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| One Stop Shop: Flu ClinicMy favorite moment today:
I work at a medical center and today we had flu clinic at work. Flu Clinic is a designated day where patients can get their influenza vaccinations. So we had long lines of people with occasion announcements of "Number 180 through 200, please proceed to the area with the green balloons."
So one of my patients asked me in all seriousness, "What is going on here? Are people voting here?"
^^*
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| WAC 246-869-220 Patient counseling requiredOh man, what a week... Before I go on about today's adventure... I would like to share a bit of knowledge about pharmacy law.
WAC 246-869-220 Patient counseling required.
The purpose of this counseling requirement is to educate the public in the use of drugs and devices dispensed upon a prescription.
(1) The pharmacist shall directly counsel the patient or patient's agent on the use of drugs or devices.
(2) For prescriptions delivered outside of the pharmacy, the pharmacist shall offer in writing, to provide direct counseling and information about the drug, including information on how to contact the pharmacist.
(3) For each patient, the pharmacist shall determine the amount of counseling that is reasonable and necessary under the circumstance to promote safe and effective administration of the medication and to facilitate an appropriate therapeutic outcome for that patient from the prescription.
(4) This rule applies to all prescriptions EXCEPT where a medication is to be administered by a licensed health professional authorized to administer medications.
In case you skip the above, please read number 4 at the very least - for my sanity. Thank you.
I work in a pharmacy associated with a clinic. So one day, one of the clinic nurses comes into the pharmacy asking for lorazepam for a patient in the treatment center. The patient needs the medication now because she's going to be transported to a hospital. I told her - I need a prescription for in-house use. She goes back and comes back with an outpatient prescription for 30 tablets. I told her - this isn't acceptable. I need a prescription for in-house use. She asks me if I can just give her one of the tablets and the patient will pick up the 29 later. I said, I can't give out a partial prescription of a outpatient prescription for in-house use. I told her I can give fill the outpatient prescription if you're going to deliver the medication. So I filled the prescription and told her, "Make sure an RN counsels on this medication." Then I wrote this on the paper that I included with the medication. The other pharmacist shouted, "Make sure you tell the patient and pay for the medication afterwards."
The next day, we receive a complaint from the patient that no one counseled her on the medication. And instead of being transported to the hospital. The patient DROVE home after taking one dose of lorazepam. If you know anything about lorazepam, it's kind of like Valium (diazepam) - you shouldn't drive on it! I wonder if something happened to the patient because why would a complaint come in.
So this nurse points a finger at me for not counseling the patient. I stated, I filled it because it was presented as an emergency to me and I told her that an RN needs to counsel on the medication and I wrote it on the paper.
My manager said my behind is covered because they told me that the patient was going to be transported and because I WROTE "RN to counsel."
What if I didn't? And how is that the nurse trying to pawn onto me that on her watch, her patient managed to wander out of the building and drive home? I think my manager is right when he's says that I'm too trusting. I hope I don't learn the hard way not to trust anyone - not even another health care professional. Ugh.
I love my job but I can't wait for this week to be over. I want to start this week all over. I wish I could share that I hope the patient is alright. I really do, I really do but man, oh man, I got scared for the first time that my license might be taken away. I wish I could stop thinking about myself and praying that the patient is a-okay. Because that's the important thing, right?
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| Hm... I finally figured out how to write a new blog entry. I'm horrible with exploring new buttons and what-nots.
I never thought my mood could really be affected by the weather. But oh-man, oh-man, did it suddenly go from winter to fall? Where did summer go? I'm a little off since it was snowing here in April. Today dragged... I had to catch myself a few times and pray that I wouldn't make any mistakes.
Like I said, today dragged... I can't quite place the word for me. Maybe because I was just highly annoyed with my first patient. He told me that his Lovenox injection "just fell apart" and he needs a new one. After inquiring how it fell apart, he finally admitted that he broke off the plunger off the syringe. I asked him if anyone counseled him on how to use the device - which he shamefully replied yes. So I called the help desk to ask about policies for lovenox replacements. Of course, since he broke the medication - he would have to pay full cost. I relayed this information to him. And he got really upset at me that he assumed he would have to pay another copay of $15 because he wanted a replacement for free. So imagine how much more angry he was at me when I quoted a price of $90. He refused the medication and I told him that since he had open heart surgery and given his risk factors, he is at high risk of blood clots without the medication. He said that there was no way he is going to take the medication and he stormed off.
I spent the day notifying his doctor, anticoagulation management service, and him on the day's incident. I was worried half to death. I know it's his last Lovenox shot and he's been taking warfarin >5 days so he theoretically should be protected but having a lab value back as evidence would make me feel a lot better.
What if he wasn't protected? What if he has a blood clot? What idiot gambles on $90 on his life after a surgical procedure?
Anyhow... that was just my first patient... and honestly my day wouldn't have been that bad except I let it get to me. Gosh, I felt like I was praying every hour for my sanity. I never ever want to let one bad moment dictate the rest of my day. Everyday is a new day. Every moment is new. Separate from the rest.
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| CrazyHm... my wireless internet doesn't work anymore. Or rather my wireless internet card. And I started to write in my paper journal more. I have a secret - I'm crazy. Maybe you already knew. But the secret is, I'm crazier than you think I am because gives me time to reflect and self-edit myself. Ha!
Something I read in Rick Warren's Purpose-driven Life:
"Humility is not thinking less of yourself; it is thinking of yourself less. Humility is thinking more of others. Humble people are so focused on serving others, they don't think of themselves."
One of the girls in my pharmacy class is going straight to a two-year bible college after pharmacy school. I asked if she was going to work part-time and she said no because the bible college was a full-time program. Gosh, doesn't that amaze you? Well, it amazes me - one of my life goals is to study the bible more formally. I haven't figured out how yet but part of it is because I just can't seem to drop everything and go. I'm impressed by people who can do that.
Anyhow, I've been feeling very restless at the moment. I wonder if this is was akathesia feels like. I feel giddy. I feel like my heart is palpitating at a million and one beats per minute outside of me. And I want to do and accomplish all my goals at once - as in right NOW, this instance. I want to get married, have kids yet go on a short-term mission, live in Korea, and attend bible college ALL at the same time, of course. Even though I can because I don't have a boyfriend, and no money as my father keeps reminding me - my priorities need to be on the nearly 50k loan I have... Argh, does anyone else feel as internally restless as I do? Does anyone else want to do everything at once - never mind oh-so-minor detail that you can't be in two places at once?
Did I mention that I am crazy?
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| Hm... my wireless internet works again. It's amazing how much time I had to do things when I didn't go on the internet so much!
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