Computers Make the Pharmacy World Go ‘Round

Computerfrustration_zpsfce93557

 

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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Out of Control

angry

 

Hello everyone! Long time, no post. I had been in the midst of moving my pharmacy. It took lots of planning, cooperation, and teamwork, but it went smoothly and now I can relax again. I will probably go on another hiatus in the upcoming months to study for a law exam. I am in the process of transferring my license to another state, and as soon as I get my authorization to test, I’m going to go back into student mode and study my buns off. But, for now, I am going to return to regular blogging. =)

So, today’s story is one I encountered a few days ago. It was the end of the night, and we were getting ready to close. A woman comes in, and one of my techs goes over to help her. She had some medications to pick up and she had requested print outs of last year’s medications for both her and her husband over the weekend. The policy at our store (in compliance with HIPAA) is that the person for whom the print out is for must be present to receive it. They also have to show ID proving they are who they say they are. The only exceptions are 1.) parents may pick up for children aged 17 & under and 2.) people who have power of attorney over another person may pick up for that individual (in which case, we ask them to bring in the POA paperwork once as proof and we mark it in our system). If the individual is not present and does not fall under one of the exceptions, we are required to mail it in our super spiffy confidential envelopes. All of our techs have been informed of this, but our newest tech dropped the ball and told this women she’d be able to pick up both hers and her husband’s.

Not surprisingly, the woman was upset. I apologized, as it was the fault of our technician’s. As sorry as I was, though, I was not about to break our HIPAA abiding policy. It’s there for the protection of everyone’s privacy and is a good policy. I offered to have it mailed first thing in the morning, letting her know I would personally ensure it got mailed. The woman kept ranting (again, not surprisingly), and I kept apologizing. Up to this point, this is a normal upset patient scenario and one I’ve dealt with several times. I take the brunt of the anger and apologize for a tech’s mistake. Usually, they either calm down after yelling a bit or storm off. This is where things got interesting and where the patient turned from angry to out of control.

She asked to speak with my manager. My manager happened to be standing not far away when the situation started, so I called her over. She also knows this print out policy, as she used to be a tech before becoming a manager. She attempted to intervene and calm the lady down. She offered her a gift card for her trouble (yay, retail store policies of feeding negative behavior!). The lady refused the offer and started to yell louder. She turned back to me, walked towards me, and got right in my face (we’re talking less than six inches from me). She started banging on our counter, and I became scared she would get physical with me and grab me by the collar of my jacket. Her yelling also started to scare the other patients in the pharmacy area. A good ten minutes go by, and this woman has not calmed down (she was actually yelling more) nor accepted any form of apology, telling us instead that we weren’t sorry. She’s still banging on our counters and is now pacing the length of the pharmacy. She kept returning to get as close to me as possible (at this point, I had stepped back a bit so she couldn’t grab me). Those shopping up front could hear her across the store and suggested to the girl working up there that she call the police. Just as my manager decides it may be a good idea to call the police, the woman finished her rant and left, continuing to yell all the way out the doors.

This was one of the few times I was actually scared of a patient. At first, I felt really bad for her. She was misinformed and had every right to be upset and angry with us. But, there is a point that most people reach when they’re yelling where they realize their carrying on won’t fix anything, so they either calm down or leave. I have never had anyone get right in my face like that before. She is one patient I hope never returns and transfers everything elsewhere. Being outright abusive to our staff is uncalled for and does not fix things. You have the right to be angry; you don’t have the right to be out of control like that. When you start scaring other patients and customers to the point where they tell our employees to call the police, that’s when you’ve gone overboard and need to stop. In the end, I still didn’t break HIPAA, and she still left without her husband’s print out. I did mail it the next morning, and it should be at their house by now. But, man…what an experience that night was.

The ironic part of this whole thing is that her husband’s print out contained five items from all of last year. She was out of control over a piece of paper with five items on it. *shakes head*

 

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Rambling on and on and on and on…

 

Both the entry’s title and the words in the picture above are things my techs have said jokingly about one of our now regular patients. It makes me angry when I hear those things. The man has severe bipolar disorder, for which he just recently started getting treatment. Whenever he calls the pharmacy, he is manic and very anxious. His phone calls can last for a long time, especially if he is worried about one of his medications. It seems like I’m the only one in the pharmacy who doesn’t mind speaking with him, though. The rambling does not bother me like it does with everyone else. In fact, I feel very bad for him. He didn’t ask for the problems he has. I am sure if he could hit a button and get rid of them, he would without hesitation. His rambling is not intentional, nor is he deliberately trying to annoy or irritate others. He is simply trying to ask questions that he, as a patient, has a right to have answered. The saddest part of it all is that he knows people don’t like when he calls–that they dread hearing his voice. Except me.

So, things have gotten to the point where he will only speak to me. Though it’s nice that he trusts me, he shouldn’t have to rely on one person to answer simple questions, such as whether his prescription is ready for pick up. I can’t understand why people get so frustrated with him. Yes, he rambles. He rambles a lot. But, all you have to do is just let him talk. I continue doing other things while I’m on the phone with him because I know most of what he’s saying is repetitive or just him thinking out loud. But, if his rambling to me for a few minutes can quiet his racing thoughts for a bit, that’s great. I don’t let it interfere with the rest of my duties more than it has to. Neither should my other techs or the other pharmacists who work there. He knows he rambles, and so he only calls on the weekends or after 6 PM on weeknights. He knows he has a problem, and he does his best to keep it from taking up our time. I couldn’t ask for anything more from this guy. He’s as good as patients come. It’s sad to me that no one else thinks so.

I think part of the problem is that other people write him off as “crazy”. They figure they’re allowed to be annoyed with him. They probably also figure he has little grip on reality. I HATE the social stigma on mental disorders. People like this man suffer every day because the people who are supposed to help them don’t. It’s not that they purposely don’t help; it’s that they write things off as part of the patients’ disorders, even when they’re not. A schizophrenic with a UTI should still be treated the same as “sane” people with UTIs. Yes, there are emotional and knowledge barriers many times, especially with the more severely mentally ill. But, you do your best to overcome them with the patient together–as a team. You don’t ignore the barrier because of the diagnosis code in their chart. If you can build a trusting relationship with your patients (“crazy” or not), you will overcome barriers much easier than if you just tell them what to do. If you can empathize with them, they will notice and appreciate it many times. Now, this isn’t fool proof. There are always people who will ignore your advice. There are always people that will be nasty. But, more often than not, being kind or empathetic leads to kindness and gratitude in return. You catch more flies with honey than vinegar.

Going back to my original story, the man called today, and I was happy to hear that he sounded much less anxious than I have ever heard him . Still a bit edgy and talking fast, but markedly better than before. I hope the pattern continues for him. I know he wants to be more level and even-toned. Maybe, someday, he will be what society deems “normal”. I couldn’t help but smile when I got off the phone with him. =)

 

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Health Insurance…My Other Specialty?

 

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I am apologizing ahead of time to my non-US readers for the confusion you will probably feel after reading this entry. Our health insurance situation in the States is screwy a lot of the time.

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Working in a community pharmacy in the US means having to deal with insurance companies about 1/3 of the day. This is true of both techs and pharmacists. We both need to know how to handle phone calls about rejected claims. My story for today is about how tiresome it can be.

I received a call from a woman in the early afternoon asking me if I remembered her situation. After talking to her, I realized I did, in fact, recall dealing with her last month. Her story was complicated, so I was glad I was able to recall the details. This woman’s insurance provider changed their plan details at the beginning of June. Same company, same representatives, but a different plan. This isn’t exactly unusual here in the States. Patients will have everything on their ends stay the same, but things on the insurance carriers’ ends change dramatically. For this woman, this not only meant that she was forced to only come to our pharmacy for prescriptions, but that the amount of pills she could get when first transferring would be different as well. She had always been allowed to get a 90 day supply of her maintenance medications before June. Now, the regulations state any time she gets a new medication that she’s never had before, she must pay her full copay for a 30 day supply first and then in subsequent refills, she can get 90 days’ worth. This wouldn’t be that bad, except that every time she goes to get her pre-existing prescriptions filled for the first time since June, they view it as the first time she’s ever had it ever filled and denies a 90 day supply. It always leads to both the pharmacy and the patient having to call and argue with the insurance provider.

Well, she called and told me she had two other prescriptions that were due to be filled. I told her I would handle the situation like last time, and she thanked me. The prescriptions were put through and (no surprise) they rejected a 90 day supply. I called and got a hold of a representative with a god complex, who told me that this override didn’t exist and that it had never been done in the past. I argued with her, trying to get her to see that it had been done last month with other medications. She basically told me it was a fluke and refused to provide any assistance. I had to call the patient, who then called the insurance provider herself. She returned my phone call a bit later and gave me a specific number to call. I called this number and was transferred to three different departments before someone was finally able to help with the situation. The actual override took about 30 seconds and consisted of a couple keystrokes and computer mouse clicks. The total time I spent dealing with this problem (which really shouldn’t be a problem) was about 45-50 minutes. I was so backed up afterwards that I had to stay an extra half hour after closing to finish checking the rest of the filled prescriptions for the day.

These kind of things are so beyond confusing and take up so much time that should be spent doing ACTUAL pharmacist duties. Because of some error in that insurance provider’s system, not only was time taken away from me, but it caused so much unnecessary stress on the patient. She shouldn’t have to call them in order to get them to listen. That middle man step should not be necessary. But, this is always the case with her medications. I’ll be happy when everything is finally all transferred over from her old pharmacy once and for all. The worst part is that her situation isn’t the most unusual thing I see. There’s a set of quadruplets that when they need medications always require a phone call to the insurance company because they are unable to provide them with their own identification numbers, so any activity appears fraudulent to the provider at first glance. Why they can’t have their own ID numbers is beyond me, but all I know is it causes four children to wait an hour and a half or longer for antibiotics when they all get sick when it should take no more than fifteen minutes.

All I can say to really sum everything up is this:  I wish my pharmacy would institute a call center like they’ve been talking about for years now. It would cut down on a lot of this unnecessary stuff and allow more time for patient contact. It would allow more time for me and every other US community pharmacy to actually practice pharmacy.

 

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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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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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