In the End

Seeing that I was working in retail for the first time, and it was an internship, I took away some thoughts on retail pharmacy. The first was customer service. I learned you always have to be on your game in front of people. There is this expectation of always having a smile, quick in acknowledging the person, and speaking in simple terms. Even though pharmacy is a complex and time consuming topic, it is placed in a setting with people who have busy lives and simple medical knowledge. One time, a customer asked me about the difference between lisinopril and Dyazide. I started out describing the molecular differences then I realized this explanation is not helping her. I summed it up as they targeted two different sites in the body.

Secondly, I became experienced at being accurate and multiple tasking. At times in the pharmacy it is crazy: phones going off, customers lining up, and running out of drugs. One has to be quick, but more importantly accurate in times of stress. When counting Vicodin, we have to double count because it is a control medication. I want to quickly and accurately count the Vicodin then move onto my next task like serving the drive thru. If I am not accurate, the customer will come back saying that we shorted him. This causes more time to deal with the situation and takes away from filling today’s prescriptions. I learned to do things right the first time because it will save me time later if issues arise.

Retail taught me to be fast and to prioritize. One area I haven’t mastered just yet is drop off. I know how to work drop off but I do not have the speed for it at peak hours. One needs to prioritize when prescriptions are due then start typing them right away. And it is just not the prescriptions from walk-ins. It is ones from the drive thru, computer system, fax, and phone calls that add to the volume at drop off. One minute I am doing fine with my prescription level then five pop up on the computer, a person walks in with two and my pharmacist gives me three from phone calls. I am quick at typing but it still takes a thorough knowledge of the inventory and solving insurance problems not to be slowed down and keep up with the volume.

I realized learning and re-learning is the key to being on top of the game. Since pharmaceutics are always evolving and adding new drugs to the market, the pharmacy has to keep up with the times. Fast movers change from time to time. Brands become generics. One can get use to certain drugs and know everything about them until a customer asks you about a new drug. If I want to be great at my job, I have to look to improve myself and test my knowledge. It is easy to get in a comfort zone and think you are doing a good job when actually you can do better.

My final thought is the people I worked with this summer. They were the number one reason I enjoyed my time in the pharmacy. For being friendly, caring, and helpful, it was easy to enjoy the good and get through the crazy times in the busy retail world. I had several co-workers my age to talk about college stuff and enjoy going to the bar after a long day at work. When I leave this week for school, I won’t miss the customers, but you guys!

Shots, Shots, Shots!

One of the new and cool skills pharmacist can perform now is immunizations. Every state except one allows in some form for pharmacists to immunize their community. Michigan allows trained and certified pharmacists to give vaccine shots just like physicians and nurses. I trained this week to be certified to give immunizations. It is not required for pharmacists to be certified immunizers, but it is extra skill I have wherever I end up in the medical field. I had a week to read 100 pages packed with information on vaccines and the basics for immunization, take a pre-test, attend a hour long conference call, and six hours of classroom training. Add in work and chores around the house, I kept pretty busy.

Bright and early on a Saturday morning I had to travel to Bloomfield Township for my immunization class. I wasn’t sure exactly where I was going and ended up a couple minutes late because Bloomfield Township doesn’t know how to logically order street address but that it is another story. It didn’t really matter because the teacher was still trying to figure out how to connect his computer to the overhead screen. Once he got it to work, we spent the next five and a half hours on the different immunizations we could perform. It is not just the influenza shot. He taught us about pneumococcal, hepatitis A and B, measles, mumps, and rubella, diphtheria, tetanus, pertussis, meningococcal, polio, and the human papilloma virus.

There is a lot of information to keep track of in terms of ages, contradictions, and how to administer the shot. It wasn’t until the last half an hour that we had to poke our classmates with two intramuscular (I.M.) and one subcutaneous (S.Q.) shot filled with saline solution. There were several pharmacists in my class learning to be immunizers for the first time too. One lady was so nervous giving her first shot that her hand was shaking though she was perfectly fine after doing the first one. I was a little nervous myself but performed well when it was my turn. I enjoy doing intramuscular shots more than subcutaneous because I.M. shots are at ninety degree angles while S.Q. shots are angled at forty-five degrees.

The biggest concern about giving shots is not how to poke the person or drawing up the solution but getting a needle stick once one removes the syringe from the skin. Many syringes today have safety devices where the needle retracts once the shot is given. Now these devices only work 50% of the times meaning technique and positioning of the immunizer needs to be appropriate. One’s legs needs to be on the opposite side of the body from the hand that has the syringe, and the sharps container needs to be next to the immunizer. If done correctly, it will be one fluid motion of poking the skin, injecting the vaccine, activating the safety device, removing the syringe, and placing the syringe into the sharps container. It can be all done in five seconds. At the moment, I am not giving out shots at my pharmacy, but I will have the skill if called upon in the future.

Intern in the ‘ship Fast Movers

Fast Movers

There is a special section in our pharmacy that we place are most filled medications. It is easier for us to grab and not go exploring in the stock bays. There are about fifty medications on these shelves give or take a few depending on the season and changes in prescribing habits. Here are a few of our fast movers you will recognize or maybe surprised they are prescribed that often.(Generic names in parentheses)

Xanax (alprazolam)

Xanax is a controlled substance prescribed for anxiety, some depression, and panic disorders. 0.25, 0.5, and 1 miligrams are the most often doses. I was surprised the most that it is prescribed so often. I do not think there has been a day that I have not counted out these tablets. It shows that many people have anxiety or depression throughout their life and it is not a small percentage of the population. And that is alright, sometimes one needs chemical change to feel better.

Vicodin (hydrocodone- acetaminophen)

Vicodin is a controlled substance prescribed for pain, and pain and really bad pain. There are several strengths but 5mg/500mg, 7.5mg/500mg, and 7.5mg/750mg are the most common. I was not surprised this was on the fast mover shelf. If Tylenol or Advil cannot do the trick, the next step is to ask for Vicodin. It works quite well because it suppresses the brain and slows nerve firing which explains the main side effect: dizziness or drowsiness. One big counselling point is Vicodin contains the same active ingredient as Tylenol: acetaminophen. One should not take both in a day because of the possibility of over medicating.

Glucophage (metformin)

Glucophage is a drug that helps lower your sugar levels in the blood. This is not a drug that increases or replaces insulin but assists with insulin’s workload. 500 mg and 1,000 mg are stored in big jug containers and the pills are pretty big too. Rule of thumb: big white tablets should always be taken with food or you will have an upset stomach.

Zocor (simvastatin)

Zocor is a cholesterol drug called a statin which is the most popular form to lower LDL cholesterol. It is very similar to other well know drugs as Lipitor and Crestor. It comes in 20 mg and 40 mg on our fast mover shelves. Recently there have been studies warning against prescribing the 80 mg strength because of higher instance of muscle pain which is a known side effect.

Birth control -Gianvi, Apri, Loestrin

There are many kinds of birth control/contraceptives on the market. There are brand names, multiple brands for the same drug and generics for those brand names. One cannot always assume contraceptive purposes because doctors do not list a reason, but birth control can help lower pain and flow during menses. And no it is not just seventeen through twenty three year olds receiving it. Older women with kids also want to control their bodies and not have unexpected surprises.

Other well known medications that are fast movers are lisinopril and hydrochlorothiazide for blood pressure, amoxicillin and azithromycin (z-pack) for bacterial infections and albuterol for asthma.

Happy 4th everyone!

Intern in the ‘ship part 3

I finally got to work drop-off! I have actually have done this before in first semester pharmacy class last year. Drop-off is either laid back or crazy busy. You can be typing a prescription, having a person waiting in line, and a person asking about insurance on the phone. My knowledge and ability to read sig codes from class has made the drop-off easier for me but it is still hard to keep up the pace. It just takes time in any job to be at proper work speed. I am learning how to enter in insurance cards in the system then run them through the system with a new prescription. It is kind of strange in the sense that it is all through the computer system and formularies. If the bill comes back 25 dollars and the customer usually pays 10 dollars then we cannot do anything about it. It is in the control of the insurance company. Many customers do not get that concept. We do not have any magic button to change the price.

Now customers can be clueless and frustrating at times, but we do have some great customers. This one parent has a child who has many prescriptions fill throughout the month. The pharmacist knows this person very well because how often they come to the pharmacy. This parent is always upbeat and understanding when there is a wait or a re-billing for a prescription. Other people like her always say along the lines of “I am here enough not to get mad over the small stuff.” These people make the job enjoyable and give confidence in one’s work. We can do our job and deliver customers medication in a pleasant matter which is otherwise an unpleasant topic: understanding and taking drugs.

What happens if you have to fill a prescription on a holiday say Memorial Day? Do not Fear! The pharmacist is here…and his pharmacy intern. Yes my pharmacy was open on Memorial Day and Yes I work that day and Yes people came in to drop off and pick up their prescriptions. It was actually quite busy in the morning with left over prescriptions and plenty of people calling to ask if we were open to pick up their medication. As the afternoon hit, the day became slower. I got to learn how to return medication to the stock shelves when customers decide not to pick up and pay for their prescription. It was not hard to learn, but I was surprise how many prescriptions people want filled but don’t pick them up. As the late afternoon came upon us, business was at a crawl which I prefer to be at a busier pace. My pharmacist showed me a website where I can receive current drug information. It gives information about new drugs on the market and good counseling points on many of the medications in the pharmacy. Yes, I worked on Memorial Day but as I said to a customer: At least it is air conditioned!

Intern in the ‘ship part 2

One word: busy. Retail is busy at least at my store. I did expect to be busy, but it is always different when you are actually in the flow of work. I have been doing pick-up, production, and drive thru for my first couple of days. I am starting to learn how to work the computer system for looking up customer’s information and refill requests. There is a ton of little things customers want like knowing when their next refill is to wanting to pick up a prescription with new insurance which takes time to enter and process. The pharmacist and techs have been great to work with. They help me out whenever I have trouble and they love making the work day enjoyable. One day I actually knocked over some food on the floor but the pharmacist wasn’t too mad. He actually helped me clean it up when he got a moment of freedom.

One thing I have not mastered yet is insurance problems. Once we get prescriptions we type them into the computer and run it through the insurance system. The system will shoot back a response with a green or red light. We like seeing GREEN lights. When a red light pops up, we have to see why it is rejected to see if we can adjust anything to make it work. The more experience technicians are quick with the computer system and can determine if anything can be done. No one wants to be the person who says to the customer “your insurance did not cover this prescription.” Even though we do not control the payment, people still vent. Luckily, I haven’t experienced someone blowing up on me. Most people are annoyed but sensible. Next week, I will be working the drop off station and some new experiences!

Intern in the ‘ship

Welcome to the College of Pharmacy summer internship blog. I am John, an upcoming P2, one of many who will be blogging about summer experiences. My experience will be in the community retail setting. Policy rules though limit what specifics I can talk about. It should be an interesting summer because this is my first time working in the pharmacy retail setting. I am hopeful I will learn a great deal and at least know what it takes to be a retail pharmacist. To explain my blog title fully, I will be working as a Pharmacy intern in Macomb Township which is about an hour north of Detroit.

I had my first day of training at the regional training center at the beginning of the week. We went over the basics of the company and work flow. I have to do some web modules tonight and I will be reviewing my pharmacy 404 notes which was dispensing lab. The computer system is not the same as dispensing lab but every community pharmacy has the same basic concepts: Picking up prescriptions, entering patient information, making the label, and checking the tablets. The next day was more in class training about ways to talk to customers and polices not to break. I thought of it as ‘all the ways to get fired on the spot’ day. Remember you have to be at least 18 to buy pseudoephedrine over the counter!

My third day of training was in the pharmacy store. I learned how to work the register and several of the pharmacy stations. Each station has a different task assigned to create better flow in the pharmacy. This place also has a drive thru (one of the busiest in the area). I got to spend some time at the pick-up and production stations. It was also neat to meet the pharmacist and see him counsel a patient. A lady was asking if ringworm was contagious. It was interesting because I knew the answer from self-care class. And yes, it is contagious. I still have a couple more days of training then I will be in the pharmacy doing the normal routine.