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| Sorry I have been absent for almost a year. If anyone still follows my blog, please let me know, so I will make an effort to post more often :) I've decided to uncover some of the protected postings from the past, so if you feel like getting a good laugh, then refer to entries from October 20, 2008 and April 21, 2008. Out of the goodness of my heart, I have volunteered to cover Christmas on-call because I've heard that from past experiences it has been a quite period. Boy, was I mistaken, as it turned out to be just the opposite of what I expected. The fun started yesterday with a spanish speaking patient. Although the company provides 24 hour language translation service, I courageously tried to steer through his ramblings in extremely heavy accent at a really fast speed. While trying to decide to myself whether I should attempt to comprehend his English, to try to remember my limited Spanish, or to summon the help of language service, my brain was fixating some familiar words in English. Few minutes later my brain was able to decipher that the patient was requesting a delivery of "small bottles" that he shoots into a "white liquid", which gave me a clue that he was probably referring to some additives, that he injects into a TPN bag. My next logical step was to try to determine from the patient the name of medication or the RX number, and that ended up being a whole different communication barrier battle itself. I could not decide to myself whether locating and reading a drug's name or the Rx number would be easier for the patient to do, so I decided to start with the name first. This is how our conversation ensued: ME: Can you please spell me out a name of the mediation on the vial? PT: B-A-X-T-E-R ME: No, this is the name of drug's manufaturer. I need you to give me the name of the drug itself, please. PT: [Pause] ...B-A-X- ME: Ok, never mind. Can you please give me the RX number? PT: 02A613 ME: No, this is the lot number. Can you please read me a different number? PT: N-D-C 00045-135- ME: No, that's not the number I am looking for. Can you read me a different number? It should be listed on the top right corner of the label. PT: [silence] ME: [getting impatient] Ok, never mind. Can you please read me a name listed on the vial, other than BAXTER?!?! PT: I-N-F-U-V-I-... That's how I finally figured out that patient was requesting multivitamins. My next logical step was to investigate why he actually needed MVIs. When I pulled up his profile in the computer system, it showed me that he had a delivery scheduled for the same day for TPN bags with MVIs. I told the patient to look inside his TPN box and to find MVIs there, and if it's missing in the delivery, then give me a call back. Fortunately, I have not heard from him again. As soon as I hang up with the patient, I got a call from a mother of a pediatric patient, whose hydration bags turned rock solid frozen because of the fridge gone bad. Then I got a call from a very upset mother of another pediatric patient, whose hydration bag has burst and leaked all over the other bags due to our lovely UPS delivery service. She complained how this happened on several occassions before, and I really empathized with her. Since the company's preferred delivery method is via UPS which costs pennies compared to the luxuriously expensive courrier services, I frankly implied that I could not guarantee that the company would make an exception just for her son alone, even though there has been a long history of mishaps in the past. As a result of this incident, I filled out a useless piece of paper called "SIO", which stands for Strategic Improvement Opportunity, and which I fill out about 98% due to UPS delivery screw ups. Then immediately after I had to handle a call regarding another screw-up with the orders. Apparently, they sent out an emergency floating nurse on a Christmas Eve for a new start vancomycin infusion since no one seemed to be aware that the patient was discharged from the hospital. After making an hour and a half drive to the patient's house, the nurse found out from the patient that she infused vancomycin in the hospital over 3 hours while the medication that was sent for home-infusion was over 1 hour. Moreover, patient had a "documented" Red Man Syndrome reaction to the medication in the past, and did not have any Benadryl stock at her home. Neither I nor the nurse on-call felt comfortable to have the patient infuse the medication, so I instructed the nurse to get a hold of a doctor on-call in order to put the infusion dose on hold and to change the orders to extend the infusion duration. The nurse on-call told me she will leave an on-call report for the on-call nurse who will be covering the following day (which starts at 8:30am) , who in turn will contact me with the updated information. My Christmas on-call fun continued the next day from my bed, starting with a call at 8:20 a.m. from a dispatcher on-call who was telling me about a panicking and angry husband of a patient, who was promised a delivery first thing in the morning for a very serious line infection, that was already delayed substantially. That surely added great Christmas spirit to the start of my day. Give me a break, people. It's Christmas and it's only an antibiotic, so ASAP delivery for this patient is definetely not going to happen. I estimated in my head that by the time that I drag myself and 3 other people to the branch (i.e. driver, CSR, and tech), by the time the ticket is created and drug compounded, nurse sent out for a visit, and drug delivered, it's going to take at least 4 hours from the time that I was awaken from my sleep. I decided to save a compounding tech some aggravation (even though she's Jewish), and to mix the medication myself. CSR asked me ahead of time to call her in if I need her because she broke up with her bf recently and needed to occupy herself with work during the holiday season. The CSR didn't help with the time commitment of the delivery (by 12pm) because she arrived half an hour later than I expected her, and once she arrived, she didn't know what she was doing (her first on-call experience). So I had to spend almost an hour trying to troublshoot her work and in fact actually doing her work. Meanwhile, I was trying to arrange another delivery for a Jewish patient, who decided to get d/c'd from the hospital on the Christmas day, so that delayed the ASAP delivery even further. In all this chaos, I forgot to notify the driver about another delivery for the evening hook-up with a nurse. The driver was actually asked to keep the delivery package with him from yesterday in order to deliver it to a patient who was potentially going to be discharged today. This strategic plan was designed for convenience purpose since it was supposed to prevent the on-call team from coming in to the branch on Christmas Day. However, due to combination of irony and "the broken phone" communication on-call pathways, the delivery was never accomplished. When I got an evening call from a floating nurse about a delivery that was MIA, I confirmed with the driver (via dispatcher-on call) that the driver had in fact delivered it to a patient's house about an hour ago, and the patient had signed the paperwork. About half an hour later, I was able to identify via speaking to the dispatcher on-call who spoke to the driver, that he was actually referring to a Jewish patient, whose delivery arrived at the same time but at the other end of the state. Needless to say, when the floating nurse has reached her destination, she was not happy to find out that it will take at least an hour for the driver to make his delivery. When I have time and a clear mind, I am determined to figure out how to improve our "broken phone" communications pathways between different people who are involved with on call responsibilities. | | |
| I am sorry that I have not been posting recently to those of you who follow my blog on a regular basis. I guess I run out of good stories to tell, or maybe I just hit a writer's block. If you have any questions for me (other than naplex preparation and free mpje questions), I'll do my best to answer them based on my work and school experience. Lately, I have had a lot of hits to my site about pharmacist work-related stress. There is almost no job in the pharmacy or any other health profession that doesn't involve some type of work-related stress. That is just the truth of it. On the other side, as the Blonde Pharmacist recently wrote in her blog (http://theblondepharmacist.wordpress.com), being a pharmacist is great, especially during the times of an economic crisis, because you will always have good stable income and you can pick and choose your job based on your interests and lifestyle needs. One of the nice things that separates a home infusion pharmacist's work schedule from a retail pharmacist or a staff pharmacist at a hospital is that you don't have to work evenings, weekends and major holidays. Unfortunately, the downside of it is being on-call 24/7 , which means that when you leave the building, the work follows you home because you are attached to a beeper around the clock. At least in retail, when you close the gate, you can finally relax, have a peace of mind and do not have to think about your job for the rest of the night. Being a home infusion pharmacist, you can bank a lot of cash while on call because you get paid by the minute spent on the phone and you are paid door-to-door if you have to make a trip to the branch. However, I have come to a conclusion that the paycheck during an on-call period is proportionally related to the stress levels. As the paycheck goes up, the quality of life tremendously goes down. Basically, throughout your on-call rotation, your days will be the same as your nights, weekdays as weekends, and at the end of the week you will forget what day of the week it is because you've been working 24/7. If you are seriously considering a pharmacy job that has a requirement with on-call 24/7 rotations, please be aware of what the job entails. When you are on-call, forget about maintaining your normal daily life activities, such as going out to a dinner, gym, movies, party, shopping, etc. When you are on-call, forget about sleeping or eating without interruption. When you are on-call, forget about sleeping late on a weekend. You may get woken up as early as 8:00am, and you will always get beeped the minute you are about to step into a shower. If you dare to step away from your house, make sure that you do not commute more than 35 miles away from the radius of your job location. If you get called in about a hospice patient referral or a wasted milrinone dose, it means you need to arrive to your job site right away so that the tech can compound the med and the driver can deliver it as soon as possible. If you are still considering a career of a home infusion pharmacist or already have a job which includes on-call rotations, here are some of my tips on how to make your job less stressful and more rewarding: 1) Make sure that the employee listing has the least amount of your phone numbers as possible. If you have a cell phone, a blackberry, and a home phone number, it's sufficient enough to give the one that you will use the most and the one that you carry with you at all times. The job provides you already with a Nextel as well as a beeper. Therefore, the more numbers that are available, the more you are going to be bothered. At one point in time, I was so busy with an on-call activity, that my beeper, Nextel, cell phone and a home phone were all ringing simultaneously! 2) If you do get a lot of calls simultaneously, make sure you know how to triage and to prioritize them in terms of urgency and importance. Obviously, if a call involves a patient on pain or inotrope management, then it is of a high priority and needs to be take care of right away. While you were wasting your time trying to troubleshoot a malfunctioning pump with a nurse or trying to resolve a delivery issue, you really should have spent that time on a clinical pharmacy issue that a triage nurse or a dispatcher on-call could not have handled. Usually, the on-call service will triage the calls appropriately, but if you get transferred to a lot of unnecessary calls about nursing or delivery issues, you should notify your supervisor and have the on-call services educated about how to triage the calls more efficiently. 3) Develop good telephone skills in assessing the patient status changes since you may often have to categorize the patient's situation as emergent (i.e. requiring immediate intervention), urgent (not life threatening) and non-urgent. Do you know when to refer a patient to ER versus dispatching a nurse to the home for an assessment? If you get a call with lab results in the middle of a night, does the physician and the patient need to be notified immediately? 4) As a pharmacist on call you may need to address medication related issues or complaints of side effects on a regular basis. Obviously, you cannot have memorized every single fact and side effect for every drug that your pharmacy carries, but it is helpful to keep in mind the most common side effects. Keep a good reference next to you at all times in case you are faced with a drug-related question that you cannot remember or answer right away. When speaking to a patient on the phone, try to stay as objective as possible and ask leading questions without making premature diagnoses and jumping to conclusions. In other words, if a patient is describing to you something that you know is 100% Red Man Syndrome, do not tend to "diagnose" and tell the patient or the physician that they may be having Red Man Syndrome since this is not within the scope of your practice. If you are faced with a decision making in an area where you are no longer competent or comfortable, do not hesitate to consult with another clinician. Sometimes it may be more appropriate to have the call triaged to another clinician where he/she will be able to make a more educated clinical decision in his/her area of expertise. 5) Develop good book keeping practices for documentation of the notes and times of all the on-call activities. This is very important for getting reimbursed in the paycheck as well as for other people's use in case that any of the issues need to be followed up in the future. As an on call pharmacist, you get paid around $1 per each minute spent on the phone, and all the minutes add up pretty fast. The rule of thumb for on-call time recording purposes at my company is the following--If you spend as little as 10 seconds of your time on the phone, it gets recorded as a minute. All of the added minutes at the end of the day then get rounded up to the nearest quarter of an hour. Being on call requires a lot of commitment and passion for patient care, good analytical and critical thinking skills, as well as ability to work well under a lot of pressure and stress. Developing good clinical decision skills takes a lot of years of education and job experience. Although many clinicians are not able to verbally describe the thought process used to come to a conclusion, it is usually attributed to "instinct/intuition" or "gut feeling." Being on call is very challenging and at the same time a very rewarding experience for a pharmacist. Even though I may be faced with a lot of aggravation and stress from being sleep deprived and beeped 24/7, it is all worth seeing the on-call team's efforts to do everything possible to provide the timely and efficient service for the hospice patients in their end-stage diseases so they can spend their last days pain-free in the comfort of their homes. For example, today I got called in to the branch in order to dispense a morphine IV drip for a 2 year old dying baby for pain related end stage infectious disease (ie sepsis). Ironically, the baby's brother had died last year about the same time (3 days before Christmas). Because the on-call team (the driver, CSR, CPhT) had responded so promptly to my call to come in to the branch to assist me in dispensing the med, the baby was able to receive the delivery within a few hours of getting the physician order. This post took me forever to write because I got interrupted by on-calls at least 3 times while writing it. There is almost no point in going to bed now because I will get interrupted at least 3 more times till my next on-call free rotation week which starts in about 6 hours. I may think of some more tips to add to my list after I get more sleep. | | |
| 1) How to handle stress (S. Africa, Zimbabwe, Ontario, Egypt, Philippines, etc—wow, it's pretty cool how people around the world get stressed. I hope they don't take my advice seriously) 2) How to handle stress in very busy times 3) How to handle neurotic boss 4) Write a message to your boss on signs of work-related stress (Vietnam) 5) Highest stress jobs 2008 (pharmacists should be in the top 5 in my opinion) 6) Pharmacists or physician less stressful 7) Name some recommendation to handle stress 8) Stress + retail 9) Stupid dr 10) 31680 moon (Netherlands) 11) Why is there an NDC number on my prescription 12) Symbol of a pharmacist in India 13) What to do if you fail naplex 14) Mpje review questions for free 15) Free mpje sample questions (that's a very popular one. In case you are one of those people wondering, there is no such a thing as "free mpje sample questions"!!!) 16) Passed prenaplex but failed naplex 17) weird questions on MPJE 18) Can a score of 74 on mpje be passing 19) Passing rate new mexico mpje? 20) numerology italia 21) Is becoming a pharmacist stressful 22) Recommendation on how to handle stress 23) What is occasional visitor (South Africa) 24) Why not put off today wha 25) home infusion pharmacies in Alaska 26) Is being a pharmacist stressful 27) doctor write me a fake rx 28) Pharmacists don't recommend profession because 29) Babysitters stealing pain medications 30) How to handle angry people + boss (Ontario)
31) How a manager handles stress in the workplace (India) | | |
| I recently had to fill out a self-evaluation for a hospital where I work on a per diem basis. One of the forms was a job description with physical, sensory and mental requirements, and whether each one had to be performed on a frequent or occasional basis. At the end I had to sign an employee acknowledgement form affirming that I am able to perform the job without limitation, and have not knowingly withheld information in relation to these requirements. I thought to myself that if the pharmacy manager at my full time job had to fill it out, he would have easily failed the mental requirements for the job position, which potentially could be grounds for the termination. These are the mental requirements: --Read, speak, write (pass) --Oriented to reality (pass) --Can control emotions (fail) --Positive attitude (fail) --Can recall/remember (pass) --Able to work with controlled substances (fail) --Can handle stress (fail) That is a pretty scary thought that he would have failed some of the most basic mental requirements for a job, and I am surprised he lasted as long as he did. When our branch manager announced 2 months ago about his resignation, everyone let out a sign of relief. Finally, the reign of chaos and terror (which was a cause of a lot of emotional distress for a lot of people) will be over! I will never know whether he himself has resigned or whether he was dismissed because he was not competent enough to handle his job responsibilities. He has "volunteered" to grace us with his presence for an indefinite period of time, so that he could clean up the mess which he himself has created. However, it seems that the longer he stayed, the more mess he created. The only times when things would go smoothly in the branch is when he would take days off ( at a rate of 2-3 times/week) in order to use up his PTO time or to attend job interviews. When we heard the news about the hiring of a new pharmacy manager, everyone let out a huge sign of relief once again, because now the idiot boss's end with the company was feasible and eminent. Sometimes I wonder to myself whether he truly realizes how much everyone loathes and ridicules him at the branch. In case you don't believe me that I have the most idiotic and lunatic boss in the world, I have substantial evidence to prove it. First of all, he presents all the symptoms of a typical patient that you can find in a psychiatric ward. These include ADD, bipolar, paranoia, OCD, and the Napoleonic Complex. I may have exaggerated a bit (except for the last one), but he himself has openly admitted about being diagnosed with a genetic mental disorder, called "Williams Syndrome." I had never heard of this disorder before, but once I learned about it, I quickly realized that my boss is a perfect representation of a person with a Williams Syndrome. One of its distinguishing characteristics is excessive talking, which became a source of great annoyance on a regular basis for everyone in the branch due to boss's extreme spurs of "speech diarrhea." He would easily decide to have a meeting in the middle of a very busy day, which would last on average of 2-3 hours. He would talk nonstop and without a breath about the most non-substantial things, which could be easily explained in only a couple of sentences by a person without this mental disorder. If you ask him a question, he could elaborate so much that he would start explaining as far from the point as possible. If in the middle of his "speech diarrhea" you will start to yawn, to stare at the ceiling, or to fall asleep, he may start to get angry that you are not paying attention, and eventually he will start to get to the point, but by that time you will already forget the original question. Another thing that drives me absolutely insane is his innate inability and incompetence to perform the duties of a pharmacy manager, while at the same time managing to create so many problems of his own. Instead of trying to resolve issues that are really worthy of his immediate attention, he would focus on issues so trite that it would only instigate and promote the workplace atmosphere to animosity and hostility. He has a specific talent at distorting the truth. For instance, just recently he has summoned to his office one of the production pharmacists and one of the technicians, as well as a Human Resource representative. The issue that he wanted to address was that he has heard about a conflict that was going on between the tech and the RPh. Here is what happened. The tech and the pharmacist looked at each other in disbelief, shrugged their shoulders, and then just openly laughed out loud in his face because that was the first time that they heard about the issue. What the boss was probably referring to was an incident from a while ago when the RPh had reprimanded the tech on a few occasions about not wearing booties in the anti-room. This was an insignificant isolated incident not really worth of mentioning in front of either the RPh, or the tech, and especially the HR. Furthermore, some of the other things that he blew out of proportion are so absurd that the production pharmacist was on a brink of leaving the company after that meeting. He accused her of saying that every pharmacist working in the branch is "stupid" with an exception of one pharmacist, Melissa, who manages a TPN team. However, he then accused the production pharmacist of calling Melissa a "TPN princess" and of complaining that she refuses to come in to the clean room to do TPN pediatric checks. In reality, the production pharmacist jokingly calls Melissa a "TPN queen" because she is the most knowledgeable and most efficient at what she does. The production pharmacist took this as an offense, and exclaimed, "No! Melissa is not a TPN princess. She is a TPN Queen!" Besides, Melissa is one of the few pharmacists that readily volunteer to come in to the clean room to do TPN pedi checks. I think this pretty much explains why my boss is the most idiotic boss that exists on the planet Earth. So if you think your boss is an idiot, now you should be aware that your situation is not as bad as it could be. If my boss was not leaving, I would be bailing out as soon as possible because my emotional stability is the most important to me. I can hardly wait for my new boss to start, and I have heard the rumors that he is tall, dark, and handsome :) | | |
| I just read an article that lists 8 jobs that are characteristic of high stress, and a feeling of indignation has slowly started to build. I am pretty sure that every pharmacist that reads the article will start to feel the same way. Why are pharmacists not listed among the physicians and nurses as one of the most stressful professions out there? They may not deal with life and death situations on a regular basis like doctors and nurses do (with an exception of critical care pharmacists), but they are equally exposed to the stressful working conditions. Just like the physicians, the pharmacists possess a tremendous wealth of medical and drug knowledge, and in most cases they don't have a luxury of looking up the information in an encyclopedia and are expected to answer drug information questions right on the spot (whether it is being addressed by public or health professionals). Just like doctors, the pharmacists are facing an increasing danger of malpractice lawsuits due to an overwhelming amount of new pharmacy law regulations as well as high prescription volumes imposed by big box retailers. Here is a no brainer. Retail pharmacists have to work long hours with few or no breaks (one of the numerous reasons why I no longer work in retail). Even the pharmacists that are not in retail may be facing high stress. Pharmacists who practice in LTC, home infusion, or hospitals do not always have regular business hours, and they may work on little sleep and take on-calls on their days off. I wonder what is everyone's stance on this article, especially the pharmacists that practice in a different field of the profession, other than retail.
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