What does a pharmacist DO?

Factual Questions
41

The whole issue of computers and software is, as always with computers everywhere, a mixed blessing.

Yes, the software will give the pharmacist a popup when potentially dangerous drug interactions are imminent, and it’s very handy–but only if the Walgreens computer has been informed about everything the patient is taking. Computers are only as smart as the people typing things into them. As observed above, some people patronize not only a Family Practice GP, but also a dermatologist, a gynecologist, and a dentist, plus they make regular Sunday afternoon swings through the hospital emergency rooms for antibiotics and painkillers and Albuterol inhalers. If all those scrips are filled at Walgreens, then no problem. But if not, then not.

Whoever quibbled about “tid”, above–Walgreens has our software rigged so it’s all like macros, we type in “tid”, and “three times a day” comes out on the label. It’s easy to type scrips with the macros–but there’s not enough room on the label for the Prednisone Protocol (“Take 4 a day for 3 days, take 3 a day for 3 days, take 2 a day for 3 days…”), so you have to type it all out in WordPad after all.

The pill-bottle-filling robot that does the bulk of the heavy lifting for us at our store (the Yuyama) is marvelous–until a pill jams in the cell, or until you need those pills “right now, customer is waiting!”, but “The Prescription Has Not Been Completed” is all you get, as the robot smugly chugs its way through its “To Do” list.

There is some extremely nifty computer-generated prescription software out there, that automatically prints out for the patient, or faxes to the pharmacy, the patient’s scrip. Would that more doctors used it. It even comes with a computer-generated doctor’s signature, with the name printed out underneath. I love typing those, 'cause you can ALWAYS read them.

So the computer makes our job easier–until the LAN crashes. Then we’re basically out of business, for hours, until Tech Support gets us back up again. It’s happened twice in the two months I’ve been there.

Just today, a woman came through the drive up and wanted to know if she could drive a car while taking mezacline, so I went to ask the pharmacist, and he responded irritably can she drive a car while she’s not on mezacline, which I interpreted a qualifed “yes”, so I passed it along to the woman, and I suggested she check with her doctor to be sure–and she said her doctor had told her to ask the pharmacist.

42

Basically, what DDG said.

However, if software is designed to catch things that are out of the ordinary, whatever that might be, there are too many variables for that to be 100% practical, at least at the retail level. In a hospital setting, where the entire medical record can be combined, including prescription drugs, it’s a different story.

But anytime you have human intervention, things are going to get ugly. A pharmacy tech where I worked was in the habit of overriding these warnings, figuring that if an MD prescribed it, it must be okay, right? Except he missed some critical things like an overdose, an interaction that had the potential to get nasty (two different docs prescribed drugs without bothering to look to see what the patient was already taking), and various other mistakes. Some of these were relatively minor, but some of these could have killed patients. The pharmacist checking prescriptions caught some of these, and the floor nurses caught the rest.

Like any other computer system, GIGO. If people don’t pay attention to what they enter (or how they enter it), the end result is going to be a mistake. This is not so bad when you’re talking about insurance claims, but could have fatal consequences when you’re talking about drugs. My father, a PharmD, has more horror stories about computers going wrong and having to move mountains to fix the problems.

Robin

43

And sometimes the patient doesn’t know what she’s been taking, or she “doesn’t want to bother the doctor” while he’s sitting there scribbling out her prescription, or she doesn’t think it’s important to tell him that her gynecologist already has her on the same antibiotic for something…But she’ll come in to pick up the GP’s antibiotic, and she’ll blurt out, “You know, Dr. Tsuda has me on this, too”, and I’ll say “Oh really” as I hand her the receipt–and the pharmacist, who may be a total jerk but who has ears like a cat when it comes to what’s going on during his watch, will come bustling over and say “what?” He may not be her Friendly Neighborhood Pharmacist, he may not be her “caretaker” in the sense of knowing precisely who she is and what she’s on, he may not know her from Adam and may devoutly wish never to see her again–but his carefully trained anal-retentive professional pharmacist’s ears heard “I’m on duplicate drugs”.

Software won’t do that.

44

And sometimes patients aren’t exactly forthcoming about what they’re taking. Patients take vitamins and herbal supplements that interact; they take OTC meds that interact; they take street or prescription narcotics that interact. And they don’t tell their doctor because it’s OTC.

Robin

45

And, as I tried to point out above, they’re also only as smart as the software company that writes their programs. (Where the smartness of the company is best measured by taking the lowest I.Q. of anybody in the software development chain and dividing this by the number of people working on the software.)

46

Huh. I worked in a mom-and-pop pharmacy in high school. Ages 15-18. In that time, I was never certified for anything, and my “official” job title was “clerk,” because I ran the cash register quite a bit.

However, I also counted pills (even Schedule IIs, with supervision), kept track of the drug inventory, compounded “special acne cream” and “diaper rash ointment,” and basically had access to anything at any time. The pharmacist I worked for liked to delegate pretty much everything while he talked to patients, deciphered handwriting, and made bottle labels on the computer.

Very small town, so very relaxed. I don’t think that the overworked Walgreens pharmacists in the next town over had anything in common with our pharmacist. He and his wife owned the whole business, and she managed the store. So it all varies on where you’re practicing pharmacy.

47

Heh. :smiley: I mentioned this to the Better Half, and he said, “Yeah, right, like you’d want Bill Gates in charge of your pills…”

Walgreens Corporate did a software upgrade last week (they implement these in the middle of the night via the huge central network).

The “filling your prescription” process, as always, begins with scanning the Rx hard copy that’s handed in at the window; the scanned image becomes part of your Walgreens computer prescription record. This is actually not a bad idea, as it means anybody anywhere can get a good look at what the doctor actually wrote.

In their zeal to obtain e-mail addresses for all customers, Corporate used to have a little sticker that printed out along with the label that said “Need E-Mail”, that the filling tech would stick on the front of the brochure (if she remembered). And then the cashier, when she handed it out, would ask them if they had an e-mail address (if she remembered.)

However, Corporate has now made it so that we can’t scan a hard copy to even begin to fill a prescription until either the “E-Mail?” blank on the patient’s Information page in the computer has something entered in it, or until the “N” for “No E-mail” blank has been checked. The “Start Scanning” box is completely grayed out until “E-Mail?” has been dealt with.

But, you know what? We discovered long ago that it really pisses people off to ask them, “Do you have an e-mail address?” They are rightfully suspicious–“Why do you want to know that?” And the majority of the old folks either can’t hear you, or don’t understand the question, and they get all flustered because you asked them a question they can’t answer.

Also, this doesn’t address the issue of the people who leave scrips in the drive-thru cage, and then vamoose. And it doesn’t address the issue of the voice mail scrips that the pharmacist gathers from the message queue. Doctors’ nurses leave these, and they have no idea whether the patient has an e-mail addy.

So are we supposed to just hang onto the scrips and not fill them, and then when the patient comes in to get their meds, tell them, “I’m sorry, your stuff isn’t done, tell me whether you have an e-mail address first, and then it’ll be another 20 minutes, have a seat”?

It took us techs about 4 seconds to decide to just Tab over 18 times, hit “N”, hit Alt-S for Save, and then Alt-T for Start Scanning.

Screw Corporate zeal.

48

(And of course I was talking to Tracer, whose quote about software got left out.)

49

True Pharmacist hero story:

My daughter had major allergy problems when she was a child including severe bouts of asthma and bronchitus (she still has many today at age 24). We had to see a sub doctor one day, new med graduate, because the regular doctor was not on call. He examined my daughter for about 2 minutes and then said he was going to inject her with drug A and prescribe drug B. I told him she had severe reactions to both drugs A and B previously and I would not allow her to get either the injection or take the script. He replied that he would take my daughter into protective custody and charge me with child endangerment if she was not injected with drug A immediately.

Long story short, I grabbed my kid, and ran to the onsite pharmacy, and the pharmacists who had taken care of her all her life. One of the pharmacists came around the counter and literally stood between me and the doctor and calmly explained to him that she should recieve neither drug A nor B.

I truely believe that my daughter is alive and healthy today due to this small group of pharmacists; Dad, two sons and two daughter-in-laws who took care of her for the first 8 years of her life.

So yeah, I respect Pharmacists. :slight_smile:

50

Great post sinjin