Sunday, August 16, 2015

DANGEROUS PHARMACY DISTRACTIONS

Dangerous Pharmacy Distractions

By

Terri DelCampo

After seven years as a retail pharmacy technician, I can speak for the dangers of on-the-job multi-tasking.   We are not selling popsicles.  We are selling serious medications that can be lethal if we make mistakes. Yet, distractions ruled as I entered, counted and packaged prescription medications for my oh-so-trusting customers.    

Fourteen hour shifts filled with music, commercials, and propaganda; oh my!

A constant, fourteen hour bombardment of satellite music is interrupted by even louder commercials and marketing propaganda, coming through the speaker situated in the ceiling right above the prescription drop-off counter. Hearing important prescription information is difficult (and sometimes impossible for hearing-impaired customers). 

Typical shift walk-through. 

Late afternoon, about a minute after five as I enter the pharmacy.  I greet the customer waiting at the register with, “I’ll be right with you,” turn to the window register where I clock in, drop my purse in the cabinet below the counter and shrug into my lab coat.

The pharmacist, asks me to get the window, “They were first.”  I do so, accepting a prescription from Mr. X.  “Date of birth, please?”  He wastes time arguing. “I’m in the computer.”  “Yes, but we look up your information with your name and date of birth,” I explain.  He gives me the date of birth.  How long will that take?”  I glance back at the bench, to see how piled up things are and shrug, turning back.  “About twenty minutes.  Is the insurance we have in your profile current?”  “Oh!  That’s right, I have a new card,” he says, fishing it out of his wallet.  I promise him I'll work quickly, thinking I should have said thirty minutes, considering probable insurance glitches, and dinner hour rush.  He leaves, and after another drive-up customer, I can get started on Mr. X.  Or so I think. 

A lady brings items to the pharmacy counter to avoid register lines up front.  She hands me a coupon that doesn’t work. Short on time, I page the manager to deal with it, and return to Mr. X’s script. 

As I pull up his profile the phone rings, announced by the automated phone voice that repeats “One Pharmacy Call” until the phone is answered, creating distractions for staff trying to concerntrate on customers and tasks at hand.  I grab the phone to receive and enter three prescriptions from Mrs. Q. She's out of her meds. I generate a label and provide a couple of pills until her doctor authorizes the refill. 

As I enter Mr. X's insurance information, another tech asks me to decipher a hand-written script.

Then a customer asks, “Do you have a rest room?”  I give them the key pad code and watch as they start to enter the stock room which would set off the alarm.  “No Ma’am, all the way in the corner,” I reiterate, my patience waning for people who can't follow simple directions. 

Mr. X. -- Eleven of the twenty minutes I promised have elapsed.  So now I hurry. 

Excuse me, do you carry Tea Tree Oil?” another voice from the drop-off.  As she follows my directions to it, she is oblivious to her little boy poking the boxes of Mucinex, watching them topple like dominoes. Only I see the mess her child is leaving in his wake. 

Unlike most insurance companies, who only require a doctor's DEA number to be recorded on a script, Mr. X’s requires his doctor’s state license number as well.  That requires an in-depth search and then the number entered manually. 

No time to pee. 

Then Mr. X’s insurance rejects his claim because of the amount prescribed which I will have to explain to him later.  I edit the prescription. 

I wait on a customer at the register with the huge pile of items, once again abandoning Mr. X’s script. 

She has seven clearance items which don’t scan and must be rung up manually.  She forgot her Discount Card.  The third phone number I enter works to pull up the card.  I remind her to update her profile information, writing the number on the receipt for her, cursing the marketing ploys that waste my time. 

Someone printed Mr. X's label while I was at the counter, so I attach it to a bag, pull the drug, and write a note on the label about the insurance issue.  He's back at the window.  I rush counting the pills and bottling them.  I hear him shout at April.  “She told me twenty minutes!  It’s been half an hour!  How long does it take to count a few pills!”  April politely explains the time variables. 

The scan fails when I sweep the vial beneath it.  It’s the right drug and the right strength, but a new manufacturer, and the change wasn’t reflected in the computer.  I edit the script and change the NDC, (National Drug Code) while Mr. X’s steams at the window. 

Impatient Mr. X watches from the window, as I wait for the pharmacist to verify the drug.  He is doing a phone consultation as Mr. X glares at me. 

Finally at the window.  “Sorry about the wait, Mr. X.”
“It’s been more than half an hour!”
“We can only estimate fill times, sir, there are many variables.  Plus, your insurance gave me a couple of issues to deal with.” “Oh?” “Your doctor wrote for ninety days and your insurance only allows thirty days at a time.” “So I lose sixty pills?” he interrupts, defensive.  “No, they go on file.  So you have the remaining 60 pills, plus three refills of 90.  That’s a year's supply of this prescription.” I explain, seeing two cars visible behind Mr. X.  And probably more around the back corner of the building. 

I ring him up. He forgot his discount card, and tells me to forget it he’s running late.  I have to try the phone number or risk getting written up for not completing register procedure, including having him sign the receipt and the sticker sheet saying he’s received counseling or didn’t require it. 

He throws the clipboard on the windowsill, tosses his script on the car seat and peels out.

An already impatient next customer pulls up to the window and goes ballistic when I tell her it’ll take thirty minutes.  “Just to slap a label on an Astelin box!” I explain there are 14 scripts in queue ahead of hers, and a person at the register, all there before the man she followed.  She said, “Well you obviously need more help!” “I would be eternally grateful if you called the customer service line and mentioned that,” I replied softly.  Compassion in her eyes, she nods, agreeing to do that. 

As the commercials, the ringing phone, and the automated voice announcing the drive-ups with a vengeance continue. 

During 10 to 14 hour shifts, almost every pharmacy staff member deals with some sort of pain, aggravated by standing without breaks all day. 

Bathroom breaks are almost non-existent.  And often there’s no paper or soap which means spending those precious break minutes finding the manager to initial products before using them. 

Additional script frustrations include:

Prior authorization required.  An annoying, 2-10 day process where the doctor must explain to the insurance company why he’s prescribing a particular drug instead of the insurance company’s preferred drug (on formularies that insurance companies change at whim). 

Inventory glitches make partial fills which require a time consuming, manually entered label necessary, and often angers customers who must return for the balance of the fill the next day. 

Incorrectly or incoherently written scripts require pharmacy staff to contact doctor’s offices or hospitals that have automated phone systems. Faxing saves time, but sometimes it’s vital to speak directly with the physician. 

Pharmacy outreach calls mean extra, unnecessary work that leaves customers feeling nagged, and pharmacists resenting the waste of their time. For the staff, it takes up down time between rushes - really, when are we supposed to go pee? 

There are many register issues. 
Pharmacies are banks, offering cash back which means change runs to the office.

Pharmacy staff are coupon expiration police.

We are guards against customers abusing the "Transfer-your-script-to-us-get-a-gift-card Deal."

We're expected to be security guards, pursuing shoplifters who may or may not be dangerous. 

Customers argue with the pharmacist’s advice once he's offered the opinion they requested.   

And through all of this, the commercials babble on…
…and on…
…and on….



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