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.