So I'm on rotations right now. Fourth year!! I didn't think I would make it. I was very close to failing the last semester of therapy due to my inability to learn antimicrobials and their appropriate regimens.
So of course I'm about to finish up an Antimicrobial Stewardship rotation.
Things have been rather...general the first 3.5 weeks of the rotation. Then last Wednesday a patient came in with large leg swelling and turning purple/black. They were in sepsis. They had cut themselves on Sunday and had gotten a prescription for Keflex. However, the cut had progressed into an infection. By the time they had gotten to the hospital we threw Primaxin, Zyvox, clindamycin, and Levaquin at them, due to the quick progression. The discoloration and swelling had moved up toward the hip area.
We couldn't transfer them to a different hospital, one more equipped for this type of issue. So we arranged for an amputation, which was successful, but unfortunately the patient was in such poor condition that they passed away. The surgeon said that the leg had pockets of fluid and gas that smelled horrible, and that the muscle had turned into mush. It was also possible that the gangrene had progressed to the lower back region.
It shook everyone up in the pharmacy and Infectious Disease department, especially since the patient passed away within 24 hours of arrival to the hospital. I've thought about that patient every day.
The cultures came back with Proteus vulgaris, Klebsiella, and Aeromonas. Aeromonas loves to live in water and is a rather sensitive microbe, but specific in what you can treat it with. I've found that Bactrim, 3rd and 4th generation cephalosporins, and the quinolones are effective in treating it. Antibiotics that are commonly prescribed in the healthcare community.
Anyway, another patient, this time a 10 year old came in on Monday with the same presentation. The culture came back today (Wednesday) positive for Aeromonas. I hope it all works out, and I will definitely check on their progress.
It was by good happenstance that the Infectious Disease physician was alerted to the patient and recognized the similar progression and ordered the culture, as well as started them on appropriate antibiotics.
I like to think that the previous patient would be somewhat glad that their infection last week was able to alert us to potentially save a 10 year old. I'll probably continue to think about these cases for a long time to come.
Thursday, September 11, 2014
Sunday, March 23, 2014
My love/hate relationship with February...
Filling prescriptions in March is slightly more simple than at any other time during the year because figuring out when controlled refills are due is just so darn easy.
My pharmacy refills controlled medications 2 days before the patient should be completely out.
Therefore, if they received a 30 day supply the month before, we will refill it on the 28th day. February usually has 28 days, so the day that you filled in February is the day that you will fill in March. It's pretty awesome that way.
However, I got into an argument with a patient today about refilling their medication. Our computer will allow the prescription to go through 3 days early, so we have to be careful. Even then, it was still too soon to fill today, as this would have been 4 days early.
Anyways, the Rx was filled on 2/24 and we "always fill 2 days before it was filled last month" and that "every time they call someone else has a different rule." Couldn't get it through their head. Tried. Failed. Frustrated. I don't doubt if they will try to get it earlier each month.
However, if you're getting 2 days early each month, but the end of the year you will have 24 extra days of medication. That's almost an entire month. Where are they all going?
My pharmacy refills controlled medications 2 days before the patient should be completely out.
Therefore, if they received a 30 day supply the month before, we will refill it on the 28th day. February usually has 28 days, so the day that you filled in February is the day that you will fill in March. It's pretty awesome that way.
However, I got into an argument with a patient today about refilling their medication. Our computer will allow the prescription to go through 3 days early, so we have to be careful. Even then, it was still too soon to fill today, as this would have been 4 days early.
Anyways, the Rx was filled on 2/24 and we "always fill 2 days before it was filled last month" and that "every time they call someone else has a different rule." Couldn't get it through their head. Tried. Failed. Frustrated. I don't doubt if they will try to get it earlier each month.
However, if you're getting 2 days early each month, but the end of the year you will have 24 extra days of medication. That's almost an entire month. Where are they all going?
Tuesday, May 28, 2013
Made your own bed...
So my second year of pharmacy school is over. I passed all the classes! Now I'm working about 40 hours a week. Nothing incredibly interesting has happened until today.
The pharmacist got a call to transfer a couple of scripts from another state. An antibiotic and pain medicine from a dentist office, nothing too interesting. Probably up here for the weekend with the holiday.
Funny thing is that we've had people try to scam by having dentists call in medication on the weekend claiming that they have a toothache. The dentist calls it in and the patient picks it up! That's great, but they're having multiple dentists call it into multiple pharmacies along the highway.
And they're not even patients with that dentist.
That was the other week though. Meh. The pharmacist was going to give benefit of the doubt, until we received a couple of calls.
One tech talked to a woman, the other tech talked to a man. They were each asking if the patient's adult child could come by to pick up the medicine.
Long story short, we were getting conflicting stories about antibiotic allergies and reasons of not picking up all the medicines together. The pharmacist called the dentist out of state on a holiday and, explaining our rationale on being extra cautious recently, low and behold the dentist recognized the name of the scammer from last week. I guess the patients are working together under different names... *sigh*
Tried to call the patient back, but they wouldn't even pick up, and never called back. I guess they figured we were onto them.
Made the long-lasting slow holiday a little more interesting though!
The pharmacist got a call to transfer a couple of scripts from another state. An antibiotic and pain medicine from a dentist office, nothing too interesting. Probably up here for the weekend with the holiday.
Funny thing is that we've had people try to scam by having dentists call in medication on the weekend claiming that they have a toothache. The dentist calls it in and the patient picks it up! That's great, but they're having multiple dentists call it into multiple pharmacies along the highway.
And they're not even patients with that dentist.
That was the other week though. Meh. The pharmacist was going to give benefit of the doubt, until we received a couple of calls.
One tech talked to a woman, the other tech talked to a man. They were each asking if the patient's adult child could come by to pick up the medicine.
Long story short, we were getting conflicting stories about antibiotic allergies and reasons of not picking up all the medicines together. The pharmacist called the dentist out of state on a holiday and, explaining our rationale on being extra cautious recently, low and behold the dentist recognized the name of the scammer from last week. I guess the patients are working together under different names... *sigh*
Tried to call the patient back, but they wouldn't even pick up, and never called back. I guess they figured we were onto them.
Made the long-lasting slow holiday a little more interesting though!
Tuesday, October 30, 2012
No respect...
I feel like Rodney Dangerfield!!
I went into work last night for a couple of hours. I never work on Mondays so I was surprised to see on my schedule the 2 hours of labor posted.
I drove 25 miles in the constant rain from Hurricane Sandy and bad drivers after completely bombing a psychiatric medicines test after working all weekend.
After coming in late and finally being able to clock in, I wait on a patient at the register.
Their prescription is not quite ready. They berate me because they dropped it off 45 minutes ago, and seriously, how long does it take to slap a label on the bottle?! Turns out it's too soon on insurance, and can't be covered for a couple more weeks, since it was just picked up a week ago. After finding out the drug is $290.56 cash, they decide to wait for a couple of weeks.
Found out later that the patient was told all of this at drop-off. *scratches head*
Another patient called in to speak with the pharmacy manager to file a complaint.
Oh no.
From what I could tell, the doctor prescribed a drug that would interact with a current drug. The pharmacist called and explained, and got the drug changed to something else. Filled it. Boom. Done. The patient picked up the script and was apparently never told of the interaction or the changed medicine.
Wanted to know why the pharmacist couldn't speak to them personally when the patient came by to pick up the meds.
We filled 370 scripts yesterday with only 1 pharmacist and 5 techs. Kinda busy. Excuse? No. But the patient talked for 10 mins on the phone about the subject. I'm surprised the pharmacist kept their cool for so long. I don't know what else could have been done after the fact. The patient may bring back the medicine due to the misunderstanding. So much for looking out for your patients!
Last story, I swear... We get these nice printouts if something is out of stock so as to remind us to order it and call the patient. I was looking through the printouts to make sure everything was ordered, and found one that I could fill. Changed the NDC, went on my way, and saw the patient had a coupon card for another drug they had ready. Reprocessed and rebilled, then went to change the paperwork.
The pharmacist was like a ninja, looking over my should for any transgressions.
"What are you doing?"
"... Um. Fixing this issue that I found?"
"Why are you digging through that person's profile?"
"...I just noticed it when looking for something else. I thought I'd go ahead and fix it."
"Oh. I thought you were just trying to make more work for yourself..."
Thank goodness that "extra work" was done because the patient showed up 2 mins before closing. Imagine if that prescription wasn't filled or if the coupon card wasn't applied before hand? ...Right. Any thank-you from the pharmacist? Pshaw...
Just no respect...
I went into work last night for a couple of hours. I never work on Mondays so I was surprised to see on my schedule the 2 hours of labor posted.
I drove 25 miles in the constant rain from Hurricane Sandy and bad drivers after completely bombing a psychiatric medicines test after working all weekend.
After coming in late and finally being able to clock in, I wait on a patient at the register.
Their prescription is not quite ready. They berate me because they dropped it off 45 minutes ago, and seriously, how long does it take to slap a label on the bottle?! Turns out it's too soon on insurance, and can't be covered for a couple more weeks, since it was just picked up a week ago. After finding out the drug is $290.56 cash, they decide to wait for a couple of weeks.
Found out later that the patient was told all of this at drop-off. *scratches head*
Another patient called in to speak with the pharmacy manager to file a complaint.
Oh no.
From what I could tell, the doctor prescribed a drug that would interact with a current drug. The pharmacist called and explained, and got the drug changed to something else. Filled it. Boom. Done. The patient picked up the script and was apparently never told of the interaction or the changed medicine.
Wanted to know why the pharmacist couldn't speak to them personally when the patient came by to pick up the meds.
We filled 370 scripts yesterday with only 1 pharmacist and 5 techs. Kinda busy. Excuse? No. But the patient talked for 10 mins on the phone about the subject. I'm surprised the pharmacist kept their cool for so long. I don't know what else could have been done after the fact. The patient may bring back the medicine due to the misunderstanding. So much for looking out for your patients!
Last story, I swear... We get these nice printouts if something is out of stock so as to remind us to order it and call the patient. I was looking through the printouts to make sure everything was ordered, and found one that I could fill. Changed the NDC, went on my way, and saw the patient had a coupon card for another drug they had ready. Reprocessed and rebilled, then went to change the paperwork.
The pharmacist was like a ninja, looking over my should for any transgressions.
"What are you doing?"
"... Um. Fixing this issue that I found?"
"Why are you digging through that person's profile?"
"...I just noticed it when looking for something else. I thought I'd go ahead and fix it."
"Oh. I thought you were just trying to make more work for yourself..."
Thank goodness that "extra work" was done because the patient showed up 2 mins before closing. Imagine if that prescription wasn't filled or if the coupon card wasn't applied before hand? ...Right. Any thank-you from the pharmacist? Pshaw...
Just no respect...
Thursday, October 25, 2012
New Tricks!
So the pharmacy world is a-changing. We have to take care of our patients now more than ever, it seems. I haven't been to work in a week, but as soon as I arrived I received a new playbook.
My state has recently updated the controlled medication laws so that when a person picks up their medicine, I need to put some sort of ID on file. Pretty nifty, but very time consuming until we get most people into the system. We don't have any form of notification posted, so that will be fun explaining the new law update to the patients. They're going to think that we're just making laws up as we go...
Also, my company has rolled out writing thank-you cards to patients. I'm not sure what this entails since we're waiting on receiving the stock from district.
And last, my company is requiring that we call at least 35 patients 3 times a week to see if they want to have any refills. We print out a report that has people that are due to have refills, and call them to see if they would like for us to go ahead and do that. Some people are receptive. Others are downright paranoid.
"Hi, this is WannabeRx from Mulpepper's Apothecary Shop in Diagon Alley. May I speak to Ms. Dilys Derwent, please?"
"This is she."
"Hi, Ms. Derwent. We have started a new program here that shows us when patients are due to have prescriptions refilled and your name came up."
"Ok, what is it?"
"Well, actually, before I can continue, for your privacy, when is your birthday and address?"
"...How do I know this is Mulpepper's Apothecary? You can't just give your information to anyone now-a-days."
"Um... Oh. Well..."
And that, my friends, is how you get into a HIPAA battle. I can't tell her any information without verifying her identity; she won't give me any information without knowing that I'm not a thief attempting to steal her identity.
Eventually, I figured that I could have her look at an old prescription bottle and read information off of there to show that I was legit. It worked, but Ms. Derwent didn't want her prescriptions filled right then. Decided that she'd call them in when they were out... o.O
It makes we wonder if more of a hindrance than a help to call these patients who seem to be well-off regardless. However, there were a couple of patients I spoke with that were very appreciative of the effort. I guess you gotta take the bad with the good...
My state has recently updated the controlled medication laws so that when a person picks up their medicine, I need to put some sort of ID on file. Pretty nifty, but very time consuming until we get most people into the system. We don't have any form of notification posted, so that will be fun explaining the new law update to the patients. They're going to think that we're just making laws up as we go...
Also, my company has rolled out writing thank-you cards to patients. I'm not sure what this entails since we're waiting on receiving the stock from district.
And last, my company is requiring that we call at least 35 patients 3 times a week to see if they want to have any refills. We print out a report that has people that are due to have refills, and call them to see if they would like for us to go ahead and do that. Some people are receptive. Others are downright paranoid.
"Hi, this is WannabeRx from Mulpepper's Apothecary Shop in Diagon Alley. May I speak to Ms. Dilys Derwent, please?"
"This is she."
"Hi, Ms. Derwent. We have started a new program here that shows us when patients are due to have prescriptions refilled and your name came up."
"Ok, what is it?"
"Well, actually, before I can continue, for your privacy, when is your birthday and address?"
"...How do I know this is Mulpepper's Apothecary? You can't just give your information to anyone now-a-days."
"Um... Oh. Well..."
And that, my friends, is how you get into a HIPAA battle. I can't tell her any information without verifying her identity; she won't give me any information without knowing that I'm not a thief attempting to steal her identity.
Eventually, I figured that I could have her look at an old prescription bottle and read information off of there to show that I was legit. It worked, but Ms. Derwent didn't want her prescriptions filled right then. Decided that she'd call them in when they were out... o.O
It makes we wonder if more of a hindrance than a help to call these patients who seem to be well-off regardless. However, there were a couple of patients I spoke with that were very appreciative of the effort. I guess you gotta take the bad with the good...
Tuesday, October 2, 2012
Professionalism
At my pharmacy school we have weekly meeting in the auditorium. These meetings could be about the student government, various announcements, or professional speakers.
Professional.
All of the students naturally sit near the back of the auditorium. Many of the students are studying for other courses or playing on their computers. We got called out on it last week and an e-mail was sent from the Dean stating that we are professionals and should treat our speakers professionally.
Therefore, the entire SOP must sit in the front 8 rows of the auditorium so that we can pay attention and give appropriate feedback for the professionals.
We all knew why we were being moved to the front, but we also had to be chastised for 10 minutes like 5 year olds as to why we were being punished. It was infuriating.
The actual lecture was interesting: how to avoid debt once you graduate. Points to be taken from this lecture:
Later on in the day there was cake for those who had a birthday in October. This is sponsored by the student government, so it is free to the students. Last month we celebrated months May - September, so there were numerous cakes. A lot of the cake was left over, so I guess they didn't want to be wasteful this time. Why worry though? There are only ~30 students with their birthday in October.
I'm one of them.
I was excited about cake. I enjoy cake as much as anyone else. I had just taken my St Johns wort without water and it had gotten stuck in my esophagus. I was happy to have such a delicious treat to wash down my medicine.
I casually stroll to the breakroom and wait in line for the cake. I make note of how many people are partaking in this celebration who do NOT have birthdays in October. Hm. Probably ~40 people more?
Unprofessional.
By the time I get to the front of the line, there is no cake left. I yell at everyone that they are "bitches and hoes who are selfish because they didn't leave any cake for who it was intended."
That oughta teach them about being professional.
Professional.
All of the students naturally sit near the back of the auditorium. Many of the students are studying for other courses or playing on their computers. We got called out on it last week and an e-mail was sent from the Dean stating that we are professionals and should treat our speakers professionally.
Therefore, the entire SOP must sit in the front 8 rows of the auditorium so that we can pay attention and give appropriate feedback for the professionals.
We all knew why we were being moved to the front, but we also had to be chastised for 10 minutes like 5 year olds as to why we were being punished. It was infuriating.
The actual lecture was interesting: how to avoid debt once you graduate. Points to be taken from this lecture:
- Open a line of credit so as to establish a credit score
- Pay all of your bills on time
- Put money away into a savings account, or even better, some account that has a higher interest
- Try to get out of debt as soon as possible - don't spend all of the first paycheck on a Jaguar
Later on in the day there was cake for those who had a birthday in October. This is sponsored by the student government, so it is free to the students. Last month we celebrated months May - September, so there were numerous cakes. A lot of the cake was left over, so I guess they didn't want to be wasteful this time. Why worry though? There are only ~30 students with their birthday in October.
I'm one of them.
I was excited about cake. I enjoy cake as much as anyone else. I had just taken my St Johns wort without water and it had gotten stuck in my esophagus. I was happy to have such a delicious treat to wash down my medicine.
I casually stroll to the breakroom and wait in line for the cake. I make note of how many people are partaking in this celebration who do NOT have birthdays in October. Hm. Probably ~40 people more?
Unprofessional.
By the time I get to the front of the line, there is no cake left. I yell at everyone that they are "bitches and hoes who are selfish because they didn't leave any cake for who it was intended."
That oughta teach them about being professional.
Turn Around of Things
So things have looked up since the last post. After my mental breakdown after the first med chem test and other assorted issues, I decided to start taking something to help with my mood swings and depression.
Enter: St. John's Wort
This is one of the most promiscuous drugs in the pharmacy. It is all of the other drugs' businesses, and tries to control them.
I am not currently taking any other medicines, not even OTC, so I'm not terribly worried about it.
My mood has increased. I've been able to focus more and study harder. I've made more flashcards and gotten much better grades than I think I deserve. Things are more positive for this pharmacy student.
I've also noticed that I've lost 6 pounds since taking this supplement. That makes me wonder if that's what makes patients less depressed. "You lost some weight! Hurrah!!" Awesome thing is that I still get to eat my pastas, cupcakes, potato chips, and ice cream and still lose this weight. It's really not fair...
I haven't heard anything about my previous roommate. They were offline for 1.5 weeks, and now won't speak to any of us. I think they just want to forget about it. Can you blame them? As long as their safe and somewhat happy, I guess that's all I can ask for.
I have found this great tumblr for pharmacy students: I prefer you call me doctor
Enter: St. John's Wort
This is one of the most promiscuous drugs in the pharmacy. It is all of the other drugs' businesses, and tries to control them.
I am not currently taking any other medicines, not even OTC, so I'm not terribly worried about it.
My mood has increased. I've been able to focus more and study harder. I've made more flashcards and gotten much better grades than I think I deserve. Things are more positive for this pharmacy student.
I've also noticed that I've lost 6 pounds since taking this supplement. That makes me wonder if that's what makes patients less depressed. "You lost some weight! Hurrah!!" Awesome thing is that I still get to eat my pastas, cupcakes, potato chips, and ice cream and still lose this weight. It's really not fair...
I haven't heard anything about my previous roommate. They were offline for 1.5 weeks, and now won't speak to any of us. I think they just want to forget about it. Can you blame them? As long as their safe and somewhat happy, I guess that's all I can ask for.
I have found this great tumblr for pharmacy students: I prefer you call me doctor
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