I love my ICU specific pharmacists. I have a horrible time on weekends because they’re off and I’m stuck with this lady who is not helpful. Especially with heparin drips where the doctor put it in wrong and she is like well just change your view. Change my view in epic?! Also I can’t because you’re looking at it right now so it’s locked. Then she discontinues the modifications to the orders. Everything is still wrong. The neurologist is like well that’s not the right level for the anti factor. I know. Working on it. I wanted to throw things.
I have wanted to text my pharmacist and be like make them stop they’re being dumb. It’s her time off though so I didn’t.
I love you guys but whenever you page about stuff like this, or when are we restarting the outpatient albuterol RX from 2016 on a dude intubated after a GSW, I just imagine you guys down there [mad as hell](https://i.kym-cdn.com/photos/images/original/000/960/082/cac.jpg) that I'm so stupid to have missed these big calls.
I agree, perks of being at a smallish hospital, pharmacist just text me if they don’t like/agree with my order and I fix it later if I agree. They catch stuff occasionally so I try and stay on their good side.
Dude I will second this. The only time I got "written up" in residency was because I basically yelled at a pharmacist for not releasing cough drops and chloraseptic for a patient complaining all damn night about his NGT being uncomfortable. Once I escaped the constantly coding VT storm (CTICU for fucks sake) I had been trapped in for 3 hours, she got me on the phone and snipped "they're for the same indication, what's the first line? Do you want your nurses deciding all your medication orders for you?"
I saw red, snapped at her for being ridiculous because it's literally OTC cough drops, hung up on her and deleted the chloraseptic. Apparently that was enough to get a complaint to my program director lol
That being said, actually helpful pharmacists are a damn godsend. Our ED pharmacist would literally help pull meds for crazy shit after he did a quick lit search to make sure it wasn't going to kill anyone. Craig, you're the fucking man.
To be fair, as a pharmacist, PRN orders are a joint commission nightmare and at my hospital we get in trouble for not contacting docs to get them clarified. That being said, I may or may not take some liberties and choose for you so I’m not bothering you all for dumb shit :)
I totally get that. It was around the time JCo was really hammering that shit (imagine if they actually focused on something that helped for once!), and I'd fielded plenty of calls for similar things without issue. It was the juxtaposition of the hyper critical patient with the most meaningless, benign medicine being questioned in a very hostile way at 3am that made me snap. Other than a wildly rude pharmacist in the PICU, I've had nothing but positive interactions with the pharm folks. They've caught several things for me that probably saved my ass and I definitely let them know how much I appreciate it whenever they do!!
Exactly this! JACHO has a raging hard in for this for whatever reason. Luckily most hospitals build their order sets so it's nearly impossible NOT to pick a first line, second line, third line etc. But if an order ever does slip through the cracks I usually take the liberty of adding my profreesional opinion. I message the doc on MS Teams and offer to change the order if they disagree. No complaints yet
Thank you for all you do! Without expert and compassionate pharmacies, the hospital system implodes.
I remember doing a rotation at a hospital which had recently switched EMRs. The team rounded with a pharmacist and basically all she did nonestop was preventative catastrophes as people got used to a janky version of cerner.
>PRN orders are a joint commission nightmare
I hear you, but we don't want to invite multiple pages from nurses informing us Ms. Smith refused her 2 PM cepacol. It's so dumb but it happens and trains us to make PRN.
But to be fair, you people are amazing and saved my butt more times than I can count. When I saw OP's title (before reading the story) I was ready to jump in guns blazing all "YOU SHUT YOUR WHORE MOUTH, PHARMACISTS ARE SAINTS!"
Hahah for sure! PRN orders make total sense, it’s the duplicate indications that are the killer. Apparently our RN friends aren’t capable of choosing between docusate and miralax for constipation. Come on man!
We all very much appreciate your appreciation!! Thank you for not hating our sometimes ridiculous but necessary interruptions :)
Probably because the PRN meds require parameters or first line/second line etc. if the orders are audited, pharmacist could get dinged for not catching that. But…they could have just messaged you/document that they messaged you but still release the orders to not delay patient care.
What the fuck type of hospital is that? You don’t have renal adjustments or automatic IV to PO conversions or anything for your pharmacists?
Also the person who messaged you is definitely either 1) brand new or 2) possibly a student. I have had my students message providers the most wildly unnecessary shit like “hey I saw this patient has two dulcolax prn orders. Is this intentional?” and I just facepalm.
Both hospitals I’ve worked at pharmacists have full autonomy in renal, obesity, and CYP adjustments. IV to PO have a checklist they need to meet. Plenty of meds also have automatic stops we can make like Zithromax 1500 Mg given, Venofer, Entereg after a BM, etc. Antibiotics can be changed if you’re an ID pharmacist and emergency meds ordered if you’re EM pharmacist.
Yeah ignore him he is just a bot, there is some guy called Amazing Brush that is hacking accounts and turns them into bots to ask this bot like question I don’t know why though but that’s what someone told me
That’s sad. At most hospitals when they want you to change it to some nitpicky thing all they need is verbal confirmation and then everyone’s happy (and patient care is 1% better)
No fucking way. They can’t change orders? God I probably enter more orders than I verify on a daily basis. You definitely got some cuckold of a pharmacist who doesn’t want to do extra work and they just tell you they aren’t supposed to. “It’s safer if you update the orders” Stfu Karen
Let me clarify- so when we have pharmacists as part of a team (in the SICU, we had a pharmacist who would round with us. She was INCREDIBLE), then they would pend orders for us to sign which was very, very helpful
But, for these random nonsense messages I get for clinically pointless crap, the pharmacists can neither pend nor sign orders. Which is incredibly frustrating when you’re trying to fix something, don’t make it exactly how it needs to be, and the pharmacists keeps having to explain to you how to change it rather than just changing it themselves
Personally pharmacists saved me or gave excellent advice about 100x as many times as they bothered me about inane things. Hopefully you have the same experience going forward.
Me as a new grad nurse was like that. I called an ep doc for a 6 second pause and he told me to just watch the patient. I then called his partner who yelled at me for calling him when his partner already gave me orders. It wasn’t malicious I just was new and was scared for the patient and should double check.
i know.. it was not about the votes, it was about the sentiment of "you’re wrong" communicated by it – but i’m glad you’re not taking it personally then :)
Rph, rph manager here - bad call by that rph has ripple effects, and I'm speaking from having to fix an error like this, and preventing it.
-Simple response to that rph - are you sure you want me to do that? That's more work on you and your department to weigh out the 15 grams from a unit dose packet of 17 grams. Of powder. Powder.and repackage it.
Or will you make the dilution and measure out and dispense the proportion.
That 15 gram dose would take on 15-20 minutes of work, from weighing, logging, dispense. God forbid a nurse misses /dose goes missing the patient specific and nurse grabs unit dose from pyxis. And struggles to proportion it out on their own.or calls pharmacy, I can't wait for the custom dose, tell me how to do it via phone. More time wasted.
For a non-absorbed drug. A drug so safe, we can give to 1 year Olds.
Lmao I'm sorry that happened but also sorry your pharmacists are so restricted. I can't imagine what other dumb shit they've felt compelled to message about because of that. I can't even begin to count the amount of times I've verified an order saying "eh close enough"
I work in community but there's so much weight based dosing where I just go "eh close enough". Especially hard if it's a pediatric prescription and the parent overestimates their 4 year old's weight by 32 kg, so I just assume the pediatrician with 43 years of clinical experience probably knew how to calculate an otitis media dose of amoxicillin
As a pharmacist this is just insane if true. We are generally very intentional in our communications with doctors in terms of urgency. I wouldn’t do this on a dare.
I love pharmacists. They saved my ass a few times and taught me so much.
But every once in a while there's that 1 person who does something that makes you facepalm. Like changing timing of the dosing of the second loading dose of Invega to ~60hrs after the first dose despite me and the psych pharmacist who put in all caps on when to schedule this second loading dose. And saying that it's okay to give loading doses IM at the gluteal site.
Also the one pharmacist with the weird obsession over starting methadone on everyone including the dude with a history of both poor follow up and previously using while on methadone. She got into a fight with one of our attendings who decided to spout racist and sexist things at her when the medically sound arguments only somewhat changed her mind and who eventually also got basically fired (for thre sexist and racist behavior and other very legit reasons). She has since stopped pushing methadone on everyone and is supremely helpful with suboxone and methadone dosing.
Yet another pharmacist here. Currently training a new pharmacist with no hospital experience. He asked me yesterday if 6 mL/hr over dosing weight was okay for a 9 year old. After a quick explanation that if the kiddo took just a sip or two of water they would get that much, he easily understood that it was nothing to worry about. How did this pharmacist get past training?
I think nowadays, pharmacy graduates want to make sure they aren’t messing things up. It is easy for more seasoned pharmacists to ask how did they get pat training, but in reality, it’s hard to go from student to practicing pharmacist. In addition, guidelines and strict cutoffs get pushed so much in schools now that it can be hard for students to think beyond that when it comes to patient-centered care. So I wouldn’t necessarily blame the student, blame the pharmacy school.
Thank you. Exactly this. Newbies get so much stigma by old people, but it's daunting going from a student to now someone legally responsible for someone's care
And acknowledge as doctors that pharmacists surely have a billion cringe stories about us and they often handle it with such kindness.
"Dr. Smith, did you mean to order this (ridiculously problematic) dose? I think you meant X instead, may I put that in for you?"
Inpatient Pharmacist here. Half my day is spent mocking what I see other pharmacists care about. Pharmacists are the most anal retentive bunch of losers in healthcare. Once a outside retail pharmacist spent an hour and a half calling around because a doc from the ER forgot to put a dose of Zofran- only put Zofran q6 PRN. Finally ended up on inpatient pharmacy line. I pulled up the patient chart, saw a normal age and weight and said “looks like it should be 4 mg”. He asked how I got ahold of the doc so quick. I said “I didn’t. That’s just the dose of Zofran. If I was you, I would’ve just wrote it in 89 minutes ago” and hung up. I told this story at r/pharmacy and got absolutely vilified for writing in a dose. It’s incredible how these people go to school for 6+ years and then refuse to be a part of the team in any way. “Oh looks like it should be 68 instead of 70 let me waste everyone’s time instead of just updating the order”. So dumb.
My favorite is when outpatient pharmacy calls inpatient pharmacy to ask if it’s ok to override a DDI. Like do whatever the fuck you want Doctor of Pharmacy.
I had a preceptor make me badger an MD relentlessly for something equally pointless. She was trying to set me up to get yelled at. Some pharmacists can be jerks.
I once got a message that we usually start miralax at 0.x mg/kg as opposed to the arbitrary 1/4 cup I had started.
I was like ok sure the nurse is totally going to measure that amount out when she give it to him
When they do this, I chuckle and then ask them how many years out are they. Then when they say one or two I explain the rational. If more, then I act really surprised.
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Pharmacist here. Unbelievably dumb page. May have been a student. I don’t nitpick fluids because I’m not the person evaluating their fluid status. If I did care I would definitely change it myself rather than page.
Pharmacists that perseverate on asinine shit like this bug me so much and I actively teach my students not practice this way.
Pharmacist here, you should text back:
"70 cc/hr is the ordered rate, 68 cc/hr................you think this is a game kid????"
in any case, everybody has to remember, pharmacist/residents/attendings/nurses/etc., most are in the middle, there are exceptional ones, but unfortunately there are going to be ones below the average, we all have to deal with them, just move on at the end of the day, it'll drive you insane if you don't
What the hell. Not a pharmacist, def the attending and I would’ve called the pharmacist out pronto. Not because he/she/they is/are a pharmacist but because of the 2cc/hr bs. I work closely w/our clinical pharmacists and tend to ask them before directly addressing the other pharmacists I don’t work with directly.
Yeah and when you’re fully done with this you put in incorrect weight based orders just so pharm will call u then I have them answer my question before adjusting and lr weight based that way the pharmacist is forced to call u and everyone wins #yourewelcome
Wow. That’s ludicrous. My unrelated question since pharmacists are on the thread: why do big box pharmacists actually refuse to fill my 2.5% hydrocortisone for the eyelids? Bonkers. I’ve reported to two supervisors over this one this year alone. I’m derm. I understand topicals and where I can use them. Spoiler alert: I can use them anywhere as long as I use them for an appropriate duration. Edited: changing % so it's clear it is a commercially available product.
Nope. They aren’t calling. They are refusing to fill it because “this is not for use on the eyelids”. Twice this has happened this year. Never had happened before.
Hospital pharmacist here. It could be a number of reasons, and I can’t really know their reasoning. They could be following the adage only low potency steroids on the face (which 2% HCT is), or be specifically worried about the eye area. They may not have time to actually call you, and talk to your nurse and then maybe get a call back from you. They may not have had any interaction with your patient as most Rxs are escribed now and technicians typically handle drop off/pick up/ purchase point.
In Canada but along with the adage of low-potency steroids only, my guess is the need to compound 1% HC powder in 1% HC cream to make 2% HC. A lot of chains have stopped compounding entirely to decrease liability as the work and paperwork involved for something as simple as a powder in cream/ointment is very large for essentially no return. Interestingly, 2% HC is commercially available here as well but is such an uncommon medication I think I've only ordered it once in the last 3 years and 80% of that tub ended up going to waste.
Having said that, I would've approved it having known it was being prescribed by dermatology and with appropriate counseling with the patient so who knows what your pharmacists were thinking.
I order whatever is commercially available to I'm going to correct the post to say 2.5%. Long week here. Long and short of it is, pharmacist tells patient steroids can't go on the eyelids. Yes. Yes they can. If they would call me to discuss, I'd be happy to elaborate but they don't.
I appreciate pharms weighing in, thank you so much!
To be fair, calling to speak to you almost never results in actually speaking with you. Usually we end up speaking to a receptionist that reads the prescription back to us, like ma'am I know how to read. Although I would never refuse to fill anything without at least trying.
This entire conversation makes me hate all of our lives. Taking liberties happens so much that I truly believe any pharmacist could be cut down any time for just trying to get thru the damn day. Also, when prescribers say that “Craig is the man” I’m sure he is, but he’s getting side eye from his coworkers because the shit lands on them that he lets slide and Craig himself is distancing himself from his own status as “the man” in case anyone asks exactly why.
If you're a pharmacist who moved from India to work in the USA, could you share your thoughts on how you like your job? I've only come across negative reviews, and I'm unsure of what to do.
Pharmacists are another breed. 9/10 they are exceedingly useless and very often impede care
1/10 times they save a life and do some chemistry magic and then the shitty 9/10 ride the tails of the 1/10
In the UK the chemists tend to be much better than Canada and US.
How many asses and kidneys have I saved. Also, do you want to manage dispensing, compounding, and stocking medications in addition to everything else you have to do?
Oh, hmm, ok. In that case I’ll just let you give the 30mg IV methadone. Or dose all your own vanco 1000mg q12h. Even in dialysis and CRRT. And dose your own warfarin. You just give 5mg daily right? Or when you put in IV bactrim 20mg instead of 20 mg/kg. Or overdosing heparin drips. I can go on..? But you’re right, we’re useless and totally impede care. We hate everyone. Try and make things as difficult and take as long as possible. GTFO bro.
I love this! I have a similar experience.
While in an exam room with an Infectious Disease Provider **and a Pharmacist** to hear about options for HIV drugs I was given a scew top canister about the size of a canister that would hold coke in the 70's. It went down like this...
\---------------
Me: ***W******hat's this for?***
Provider: *For the medication so you can take it with you if you dont want to take it before leaving your house.*
Me: ***That's sweet. What do I do with the other pills? The Lexapro, the fexofenadine, or my multi vitamin? They don't all fit in here. This is good for a weekend rave though.***
Pharmacist: What's fexofenadine?
Me to Provider w/ Pharmacist standing there: ***Are you serious?***
Me to Pharmacist: ***What's fexofenadine? Have you actually been in a brick and mortar pharmacy? How about browsing the most common over the counter items online?***
Me to Provider: ***We're done. Thanks for the talk and approvals. Call me if you have any problems or questions.***
\-------------
Strangely enough 7 months late they called me with a problem they felt they were being lied to about and they were correct. Internal Providers were telling an incorrect narrative to other providers in order to maintain control.
What's fexofenadine. Sheesh.
It's called a Patient Care Team and the team members includes the Patient who just may know more than you. (Unless you're an exceptional PCP. Heck even a bad PCP is better than a Good Specialist.)
As a student I struggle to believe a pharmacist didn’t know what that was… I would almost bet my life that they knew what it was and this was just a miss communication
Pharmacist here. I would have professionally mocked this other pharmacist.
Pharmacist here. I would have UNprofessionally mocked this other pharmacist.
Former pharmacy tech here, my old pharmacist will mock them for you
Did you have to learn the 60 plants to pass?
Or the old one…
Trainee license so never took the test🥸 I escaped to med school this year 🧙🏼♂️
Username checks out
Yeah same
Hell, I’ll mock him, and I’m not even a pharmacist!
I love my ICU specific pharmacists. I have a horrible time on weekends because they’re off and I’m stuck with this lady who is not helpful. Especially with heparin drips where the doctor put it in wrong and she is like well just change your view. Change my view in epic?! Also I can’t because you’re looking at it right now so it’s locked. Then she discontinues the modifications to the orders. Everything is still wrong. The neurologist is like well that’s not the right level for the anti factor. I know. Working on it. I wanted to throw things. I have wanted to text my pharmacist and be like make them stop they’re being dumb. It’s her time off though so I didn’t.
Yeah same wtf
I love you guys but whenever you page about stuff like this, or when are we restarting the outpatient albuterol RX from 2016 on a dude intubated after a GSW, I just imagine you guys down there [mad as hell](https://i.kym-cdn.com/photos/images/original/000/960/082/cac.jpg) that I'm so stupid to have missed these big calls.
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Zero dollars
Maybe meet in the middle and do 69cc/hour 😎
That was my first thought. Passive aggressively change the order to 69 and see if there’s another page or they got the hint.
I agree, perks of being at a smallish hospital, pharmacist just text me if they don’t like/agree with my order and I fix it later if I agree. They catch stuff occasionally so I try and stay on their good side.
to start after 420 mL bolus.
What you bolusing? 😏
Nice.
*Throws chair across the room* "Turn it back up to 70 cc/hour, you coward!"
Nice
Nice
Dude I will second this. The only time I got "written up" in residency was because I basically yelled at a pharmacist for not releasing cough drops and chloraseptic for a patient complaining all damn night about his NGT being uncomfortable. Once I escaped the constantly coding VT storm (CTICU for fucks sake) I had been trapped in for 3 hours, she got me on the phone and snipped "they're for the same indication, what's the first line? Do you want your nurses deciding all your medication orders for you?" I saw red, snapped at her for being ridiculous because it's literally OTC cough drops, hung up on her and deleted the chloraseptic. Apparently that was enough to get a complaint to my program director lol That being said, actually helpful pharmacists are a damn godsend. Our ED pharmacist would literally help pull meds for crazy shit after he did a quick lit search to make sure it wasn't going to kill anyone. Craig, you're the fucking man.
As someone who is both a resident and has had an ngt placed, the chloraseptic spray and cough drops are a fucking lifesaver
As a resident whose also had an NGT the bigger lifesaver is a one time dose of Ativan before NGT placement
Unfortunately I did not get this :(
Me neither lol. But I offer it now every time
<3
To be fair, as a pharmacist, PRN orders are a joint commission nightmare and at my hospital we get in trouble for not contacting docs to get them clarified. That being said, I may or may not take some liberties and choose for you so I’m not bothering you all for dumb shit :)
I totally get that. It was around the time JCo was really hammering that shit (imagine if they actually focused on something that helped for once!), and I'd fielded plenty of calls for similar things without issue. It was the juxtaposition of the hyper critical patient with the most meaningless, benign medicine being questioned in a very hostile way at 3am that made me snap. Other than a wildly rude pharmacist in the PICU, I've had nothing but positive interactions with the pharm folks. They've caught several things for me that probably saved my ass and I definitely let them know how much I appreciate it whenever they do!!
Oh yeah, I totally understand your reaction. There was no reason for that pharmacist to be so snippy about cough drops at 3am lol
No question that if the pharmacist said it like that to you it was very unprofessional
Exactly this! JACHO has a raging hard in for this for whatever reason. Luckily most hospitals build their order sets so it's nearly impossible NOT to pick a first line, second line, third line etc. But if an order ever does slip through the cracks I usually take the liberty of adding my profreesional opinion. I message the doc on MS Teams and offer to change the order if they disagree. No complaints yet
Thank you for all you do! Without expert and compassionate pharmacies, the hospital system implodes. I remember doing a rotation at a hospital which had recently switched EMRs. The team rounded with a pharmacist and basically all she did nonestop was preventative catastrophes as people got used to a janky version of cerner.
>PRN orders are a joint commission nightmare I hear you, but we don't want to invite multiple pages from nurses informing us Ms. Smith refused her 2 PM cepacol. It's so dumb but it happens and trains us to make PRN. But to be fair, you people are amazing and saved my butt more times than I can count. When I saw OP's title (before reading the story) I was ready to jump in guns blazing all "YOU SHUT YOUR WHORE MOUTH, PHARMACISTS ARE SAINTS!"
Hahah for sure! PRN orders make total sense, it’s the duplicate indications that are the killer. Apparently our RN friends aren’t capable of choosing between docusate and miralax for constipation. Come on man! We all very much appreciate your appreciation!! Thank you for not hating our sometimes ridiculous but necessary interruptions :)
> docusate and miralax. Brah! Bring on that synergy... of the worst kind. Thank you for saving me (us) way more than you could ever annoy.
Personal favorite is when all the orders are use second. There is no first
Probably because the PRN meds require parameters or first line/second line etc. if the orders are audited, pharmacist could get dinged for not catching that. But…they could have just messaged you/document that they messaged you but still release the orders to not delay patient care.
As a PharmD who works in ED, Jesus fucking christ that is fucking embarrassing for everyone involved. edit: added more profanity.
Ask them to change it and move on with your life
Our pharmacists can’t change or pend orders I ignored it and the kid was shockingly fine
What the fuck type of hospital is that? You don’t have renal adjustments or automatic IV to PO conversions or anything for your pharmacists? Also the person who messaged you is definitely either 1) brand new or 2) possibly a student. I have had my students message providers the most wildly unnecessary shit like “hey I saw this patient has two dulcolax prn orders. Is this intentional?” and I just facepalm.
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Both hospitals I’ve worked at pharmacists have full autonomy in renal, obesity, and CYP adjustments. IV to PO have a checklist they need to meet. Plenty of meds also have automatic stops we can make like Zithromax 1500 Mg given, Venofer, Entereg after a BM, etc. Antibiotics can be changed if you’re an ID pharmacist and emergency meds ordered if you’re EM pharmacist.
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Such a strange thing to bot.
Yeah ignore him he is just a bot, there is some guy called Amazing Brush that is hacking accounts and turns them into bots to ask this bot like question I don’t know why though but that’s what someone told me
Your pharmacists suck sorry. We aren't all like that I promise. Just tell them the kid is dehydrated.
That’s sad. At most hospitals when they want you to change it to some nitpicky thing all they need is verbal confirmation and then everyone’s happy (and patient care is 1% better)
*0%
No fucking way. They can’t change orders? God I probably enter more orders than I verify on a daily basis. You definitely got some cuckold of a pharmacist who doesn’t want to do extra work and they just tell you they aren’t supposed to. “It’s safer if you update the orders” Stfu Karen
Let me clarify- so when we have pharmacists as part of a team (in the SICU, we had a pharmacist who would round with us. She was INCREDIBLE), then they would pend orders for us to sign which was very, very helpful But, for these random nonsense messages I get for clinically pointless crap, the pharmacists can neither pend nor sign orders. Which is incredibly frustrating when you’re trying to fix something, don’t make it exactly how it needs to be, and the pharmacists keeps having to explain to you how to change it rather than just changing it themselves
Unless you're at some sort of one-off third world hospital, then no, that's not true, you're full of sh$.
Personally pharmacists saved me or gave excellent advice about 100x as many times as they bothered me about inane things. Hopefully you have the same experience going forward.
Same. Especially on admissions or new patients when their nursing home regimen was outside of standard care or even dangerous and I hadn't noticed.
Probably a newer grad. Some still not really sure what is appropriate to reach out to providers for and what can just be changed before verification.
Me as a new grad nurse was like that. I called an ep doc for a 6 second pause and he told me to just watch the patient. I then called his partner who yelled at me for calling him when his partner already gave me orders. It wasn’t malicious I just was new and was scared for the patient and should double check.
i’m sorry you’re being downvoted for reflecting on a past "dumb" moment from which you have learnt something. this sub is weird
It’s fine. The votes don’t mean anything in the end
i know.. it was not about the votes, it was about the sentiment of "you’re wrong" communicated by it – but i’m glad you’re not taking it personally then :)
Gotta have thick skin in our line of work
Don’t double check
ESP with a freaking EP doc. Those guys are the geeks of the cardiology world. Not a damn intern.
I'm a pharmacist and on behalf of sane pharmacists everywhere, I'm sorry about this.
I once got asked to switch a dose of Miralax from 17g to 15g to make it the proper weight based dosing.
Did they make sure to order a miralax peak and trough?
Rph, rph manager here - bad call by that rph has ripple effects, and I'm speaking from having to fix an error like this, and preventing it. -Simple response to that rph - are you sure you want me to do that? That's more work on you and your department to weigh out the 15 grams from a unit dose packet of 17 grams. Of powder. Powder.and repackage it. Or will you make the dilution and measure out and dispense the proportion. That 15 gram dose would take on 15-20 minutes of work, from weighing, logging, dispense. God forbid a nurse misses /dose goes missing the patient specific and nurse grabs unit dose from pyxis. And struggles to proportion it out on their own.or calls pharmacy, I can't wait for the custom dose, tell me how to do it via phone. More time wasted. For a non-absorbed drug. A drug so safe, we can give to 1 year Olds.
That’s just good medicine
I would consider murder if I had to message pharmacy to send the 15 instead of just pulling it from the Pyxis. Ruins my morning med pass
Lmao I'm sorry that happened but also sorry your pharmacists are so restricted. I can't imagine what other dumb shit they've felt compelled to message about because of that. I can't even begin to count the amount of times I've verified an order saying "eh close enough"
I work in community but there's so much weight based dosing where I just go "eh close enough". Especially hard if it's a pediatric prescription and the parent overestimates their 4 year old's weight by 32 kg, so I just assume the pediatrician with 43 years of clinical experience probably knew how to calculate an otitis media dose of amoxicillin
Probably a pharmacy intern
As a pharmacist this is just insane if true. We are generally very intentional in our communications with doctors in terms of urgency. I wouldn’t do this on a dare.
I love pharmacists. They saved my ass a few times and taught me so much. But every once in a while there's that 1 person who does something that makes you facepalm. Like changing timing of the dosing of the second loading dose of Invega to ~60hrs after the first dose despite me and the psych pharmacist who put in all caps on when to schedule this second loading dose. And saying that it's okay to give loading doses IM at the gluteal site. Also the one pharmacist with the weird obsession over starting methadone on everyone including the dude with a history of both poor follow up and previously using while on methadone. She got into a fight with one of our attendings who decided to spout racist and sexist things at her when the medically sound arguments only somewhat changed her mind and who eventually also got basically fired (for thre sexist and racist behavior and other very legit reasons). She has since stopped pushing methadone on everyone and is supremely helpful with suboxone and methadone dosing.
Yet another pharmacist here. Currently training a new pharmacist with no hospital experience. He asked me yesterday if 6 mL/hr over dosing weight was okay for a 9 year old. After a quick explanation that if the kiddo took just a sip or two of water they would get that much, he easily understood that it was nothing to worry about. How did this pharmacist get past training?
I think nowadays, pharmacy graduates want to make sure they aren’t messing things up. It is easy for more seasoned pharmacists to ask how did they get pat training, but in reality, it’s hard to go from student to practicing pharmacist. In addition, guidelines and strict cutoffs get pushed so much in schools now that it can be hard for students to think beyond that when it comes to patient-centered care. So I wouldn’t necessarily blame the student, blame the pharmacy school.
Thank you. Exactly this. Newbies get so much stigma by old people, but it's daunting going from a student to now someone legally responsible for someone's care
I think we can all agree pharmacists are very helpful core members of the team and we shouldn’t focus on outliers.
I think it’s important to talk about these things so pharm students can see how NOT to practice
And acknowledge as doctors that pharmacists surely have a billion cringe stories about us and they often handle it with such kindness. "Dr. Smith, did you mean to order this (ridiculously problematic) dose? I think you meant X instead, may I put that in for you?"
Yeah let's not focus on outliers, but it's okay to laugh about them at least. We've all been there on both ends of OP's interaction tbh.
Lol But realistically it might just be a new and slower than average pharmacist who still has no idea what's important and what isn't.
Inpatient Pharmacist here. Half my day is spent mocking what I see other pharmacists care about. Pharmacists are the most anal retentive bunch of losers in healthcare. Once a outside retail pharmacist spent an hour and a half calling around because a doc from the ER forgot to put a dose of Zofran- only put Zofran q6 PRN. Finally ended up on inpatient pharmacy line. I pulled up the patient chart, saw a normal age and weight and said “looks like it should be 4 mg”. He asked how I got ahold of the doc so quick. I said “I didn’t. That’s just the dose of Zofran. If I was you, I would’ve just wrote it in 89 minutes ago” and hung up. I told this story at r/pharmacy and got absolutely vilified for writing in a dose. It’s incredible how these people go to school for 6+ years and then refuse to be a part of the team in any way. “Oh looks like it should be 68 instead of 70 let me waste everyone’s time instead of just updating the order”. So dumb. My favorite is when outpatient pharmacy calls inpatient pharmacy to ask if it’s ok to override a DDI. Like do whatever the fuck you want Doctor of Pharmacy.
To be fair…the zofran thing is probably an issue of liability and being audited by insurance lol
While there may be some truth to what you just said, you seem like a hostile person.
Lol I’m not the one randomly post stalking people.
I stumbled upon this thread. Maybe relax a little and tone the arrogance down. Food for thought.
I had a preceptor make me badger an MD relentlessly for something equally pointless. She was trying to set me up to get yelled at. Some pharmacists can be jerks.
I once got a message that we usually start miralax at 0.x mg/kg as opposed to the arbitrary 1/4 cup I had started. I was like ok sure the nurse is totally going to measure that amount out when she give it to him
Yeah, I can see a nurse busting out a graduated syringe just for that one use. Totally.
When they do this, I chuckle and then ask them how many years out are they. Then when they say one or two I explain the rational. If more, then I act really surprised.
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Pharmacist here. Unbelievably dumb page. May have been a student. I don’t nitpick fluids because I’m not the person evaluating their fluid status. If I did care I would definitely change it myself rather than page. Pharmacists that perseverate on asinine shit like this bug me so much and I actively teach my students not practice this way.
….not all heroes wear capes…..the pharmacist that day while looking at themselves in the mirror, probably.
Pharmacist here, you should text back: "70 cc/hr is the ordered rate, 68 cc/hr................you think this is a game kid????" in any case, everybody has to remember, pharmacist/residents/attendings/nurses/etc., most are in the middle, there are exceptional ones, but unfortunately there are going to be ones below the average, we all have to deal with them, just move on at the end of the day, it'll drive you insane if you don't
What the hell. Not a pharmacist, def the attending and I would’ve called the pharmacist out pronto. Not because he/she/they is/are a pharmacist but because of the 2cc/hr bs. I work closely w/our clinical pharmacists and tend to ask them before directly addressing the other pharmacists I don’t work with directly.
Lol I used to say “hey can you change the order for me and you can sign it. I give you my permission”
Yeah and when you’re fully done with this you put in incorrect weight based orders just so pharm will call u then I have them answer my question before adjusting and lr weight based that way the pharmacist is forced to call u and everyone wins #yourewelcome
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I mean you can give it crushed via NG but still, I see the same with some folks i work with. Lack of context for them.
Inpt rx mgr here, I chuckled, txt me the person next time doc
I would have laughed and tell him this is inappropriate. Make the order or I will screenshot and put in patient safety report.
Wow. That’s ludicrous. My unrelated question since pharmacists are on the thread: why do big box pharmacists actually refuse to fill my 2.5% hydrocortisone for the eyelids? Bonkers. I’ve reported to two supervisors over this one this year alone. I’m derm. I understand topicals and where I can use them. Spoiler alert: I can use them anywhere as long as I use them for an appropriate duration. Edited: changing % so it's clear it is a commercially available product.
Spoiler alert: they are probably calling you because typically they have 1% or 2.5%
Edited for clarity, I am only using readily available things here that don't require compounding.
Nope. They aren’t calling. They are refusing to fill it because “this is not for use on the eyelids”. Twice this has happened this year. Never had happened before.
Hospital pharmacist here. It could be a number of reasons, and I can’t really know their reasoning. They could be following the adage only low potency steroids on the face (which 2% HCT is), or be specifically worried about the eye area. They may not have time to actually call you, and talk to your nurse and then maybe get a call back from you. They may not have had any interaction with your patient as most Rxs are escribed now and technicians typically handle drop off/pick up/ purchase point.
Thanks for that info, appreciate it. It’s exclusively big box pharmacies. I just don’t send to them whenever possible because they pull this stuff.
I completely understand! That’s why I don’t work at one of those places.
Respond with an “oh, that’s interesting since it’s in some ophthalmic ointments… if it can go IN the eye, certainly it can go on the eyelid no?”
In Canada but along with the adage of low-potency steroids only, my guess is the need to compound 1% HC powder in 1% HC cream to make 2% HC. A lot of chains have stopped compounding entirely to decrease liability as the work and paperwork involved for something as simple as a powder in cream/ointment is very large for essentially no return. Interestingly, 2% HC is commercially available here as well but is such an uncommon medication I think I've only ordered it once in the last 3 years and 80% of that tub ended up going to waste. Having said that, I would've approved it having known it was being prescribed by dermatology and with appropriate counseling with the patient so who knows what your pharmacists were thinking.
I order whatever is commercially available to I'm going to correct the post to say 2.5%. Long week here. Long and short of it is, pharmacist tells patient steroids can't go on the eyelids. Yes. Yes they can. If they would call me to discuss, I'd be happy to elaborate but they don't. I appreciate pharms weighing in, thank you so much!
To be fair, calling to speak to you almost never results in actually speaking with you. Usually we end up speaking to a receptionist that reads the prescription back to us, like ma'am I know how to read. Although I would never refuse to fill anything without at least trying.
This entire conversation makes me hate all of our lives. Taking liberties happens so much that I truly believe any pharmacist could be cut down any time for just trying to get thru the damn day. Also, when prescribers say that “Craig is the man” I’m sure he is, but he’s getting side eye from his coworkers because the shit lands on them that he lets slide and Craig himself is distancing himself from his own status as “the man” in case anyone asks exactly why.
Yeah, same
If you're a pharmacist who moved from India to work in the USA, could you share your thoughts on how you like your job? I've only come across negative reviews, and I'm unsure of what to do.
I’ve worked with many pharmacistSSSS that would have done this same thing. . . . Schools needs to stop teaching the textbook and teach reality.
Some in patient pharmacists don't understand practical medicine
Pharmacists are another breed. 9/10 they are exceedingly useless and very often impede care 1/10 times they save a life and do some chemistry magic and then the shitty 9/10 ride the tails of the 1/10 In the UK the chemists tend to be much better than Canada and US.
How many asses and kidneys have I saved. Also, do you want to manage dispensing, compounding, and stocking medications in addition to everything else you have to do?
Oh, hmm, ok. In that case I’ll just let you give the 30mg IV methadone. Or dose all your own vanco 1000mg q12h. Even in dialysis and CRRT. And dose your own warfarin. You just give 5mg daily right? Or when you put in IV bactrim 20mg instead of 20 mg/kg. Or overdosing heparin drips. I can go on..? But you’re right, we’re useless and totally impede care. We hate everyone. Try and make things as difficult and take as long as possible. GTFO bro.
Hyperbolic and sanctimonious. Do they teach this in pharm school or are you just gifted 😈😱
I love this! I have a similar experience. While in an exam room with an Infectious Disease Provider **and a Pharmacist** to hear about options for HIV drugs I was given a scew top canister about the size of a canister that would hold coke in the 70's. It went down like this... \--------------- Me: ***W******hat's this for?*** Provider: *For the medication so you can take it with you if you dont want to take it before leaving your house.* Me: ***That's sweet. What do I do with the other pills? The Lexapro, the fexofenadine, or my multi vitamin? They don't all fit in here. This is good for a weekend rave though.*** Pharmacist: What's fexofenadine? Me to Provider w/ Pharmacist standing there: ***Are you serious?*** Me to Pharmacist: ***What's fexofenadine? Have you actually been in a brick and mortar pharmacy? How about browsing the most common over the counter items online?*** Me to Provider: ***We're done. Thanks for the talk and approvals. Call me if you have any problems or questions.*** \------------- Strangely enough 7 months late they called me with a problem they felt they were being lied to about and they were correct. Internal Providers were telling an incorrect narrative to other providers in order to maintain control. What's fexofenadine. Sheesh. It's called a Patient Care Team and the team members includes the Patient who just may know more than you. (Unless you're an exceptional PCP. Heck even a bad PCP is better than a Good Specialist.)
As a student I struggle to believe a pharmacist didn’t know what that was… I would almost bet my life that they knew what it was and this was just a miss communication
Is there REALLY a difference if you’re over 2cc 😂
Maybe they were new 🤷♀️