When Are Cuts Simply Too Much?

For the longest time pharmacists have talked about numbers. Hospital pharmacists brag about the how many beds their institution is. Retail pharmacists brag about how many scripts they do per day. Some pharmacists also brag about how much profit their pharmacy made and how big their personal bonus was.

When do pharmacists brag about cutting hours?

This is where my usually funny and quirky self turns dead serious.

Let’s face it, in the current economic situation hours and employees seem to be getting laid off or cut everywhere. The once secure job of working in a pharmacy, which was once thought to be an untouchable industry, is not immune either. Pharmacy technicians are especially susceptible to having their hours cut because a pharmacy can run without them but it MUST have a licensed pharmacist.

Over the past year or so I have seen the hours at my own store cut. It was no sooner that we got a new technician hired (based on old corporate staffing guidelines) that we had to cut them 3 weeks later. In addition to this cut of 30+ hours, we had to cut every other technician down from 40 to 36 hours, for a total savings of about 50 hours plus one persons benefits. At the same time, our volume remained unchanged.

Who runs the pharmacy?

These cuts started taking their toll. We had increased wait times for prescriptions to get filled, we had a decrease in our patient satisfaction and increase in complaints, and we had technicians who were getting more and more stressed out as well as an increase burden on the pharmacist. Some people would call this “being more efficient”, which translates to the almighty stock price and analysts as “increased profits”. This is the major downfall of all corporate pharmacies, the stock price.

Notice a few piles going?

I know this isn’t just the company I work for cutting their hours either (example 1, 2, 3, Canada) Almost every one of my friends who is a pharmacist, in both retail and other settings, have seen hours cut. Part time and floater pharmacists are having hours cut or are being phased out, older pharmacists are being forced to retire, and pharmacy technicians are having their jobs cut like the woman in the shower scene of Alfred Hitchcock’s Psycho! To be fair we should have seen this coming. When automation was put into pharmacies it was for 2 reasons, to reduce errors (which I feel it has depending on circumstances) and to REDUCE COSTS.

From others I have talked too this is an issue affecting more than pharmacy. Physicians are having to see more patients or staff longer hours, nurses are taking on more patients as well and not to mention the increase in scripts I see from physician assistants and certified nurse practitioners. For now I will just focus of pharmacy as that is my own profession and what I know best…

So from the outside looking in, it is easy to say, “Well if there were hours to cut, that makes sense. You have to increase profits and productivity as a company. These times are tough.” That argument does make some sense, however with an increase burden put on pharmacists, as with any medical professional, the chance of error goes up, dramatically. According to the Institute for Safe Medication Practices (ISMP), there are 10 key elements that affect medication error rates. Of these 10 key elements, I can see an overworked or stressed out pharmacist being affected by these: Communication of drug information, Drug labeling, packaging and nomenclature, Environmental factors, Staff competency and education, Patient education, and Quality process and risk management. Realistically I can extrapolate scenarios for all of the others but these are probably the biggest areas that would be impacted or would impact the pharmacists’ ability to do their necessary duties to acceptable standards. I do not feel that acceptable should be the goal in healthcare, the goal should be the best possible but cuts have lowered that standard due to an increase in workload.

Now this picture is probably taken out of context but what if there is no one working but one pharmacist? Expect good service or them to be stressed?

Then you have stories like this… “Pharmacist Gives Pregnant Woman Wrong Prescription”

Please watch this video. It does have some media extravagance BUT it should never have happened. I cannot say if pharmacists or technicians here had recent cuts or are overworked but it is an omen to what could happen if cuts continue.

Before people say this is just another pharmacist ranting and venting under an anonymous blog, let me explain something. I am doing this for patient safety, I pray to never make a mistake but realize that is impossible. I would like any possible thing done to avoid mistakes so patients do not get hurt or worse. Yes, I would appreciate less stress at work, but where I work, that is unlikely to happen too much due to the clientele in my area. I am pushing against these cuts because I feel it does not allow pharmacists to use their full ability to help patients. It also does not give patients the best possible healthcare they would like. Therefore, this is as much a patient issue as it is a risk management issue. These are two things that most corporations care greatly about but are blinded by the almighty stock price and perception of their company. I think this quote from the recent movie Wall Street: Money Never Sleeps sums it up very well:

“Is greed still good? Somebody reminded me the other night that I once said ‘greed is good.’ I swear I don't remember it but it sounds like something I would say in the eighties.”

– Gordon Gecko

This leaves the question of, “So what can we do now?” The answer is not very simple and does involve some work but is more than reasonable. LET CORPORATE HEAR IT! In the wake of hour cuts and customer complaints I have taken an active role to ensure my store gets back to having improved staffing. Any time a patient complains or comments of how short of help we are I am always quick to point out exactly where they can go online to let my company know about how they feel and offer them the corporate service hotline. So far it has worked a little in corporate let all of the 36 hour technicians back up to their gull 40 hours. It’s not world changing but it is a start. Since increasing our hours, the district manager has noted that our complaints are down and that our volume has picked up a little bit. Hence the increased staffing has worked to his advantage and to that of my sanity as well as to the benefit of my patients. I wouldn’t call it protesting but the two most powerful things a patient has is their voice and their dollar.

I really hope to see them both used wisely.

When A Medical Professional Turns Into The Patient...

I woke up the other morning with pretty badly irritated eye. Apparently I forgot to take my contacts out before going to bed. WHOOPS! I walked into the bathroom and looked into the mirror just to see how seriously red my eye was. I decided to take my contacts out, not sure whether it would make the situation worse or not. It made it worse, much worse! My eyes had a sharp stabbing pain whether it was open or shut. I continued to cover and wipe my eyes of drainage and decided to lay down and see if it passed. This did not help very much so I got the idea to put some contact solution into my eye in hopes it would bring some relief. It only stung more.

I guess I had to go to the pharmacy to see if something like Clear eyes or Visine would help. I figured that if this didn't do the trick, I might have to get some further medical attention that was above my own skill as a pharmacist.

The pharmacy I went to was the one I currently work at. I called a friend and he went with me in case my eye really bugged me. I made it to the pharmacy, picked out the eye drops I had in mind and left. My friend drove me home and stuck around to make sure I was alright. Thank God for good friends. The eye drops burned and did not seem to help much. I waited awhile and tried them again still to no avail. It was time to seek further care.

My friend drove me to an Urgicare which I used to know some nurses at. When we got there I had to fill out 4 forms and give them my insurance and identification. Filling out forms with one hand over your eye is not the most fun, especially after a 20 minute car ride which simply looking out the window makes you nauseated. I turn in the forms and waited to be seen. I waited about an hour and fifteen minutes in the waiting room before being called back to an exam room. Finally!

Once in the exam room the nurses came and asked some basic history and pain questions. They also took my blood pressure and they took it wrong. They raised my arm just over shoulder height and took it. Blood pressure readings should be done at heart level, at least that's what they taught me. I then continued to wait 45 minutes for the physicians to come into the room. He explained what he thought it was (since I gave a very detailed explanation he probably could have diagnosed it without even seeing me) and what he was going to do to examine it. Overall, he was very professional and I was pleased with his work. He then explained he did not see anything serious but was going to give me and antibiotic just to be safe. I then told him I was a pharmacist and wondered what he was thinking for an antibiotic. He said I should have mentioned it earlier and said he was going to write for Vigamox.

Wrong answer.

I knew Vigamox is over $100 a bottle and requires a prior authorization for every insurance I have every dealt with including my own. I suggested tobramycin and explained to him what I knew. He agreed and appreciated my knowledge then left to write the prescription. He came back and gave me follow up instructions if needed, including an ophthalmologist he knew personally, as well as the prescription for tobramycin eye drops, then showed me out to the nursing staff to sign one more item.

When I saw the nurses and signed their document, I asked them to call my prescription into a pharmacy near by that was part of the chain I work for. They were hesitant and said they do not do that.

Wrong asnwer.

I told them I am a pharmacist and that I knew the pharmacist they would be calling it into. They checked with the physician who literally said, "Ya, why wouldn't we call it in?" They agreed and I left with my friend to go to the pharmacy.

We got to the pharmacy 30 minutes prior to close and to no surprise my prescription was not ready. I asked how long and the intern, who I knew, said that the pharmacist did not take it because they were out of stock of it. Personally, I would have still taken it and then offered the patient to transfer it, but to each their own. The pharmacist said the Urgicare was going to call me to call another pharmacy with it or to preferably to pick it up. One problem, my cell phone was dead. Thankfully, my friend let me use his phone to call the Urgicare and call it into the exact pharmacy I work at, to which the Urgicare nurse obliged.

We drove to my pharmacy, speeding a little since we know we would be getting there with in 5 minutes of closing. I called ahead as we pulled off the highway and my pharmacist partner said it was ready and he would stay open until I got there and that he rushed it since he knew it was mine. Again, I am thankful I know how the medical system works and some people in it, which allowed me to get my prescription in a fairly timely manner.

As I was rung out by my cashier, I thought to myself, "What if I wasn't a pharmacist?" This would have meant that the doctor would have written for an expensive prescription which my insurance wouldn't have covered. I would have gotten to the first pharmacy and been pretty frustrated since I had spent 2 hours plus at the Urgicare and still had a sore eye. If the pharmacist would have called the Urgicare to change the prescription, she would than have not had the antibiotic in stock. I then would have to go to another pharmacy to get my prescription. I also would not even be able to stay with the same chain to get my prescription that night since they all would have been closed. I may have even not gotten my prescription that night. On top of all of this the antibiotic I did receive needs to be applied every 3 hours while awake. This is fine by me, since it was $4 instead of over $100, but even as a medical professional applying an eye drop every 3 hours is hard to remember. Imagine if I were a patient again, I would probably be annoyed and not understand why the drop needs to be used so often.

This whole experience really did make me think differently about patients who come in last minute. Ironically enough I had a patient about my age come in with an antibiotic 5 minutes prior to close while I was already busy the night prior to my eye injury. I told him to stick around as I would make sure he got it before he left. The man was grateful for my services and that I took care of him despite being busy. I now fully appreciate his appreciation for me taking care of him despite the fact that I was closing really soon. Thankfully, karma must have paid off and taken care of me when I needed it. I can definitely say I look at the last minute patient with a little bit more respect considering what they might have just been through. If a last minute patient just hurried to make it in, I will definitely take care of them as long as they are in a true urgent need and not just filling a prescription they had for 2 weeks. This is especially true if a patient has an antibiotic or is from an Urgicare!

15 Pharmacy Rules for Patients

Pharmacy Rule #1: If your name looks like a set of Scrabbles tiles don't yell at me if I butcher it.

Pharmacy Rule #2: I can only explain your insurance only covers 30 days worth of medication instead of 90 in so many ways before I give up. I am not bad at dumbing things down, you may just not be that intelligent.

Pharmacy Rule #3: If you don't know the date of birth or address for the prescription you are picking up, I do not know how to sell it to you. Double checks are there for a reason.

Pharmacy Rule #4: If I tell you your refill is too soon and you try to have it transferred to a different pharmacy, I will make sure the other pharmacist knows it's too soon and that you are a current problem for me. Therefore they won't fill it either.

Pharmacy Rule #5: If you try to get you pain medication filled too early repeatedly you will get a nice note in your profile that will let other pharmacists know this.

Pharmacy Rule #6: Respect. Respect the pharmacist and the technicians. Respect is mutual and if you don't respect us, we will not respect you.

Pharmacy Rule #7: If you do not think something is correct please feel free to ask. If you do I will look into it and try to correct and problem willingly. If you yell and make a scene, I probably will not go out of my way (unless it's truly bad).

Pharmacy Rule #8: If you simply say thanks or show that you appreciate my work, I will bust my hump for your gratitude and take care of you.

Pharmacy Rule #9: If I can't read it, I can't fill it. I will try to clarify any issue, unless you act indignant towards the fact that my effort and care may take a few more minutes to ensure YOU get what YOU need.

Pharmacy Rule #10: Your physician isn't always right. Neither am I and neither are you. Everyone's human, so there is no reason to go crazy about something if it's small. If it's big bring to my attention as politely as possible and it WILL be resolved.

Pharmacy Rule #11: Controlled medications are controlled for a reason. This is why I can not fill them early. Drug abuse is real and very serious. No early controls. Period.

Pharmacy Rule #12: I see more patients than any other medical professional and do it fast and accurate. If I need extra time to ensure something is correct, please allow it. It is YOUR health.

Pharmacy Rule #13: If you think my hold time sucks, feel free to call your own insurance company. I do it all the time for YOUR gain, not mine. Trust me it sucks 5 times worse.

Pharmacy Rule #14: There are many pharmacies and pharmacists out there. If you and I don't get along or see eye to eye, feel free to venture elsewhere for BOTH of our sanities.

Pharmacy Rule #15: I became a pharmacist to help people. I did not go through 6 years or more of college, stay up countless hours studying and busting my hump to be a pain in your side or to play God as some may accuse me of. I use knowledge, legalities and logic to ensure what I am doing is the best for my patients and others. This is why I am a pharmacist.

That is all of my pharmacy rules for patients.

Until I can think of more.