Keep Out of the Reach of Children

 

I have found that one of the things I do while it’s not too busy at work take note of how parents handle their children’s antics. Not to pick on them or snicker. Just out of curiosity, since every parent handles it differently. But, today, I couldn’t help but shake my head and chuckle.

Meet the “parent of the year”…

The mother had just picked up her albuterol inhaler right after we opened. Later on, we get a phone call from her asking for a refill. We ask why she needs it refilled again on the same day. Her answer is as follows:

“Well, I let my son play with it because his squirt gun broke. Now, it’s all gone.”

It was so difficult to keep a calm, serious sounding demeanor because I wanted to laugh so hard. I have never heard something so ridiculous. She then asked if we could get an override from the insurance for a new one. Her insurance didn’t allow for lost/spilled medication overrides, so we offered her an in-store discount. Even so, the price was still $30, which she couldn’t afford. She said she’d get it filled again when she had the money.

After the phone call ended, I burst out laughing. Why on earth would you willingly allow your child to play with your medication?? Not only will that leave you without medication, but more importantly that could be dangerous to your child! It’s just an all around bad situation, which should have never happened.

*shakes head*

Moral of the story — There is a reason all medications say keep out of the reach of children on them.

 

Image courtesy of http://i29.photobucket.com/albums/c267/Drennon1/inhaler.png

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Change

 

So, I feel all better! Hooray! I worked yesterday, but it was a repeat of Saturday, so I didn’t even bother posting. Today was like a whole new world, though, and food has never tasted better. =) So, back to the normal entries!

I feel the picture up above is a great description of many types of drug regimens. You start at one point, and you may continue along that line for the entire time you’re on it. But, at any given time, the prescriber may decide the dosage should be changed or something should be added/subtracted. This can leave patients confused about what to take and when. This, in turn, leads to all kinds of issues.

Lately, I’ve been coming across a lot of the same general problem. People come into the pharmacy and want to fill Drug X. We attempt to fill it, and it is WAY too early, so the insurance rejects it. Now, I’m not talking 4 or 5 days early. I mean 14-20 days too early. I tell the patient this, and the most common reply, as of late, has been, “Well, the doctor told me to double it, so I’ve been taking two pills instead of one.” This situation has also applied to diabetes testing supplies a lot lately too. I try to explain that without a new prescription with the new directions, there is nothing I can do to get the insurance to cover it, but people tend to either get upset or confused. So, allow me to lay out the scenario here in short story format, and then I’ll explain where things went awry.

*****
The character below is purely fictional. Any resemblances or similarities are purely coincidental.
*****

Bertha Jones comes to the pharmacy with a prescription for Accu-Touch Lite blood glucose meter and supplies (notice my play on common brand names there ^_~). Her endocrinologist wrote on her prescriptions that she uses her supplies to check her blood sugar twice a day, since she is a newly diagnosed diabetic. Bertha’s insurance covers everything for a 30 day supply, and she gets the meter for free. Bertha is a happy patient and goes home to start using everything that night.

About a week after her first refill, she goes for a follow-up visit with her endocrinologist. Her blood tests and other such things haven’t improved. In fact, they’ve worsened a little bit. The physician wants her to start testing her blood sugar more often. He tells her to test herself 4 times a day until her next appointment. She sighs, but understands the importance and starts following the physician’s orders. Ten days later, she’s down to only two test strips. “Oh no!” she thinks to herself, and she rushes off to the pharmacy. She tells them what she needs refilled and says she wants to wait. She just takes a seat, only to be called back to the drop off window. The person there tells her the insurance won’t pay for the supplies for another week.

“But, I’m almost out!” she tells them. “I only have two strips left!”

The person at the window tells her she just filled them a little over two weeks ago, and that she should have more than enough at home. She insists that she doesn’t because her endocrinologist told her to start using them 4 times a day, instead of 2. She is told that she needs a new prescription stating this or the insurance won’t cover it. “But, why?” she wonders. “My doctor told me I could. Isn’t that enough for the insurance?” She tries to explain herself more to the person, but they keep telling her she needs a new script. She gets frustrated and leaves. “I’ll just have to wait a week, I guess.” She uses her last two test strips and decides to return to the pharmacy once the insurance will pay for it. She never calls her physician, and the pharmacy never receives a new prescription. This pattern repeats itself until she is out of refills and is forced to get a new script.

*****

So, where did things go wrong? Ms. Jones was on track with her first refill. What happened? Well, her physician made a significant change to her testing regimen. He doubled the frequency. The good news is that she understood it and followed his directions. The bad news is that no one else involved in Bertha’s health care knows this. The one and only way both pharmacies and insurance companies know when something has changed is by having a prescription alerting them of the change. Otherwise, both assume all is the same. So, when Bertha ran out of the test strips, she couldn’t get a refill. Why? Because only her and the physician know something has changed. To the pharmacy and the insurance company, it appears that Ms. Jones is only using her supplies twice a day, even though that’s not the case. So, Bertha cannot get her refills based on the original script.

So, then is it Bertha’s fault that the pharmacy was unaware? No, not really. The physician should be well aware that any changes in therapy have to be documented and sent over to the pharmacy. But, some physicians forget or their office staff doesn’t get around to it or things get lost in translation or a bunch of other things arise that may have prevented this. Whatever the reason, though, there are many times that physicians increase the frequencies of therapies and don’t notify the pharmacy. This leads to much frustration on the patient’s part, unfortunately.

So, how can this situation be avoided? It’s simple. Anytime something changes with your prescriptions, whether it be for diabetes supplies, like in the above example, or for other maintenance medications, TELL YOUR PHARMACY. Actually, the best thing to do is to ask the physician before you leave the office for a prescription for the changed prescription. But, even if you don’t, by telling your pharmacy, they can call the physician’s office if it doesn’t show up. Now, in the ideal world of retail pharmacy, this would be done on the day you have your appointment, and the pharmacist will call you to let you know when it has arrived. In the real world of retail pharmacy, this doesn’t happen and never will due to high volume. It’s not that we don’t want to; it’s that we don’t have the time to do this for everyone every single day. So, as a huge favor to your pharmacy staff, try to remember to give us a call the day after your appointment to ask about the new prescription. By then, the physician will have had ample time to send it over, and the pharmacist will be sure to call on it if it’s not there. A really good pharmacist will remember your name and call you back when the prescription has been filled. (*coughcough* ^_^) All self-praising aside, I do try to do this if I personally speak with the patient, since it’s how I would want my own family treated. I don’t typically answer those calls that much (my techs do), and a phone call takes all of a minute.

So, yeah, that’s my blurb for today. Long-winded, I know, but I think I made my point clear. I think. Let me know if it seems choppy or confusing. =) Toodles!

 

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Stomach Flu

 

Having to work and having the stomach flu is not fun. AT ALL. Ugh… I feel awful, and I probably looked green or pale all day. I wonder if any of my patients noticed. I tried to put on my best face during my shift. All I could think of was how good it would feel to crawl into bed. But, the pharmacy must go on! The whole day was so blurred together for me, though, that I really can’t focus enough to write anything tonight. I still feel gross. Pepto and Gatorade are my friends for right now. So, I hope you all accept my apology for such a disappointing entry today. Hopefully, I’ll be back at 100% tomorrow.

 

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A Breath of Fresh Air

 

Today, I have a lovely story to share. It warmed my heart and made my day. ^_^

Around lunch time, I received a call from a physician’s office inquiring about an elderly woman’s most recent fill date for a rescue inhaler. Looking at her profile, I noticed it was filled less than a week ago. The nurse I was speaking with told me the woman stated that her inhalers are always defective when she gets them filled. I remember a month or so ago the patient had contacted the manufacturer about it, and they sent a replacement to our pharmacy to give to her. I told the nurse to have the woman come to the pharmacy, and I would be able to determine if the defect was real or if this was simply a case of the patient not knowing the correct administration technique. The nurse thanked me and hung up.

A few hours later, the patient stopped by. Now, I love my elderly patients, especially the little, old ladies. They are full of stories and generally appreciate the pharmacy staff’s help. I tend to go out of my way to help them, since they seem to put the most blind faith in us. The woman handed me her inhaler. I pushed the canister down, but nothing came out. I told the woman I would be right back. I went over to our sink and gently cleaned out the mouthpiece with a paper towel and warm water. Putting it back together, I found that a good clean was all it needed. I returned it to the lady, who used a puff right then and there as a test. I gave her a few tips on inhaler technique and the proper way to clean it. She looked at me with a very serious face, waved her index finger, and said, “Come here for a minute.” Thinking she was going to ask me something else about the inhaler, I was happily surprised by the big hug I received from her with a whispered, “Thank you,” in my ear. She said I relieved her fear of not being able to breathe. She told me I would be her go-to person for help from now on. It’s amazing how one small action can mean the world to some people.

^_^

It is days like these that make everything worth it. I am proud to be a pharmacist, and I love my job.

 

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Facepalm

 

Today I came across a huge “no-no” at the pharmacy. The worst part about the whole situation was the fact that I couldn’t get the patient to understand why it was so bad.

A woman came in to fill some lancets, insulin, and syringes. Noticing we had no diabetes medications or supplies in her profile at all, I asked her if she need a script for test strips as well, offering to call the doctor if she did. She said she didn’t because she wasn’t out of them yet. I started inputting the scripts to give her a price on them after her insurance was billed.

It was relatively inexpensive (less than $10 each), considering the price of the insulin without insurance. When I gave her the total, she groaned, telling me money was so tight that even that was a lot. I felt bad. I hate that the economy makes people choose between prescriptions and other necessities. She decided to only get the insulin and syringes. I apologized for the price. Up to this point, this was a normal interaction tinged with sadness. That’s when these words were spoken:

“It’s ok. I’ll just keep using the lancet that’s in the poker right now.”

I warned her this wasn’t a smart idea because she could cause herself an unwanted infection. She shrugged her shoulders and told me she’s been doing it for years. She also told me she reuses her syringes multiple times until the needle tip gets bent. In my head, all I could think was, “ARGH!!” Again, I told her this was bad news bears, emphasizing how important using a clean needle every time was. She laughed, saying, “Honey, it hasn’t killed me yet, and it’s not going to any time soon.” I wanted to bang my head on the wall.

So after that, I filled her prescriptions. When I started ringing her out, I reminded her that she should discard her insulin vial once it’s been opened for 28 days. She laughed again and told me she liked to try to stretch it as far as it can go. I told her that it wouldn’t be as effective, and her blood sugar readings may be more uncontrollable after that point. She smiled, winked, and replied, “I’ll think about.” That’s when she left.

Reflecting on this, I’m still shaking my head. Reusing things that pierce your skin is a HUGE “no-no”. You put yourself at risk for infections. I have heard of many people using lancets over and over, including a family member of mine. This is not unusual, even though it’s bad. But reusing syringes?? That’s just awful and, in my opinion, gross. I shudder thinking about it. It’s a step below sharing needles.

Readers, I know times are tough and money is tight, but please don’t reuse anything that pierces your skin. It’s not worth the potential complications it can cause. Syringes aren’t too expensive out of pocket, and every insurance I’ve ever billed covers them for diabetics. Don’t risk a massive skin infection or worse in the name of penny pinching. It may cost you much, much more.

 

Image courtesy of http://i631.photobucket.com/albums/uu32/Solar_Scorcher/111.jpg

Stuttering

 

Today, I ran into a very interesting, unusual situation. I had someone come to the pharmacy with a speech disorder that makes him stutter very badly. I have dealt with language barriers in the past, but this one was new to me today.

He had come in for a new medication that he had never taken before. At the pharmacy I work in, our computer system flags prescriptions that have never been filled for the patient. It then prompts the person ringing register to bring over the pharmacist so he/she can discuss side effects and such with the patient. It’s a pretty good system and one I feel is important. Anyway, it flagged me to talk to him about a blood pressure medication. I went over and started my spiel. After I finished, I asked him what questions he had. That’s when I realized he was a stutterer.

For whatever reason, this doesn’t bother me. Not at all. I have all the patience in the world for people who stutter. Maybe it’s because I tend to fill most of my sentences with, “Um,” and backtrack my statements when I’m in the middle of them. It’s not stuttering, but I’m sure it’s annoying. But, I digress. Whatever the reasoning, stuttering doesn’t bother me. He was very appreciative of this. After we talked about the medication, he told me about a visit he had to another pharmacy in another state. He told me the pharmacy staff was rude and didn’t let him talk or explain himself. He thanked me and told me he would definitely come back to our pharmacy again. Sure, the conversation took five minutes when it should have taken two, but it was important, and I made a connection with another patient. It’s things like this that make me proud to be a pharmacist and make it all worth it. =)

The one thing that really aggravated me, though, was the looks he got from the other patients in the pharmacy. As he was talking to me, everybody else stared at him with disapproving expressions. I even saw a person snicker and hide a chuckle. How horribly rude some people can be! He can’t help stuttering. It’s not like he chose to have a speech impediment. Have some compassion and respect!

Anywho, that’s it for today. Sorry about the massive entry upload. I backdated the ones from over the weekend because I was exceedingly busy and didn’t get time to upload them. They were written; they just needed to be pasted to here (and a nifty picture needed to be added). I hope everyone is well!

 

Image courtesy of http://i522.photobucket.com/albums/w345/andreaperez_photo/stutter.jpg

Pain

Image

 

Today was a bit busier than yesterday. We had quite the Sunday rush, and the front store was short a person thanks to the stomach bug that’s been going around. So, all in all, I guess I got what I was wishing for yesterday, haha.

The major theme I came across today was people’s reactions to pain. It amazes me how different people are when they’re in pain vs. when they’re not. They are almost a completely different person. I personally know a few people who suffer from chronic pain, so I have known about this phenomenon for a long time. But still, the reactions I see in the pharmacy sometimes surprise me because they’re so over-the-top.

There was one woman who came in today. She had just had major abdominal surgery done and was in a great deal of pain. She brings in a script for a narcotic pain medication. When it was run through her insurance, I received a rejection message stating it was too soon to be filled until the following day. I told her this, and she asked if she could just pay cash for it. I refused because of what the medication was. Had it been a non-controlled maintenance medication, then I would have let her pay out of pocket without any problems. But, seeing that it belonged to the most controlled class of medications, I politely told her no.

She immediately started screaming about how much pain she was in and that the doctor told her she could get it filled early because the directions were changed. Because she had gotten it at another pharmacy the previous time, I could not verify this without calling them, and they were closed. I told her if she got a hold of her doctor personally, and he authorized the fill over the phone to me, I would fill it, otherwise, my answer remained the same. She banged her fists on the counter and continued yelling. She couldn’t understand why it was her responsibility to call the doctor and not ours. At our pharmacy, when a person insists a narcotic is allowed to be filled early, the pharmacy personnel do not call on it. We have quite a number of people that have had past issues with prescription drug abuse, so we choose not to cater to them for safety issues.

To make this long story short, the physician did end up calling me and verifying that it was, indeed, allowed to be filled early. He stated that he gave her a very limited amount of pills for this very reason. I filled them for her, wanting to just get her out because her carrying on was making some of the other patients in the waiting area nervous. I went to the register to start ringing her out. That’s when it happened–the words, “I’m sorry,” escaped from her mouth. It’s very rare that we hear apologies from the people that have two year old inspired tantrums over their medications. I was shocked. She apologized for her behavior; she was just in a lot of pain. After some more apologizing, she left.

Other similar things happened today, all of which were due to the patient being in pain. But, that was probably the best story of the day.

 

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