October 7, 2019

Flu shot season is in full swing. We did 100 flu shots alone last week and probably 20 non-flu shots, too. My staff pharmacist is struggling to keep things running. I just consider the shots as part of workflow and don’t let it interrupt my day. Yeah, it can get crazy when 5 families show up at the same time, but it’s manageable. My techs know how to get everything together and how to stage the shots, so it should be fine. My staff pharmacist just needs to let it work instead of fighting it.

Today is the first day we can officially give annual reviews. I dread this time of year. I feel like there is no time during the year to actively manage performance other than day-to-day coaching. Deep conversations would be more effective, but we’re bare-bones staff-wise. There is simply not time for it. Even if I went to work on my day off, it would hurt the pharmacy taking someone out of workflow. That frustrates me no end.

On a good note, my reputation for giving excellent shots remains. Patients have been excited to see I am present and the one to provide the shots. Afterward, they often exclaim how painless and easy it was. It makes me happy to have such good technique.

Otherwise, I’m still trying to hire another tech. With my full-timer going on disability in a month, I’m a little panicked about not having help. I interviewed a woman yesterday, and I’m hopeful she’ll accept the offer. Time will tell.

September 22, 2019

It’s been a strange last few weeks. Our assistant store manager trainee got promoted to assistant store manager then within a week was transferred to another location. It sucks. She was helpful and will be missed.

Our store manager’s last day was last Thursday. He was given a store in a much different environment with a task to “turn it around”. I’m incredibly sad to see him go. He was the first store manager who actually helped me be a better pharmacy manager.

My full-time technician has to have a hysterectomy and will be out 6 weeks. Fortunately, I have about 6 weeks before then to find some extra help. The applicants have not been coming though.

One of my new technicians asked for her hours to be cut, so there’s less help. In good news with her, she has been learning and gaining confidence thus being more effective and helpful when she works.

One of the front-end employees that is licensed and cross-trained put in her 2 weeks notice to take a job with better hours and pay. She’ll be missed, too.

Personnel management is the hardest part of being a pharmacy manager. It’s not just the discipline side. Scheduling and hiring can be just as tough. Next month starts annual review talks with staff members. Here’s hoping they are productive and not ignored. I am nervous about the talk with my staff pharmacist. He is going to have to go on probation so to speak since his performance is pretty awful. More to come later…

September 7, 2019

Today was somewhat unpleasant. I had to deal strongly with 2 opioid users.

The first had never filled with my company, so we had no history to immediately check. We processed a hydrocodone RX, and the insurance rejected the claim stating the patient was on interacting medications. I accessed the PDMP and fortunately found information on what the interactions entailed (other controlled substances, including duplicate opioid therapy). For my due diligence, I contacted the hydrocodone prescriber to ensure the prescriber was aware of the interactions and was still ok with us dispensing the hydrocodone. The prescriber was very irritated that the patient did NOT state all of the medications, so the prescriber instructed me to cancel the hydrocodone prescription. As a courtesy, I contacted the patient to inform of the situation. No surprise, I received a lot of pushback. The patient argued and argued. I told the patient that this is between them and the prescriber. There was nothing further I could do. 20 minutes later, I received a call from the prescriber asking for more information from the PDMP. I read exactly what the PDMP said to the prescriber. The prescriber then asked if I could dispense only 3 tablets. As I had not yet cancelled the RX in our computer system, I was able to document the conversation and prepare the RX for 3 tablets. The patient came to get the RX and was furious that only 3 tablets were authorized. I told the patient that this is between them and the prescriber. I have done my due diligence and must follow the prescriber’s direction. The patient then stormed off. At this point, I was worried that the patient was intending to force me to dispense more (gunpoint, for example). Fortunately, the patient returned about 30 minutes later, in the drive-thru, so there was zero chance of harm. The patient took the 3 tablets and left, hopefully for good.

The second patient came to the pharmacy requesting I do a pill identification. I checked the identifier and determined the pill was ibuprofen 200mg (OTC). The patient then claimed that this was dispensed in place of tramadol as listed on the bottle. I then checked the patient’s history to see which staff was involved in the fill and check process, discovering that I was the one who did the final product check. I then informed the patient of my method of checking filled RX’s and how even today I discovered an RX that was missing just 1 pill. I do this frequently. I can spot even 1 pill of a wrong MFR that looks very similar to the correct product. I have done it many times before, and I will continue to ensure proper dispensing going forward. I assured the patient that it was impossible that we dispensed the ibuprofen in place of tramadol. The patient tried to argue, but I wouldn’t have it and recommended the patient check with others in the household that could have access. The patient then gave up and left. A little while later, I received a call from this patient asking if the ibuprofen was prescription only. I responded that it was OTC only and that we do not carry OTC ibuprofen in the pharmacy. The patient sighed then hung up. I honestly think the patient put the ibuprofen in the bottle themselves and was trying to get more tramadol. Sad.

September 4, 2019

Staffing changes are rough. They can be good, like us getting rid of a super negative technician. They can also be bad, like hiring someone who shows zero initiative. Stagnation can be just as bad. I am irritated just seeing my staff pharmacist who just cannot retain information and repeatedly makes errors that I have to fix. Simple concepts like reading patient profile notes would prevent so many problems, yet this pharmacist is “too busy” to do it.

Working for a major corporation is going from frustrating and defeating to frightening. It used to be that pharmacy managers only had their bonuses affected when it came to metrics. Now, salaries may be negatively affected if metrics aren’t met. Staff pharmacists are being included in the metric-affected salary issue too. To top it off, managers are required to “have talks” with any subordinates who discuss unionization to prevent this activity. It just feels wrong.

Flu shot season is now upon us. So far, it’s been pretty manageable. We get a handful of shots per day, so it hasn’t disrupted workflow much. I honestly don’t mind giving shots. I have a reputation for doing that well, and it’s an opportunity for me to leave my “cage” and even *gasp* have a seat for a moment! I’m also pushing eligible individuals to get Prevnar13 before Medicare stops covering it. ACIP recommended against regular vaccination with Prevnar13 in the 65+ population due to presumed herd immunity. I say “Keep the herd strong! Get the vaccine while it’s still covered!” I honestly believe next year will bring no coverage for the vaccine in the 65+ population.

August 16, 2019

So my senior technician resigned after being interviewed and admitting to using illegal drugs. Fortunately, I have 2 new hires in process, so I shouldn’t have too much lag in technician coverage. One new hire is young with some medical field experience; I’m not sure if she’ll last long though. The second is a long-time certified technician who got laid off when her employer was bought out by a big chain. I have high hopes for her and our services. I’m hoping to get MTM going again. Having a technician help manage the administrative stuff will allow me to provide those services I really want to do.

As for my other technicians, they seem excited to have some new blood coming into the pharmacy. Two techs are going back to school next week and want their hours reduced. One tech is leaving for boot camp mid-September. That leaves me with 1 full-time tech before the new hires are working regularly. I hope to have them trained enough before September hits.

July 30, 2019

I think my new medication is screwing up my emotions, as in I don’t really experience them now. I haven’t written because I haven’t had anything to talk about. I’m not convinced that interactions with patients haven’t been worth sharing; I simply have not felt anything with regard to those interactions. I am pursuing this with my doctor, so I hope to have more to say soon.

July 18, 2019

Today was a pretty good day.

I had a regular patient request a consultation with me for training on a glucometer. It turned into a full-blown diabetic education session with him and his wife. This is what I’m trained and certified to do. It’s been my focus since pharmacy school. It was such a fun interactive discussion, and I felt so revived by it!

The pharmacy staff (myself included) was congratulated and encouraged by our store manager for running such a smooth operation the last week. We’ve had no complaints, been filling ahead, and doing all the little things corporate tells us to do. We’ve even been able to do some deep cleaning, which is always satisfying to complete.

July 17, 2019

I had a lovely interaction with a woman looking for a product I had never heard of. I found it on our company website and offered to order it for her. The process was super smooth, she received free shipping, and was able to pay at the counter. She was super sweet and appreciative. She was pretty mesmerized by our ordering system, and I was glad we could get her what she needed.

I was infuriated by my pharmacist coworker. This pharmacist puts blocks on the sale of so many prescriptions for stupid reasons. Yeah, interactions make increase certain risks but most are health condition predisposed. There was also a block on a cholesterol medication because the patient had received a different one in May…. not a big deal right? Sure, except that this was a refill and had already been addressed last month. I was irritated that my time, my patient’s time, and my technician’s time were disrupted by an unnecessary consultation.

I’m really proud of my technicians. They’ve become so much more competent and confident lately. I can just hand them things to get done, and they do the work without question. It relaxes me so much to have less on my plate and be able to count on them to get things done.

July 16, 2019

Today is a rant.

My position is again being threatened because metrics aren’t good enough. It’s so frustrating when I don’t have enough help to maintain excellent patient care and provide excellent service. I simply cannot be in two places at once, and neither can my technician. I rarely have more than 1 technician at a time.

I clearly do not know how to communicate with the other pharmacist I work with as that pharmacist doesn’t listen and retain anything I say. Sadly, upper management considers it my fault that the other pharmacist can’t recite policy. I would like to state that I have gone through all the material with this pharmacist more than once, have created a binder with printed materials outlining every single thing management wants, and have shown the pharmacist exactly where to find it (in plain sight!!!).

I’m having a terrible time finding new technicians. Half or more cannot pass the entry questionnaires and are eliminated before I can even speak with them. Others schedule interviews and don’t show up. The rest don’t call back to even schedule. I would take high school students at this point!

One good thing: My technicians are motivated to complete tasks to help me retain my position. Half have said they would quit if I was forced to leave. It’s reassuring, but I really need the numbers to back it up and retain my job. Thank goodness my student loans are paid off.

July 15, 2019

The Good: Spoke with a woman on the phone that isn’t my patient but was referred to me by a friend as I “know a lot and can be trusted”. That was a beautiful compliment. We discussed Xifaxan use for IBS, and she asked if she should take a probiotic. I recommended against it since the prescriber thinks there is bacterial overgrowth. I told her “There really can be too much of a good thing”. She thanked me for the advice and told me she really appreciated the information. Yay for satisfying conversation that really uses my knowledge.

The Bad: Helped a woman in drive thru who wanted to pick up an RX for her daughter. Daughter had never filled with us before, so we didn’t have insurance information (and couldn’t find it with our search tool). Mom hands me a medical only insurance card that doesn’t even list which PBM they use. Mom tells me that she uses all these other pharmacies without any trouble. I find Mom’s info in our system and transfer it to daughter’s profile. Claim processes but med is non-formulary, so they refuse to pay anything on it. Mom refuses med and claims I don’t know what I’m doing. Ugh.

The Fun: Regular patient comes up to my counter. He’s snarky about waiting so I give him a hard time jestingly. He puts a six-pack of hard cider on the counter and tells me he also needs to pick up his wife’s “medicine”. We both laughed. His wife walks up and joins in the banter. It was a fantastic way to start the day!

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