I Hope This Patient is Okay…



So, I have an interesting story from today. It’s one that worries me, but also makes me shake my head.

I had a woman call me, asking if I could give her a few pills to tide her over until Monday when she can call the doctor for more refills. I ask her name and find that she hasn’t been to our pharmacy for over a year. I ask what she’s looking for and she tells me it’s a heart medication that is for 40mg. I notice there is a very old script for furosemide, so I ask if that’s what she’s looking for, she says no and that it starts with a “car” sound. I ask her if it’s carvedilol, and she says yes. The most recent script is for a low strength. I ask if she’s gotten it filled since the previous time she was here. She tells me her cardiologist has been directly dispensing it from his office. (I wasn’t aware they did this for things other than controls or samples of brand name medications, but I didn’t question it.)

She states she really needs it because she’s out of town and very far away from home. I tell her that there’s not much I can do, since the dose she’s asking for is not on record with us. I also tell her that since she hasn’t been to our pharmacy in so long, I don’t fell comfortable providing the medication. She suddenly tells me she has retained 15 pounds worth of fluid in the past few days and her skin is yellowing. I tell her that’s quite serious and that she should be seen right away. She starts asking what she should do, since she’s worried about her condition. I tell her that the best option is to head to the ER. I told her that even if we did have a current prescription on file, I’d still suggest going to the ER because she could be going into congestive heart failure. She tells me she doesn’t want to because “the ER sucks big time”. I tell her that even though ERs are usually a pain, this situation requires action be taken soon. She continues to tell me I should just give her the medication. I again tell her no. She asks what will happen if she doesn’t go to the ER. I tell her that she could possibly go into heart failure, which has very poor outcomes when left untreated.

“Oh well. I guess that will have to do. I don’t have time to go to the ER.” –Click–

I did try to call her back right after she hung up, thinking maybe I could calm her down and get her to see my reasoning. Her number on file was invalid. I don’t know what else I could have done. I will gladly give people a few pills for a maintenance medication if they run out on the weekend or the prescriber hasn’t replied to our refill request by Friday evening. Seeing as how this woman had not been to our pharmacy in so long and how the dose she claims to take didn’t match up with the one she used to take, I didn’t feel comfortable giving her any. In all honesty, she probably needs some IV diuretics and a few diagnostic tests. The way she described herself is not something that should be left alone. I am worried that she will start experiencing organ failure, especially considering the jaundiced skin.

It’s people like her that make me both sad and confused. If she’s seeing a cardiologist, then she obviously has heart problems. I am sure he explained to her the difference between emergent and non-emergent problems. Most do. For her to refuse to go to the ER like that is very stubborn. It’s sad because she doesn’t seem to understand the gravity of her situation, but it’s also frustrating. People need to be more involved in their own health care. If you see your skin suddenly turn yellow, that means your liver is probably not doing so well. It’s not something you wait around to see if it gets better. If you gain more than 10 pounds in a day or two, that is water weight. It takes a lot longer to gain weight due to fat accumulation. Lots of water weight usually indicates your heart isn’t working right. It is also not something to be taken lightly. Both require at least a call in to the doctor. He will probably either have you come in to the office that day or go to the hospital. Regardless, a physician should be involved as soon as the symptoms start.

-Sigh- I hope that woman is okay. =(


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Computers Make the Pharmacy World Go ‘Round



So, the biggest issue our pharmacy has been dealing lately is a slew of computer problems. Almost every day since the new store opened, we have been unable to use any of the computers in our pharmacy for a good portion of the day. Several times, they have crashed in the evening and stayed down until after we closed. Our pharmacy is open for 11 & 1/2 hours a day during the weeks; there were a couple days where we couldn’t use our computers for 6 of those hours. Trying to do 11 & 1/2 hours’ worth of work in about 5 hours is not fun. I have felt like the figure in the animation above many days. Both my partner and I have had to come in before the pharmacy opens our our days off to clean up what couldn’t be finished the previous night. It has been quite exhausting.

Luckily, our patients have been so understanding throughout this whole thing. I find it interesting the difference between how my partner and I have been handling this. If a person comes in with a script and our computers are down, I give him/her enough for a day or two without hesitation. The only exception for me is narcotics but I do my best to find those patients the closest pharmacy to us that can fill it. But, as far as benzos and hydrocodone goes, I’ll even give a few of them. I just always make sure to mark down if they got any and subtract it from the balance on the script. My partner, on the other hand, has been completely turning people away, even those with non-controlled scripts. I don’t understand why. I feel getting a patient started on an antibiotic or making sure a person doesn’t lapse in his/her Coumadin therapy is important. Our computers being down shouldn’t affect this. I am still going to practice pharmacy without them, and I am still going to put patient care first. I guess not all pharmacists feel the same, though.

I am hoping that our computer issues have finally been resolved. Yesterday was the first day they stayed up all day. Maybe it’s a good omen! =) I hope everyone’s days are going well and that your pharmacies are filled with working computers!


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