The Apathetic Apothecary

PharmD and Other Ramblings

2007-10-13T06:30:00.000-06:00

I have been reading a lot of blogs lately. Mostly pharmacists, but a few pharmacy students, medical students, etc. as well. I don’t want to offend any students, but I have to say that I am not a big fan of the PharmD degree, particularly as it is currently structured. (Change that, I don’t want to offend PharmGirl, I really don’t care if I offend anyone else reading this.) Now before you start thinking that I am just a cranky old fart that is jealous because I don’t have the coveted “Doctor” in front of my name, let me say that I am enrolled in a non-traditional PharmD program. I have been a hospital pharmacist for 15 years, and graduating with a new degree will not change my job, salary, or anything else of great importance to me. I’ll explain why I am doing it in another post. Now, if you are a pharmacist in the real world, (real world= not academia and not Arkansas) and you actually use the title “Doctor”, you are probably a pretentious ass and you aren’t going to get this anyway. But let me explain what I am talking about.
I have always felt that the PharmD was created as a ploy by universities to figure out how to screw a bunch of people that are going to make a lot of money into paying one extra years tuition. (Yes, your instructors really do resent the fact that when you graduate you will be making a lot more money than they are. Back when I was in school they invented this phantom “Pharmacy Enhancement Fee” of $100/semester that they charged all the pharmacy students.) I am convinced that there is very little that you will learn in a rotation that you could not learn on the job while you are making some money.
Let’s face it; pharmacy school is a long hard deal, even before you get to rotations. A lot of shit is crammed into your head in an academic setting, and it is impossible for anyone to retain everything. By the time you do get to rotations, a lot of students see the light at the end of the tunnel, and all they want to do is whatever it takes to graduate. I know it is not convenient (because I am doing it), and I know it really isn’t feasible, but from a purely logical standpoint I think they should have kept the B.S. degree and required 3-4 years of work experience before you go back for a PharmD if you want one. A lot of this stuff makes a whole lot more sense once you have a lot of experience. (Hate to burst your bubble, but a lot of things you learn in school, like kinetics for example, are largely horse shit. Kinetics is something that you get a feel for, and if you just applied the book knowledge, you would find that your levels are always screwed up). But I digress. This is getting too long, so I will wrap up and maybe add some thoughts later. Just one other thing. The PharmD is an entry level degree. It is not a doctorate degree, and you are just fooling yourself if you think it is. I know it sounds cool, and I know that most schools have moved it to the graduate school so that they could jack up the tuition to ungodly levels. Being in the graduate school does not make it a PhD. Just cuz your cat had kittens in the oven, that doesn’t make them biscuits

STAT My Ass...It can Wait

2007-09-29T04:49:00.000-06:00

STAT: Abbr for Latin statim, at once, immediately.
That is the Stedman's Medical Definition of the word stat. On television shows when they say "stat" it sounds really important and someone is usually dying, and the magic "stat" word is going to save their ass. In real life, when a nurse says "stat", it has a slightly different meaning. A rough translation would be something along the lines of "I had my head up my ass, and I forgot to order this really important shit that just ran dry. So you need to stop what you are doing and pretend that I am the only fucktard nurse in the hospital tonight. It doesn't matter how long it takes to dissolve, I need it 10 minutes ago." Case in point: I get a message from this idiot on the floor: "need epidural stat, bag almost out", or something along those lines. Now this particular bag is lasting the patient about 18hrs. And this particular fucktard has been at work for 10 hrs. Now here is a novel idea: Pay the fuck attention. Order the shit in a timely manner. Look at the fucking pump when you come on shift, and you will have a rough idea when you will need another bag. Put those critical thinking skills that you acquired at the community college to work.

Other Misuses of "Stat"
Doctor's and nurses both have other ways to misuse "stat".
I don't care if your patient hasn't shit in 3 weeks, a dulcolax suppository is not stat, so don't call and try to convince me that it is. A fucking catapres patch takes a couple of days to start working, so don't try to give me that stat shit. Order something more appropriate. And most importantly, I do not give a shit if it is time for you to go home, or if you have a tee time in an hour. These are not reasons for stat, these are reasons for me to take my own sweet time.
I can't fucking believe it. While I was typing that last line, I just received a "stat" order for some fucking chapstick. That says it all.

How to Write an Order....Rocket Science for the Masses

2007-08-19T01:39:00.000-06:00

I am a relatively simple person. When I receive an order for a patient, I am looking for a few little things that we like to call "elements of an order". You know, simple little things like:

The name of the drug
The strength of the drug
The route of administration
The frequency of administration
If it is an IV fluid, the rate of administration.
If it is ordered PRN, the reason for administration.

For 99.9% of orders this will cut it. And most orders can get by with just the first four items. I know that if you are not in health care, this seems like a relatively easy task. In actual practice, it is apparently somewhat harder than differential calculus. Here is an example of an actual order that I received. "OK to take steroids every once in a while". I won't even grace that with a comment. So for any of you who may write orders, and were out on a bender when they covered this in school, lets go over this extremely complicated undertaking.

1. The name of the drug

Now, I know I shouldn't have to comment on this, but this not the pharmacy psychic hotline. If you write some dumb shit, like "10 mg now", or "20 meq now", you will get a phone call to remind you that you are an idiot. Read the fucking order after you write it, and if it doesn't make sense, fill in the blanks.

2. The strength of the drug

Ok, I realize that most of the time, when you leave this off it is because you have no clue what strength it comes in or how to dose it. So you might want to consider looking into this before you write the order. Don't wait till I call you and then just say "Just the normal dose, I guess". News flash: A lot of this shit comes in multiple strengths. I need a little more information to help you figure it out.

3. The route of administration

Guess what? Some of these magic medicinals come more than one way. Like pills, iv, suppository, inhaler, and maybe a few I am not thinking of right now. Maybe you would care to share which is your preference.

4. The frequency of administration

Observation: You write an order that says "Ativan 2mg prn agitation" Now lets say that I am being particularly generous and overlook the fact that you didn't write a route on the order (see lesson #2). If I were to trust the nurse and put it in as an IV push cuz that is what she wants, she will give that shit every 5 minutes until your patient is too doped up to push the call light every 5 minutes which is why she told you she needed ativan in the first place. And then I would have to get out of this chair to respond to the "rescue team" to help with the unresponsive patient that isn't breathing. They might even make you come up to the floor. So how about you just do us both a favor and write a fucking frequency on the order in the first place.

5. If it is an IV fluid, the rate of administration

Nurse Nancy needs to know what numbers to punch in her little pump. Nuff said.

6. If it is ordered PRN, the reason for administration.

Not only is this a JCAHO requirement, it is common sense. First off, some of my magic potions are used for a multitude of things. Couple that with the fact that Nurse Nancy knows even less about this than you do, (if that is possible), and she will never figure out what to give and when to give it. So if Mrs. Johnson takes her blood pressure medicine prn, (not a good idea), how about you at least help Nurse Nancy out and put some paramaters with the order.

Now lets say you are paying attention, and you change your evil ways and start using these little tips. Don't get over confident. Even if you get these little elements correct, which would be a good start, there are still numerous ways that you can, and will, fuck up an order. We will discuss these another day. For now, just work on these six, and maybe try to put the patients name somewhere on the page so that I know whom it is for.

Some think that CPOE (physician order entry) will solve all these problems. These people also believe in Santa and the Easter bunny. I am sure that I can supply proof of this later this year when we implement it.

A Blog is Born

2007-08-17T02:57:00.000-06:00

Ok, I admit it. I am rapidly becoming an old fart. I will be 45 in a few months. I don't understand text messaging, (pick up the damn phone and call me), and until recently I didn't get this whole blogging thing. I am a busy man. I have shit to do. I don't live in my parents basement, and I don't go to Star Trek conventions. Why in the hell would I spend my time reading about someone elses problems?
Well, that was before someone turned me on to The Angry Pharmacist. (www.theangrypharmacist.com) And of course he had to link to other pharmacy blogs, that linked to other pharmacy blogs.....and now I am addicted to this shit like heroin. I don't even work retail, but I used to work PRN retail and all the memories hit home. I only found one hospital pharmacy blog, so I decided to give this a try. Besides, I found that I can waste my employers time instead of my own. Life is good.