Category Archives: Nurses and Hospitals

Phone-in Rx’s for Dummies

Dear Staff of Doctors Offices Everywhere,

There is an obvious lack of common knowledge in Doctors office as to the “proper” way to phone in an Rx.  So I have taken upon myself to give you all a little guideline to hang up in your office so you and/or your office staff don’t become a target of an angry rant on this site.  Consider it my gift to you.

The Angry Pharmacist Guide to Phone In Prescriptions
The Angry Pharmacist (c) 2009
http://www.theangrypharmacist.com

  1. Before you pick up the phone, you must ask yourself a few simple questions:
    1. Do I speak LOUD and CLEAR English and do not mumble (you might need to ask a few office people their opinion of this)?
    2. Do I have the patients full name and date of birth?
    3. Can I read what the doctor has written?
    4. Do I know MY NAME and THE DOCTORS NAME?
    5. If I read what the doctor has written (see 1.3) , can I make out exactly what drug it is, what strength it is, how often is it to be taken.  Even if you have no idea what the drug is, you should be able to use your high-school education to deduce (that’s fancy-talk for figure out) how to take the drug.  If you are unable to determine this, consult the doctor or find someone in the office who can.
    6. Try to sound out the drug name.  Ask someone how to say it if you are confused.  Most drugs names sound similar, so if you are hopelessly confused just be prepared to spell it.
    7. Is there anything here that I might get confused about if asked questions.  Such as a possible 0 looking like an 8 or a 6, or why someone would need #400 Norco with 10 refills.  Giving Ambien (that everyone knows is for sleep) twice daily is obviously wrong as well.
  2. Having your pre-NewRx checklist, you are ready to call:
    1. Double check with the patient as to the pharmacy of choice, and also double check to see that you are calling the correct pharmacy.  In most phone books, the name of the pharmacy is on the LEFT and their number is on the RIGHT.  Use a piece of paper to keep a straight line if you are cross eyed and can’t seem to follow from LEFT to RIGHT.
    2. If you are calling a chain or any pharmacy with an automated system, go to the menu entry for a new Rx.
    3. If you are calling an independent and a LIVE PERSON answers the phone, you are most likely talking with a clerk who CANNOT TAKE YOUR NEW PRESCRIPTION.  Kindly ask to speak with a Pharmacist and state that you have a new prescription to call in.
    4. If you call it in to the wrong pharmacy, CALL THE WRONG PHARMACY BACK AND CANCEL THE PRESCRIPTION!  DO NOT CALL THE CORRECT PHARMACY UNTIL THIS IS DONE!  What happens is the wrong pharmacy processes it, and blocks the correct pharmacy from processing it through the insurance.  We would rather have you CALL and CANCEL THE RX vs having to deal with having another pharmacy return-to-stock and backing the prescription out.
  3. Speaking with the pharmacist:
    1. When the pharmacist answers, speak LOUD and CLEAR.  There is a lot of background noise in a pharmacy and softly mumbling will get your ass hung-up on.
    2. Tell them immediately what YOUR name is and WHERE YOU ARE CALLING FROM.  Nothing pisses off pharmacists more than when someone is giving a new Rx and they have no idea where they are calling from (hey, they could be the patient calling in a phony).
    3. Say the patients name in a way that we can understand.  You may be proud of your Mexican accent and the way you say Mexican names, but the non-Mexican pharmacist on the other end of the phone has no idea how to spell your ooplahs, n-yays and tongue-rolls.  Most pharmacists will want you to spell the name anyways due to the outrageous and stupid names people are making up for their kids now-days.  Say it like a white-boy and you should be safe.
    4. Immediately give the date-of-birth.  We shouldn’t have to ask for it because you should give it automatically.  You should already know where it is and don’t need to hunt/change screens for it.
    5. Give the first drug, strength, and directions.  Speak SLOW, AND CLEAR.  You can say it a whole lot faster than most of us can write it.  Calling in an Rx is not a race.  If you cannot pronounce the drug, just straight out say “I’m spelling this for you”. 
    6. If at any time you use the phrase “This looks like…” or “I think this is…”, you should re-read the section about preparing for the call in, and contemplate having somebody else call in Rx’s who can actually read and follow directions.
    7. When finished with the last drug, say “That’s all”.  This is not the time for awkward silence as the pharmacist patiently awaits another drug and you just sit silently waiting for the pharmacist to magically read your mind.
    8. Be prepared to give your name again, since we forgot your name a long time ago, and feel free to ask the pharmacist his name if you have to record that down.
    9. If the pharmacist has any questions (or the drug isn’t covered) be prepared to write down what /is/ covered and give the pharmacist a call right back.  We don’t expect you to give us an answer right away, and honestly we’d rather get a call/fax back than sit on your shitty hold music while you waddle your ass down the hall and ask the doctor in slow motion.

Following this guide will provide many happy memories with dealing with hard-working and stressed out Pharmacists.

Love,

The Angry Pharmacist

The time for candy coating it is over….

I’m tired of candy coating and being all “politically correct” about this issue, so I’m just going to come right out and be an asshole. You’ve been warned:
If you cannot speak clear English, do NOT call in prescriptions. Yes, I’m calling you all out: STOP FUCKING CALLING IN PRESCRIPTIONS IF YOU HAVE A THICK ACCENT. PUT DOWN THE FUCKING PHONE, AND EITHER FAX OR GET SOMEONE WHO SPEAKS CLEAR ENGLISH TO CALL IT IN.
Do you know how fucking frustrating it is to have to have a ‘nurse’ repeat him/herself about 20 times because it all sounds the fucking same?
Now I’m not saying that you aren’t smart, or capable, or a bad person. I’m making a statement of fact that when lives are on the line, pharmacists need someone who can speak clear English when calling in medications. I’m tired of this happy-go-lucky huggy embrace everyone society that we have now that just looks the other way when some un-educated foreign drone calls in 20 Rx’s that all sounds like vowels on my answering machine. I’m sorry, but stop it. Get someone who can speak English to make that call. Me calling you back to “confirm” is not only a waste of both of our times, but 100% unnecessary if it was done correctly and clearly in the first place.
You think I’m being an insensitive racist asshole. You’re right, I care about my patients, and my state license/livelihood/my patients life is riding on your piss-poor language skills coupled with a ‘degree’ from a 3 month community college program. I’m sorry if I hurt your feelings, welcome to the world of medicine. I’m sorry if you cant help your accent; doesn’t mean you need to change jobs, just don’t call in Rx’s. They don’t let retards fly fighter jets and you don’t see them getting butthurt by this.
So pony up and accept it. Drugs sound the same. Obviously you don’t know this because you are still calling in Hydr-vowel-vowel-bok-bok-bok and require an interrogation session for me to determine if you mean HydrALAzine vs HydrOXYzine, TopROL vs TopaMAX, BID vs TID, etc etc etc.
This doesn’t stop at nurses, oh no. Pharmacists and Doctors are just as bad. If I request you to fax over that copy, and you are “too busy” and want to give a verbal, I’m just going to come right out and say that I want it faxed because I can’t understand what the fuck you are saying. I pressed “1” for English bitch!
So yeah, I’m an asshole. However I’m an asshole not because I hate you, or your race, or where you came from. I’m an asshole because you don’t seem to get the very clear and very important concept that you lack a very vital language skill that puts not only my patients life on the line but my license and store as well. Medicine requires clarity or people get hurt, you should of learned that in school. Sorry for fucking caring for the whole at the expense of insulting a few.
Oh, you know when I said I was sorry up there? I lied. I’m not sorry. I shouldn’t be sorry for standing up for patient safety when nobody else seems to have the balls to confront this issue (and make people upset? Oh no!).

Pharmacy Certainties

There are some things that go on in a pharmacy that are set in stone like the sun rising in the morning. Pharmacy school should publish this list for their students. Seriously, its all true. Lets examine a few:

  • Drug reps/Headhunters/Pharm Companies/etc will always call you/stop by at the absolute worst time. Much like the tuesday after a three day weekend, or on the first of the month. During the slow times of the month you wont hear a peep from them.
  • Your most important tech will make a doctors appointment on the tuesday after a three day weekend and be gone for half of the day. You wonder why he/she couldn’t make that appointment for some day when you aren’t contemplating suicide.
  • The patient who you thought you filled that Rx correctly for ended up having another last name and the same birth-date as someone else in your system. Of course they don’t tell you this until after they have received the Rx and loudly proclaim that you filled it for the wrong person with a store full of people. I mean aren’t we supposed to know that her full name is Maria Consuelo Rodriguez Maravilla Hernandez Guadalupe AIAIAIAIA ARRIBA?
  • That bottle of expensive-drug-x is exactly one tablet short to fill that Rx, and the patient wants you to order a whole new bottle of #100 so you can fill the balance of 1 tablet. Oh, and the patient is the only person you have on this medication.
  • Someone will always come into the store with a fistful of Rx’s at exactly 1 min until closing, and want them all right now. This is after most of your staff have already left leaving you alone to do all the work.
  • Your bazillion dollar counting machine will blow up only when half of your staff calls in sick, and you really really need it.
  • Insurance cards + correct ID number = HAHAHAH RIGHT!
  • Argus and Wellpoint will be down, but not at the same time. We cant have you do absolutely nothing all day, so we’re just going to fuck up half of your day.
  • Your computer system/network/DSL goes out when your computer guy is on vacation.
  • “This is not the ID card you are looking for” *hand wavy jedi trick*
  • When you call out a patients name to tell them their Rx is ready, the wrong person will come up and claim it. Then get pissed off because to them “John” sounds like “Steven”.
  • 30 min into a phone call to the pharmacy help desk of the insurance company to get an ID number, the patient will magically pull a current ID card out of his/her ass then wonder why you are upset at them.
  • The “Nurse” calling in the Rx wont be able to read doctors handwriting, then spend 10 min taking a poll in the front office as to what that sig looks like. Heaven forbid she couldn’t read over the Rx before she got you on the phone.
  • When looking at a doctors scribble, you will always pick the wrong doctor in your system. We are expected to be able to read sloppy signatures much like we are able to tell our own shit-smear on a piece of toilet paper.
  • The one doctor who does not know about the iPledge program or NPI numbers is the one you deal with on a daily basis, and the only one that you can’t really tell to go eat a dick.
  • The pharmacy calling you for copies doesn’t have a pharmacist, and the two-bit clerk who called you doesn’t know their fax number or have any Rx numbers.
  • A patient brings in lunch for your staff, but you cant eat it because you are up to your eyeballs in work. It smells really nice though.
  • There is only 1 scoop of coffee grounds left in the container, so you just drink brown water all day.
    Last but not least:

  • That bottle of gin that you were so looking forward to after days like yesterday will be sitting on your bar empty when you need it the most.
  • RN’s vs NA/MA

    I know I’m going to get some hatemail with this one, but this topic really bugs the hell out of me.
    I get this call today from the hospital (as if the gods themselves read my blog and graced me with discharge orders) from a self identified “Nurse” from the “floor” who could barely speak english. I asked her “Oh? You’re a nurse? Where did you go to nursing school?” She gave me some junior college somewhere I had never heard of. I then asked her “Are you an RN?” She said “No, i’m just a nursing assistant”.
    Why are Nursing Assistants and Medical Assistants and other NON REGISTERED NURSES calling themselves NURSES? Why?! Do pharm techs call themselves pharmacists? I dont see why they cant by their standards, they go to school, and do 3/4th of the work a pharmacist does.. Why doesnt a PA or an NP call themselves a doctor? They do basically the same job dont they? Do security guards call themselves policemen? NO!@#!
    I’ll tell you why, because ITS FUCKING WRONG. Thats right, MA’s and NA calling themselves nurses is WRONG. Why haven’t the tried and true RN’s of the world put the backhand of justice down on the ignorant fools who are calling themselves something that they aren’t. Here you have the title “Nurse” splattered around any half-witted moron who completes a 4 month course at some shitty junior college only to throw “Nurse” around and ruin it for the people who went to an actual college, actually have a BS in Nursing, and actually KNOW something about medicine. It’s shitty I tell you. If I were an RN I’d be mad as hell and backhanding mofo’s left and right!
    Now once in a while I’ll get someone who identified themselves as an “MA”, but with the accent it sounds like “PA” so I get confused for a second before I realize whats going on. But the majority of the grunt hospital “Nurses” really arent nurses at all, but go around using that title. Its a conspiracy, and I’m the first to report it.
    Now I also get down on pharmacist who go around waving their PharmD penises in the air and demand people off the street call them “Doctor”. I can see using the “Doctor” title while you’re working on the floors in the hospital (sorta), but with the common folk? Gimme a break. Put your tiny penis away and just face the fact that you’re just a pharmacist like me, the drugnazi, and all other retail folk. Hell, I have a PharmD, didnt realize that did you? Its because I DONT FUCKING FLAUNT IT. Doctor only in title, not in spirit is what I always say.
    I still havent gotten an email from DrugNazi about PharmBoozeFest’07

    The fun of Discharge Medication

    Whats more fun than a kick in the balls? More exciting than seeing plastic bags full of random pill bottles plunk on your counter? More uplifting than seeing that 65 year old who cant tie her own shoes walk in the front door with yet another barrage of same questions she asked yesterday? More hilarious than watching an Alzheimer’s patient go greeting card shopping?
    DISCHARGE ORDERS!
    Thats right! Pages upon pages of fun!
    Let me explain why they frustrate the hell out of us:
    If they are phoned in, they are usually called in by a nurse (i use that term VERY VERY loosely) who cannot speak english. They usually involve 20 some-odd drugs, and the nurse cant figure out how to fax them over, and demands to just verbally give them. After 20 mins of ‘eye tink dats hydoxyzyzine (?!?!?)’ sort of mayhem, they want you to READ back to them all of the medications they called in, upon which they somehow get really confused and make you start over not once, not twice, but three times. Did I mention that she cannot read the doctors handwriting, so shes GUESSING at most of these? Yanno, people really throw the term ‘Nurse’ around like it means something now days.. You a MA? You’re a NURSE! You’re a Nursing Assistant? NURSE FOR YOU! You clean the floors? NURSE! If I were a ‘real’ RN-type nurse, and associated with these types of ‘nurses’, i’d be pissed. Of course I’m in the camp that gets pissed when PharmD’s call themselves “Doctor”. Anyhoo, I digress, back on track.
    When you are fortunate enough to get a REAL nurse who calls you and spends all of 30 seconds getting your fax number and saying “i’ll send it over” (thank you, we love you). One of the following will (not maybe, will) happen:

  • The page will fax so horribly, it looks like a 2 year old took a dump on a piece of paper and then scribbled with it.
  • The doctor will sign but not print his name, so these drugs are written by Rsquiggle Mcsqiggle
  • The hospitals letterhead will be written or scribbled over so you have no idea where to call for clarification
  • The patients name wont fax, or better yet, you get just random letters in the persons name (Vanna, can I buy a vowel?)
  • The fax goes to the wrong pharmacy
  • The order finally comes in.. 10 min before closing.. Before a 3 day weekend…
    Now all of these are really that bad, so why do we hate discharge orders?
    Because the patient picked up all of his medication from your store…. Last week…. And they’re all on this discharge sheet… All changed…. I can hear the collective sigh from pharmacists across the nation. Here is why we’re screwed in this case:

  • Insurance is going to balk at filling the same medication with a different strength and sig. Their systems are going to show it filled 3 days ago, so its going to reject.
  • The patient is 99% of the time not mentally able to comprehend taking 1/2 of this drug, while taking 2 of these. Even if you make them bring in all of the bottles and stick new labels on them, they are going to take them the way they have been taking them for the last 5 years.
  • The doctor is going to see his patient in 2 weeks, freak out at what the dipshit resident did while he/she was in the hospital, and change things yet again.
    So yeah, for pharmacists, its a lose-lose situation. You’re getting screwed by the insurance company; you’re getting screwed by the patient who has the understanding of a turd when it comes to what medication does what and changes; and you’re just bending yourself over to just have this all happen again in 2 weeks when he has an appointment with his primary care doctor.
    DrugNazi/Monkey – Lets go out drinking. Seriously. I dont care where you are, I will drive, fly, hitchhike, etc to you. We need to meet up, plunk down a few hundred on a nice bottle of expensive scotch, and see who’s store is more hellish. email me: druglord@theangrypharmacist.com
    Oh, and the rest of the internet is posting these wierd numbers on their webpage, so I will too dammit! I’m internet hip! Maybe i’ll win a prize or something.
    09-f9-11-02-9d-74-e3-5b-d8-41-56-c5-63-56-88-c0

  • The County Hospital

    Now feel free to correct me if i’m wrong, but is every county hospital the most mismanaged, poorly ran, sinkhole of my tax-paying dollars on the planet?
    Why dont I just throw 1/3 of my paycheck into the air and let the retarded rejects of the medical profession (if you want to associate them with that) pick up the free money?
    Now i’m just going to be talking about the county hospital in my county. This may or may not apply to yours. Where should I start bitching:

  • Refill requests take over a week to get responses on. All clinics have different fax numbers, and instead of giving us a note saying “not our patient” or “we’re forwarding this to the proper department” they just throw our faxes away. By the 10th fax (and 2 weeks later) they finally write in big nasty letters “NOT OUR PATIENT”. Thanks fuckheads.
  • Good luck getting a diagnosis for anything that requires a prior auth. Some douchebag intern wrote an Rx for Zyvox. We asked for a diagnosis and a C&S (culture and sensitivity) report. Yanno, because the state-plan this person was on didnt feel like shelling out a few grand for 20 tablets. The damn hospital not only didnt fax us the C&S report, but the diagnosis was “HTN, Depression, Lupis, etc”. Not ONE fucking thing that had to do with Zyvox. What makes this worse, is that we had to fax it over 7 FUCKING times and took over 19 days to get a response!@#!
  • Doctors are idiots over there. Now I understand that interns and residents are still learning, and I need to cut them some slack. But when I correct the SAME FUCKING MISTAKE you have made 5 times, you should fucking LEARN NOT TO MAKE IT!!! Also, just because a drug is NEW does not mean its BETTER or COVERED. Give me your credit card number and i’ll fill the newest drug that some drug rep scum sucked you off on so you’ll write for it.
  • The staff are idiots. I swear, the county hires the lowest of the low. Called the ‘public trough’ by some, they hire barely compentant staff, and provide too much red tape to actually fire them. Huge payroll with people barely doing enough to justify their existance. Just to give you an example. We fill some county clinic Rx’s with a separate stock. Mostly condoms, foam, and birth control shit. We use their stock, but we bill them a dispensing fee. The accounting department doesnt want any sort of patient information (Medical record numbers, names, etc) due to HIPAA on the bill. So in theory I could bill them for 1.8 trillion dollars, and they would happily pay it because they have NO verification of the patients serviced. The other side of the billing department wants the patient list so they can see the usage and by whom, but dont want any billing information given because its ‘not their department’. Left hand, I would like to introduce you to right hand. Another example of employee douchery involve a bunch of the staff who got the novel idea to take our faxed refill requests, highlight the name of the patient, the Rx number, and the drug with a dark colored highlighter (because the highlighters are paid for with MY FUCKING TAX MONEY) and then fax it back. They were completely unaware that the fucking highlighter make the text appear BLACKED OUT like some secret government document. 5 faxes saying “DONT HIGHLIGHT PATIENT INFORMATION” and the finally got it. 5 faxes.. FUCKING 5!!@#!
  • English + medication names + me = this blog. Ive bitched about this enough, so I dont need to rehash it. But I will say that if you cant speak english, you have no business calling in prescriptions. The Rx’s from that place are already so fucked up initially, that garbling drug names with your accent really doesn’t help the situation. I’m glad you immigrated to this country, i’m glad you’re working rather than leeching off the sys..er..scratch that. But the harsh reality is that if you fuck up, your license that you spent 7 years of college is not on the line. Your 4 month program at a community college might be, but not your pharmacy license. Trust me, get someone who can speak fucking english. You wouldnt want your parents getting Rx’s called in by you, I dont either.
    Anyone who is in favor of socialized medicine needs to deal with a county ran hospital. They can fuck up a free lunch. If the county ever hired someone with any management brains over there, there would be a whole shitpot full of walking papers given.
    As I said before, there are a ton of county workers who really do work hard, and do a really good job to keep that place together. Whats even funnier is that the inpatient/outpatient pharmacy there is the island of sanity and dignity that place has. My hats off to them, they must drink and take more medication than I do.

  • CNM/PA/NP, Home Health Nurses, and Stupidty

    I love getting hate mail from people who try to defend what I bitch about. Here is a good one:
    Most CNMs have Master’s Degrees…hardly career college.
    My response to that:
    Then learn your shit so I dont have to correct your errors. If you have a “masters” degree, then obvously you should have some brain cells in your noggin so I dont have to waste my time correcting your fatal fuckups. I get my shit in order before I speak with a doctor about a medication, so you should have your shit together before you speak with me about medication.
    Lets rehash the whole CNM/PA/NP issue shall we? For those of you who arent in the medical profession, heres a quick breakdown:
    CNM: Certified Nurse Midwife – Basically someone there when you have a baby. Why they gave these people the ability to write prescriptions is beyond me. Their scope of practice is about a half dozen drugs.
    NP: Nurse Practioner – At one time could prescribe everything a doctor could except C-2 narcotics (Morphine, Ritalin, etc). Thats changed.
    PA: Physicans Assistant – A NP but could write triplicate Rx’s for Morphine, etc.
    Now PA/NP’s are interchangeable.
    Back to the rant:
    How many pharmacists in the crowd have saved a CNM/PA/NP/Whoever-they-are-allowing-to-write-Rx’s-now-days/etc asses from something severe. Say like confusing hydroxyzine with hydralazine, or my favorite lamictal with lomotil.
    I had a NP sit there and argue with me that hydralazine was for itching. This was a white chick too, so there wasnt any accent (dont get me started) or language issues. She was dead set that hydralazine was for itching. Well, I guess if you take enough of it you wont have an itch anymore.
    Now this isnt a bash on all NP/PA’s, because i’ve met some of them that really know more than the Dr they work under. This is just a bash to all the stupid ones with the ego of a doctor, but without the schooling or balls to back it up.
    Lets move on now to Home Health Nurses. I had a nice call day before yesterday from a Home Health Nurse that went something like this:
    Her: “We have a problem here”
    Me: *sigh*
    Her: “I am supposed to give this person 10mg of methadone twice daily, but you dispensed the 5mg tablets”
    Me: “What does it say on the label”
    Her: “Take 2 tablets (10mg) twice daily”
    Me: “So whats the problem”
    Her: “These are 5mg tablets!”
    Me: “Yeah, you give 2. 5 + 5 = 10”
    Her: “Oh”
    Me: !@#!$!@#!@#!$!
    I swear, thats how the conversation went. When I hung up, I walked into the back room, sat down, and sobbed for the medical profession.
    Another fun story involves a tube of Regranex. Now most pharmacists out there are rolling their eyes at this point, because Regranex comes in a 15gm tube (small), and costs about 500 bucks a pop. Its used for chronic wound healing, and has a mathmatical formula to specfiy how much to squeeze out based upon the wound dimensions. Its like width x length x 0.6 = inches to squeeze out.
    So I managed to jump through the hoops to get this covered for this poor lady. Spent a few hours on the phone, and the insurance company decided to auth a few months of treatment to see if it’ll work. I call up the patient, and talk to the home health nurse:
    Me: “You know how to apply this right?”
    Her: “Yes”
    Me: “Its width x length x 0.6 = inches to apply – change with saline dressing after 12 hours”
    Her: “Ive done this before”
    Her: “Okay, just making sure”
    Drug goes out, and I get a call a day-and-a-half later. Its the home health nurse:
    Her: “I need another tube of Regranex”
    Me: “uh, why? This should last you for 2 weeks”
    Her: “I used it all up”
    Me: “But the wound is . You would need like 0.75″ of cream”
    Her: “I used it all up”
    Me: “You realize thats 500 bucks a tube right?”
    Her: “Will another tube be sent out today?”
    Now at this point I get the patient on the phone (who is very kind and sweet). She tells me the dumb twat was just latering it on like neosporin and used up the whole tube. I come unglued. I speak with her manager, and proceed to give her both barrels. It took me an act of God to get this shit covered, and a fucking dumb ignorant twat just blew what small chance I had. What burns me up even more is that I asked the dumb hoe if she knew how to apply it, and she blew me off.
    Ive been scarred by home health nurses ever since. The real pushy and demanding ones are the worst. When they start off the conversation with “You need to do…” my brain shuts off, and I just lay into them. I’m not their bitch and i’m not going to do their job for them.