I can remember a time when it wasn't unusual for pharmacies to borrow pills from each other in order to take care of a customer. These days though, you pretty much always just send them to the store that has the goods. Probably because we care far less about your business than we used to. Hate to break it to you, but as prescription counts go through the roof, your particular prescription counts for less and less. At any rate, the fact she wanted a borrow and the desperation in her voice told me there was a story here. I made its telling the price of my cooperation.
It seems that the day before, another pharmacist at this store named Hillary received a prescription for Biaxin. Having none on the shelf, she filled it with Biaxin XL and told the customer that they could "just scrape off the enteric coating." Hillary then thought better of it later on that night and left a message on the store's voicemail explaining what she had done. Meaning the pharmacist I was talking to walked in the door and started her day having to clean up a giant stinking pile of crap she had nothing to do with.
It wasn't an accident. An actual real, licensed pharmacist thought about it and deliberately dispensed the wrong drug. I swear to God and anything else holy or evil if you are a pharmacist, and you ever work with me, and you ever do anything like this that I have to deal with, I will not kill you. I will torture you in the most possibly painful way I can think of for as long as I can get away with it.
Of course I also wonder what kind of person hears "scrape the coating off your tablets" and considers that to be a sound plan. But pretty much all the blame goes to the pharmacist here, who should be tortured.
Although her name wasn't Hillary. I changed her name not only to protect the guilty, but hoping to create some sort of negative subliminal impression that will help you do the right thing on Tuesday.
14 comments:
Wow, that's... astonishing.
There are some dumb people practicing the profession out there. One time I had a patient whose husband was getting chemo at our clinic complain that her pharmacist had tried to give her Innohep instead of Eprex, claiming that they were the same thing (for those of you not in the know, Eprex is given to raise red blood cell counts, and Innohep is an anticoagulant - NOT good drugs to be mixing up). This guy apparently even argued with the patient's wife when she tried to tell him something wasn't right. The wife was an 85 year old woman, too - thankfully she was with it and stuck to her guns. We called and straightened the whole mess out, which did give me the opportunity to ask the guy what the f**k he thought he was doing (I failed to get a very coherent answer). I suggested the patient file a formal complaint with the Ontario College of Pharmacists, so I hope my little friend there will be getting an unwanted summons fairly soon.
Hope that the person who dispensed the wrong pills and the nutty advice learned a big lesson!
Like the Hillary note....
Wow. That is, well, appalling.
And timely for me. I have a lecture to give on controlled release products tomorrow. The students are getting this anecdote. It won't be the first time you've been mentioned in my class (and given due credit, too).
I think part of my pharmaceutics-teaching soul died when I read the "just scrape off the coating" bit. I really, really want to know where that person went to school, and if it was a case of her never listening in class, or this being something that never even got taught.
Somebody needs to yank "Hillary's" license STAT.
And as much as I hate to say it, but at least it was an antibiotic and not something more dangerous. She could have killed somebody!
Had a pharmacist in my store a couple months ago covering.
First let me start by saying she got her degree and then became a drug rep for about 10 years. Then decided to get her license and start to practice in the retail setting.
She was alone for part of the day (on a Saturday, 10 hours about 50 rxs, so not too bad). I come in on monday to a patient asking me why her meds came in a different bottle than she is used to....
So, think back to the first days of school, you learned some basic things: Dont tell people they can use their 3 year old tetracycline, No you cannot have an early refill, Vancomycin sucks, and one that is drilled in is...you CANNOT take Nitro SL tabs out of their little glass bottle, they stay in there and you do not take them out as the plastic can degrade the nitro, and any moisture can destroy the little buggers.
Yep, she opened the little glass bottles and poured it in the plastic bottle! I asked what she was thinking, it is not good if these people have chest pain and their nitro does not work. Perhaps she should flip through a few books before coming back.
Cringing at the repacking of the nitroglycerin....
Well, a class full of first-year pharmacy students gasped audibly at this anecdote, BEFORE they had heard 90% of the controlled release lecture, because they have common sense. The fact that someone made it through some program and still did this just makes me sad and horrified.
LOL... The nitroglycerin... My first day as a tech I specifically asked what to do regarding the packaging... They said to put the pills in a plastic vial... I thought that was weird because I remembered something from class about that drug... So, I counted them out and dumped them into a vial... What they MEANT to tell me to do was to put the sealed glass bottle in a plastic vial and label it... Sigh... Strangely, I haven't had to fill for those pills again...
Wow...can hardly believe these pharmacists made it through school, internship, externship and into real world. What's going on? So far in the past two years in the agency work I've done I've had personal experience with pharmacists now sitting in Federal prison for tax fraud, saving up narcotics from compounding, taking pills from the inventory, doing stupid things like putting emergency supply tablets in an unmarked vial, and now these incidents of telling patients stupidities. Are these accumulated 'momentary' discretions a sign of professional mental lapses into uncommon sense, lack of (or imbalance of too much pressure) oversights, or just too much fray as Ole Pharmacist mentions in lack of uninterrupted workflow? In my work, I strive for consistency. It helps with decision-making in unfamiliar situations. If I didn't have Biaxin XL and told the patient mistakenly that I had the drug, for instance, I'd apologize and say, 'Sorry, I thought I had what was needed to fill the prescription, but I don't and this Rx will either need to be taken somewhere else, or filled when I can get some, or if I can talk with the physician about an alternative' but tell a patient 'to scrape off a coating'? Some things are pretty basic when come out of school--don't sell expired medication, don't misbrand/mislabel, don't lie, don't steal, etc., and fill prescriptions correctly.
I worked with an extern one time who was a complete idiot. The one incident that stands out is when a little old man came up and asked what he could do for his hemmorhoids. She told him to use capsacium cream. I couldn't believe what I was hearing!! I had to RUN over to the other side of the pharmacy to correct her so this poor man would not be in pain for days!!! For the love of pete - capsacium cream for hemmorhoids!? Holy shit!
Unfortunately, as a tech (and hopefully a future pharmacist), I've worked with a lot of floating pharmacists like this (well, maybe they weren't idiots, they just didn't care, but either way they made WAY too many mistakes.)
Actually I changed my mind. You can't do something like this (or the many pharmacist mistakes I've caught--it's supposed to be the other way around, isn't it?) and not be an idiot.
Sorry to have to make you moderate twice, Drugmonkey! I love your blog!
Either the individual standards of practice are deteriorating (i.e., actually not caring about which drug delivery system is being dispensed), or some of today's pharmacists are in such a f*****g hurry that they will say or do anything to move the prescription conveyor belt along. Nope, I won't. I'll piss you off every time (as gently as possible) telling you I don't have any Biaxin in stock.
Ever notice how a control release product comes out right about the time the drug's patent is expiring? I bet they don't teach that in Pharmacy School.
Anonymous,
Actually, some of us are cynical enough that we in fact do teach that controlled release products tend to come onto the market just as the patent is expiring.
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