Monthly Archives: March 2012

Worst reasons for near misses

I want to share with you some of the excuses I have heard from staff when they make a dispensing near miss. I appreciate that we are all human and, therefore, make mistakes but I can’t help feeling annoyed when instead of a simple apology and moment of recognition the following excuses are blurted out on a daily basis as to why the mistake occurred:

1. It’s too hot

2. It’s too cold

3. I’m hungry

4. I had too much to eat at lunch

5. It wasn’t me (no one owns up and the label is not signed)

6. It wasn’t me (they dispute it even though they have signed the label)

7. I just stuck the labels on, I did not dispense it

8. The box is a different colour and I got confused

9. The box is the same colour; it’s just a different drug unfortunately

10. I labelled it as amoxicillin 500mg so don’t understand why the label came out as amoxicillin 250mg

11. I’m thirsty

12. I need a wee

13. That’s what they had last time

14. I didn’t label it, it’s the labeller’s fault

15. I thought it said glycerin suppositories not glyceryl trinitrate spray. Is there a difference?       

What’s the worst reasons you’ve heard?

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OTC addiction (guest post by @zams123)

Guest post by @zams123

I t’s worrying how the majority of people in some areas have a problem with drug abuse and addiction. This problem in community pharmacy however can be very annoying.

For example, how many community pharmacists today are faced with frequent over-the-counter requests for co-codamol products? The same people keep coming in to buy co-codamol, solpadeine plus etc feeding the staff and pharmacist with more or less the same story: ‘I’ve run out of my prescription co-codamol 30/500mg tablets’, ‘its for my back pain, nothing else agrees with me’ or even ‘my doctor recommended it’… It becomes conflicting when we are put in a position to refuse the sale; customers kick off and become rude, complaints arise and go to headoffice department, but the end result is that they are going to buy the co-codamol product from another pharmacy using the same story again.

It can also be annoying that GP’s might not realise what our OTC licensing issues are and recommend patients to buy over the counter as it’s probably cheaper than on prescription.

This problem does not just apply to co-codamol, it’s other products too such as codeine linctus and kaolin and morphine. The frequent requests I had in my pharmacy for kaolin and morphine mixture were atrocious that I had to remove it off the shelf.

In my pharmacy we are recording on paper when we sell these products to suspected drug abusers. Apart from this, how else can we resolve issues with codeine addiction and drug misuse?

Liar Liar

Patient: Hi, can i have some co-codamol please?

Mr Dispenser: Is it for you or someone else?

Patient: Me

Mr Dispenser: Have you had it before?

Patient: Yes

Mr Dispenser: Recently?

Patient: No

Mr Dispenser: What pain is it for?

Patient: Back pain. Only thing that works

Mr Dispenser: Its only for three days use

Patient: Ok

Mr Dispenser: Are you on any other medication?

Patient: No

Mr Dispenser: That means over the counter, prescribed or herbal?

Patient: No

Mr Dispenser: Dont take any paracetamol with this as it contains paracetamol

Patient: Yeah, i know

Mr Dispenser: Thats £1.49 please

Patient: Oh, while I’m here can i pick up my prescription. I ordered it last week. Got no tablets left….

What would you do?

Its 9.00pm on a Saturday evening and you are still at work. A patient brings in a prescription for 500g E45 cream and you don’t have the item in stock. You are closed tomorrow.
Do you:
A] Say that you don’t have it in and ask them to try elsewhere
B] Offer to order it in for Monday
C] Ring your competitor across the road and if they have it in, send the patient across
D] Ask patient to ring out of hours doctors to get an alternative prescribed
E] Try [probably in vain] to convince them to buy a small tube of it for over the weekend
F] Other

Stand up for what you believe in

Something happened today in the pharmacy which annoyed me. Maybe I am old fashioned but I believe I have some values that some people don’t seem to possess.

Our bench in the shop has space for five people. There were six people sat on it today. From left to right, there was a 9 year old boy, his 30 something mum, a late 60s man with a walking stick, a 30 something couple and the man had his toddler on his knee.

Then a late 70s lady entered. Have a guess which person stood up and gave their seat up? Yes, it was the old man. The lady tried to protest but he was having none of it and made her sit down. He stood up with the aid of his stick.

None of the younger folk offered their seat or even battered an eyelid. The two elderly people did not say anything or complain. They were the nice old people and not the grumpy ones. I would have given my seat up because its the right thing to do.

The effect of medicines on the olfactory system

The effect of medicines on the olfactory system

Introduction

Olfaction is the sense of smell. A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.

Aim

The aim is to find smelly drugs

Method

A closed leading question was sent as a tweet was sent to 370 people that follow @MrDispenser asking to tell me about drugs that smell good or bad. No financial inducement was given. Ethics approval was not obtained. An application for funding was made and denied by the National Lottery. Consent was obtained via direct message for tweets to appear in this report.

Results

30 people replied.

Table 1: Table to show gender of people that replied

Gender Number
Male 7
Female 21
Unable to work out as name is ambiguous and profile pic is not a face pic 2

My tweet was retweeted once. Two people did not give consent for their tweets to appear. Two did not reply so consent was given on their behalf

Selection of tweets

@zams123: depakote does smell like cannabis.

@L1ttlepetal: my dispenser ex bar manager said it smells like stale beer

 

Neo-Mercazole

This was very popular and my personal favourite too!

@josephbush cannot beat Neo-Mercazole

@indisangar neo-mercazole smells like strawberry milkshake

@susieminney carbimazole smell of milkshake

 

Celevac

Another popular choice

@laura_anne182  prefer Celevac. Serial tub-sniffer

@JustHelenYeah Celevac has to be the best for smell and colour

@Mushypea Celevac… just like strawberry milkshake

 

Bendroflumethiazide 2.5mg

This is the ronseal of tablets

@laura_anne182 Bendro 2.5mg (tubs of 500) smells like a chair in an old folks home.

@indisangar bendro smells like p**s, kind of appropriate, isn’t it?

@jommcmillan bendros smell like what they do

@cathrynjbrown Bad = bendro,

@susieminney bendroflumethiazide smells like stale wee. Ironic really.

@zams123 I like the musky smell of bendros! Weird I know!

 

Relifex

Also popular

@catrionabrodie: Nabumetone (especially Relifex) smells like butterscotch

@alkemist 1912: Relifex smell of butterscotch

@Mushypea:  Relifex was like butterscotch

@cathrynjbrown good: relifex

 

Vitamin B

Controversial tablet

@PatelSuk  Can’t believe no one’s mentioned Vitamin B compound. Weirdly addictive

@Anj17 I don’t like vitamin B. ewww smell.

@susieminney I love the smell of vitamin B in any shape or form

Vitamin caps BPC

Another controversial one

@laura_anne182 Funny how the smells can grow on you. I am now quite fond of the stinky vitamin caps

@lilygidley vitamin caps like Bovril

@JoMyattL I love vitamin caps BPC

@zams123 vitamin bpc caps smell horrible.

@josephbush vit caps = Bovril-y goodness

@NeelmSaina vitamin bpc capsules… Marmite smell?

@cathrynjbrown  Bad:  vitamin caps bpc

 

Antibiotics

Strong views on these common drugs

@Anj17 the banana amox.. yummy

@NeelmSaina bad = cephalexin caps

@Sairah_Banu flucloxacillin smells of the 1p sherberts

@Mushypea: fluclox caps are suphur like

@cathrynjbrown:  Bad:  flucloxacillin caps

@laura_anne182: Ciproxin susp smells like barrats fruit salads

@adamplum love the smell of fluclox mixture

@clareylang yes I agree. The liquid is completely the opposite of the caps

@cathrynbrown  Oh yes, the waft of amoxil or distaclor powder as you pour the water in

@clareylang Augmentin Duo smells well nice

@susieminney cephalosporins smell of cat wee

@becky_ross_23 Co-danthramer suspension smells exactly like tinned peaches

 

Aspirin

The smell is explained with science!

@zams123 Aspirin 75mg disp smells of salt and vinegar crisps

@clareylang aspirin really does smell like that

@adamplum cos acetyl-salicylic acid breaks down to acetic acid

 

Spironolactone

Smells like toothpaste

@EmmTurner spironolactone smells like menthol

@Pillmanuk spironolactone used to smell of minty wee

 

Miscellaneous

@tinaallsup: Neoral smells very strongly of beer. No complaints

@pakili1981: lamotrigine smells like lollies

@Sareenuh Vicks VapoRub Mmmmmm@mgcmitchell capol yum yum

@mgcmitchell pabrinex, TPN, and coal tar are bad

@Sairah_Banu: fentanyl patches smell really weird as well

@jommcmillan: Anybody remember Junifen? Used to smell like lemon puff biscuits

@pillmanuk NEVER smell heminevrin liquid

@misspill never break a full bottle in the dispensary either

Two people have said that Mecysteine smells horrible!

27 drugs were mentioned.

Discussion

Drugs smell. Vitamin caps BPC was the most commented drug. Relifex and Celevac were the best smelling drugs. Bendroflumethiazde was the worst smelling drug.

Future research

Use facebook too

Conclusion

MURs will never be boring again

References

Wikipedia

Fresh Pharmacist of Bel-Air

Now this is the story all about how

My life got flipped, turned upside down

And I’d like to take a minute just sit right there

I’ll tell you how I became the pharmacist of a town called Bel-Air

In West Yorkshire PCT born and raised

In the dispensary where I spent most of my days

Chilling out, dispensing, relaxing all cool

And all doing some chlaymdia screening outside of the school

When a couple of GPs said ‘we’re up in no good’

Started making trouble in my neighbourhood

I got in one little fight and my Area manager got scared

And said ‘you’re moving with your cluster manager in Bel-Air’

I begged and pleaded with her the other day

But she packed my MDS and sent me on my way

She gave me a kissin’ and she gave me my ticket

I put my ipod on and said I might as well kick it

I whistled for a delivery driver and when it came near

the License plate said ‘Fresh’ and had a pestle n mortar in the mirror

If anything I could say that this delivery van was rare

But I thought now forget it, yo home to Bel-Air

I pulled up to a pharmacy about seven or eight

And I yelled to the delivery driver ‘Yo, home smell you later’

Looked at my pharmacy I was finally there

To sit on my throne as the pharmacist of Bel-Air

Exciting vacancy at Mr D’s pharmacy

Mr Dispenser’s pharmacy is a forward thinking organisation and is honoured to create a new position in pharmacy: The receptionist

Must be a stubborn, miserable individual and have balls of steel (Not literally. See Dr Christian if literally)

Skills:

Be able to takes ages in answering the phone.

Be able to handle being the first port of call for the patient

Ability to grill patients as to why they want to see the pharmacist

Telling patients that they wont be able to see the pharmacist until a week on Tuesday.

Not let doctors get through on the phone if they wish to speak to the pharmacist

Will be expected to give pharmaceutical advice with no training provided

Be able to charge for sample bottles

Explain that the pharmacist is busy, even though he is visible drinking a cold cup of tea.

Be able to refer patients to the GP as the pharmacist is busy

Be able to give out confidential information over the phone without checking who the caller is.

Be able to look down on people

Salary: Minimum wage

Closing date: 1st April

Please apply via twitter

Some like it hot

Some people cannot function in the morning without some caffeine. The United Kingdom Tea Council (http://www.tea.co.uk/teafacts) state that 80% of office workers now claim they find out more about what’s going on at work over a cup of tea than in any other way. The figure is 98% in pharmacy.

You go to some branches and there is a hot drink offered to you as soon as you walk in. In others, you are pointed to the direction of the kettle. Sometimes it’s so busy that no one makes a drink all day and you never go back to that pharmacy.

It may be wise to bring a travel mug with you as it’s rare that you get to finish a full mug of the hot stuff. My own philosophy is to drink hot blackcurrant or orange cordial. This is normally met with strange looks. Hot cordial is like a placebo Lemsip. Once it cools down though, you can still drink it. Cold coffee is vile.

Some people don’t like making tea and always say that it’s not their turn. Some pharmacies have a rota and SOP in place. This includes a list on the wall stating who has what. If you give Sarah black tea instead of white coffee, then the near miss log is helpfully on the wall too. People have their own mugs too. Some have their names or age on which is helpful.

If you time tea making just right then a patient will always chime in that they want a cuppa too. It’s a rite of passage for the 14 year old work experience boy to make tea for everyone. This is generally the first time they have ever made tea in their life and they need advising that you need to actually switch the kettle on to get a hot drink.

Most pharmacies collect tea money from staff in order to finance hot beverages. One person is usually put in charge of this complicated and not to forget important task. Often excel spread sheets are used to name and shame staff who conveniently forget to pay up.

Staff are generally on a diet so have no sugar and opt for three biscuits instead. On a good week of offers at the supermarket there may be sightings of hot chocolate and “fancy” caffeine options available at the Phraamcy. Upper class pharmacies, offer soup. Bovril however, is not allowed in my pharmacy. Yuck!

The hot drink is one of the most enjoyable aspects of the day. Lets face it coffee is like lubrication to the work flow, an essential uplift. It may possible to hook up freshly brewed coffee to the Methameasure machine. Staff would be allowed 200ml TDS after successful fingerprint recognition. I’m still waiting for the patent to be approved.

For a few brief seconds, when your lips touch the warmth of your mug and get soaked by the milkiness of your perfect cuppa, you can forget about the chaos and imagine a better place.