A pharmacist's fantasy

What woke me up on the first day of my long-awaited vacation? Was it the smell of sizzling bacon wafting past my face? A sweet, sweet pancake breakfast? The amber rays of morning light warming the bedroom? A rushing surge of energy after a restful night, pushing me to get outside for an invigorating morning run?

Well, now I'm drooling.

Nope.


Nothing so cool as all that.


It was none other than the fantasy every community-practicing pharmacist has probably had at one time or another, and it goes a little something like this: "I wonder what would happen if I put my supervisor in the exact same conditions that I handle every day. Could I create a simulation? Like a patient care lab scenario from pharmacy school, only it's a 'retail hell' scenario?"


I'd set it up in a physical pharmacy. Maybe it'd be just an hour. We could take the 300 scripts many pharmacists process in a days work and divide that down to the approximate 37.5 scripts they'd need to process, beginning to end, in that hour.


We would know in advance just how many wrenches to throw into those 37.5 prescriptions. Maybe a few types of insurance rejections, a few out of stock drugs, several required counsel patients, some drug interactions, a few drug therapy problems they'd only catch if they did the real, OBRA-outlined retrospective and prospective DUR. Sprinkle in a few immunizations because it's October, duh.


Oh, we'll give them a technician. The best of technicians. The fastest at everything.


With one catch.


This technician is an actor.


THIS technician knows about every possible pre-planned curveball, and exactly how to present it to the "pharmacist on duty" for full realism.


"Dr. Hiunmity," he says, "I have an insurance rejection I need you to look at," all while knowing exactly how it should be handled, but using this opportunity to challenge the pharmacist to see what it would be like to work with an undercompensated, inexperienced technician like we are constantly told is necessary and sufficient.


"Thank you for calling Simulated Pharmacy, Matt the Technician speaking," he says in pleasantly honeyed tones, "Oh, of course I'll get the pharmacist for you Ms. Needsarefill."


"Your payment is all processed, Mr. Newmeds, let me get the pharmacist to talk to you about those new diabetes medicines, he'll show you exactly how to use that monitor as well, and he may want to recommend some additional vaccines because of your new diagnosis."


"Dr. Hiunmity, there's an angry man at the counter, something about his daughter came to pick up his meds last week, and they're all the wrong ones, and she paid way too much, and we have to take them all back and refund him or he's going to sue." Matt shrugs.


Meanwhile, Dr. Hiunmity is staring at an Rx for data review that Matt accepted at the counter a few patients ago, as a waiter of course, for Adderall 20mg 2TID, from a PA at a family medicine practice located a 3 hours' drive away.


The daily order arrives.


C2's have to be checked in.


Matt is working at the drive through and 2 phone lines are ringing.


Maybe we should extend it to the full shift length, 8 or even 12, maybe 14 hours. We'll have to add some more technician actors to the mix for that.


Let's see if this chocolate factory can keep going faster and faster until Dr. Hiunmity is stuffing prescriptions under his hat like Lucy and Ethel on the wrapping lines. Too bad he can't eat any chocolates like they could, since he won't have any breaks. Maybe we'll tell him he can't have any food or drinks in the pharmacy either. Gotta pee? The bathroom is an eighth of a mile that way, welcome back to Rxs in the RED when you return.


When this hellish simulation finally concludes, the acting pharmacist gets "evaluated."


Points off for everything he missed.


Me, observing the chaos...and judging.

Those diabetic supply orders he approved didn't have a diagnosis code, and the tech had changed the dispensed product to Accu-chek supplies when the order stated One Touch. That's an audit item. Not to mention there was no justification on file for TID testing for a non-insulin injecting patient.


The refill for Proair he checked, well, he missed the fact that it's been filled every 16th day on the dot for 6 months, and yet the patient hasn't refilled their maintenance inhaler in 4 months. Oh, and they've recently started on a benzodiazepine Rx to manage their unexplained, new-onset anxiety and tremors.


That refill for Mr. Muskelschmerz's 80 mg simvastatin, he didn't get the Adherence TIP completed for it, nor did the patient's phone number get updated to a valid contact number so that the TIP can be completed by phone. The patient won't be back for 5 months because his cramps are so bad he just takes the meds "every couple days or so."


He got two bad patient surveys during the hour because

1) he didn't call the Ms. Farraway and tell her he had to order her brand name Coumadin, and she drove all the way here from Outinthesticks, only to be told it won't be here til tomorrow,

and

2) His drive thru doesn't have two lanes, and Mr. Impashuns thinks it should.


Matt didn't ask the new patient from the urgent care if she had any drug allergies or medical conditions during registration, and Dr. Hiunmity didn't ask during the counsel because it didn't pop up on his DUR screen. The patient has hives now because she assumed cephalexin was a different medicine than the Keflex she took years ago.


The ninety day Rx for Mr. Silentkilla actually only had 30 tablets of lisinopril in it, and Dr. Hiunmity didn't notice at product verification.


There was an error made on the first fill of Mrs. Royal's allopurinol last month, and Dr. Hiunmity caught and corrected it for this fill, but he didn't complete the corporate error report before the end of his shift. He's now on his final warning for error reporting, and next time, he's terminated.


Dr. Hiunmity didn't do a sufficient amount of verification for other stores that his computer system has shared verification for. He also didn't administer enough flu shots, AND the ones he did, he failed to recommend another indicated vaccine for the patient to increase "public health"...and the size of his employer's coffers.

Not-so-secretly reveling in every line item failure.

He failed to check the PDMP/CSMD/CURES/OARRS/whatever opioid monitoring database on that oxymorphone, and it was 5 days early. He also didn't offer the patient naloxone.


Technician Katrina didn't take her break when she was supposed to, because she thought she could help catch up the growing pick up line, and now there's a labor violation.


His wait time was 13 minutes, 4 minutes over the "district average" from last week. It doesn't matter that someone is clearly gaming the wait-time system.


Oh, and that Keflex patient is definitely suing.


Now, the board inspector was here the whole time, and he noticed 3 times Technician Susie tried to save the pharmacist some time by asking, "Do you have any questions about this medication?" and suddenly Dr. Hiunmity is on the hook for a board rule violation of allowing "screening" during his shift.


How long do you think your supervisor could last? What about their supervisor? The president? The CEO? How quickly do you think policies would change after they all failed...and failed miserably?


Me again, after seeing my pharmacy fantasy realized. No, not her. Him. I'd need a new occupation in a new location. There's no way they'd let me stay after that.



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