge take a bit of the pressure off here. You still can never know 100% what happened in the IV room, but it at least shows you photos of each step taking and the volume added of each component. My contact at Epic tells me they are trying to develop this feature in an upcoming release, so hopefully the functionally becomes far more widespread.
That's what I hate about academia. They have a nasty habit of devaluing and discarding the traditional duties of the pharmacist in favor of the idealized clinical pharmacist. It's like they are trying to drive 90% of students into <10% of the available jobs. It's really putting the cart before the horse.
Some schools are so "bleeding heart" liberal that if you bring up potential issues such as this one (e.g., new policies like TCT resulting in reduced demand for pharmacists and therefore a worsened job market), the professors admonish you for "not putting the patients first," as if to say that you didn't go into pharmacy for the right reasons if you're not prepared to self-sacrifice the existence of your own career.....
Pretty true. I don't even bother talking in class but just mentioning the fact that I'm considering working retail when I graduate to my facility adviser didn't really go over that great...
We don't do this for IV's, and I'm comfortable with trusting my techs if I'm given the vials after and if our internal processes are adhered to.
Anyway, TCT, no one signs the product, there is no pharmacist to blame per se. Someone signs an audit log. If there's an error, it's reported internally and covered under 1157 evidence protection and not subject to discovery by opposing counsel.
The hospital would retain ultimate liability for process failure, and possibly the PIC would be on the hook, but given the population we're serving, it's unlikely a single dose on a PO product would end up killing someone...or could be teased out post-mortem.
Also-bedside barcoding shifts liability to nursing, if they bypass the scan of a drug that was improperly filled and dispensed, I feel liability would fall there.
But again, 1157 applies in CA. Don't forget the $250k MICRA limit will keep most lawyers from taking on these cases.
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I don't care about lawyers, I just care about the state board lol. I don't know about 1157 but I live in a state quite unlike California, in either case if the error if attributed to the process/workflow as opposed to the individual then I guess it's not a big deal for the pharmacist.
What I meant was that with IVs the integrity of the product is somewhat out of the pharmacists control seeing as they are just looking at vials; there is an element of trust. I wasn't implying that techs do product verification on IVs but just comparing the inability of the pharmacist to dispense the product with 100% confidence.
I basically learned the hard way to not talk in class. Many (all?) of my classmates are delusional. Several of them told me to my face that even if the job market sucks (or sucks even worse) when we graduate in several more years, they're just going to create their own jobs by being great pharmacists. I tell them, "But what if a store only employs 3 pharmacists as a matter of corporate policy, so that 'creating your own position' isn't really a possibility," and they tell me I have a bad attitude, I went to pharmacy school for the wrong reasons, maybe I should do something else entirely, etc. (yes, similar to my experiences posting here on SDN, conversations with my classmates often end with the other person telling me to do something else entirely -- but for different reasons).
TCT is not just hospital, they are looking at it for retail and mail.
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Eh, social policies are more the issue. Certain policies would have irreparably altered my life were they not in place, so they kind of matter. And then there's my friends, family, and those I care about whose lives could get messy under certain right-leaning policies.
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Do you know what kinds of efforts are being made to implement TCT in retail pharmacy? Just wondering what's on the horizon for the future
The whole point of TCT is to save pharmacist hours. Since many (most?) retail pharmacies only have one pharmacist on duty in the first place TCT would be completely pointless.
This is from the CA BOP (some document I found when they were amending something, not important):
I don't get why the peanut gallery here is so worked up over TCT, it's worked fantastically for us since 2007. Us pharmacists have a bigger impact for more patients on the floors of the units (aka using our education) than mindlessly making sure tablet A is really tablet A...I don't see why chasing after a job function that's easily replaceable by machines and technicians is a good idea.
Besides, technicians and machines do it better.
Don't get me wrong, I enjoy a little mindless product checking every now and then....if anything, to remind me where I came from. But if you went into this thinking that was the end all, be all of pharmacy....well that sucks, the dust bin is over there.
It's like having airline pilot loading the luggage before a flight... I guess he/she can do it, but I'd rather they spend the time reviewing the flight path and weather patterns before we take off.
I don't get why the peanut gallery here is so worked up over TCT, it's worked fantastically for us since 2007. Us pharmacists have a bigger impact for more patients on the floors of the units (aka using our education) than mindlessly making sure tablet A is really tablet A...I don't see why chasing after a job function that's easily replaceable by machines and technicians is a good idea.
Besides, technicians and machines do it better.
Don't get me wrong, I enjoy a little mindless product checking every now and then....if anything, to remind me where I came from. But if you went into this thinking that was the end all, be all of pharmacy....well that sucks, the dust bin is over there.
It's like having airline pilot loading the luggage before a flight... I guess he/she can do it, but I'd rather they spend the time reviewing the flight path and weather patterns before we take off.
There's always the element of trust involved, short of you shadowing the technician (why even bother at that point, just do it yourself?) It's all about risk mitigation then...you have to be able to trace their task from start to finish and be able to ensure, short of outright fraud/intentional obfuscation, that your technician did in fact make Product C from Pieces A & B in the correct amount.
For EXTREMELY high risk situations, I will personally set up the technician with guide them through it (non-standard dosing type stuff, high risk electrolytes like using NaCl 23.4% 30 mL vial to compound something in a NICU pt). For lower risk stuff, if you draw 3 gm of mag out of a 10 gm vial and I swirl the vial around and go "yeah eh, looks like there's 70% left" then my confidence goes to 99% that you did it right and I sign off/go on with my life. If you took a 40 meq KCl vial and divvied it up into 4 x 1L NS bags...I'm going to have to trust that you actually punctured into 4 bags and not just dumped everything into bag 1.
Maybe I'll look at the port and see if there's a puncture mark, but I'll look at your notes and sign off/move on with life. If in fact there was an error and you did just dump 40 meq into one bag and the other 3 are blank...seeing as the rate was 125 ml/hr, the worst case scenario is your patient gets 40 meq over the first 8 hours and nothing over the next 24 hours...no one is gonna die.
Okay lemme wrap this up (tl;dr).... trust involved, but you weigh risks (worst case scenario), review the situation (is the compounding area messy as hell, can you not follow the steps, and is there a chance of mix up going on?) and make a decision as to when a product is worthy of your signature, because realistically you can't shadow your technician every single second of the day.
I think the reason people are worried about TCT is because, outside of CA, there aren't many clinical pharmacy positions at all. Here in GA, the vast majority of hospital jobs for pharmacists involve doing standard pharmacist work because the clinical positions just don't exist. In other words, I was told by a local hospital network DOP that at least 90%-93% of their pharmacist positions are "staff pharmacist" (not clinical) positions, so if TCT was implemented here, that means that 9 out of 10 pharmacists could be at risk for losing their jobs since they could be replaced by a TCT system. So I guess the point I'm trying to make is that a job market for clinical pharmacy actually needs to be established in order for most pharmacists to have an opportunity to use their education to the extent you're talking about.
I tend to keep my views to myself in public, but I do strongly care about politics. Things like the ACA, tax rates, student loan repayment reforms and other such pieces of legislation would strongly impact me. I also do care about American foreign policy and domestic issues.
I mean...do these "staff pharmacists" verify orders? Do they call prescribers if there's a mistake or if something can be optimized? That's a clinical pharmacist through and through.
Someone has to sign off on the order, not just the product.
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I don't know what everyone else said above because I didn't read them. But I care about politics because these things called nuclear weapons exist and they could wipe us all off the face of the planet. North Korea is a few years away from reaching Seattle with a nuclear weapon. So yeah, I consider politics pretty important.
Also, taxes, regulations, business climate, social advancement, freedom of speech and expression, quality of healthcare, gun ownership, stock market stability, interest rates are important to me.
If you sum it all up, everything about life is dictated by politics.
I'm curious to how the OP benefited from the economy crash in 2008 and the ACA? Did you actually profit from these things and please give details because I'm looking for ways to hedge against future disasters.
YOU GOTTA KNOW THE RULES IF YOU'RE GONNA PLAY THE GAME
Lol I had exact same experience with my classmates. I see some wearing " provider status" t shirt, I go like
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. Some have joined multiple organization in dream of gaining residency to be clinical pharmacist.Lol I had exact same experience with my classmates. I see some wearing " provider status" t shirt, I go like
LOL, it's the same way with the students in my class, especially the young ones (very idealistic). Also, I'm seeing the same thing regarding students joining lots of clubs, organizations, etc. so they can pad their future residency applications. Whenever I talk to them after class and tell them that I'm probably going to have too much debt to pay back to be able to afford to do residency and then make $80k as a clinical pharmacist (as compared to $120k-$130k as a retail pharmacist), they talk down to me and give me the "are you sure you should be here?" talk.
I was watching an active hostage situation apparently caused by a mental health crisis and it reminded me of why we should care about politics/each other. "Personal accountability" and taking care of ones own mental health is something we should strive for, but when your family member is on the other side of a gun from a deranged person do you really give a **** that $5 even $10 of your taxes could have gone to free clinics?
