Transfers

 

Today, I dealt with several transfers from other pharmacies. There were more than most days, and the common factor seemed to be confusion as to why it would take longer than 15 minutes to fill their prescriptions. Try as I may to explain why, there were just some people who didn’t understand and, therefore, were annoyed and irritated. So, here’s a step-by-step list of what has to happen in order to transfer refills from one pharmacy to another. This list does not include transferring within a chain (ex. transferring a prescription from one Walgreens to another). That process is less cumbersome.

For ease of explaining, Pharmacy A will be the pharmacy you last had the script filled at, and Pharmacy B will be the pharmacy you want the prescription to be filled at now.


Step 1

The pharmacist on duty at Pharmacy B must gather as much information about the prescription(s) you need as they can. When people have their bottle(s) from Pharmacy A with them, it’s a blessing. The more information the pharmacist has before continuing past this step, the faster the transfer will be made.


Step 2

The pharmacist at Pharmacy A must be called by the pharmacist at Pharmacy B. This can only be done by pharmacists and, in some places, pharmacy interns (those studying to be pharmacists).  Therefore, both the pharmacists at Pharmacy A and B must be available for a few minutes per prescription. Depending on the workflow at either store, it can take a bit before the pharmacist from Pharmacy B can make the call and the pharmacist from Pharmacy A can answer the call. I once sat on hold with a mail order pharmacy for 20 minutes before I got a hold of someone.


Step 3

The following information must be documented on prescription pads by the pharmacist at Pharmacy B:

  • drug name
  • drug strength
  • medication quantity
  • directions
  • number of refills remaining
  • prescription number from Pharmacy A
  • date the prescription was written by the prescriber
  • date the prescription was first filled
  • date the prescription was most recently filled
  • the prescriber’s name and credentials
  • Pharmacy A’s address and other information
  • the name of the pharmacist at Pharmacy A

The pharmacist at Pharmacy B must then share his/her name and Pharmacy B’s information with Pharmacy A.  Pharmacy A must document this in their system before continuing. This must be done individually foreach prescription that is transferred. This is why it takes a few minutes per prescription.


Step 4

Pharmacy A inactivates the prescription(s) in their computer, and Pharmacy B fills the prescription(s). That’s where the regular filling process kicks in. See the steps in my entry entitled “Narcs” to see what that entails.

 
Some important things to know about transfers:

  • Narcotic prescriptions cannot be transferred.
  • Some places do not allow for controlled medications of any kind to be transferred, even if they have refills.
  • Prescriptions can only be transferred if the prescription has refills and is not expired.
  • If you are transferring from a mail order service to a retail pharmacy, you may not be able to get the same amount of medication in the store as you do through the mail. A lot of insurance companies (in the US) allow for 90 days’ worth by mail but only 30 days in the pharmacy.
  • The prescription cannot be transferred if the pharmacy it was originally from is closed.

So, that’s my spiel for today. Hopefully, this entry wasn’t too confusing. Hope your days are all going great! =)

 

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Routes of Administration

 

Today, I ran into an issue that should be shared with all patients. I saw one of my favorite wife/husband patient combinations during my shift. I met them not long after starting at my current pharmacy, and I was able to help them save some money on prescriptions. They have sought me out for advice ever since.

Today, they came into the pharmacy to return a steroid cream. I asked them why, and the wife responded that the list of side effects on the medication guide scared her. She said she had decided not to use it. I asked her if she has discussed not using it with her physician, and she told me she had not. So, I started to go through the medication guide with her sentence by sentence to see what was the most troubling for her.

After some explanation, I realized the side effect she was most worried about was the immunosuppressant effect steroids can have. I explained to her that this adverse reaction was not one that should concern her too much. I told her that this effect happens after months of therapy and is more likely to occur with oral steroids. She calmed down immensely afterwards. She ended up taking the medication back home with her. I encouraged her to call or come back if she had more questions.

I have come across this situation a few times before. A patient has a non-oral therapy. They decide to read the warnings and other patient information, and they come across side effects that are mainly related to the oral form of the drug. It scares them, and they stop taking it. Once they realize there is no reason to worry about side effects A and B, though, they calm down and become more adherent.

One thing patients need to realize is that the medication guides that print out with the prescription labels at the pharmacy are required to include everything under the sun for that drug. It will include the side effects for the oral form, as well as other routes of administration (topical, rectal, vaginal, etc). So if you are picking up a prescription for a non-oral medication and are concerned or unsure, ask the pharmacist which side effects are the ones most likely to happen while you’re on it. Try not to scare yourself out of using the medication before you ever use it. As a general rule with many medications, you will probably never experience most of the side effects listed on the medication guide, especially if the prescription is for something non-oral. They are there to tell you all the possibilities for every person who might ever use the medication, not to forecast what will definitely happen when you use it.

 

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Verifying Identity

 

Today’s story is a quick one, but definitely it stood out from the masses!

We had a patient come to pick up his prescription around dinner time. The technician who was ringing register followed the proper pick up procedures, which include verifying either the patient’s date of birth or address before allowing them to take it home. The patient was very rude when he answered the question, shouting his date of birth as loud as possible, then asking in a very demeaning tone, “Is that loud enough for you, buddy?” He proceeded to say he would report him to the state police for a violation of privacy if he was ever asked for his personal information again. The technician tried to explain that the only reason he was asking was to make sure he had the correct prescription for the right person in his hands. The patient arrogantly replied, “I am the only one with that last name who’s a patient here.” (That statement isn’t true, but he wouldn’t know that because of HIPAA.) He then muttered something about a conspiracy, purchased his prescription, and left.

My internal thought process was, “What a rude [insert expletive here]!” It makes sense to have some sort of verification process to pick up prescriptions. Every pharmacy is slightly different, but most ask for the name of the patient and a second identifier. If he didn’t want to announce his information, all he had to do was provide us with photo identification. We have several people that don’t like to say these things out loud, and it’s perfectly understandable. Why should they have to say their personal information out loud? We don’t ask questions if they provide photo ID, and truthfully, I prefer when people go that route because I can verify multiple identifiers quickly and efficiently. This man’s rude behavior was quite uncalled for, especially considering there was no one in the pharmacy area and the technician was using his “inside voice”.

Out of curiosity, does anyone else have similar stories to share? I’ve run into this situation a few times in the past, but never have I seen someone get so angry about it.

 

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Inappropriate Conduct

 

Today’s theme is actually borderline comedic. I say borderline because it’s actually very rude at the core, but has a funny appearance at first glance. Today, I’m going to talk about inappropriate sexual conduct in the pharmacy. Get your chuckles out now because the remainder of this will be very serious.

In the past week, I have seen WAY too many examples of inappropriate conduct in the pharmacy. Not from our employees, but from our patients. Now, I don’t mind hearing compliments from people about how nice our staff looks, and I don’t view it as harassment. But, when a person starts making sexual passes at our staff, that’s not only rude, it’s embarrassing and uncomfortable as well. The conversation below happened today at our drive-thru between one of our young female techs and a middle aged man picking up his wife’s prescription.

“How can I help you?”
“I’m sorry I parked so far away.”
“No, it’s not your fault. I’m just short.”
“That’s okay. I like ’em short.” *wink*
“Who are you picking up for, sir?”
“My wife. I like it when you call me sir.”
“Do you have any questions for the pharmacist?”
“Yeah. How can I get you in my truck for a nice, long ride, sweet thing?”

Wow. Just wow. Very classy. -_-

This kind of behavior is awful to start with, but of all places, what would make someone think it’s okay to behave like this at a pharmacy? Save it for the bar, buddy. I’ve been seeing this sort of thing a lot lately, and I don’t know why. It’s happening to both our male and female employees, and it has no age or marital status boundaries. I feel like posting the following in the pharmacy.

 

Pharmacy Etiquette Notice
1. Please, do not make any sexual passes or references towards our employees.
2. Please, do not ask for our employees’ telephone numbers or other contact information.
3. Please, do not hand out your contact information to our employees while they are on duty.
4. Please, do not touch our employees in a non-professional manner.
5. Please, refrain from flirting with any employees.

 

I am still very disgusted by the behavior I’ve been witnessing in the recent past. Unfortunately, we cannot ask these people to leave the premises for this sort of thing, since it is not physically harmful. Thank you, corporate regulations, for such a stupid rule.

My take-away point is this:  Readers, please do not act in a flirty or sexual manner to pharmacy employees. They may find it harassing, even if you are joking. And, please, spread this message. Spread it far and wide. I think half the problem is that people don’t realize how uncomfortable they may be making someone else. And, if they don’t know there’s a problem, they won’t be able to fix it.

 

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Mixing Flavors

 

We all remember how some of the liquid medications that we had to take as children tasted. There was yummy, bubble gum amoxicillin. There was disgusting, bitter Augmentin that we could barely tolerate enough to swallow. There was sweet, grape Dimetapp that soothed a sore throat and quieted a cough. Those are just a few I personally remember be given as a small child when head colds, strep throat, and walking pneumonia came my way. Unfortunately for me, the flavor of the medication was what it was. I just had to deal with it if it was nasty. Today, there is the option to flavor liquid medications if the original flavor is yucky. The brand of flavoring drops we use at my pharmacy is FLAVORx. I feel it works pretty well, and it’s a reasonable price ($2.99 USD per prescription). Having personally taste tested many of my “creations”, I feel comfortable telling my patients which flavor is their best bet to cover up the “yuckiness”.

There are some people, though, that cannot afford the service very easily. We have a high welfare population in my area, so I try to tell these people other ways to diminish the bad flavors. I also offer to flavor it at any time if they find it just too difficult to swallow it as is. The one thing I always tell people is to have a “chaser” ready for the really bad tasting things (Augmentin, Cleocin, etc). I also tell them to try sucking on an ice cube or ice pop for a few minutes prior to administration to help dull the taste buds. I always recommend keeping things in the fridge for the medications that don’t have specific storage requirements (azithromycin, prednisolone, etc). Most people find a combination of factors that works, and if they don’t, they come back in a day or two to ask for the flavoring service.

My story today is about a mother who was picking up some liquid allergy medication for her daughter. She asked me if it was okay to put it in the fridge. I told her that was fine and would help improve taste. She commented that taste isn’t a problem since they always mix the medication with whatever beverage she is having at the time of administration. She began listing off every drink you could think of–soda, milk, juice, tea…you get the picture. I asked her if someone had told her it was okay to do this with the medication. She said she came up with the idea by herself. Instead of going through each drink to see if it was okay to mix the medication in them, I asked her to refrain from doing this because I was unaware if it had any negative implications. She seemed confused, so I explained there are some medications that if mixed with or taken at the same time as some beverages could essentially be made inactive in the body. She nodded, and asked for tips on how to make the taste less bitter. I gave her my normal spiel, and she thanked me. She ended up coming back later to ask for the flavoring service just to make sure it was palatable enough.

My advice here for my readers is to never mix liquid medications with other beverages without contacting a healthcare professional (preferably a pharmacist) first. You want to make sure the drug is as effective as possible when taking it. Whether it be by finding something that is acceptable to mix it with or by flavoring the medication itself, we can help you figure out a way to make it less yucky.

 

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Sticks and Stones May Break Your Bones…

 

Today, I got to see one of my favorite patients. It helped make the otherwise hectic day a bit easier. There’s a funny story about how I connected with this person that I must explain first.

Not long after I started working at my pharmacy, this woman came in to get her husband’s medication. She was very rude to all of our staff, so I took note to remember her name, so I knew when I needed to be extra nice and calm. Then one night, she came in to get some inhalers filled and had no idea how to use them. I took the time to explain the technique, and, ever since, we’ve been on great terms. She looks for me and trusts me.

Back to the present… She came in to get her husband’s meds filled and shared a shocking story with me. Almost two years ago, he had extensive surgery in multiple areas of his body. Ever since, he has been nearly bed bound due to the pain resulting from the surgery. They told him he just handled the procedure poorly, and that his only option was pain management. So, for the past 18 months, the poor man has been on and off all different pain regimens.

Desperate for any answers, the couple decided to get a second opinion because he did not like being on all the pain meds. His wife told me today that the other facility he went to informed him some of the rods, pins, and screws were placed incorrectly during his original surgery. She told me the original surgeons refused to go back and fix it. She stated they were going to go out of the area to try to get it fixed.

I was appalled by her story! This man has such a poor quality of life right now, and the surgeons won’t attempt to fix the mistakes they made? That screams unethical to me. It also has “potential lawsuit” written all over it. Even if they don’t feel comfortable opening him up again, they should have at least told the man the truth about the surgery outcome instead of covering it up. According to his wife, the second facility needed only to look at basic imaging studies to know that the hardware was placed incorrectly, so the original surgeons should have been able to tell a mistake had been made.

Lying to a patient is bad and unethical, yet healthcare professionals do it. It usually comes back to bite you in the end. My only hope is that this man can get the mistakes fixed to a point where he can have a decent quality of life again. =/

 

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