Was thinking about moderators, and how users always have plenty of opinions about what moderators are doing wrong, but seems like you see less commentary from the moderators themselves about what it takes to do a good job.
Which is probably true across any situation where there’s a smaller number of leaders and a larger number of people in other roles.
Having experienced it, what does it take to lead a project, be a supervisor/boss, board member, pastor, dungeon master, legislator, etc?
Ya know a lot of ppl think pharmacists are just about putting pills in a bottle… but in all honesty in the role that I work clinically in a trauma center, I would say what sets a good pharmacist from a mediocre one is being able to catch everyone’s mistakes.
Your fellow pharmacists, techs in the pharmacy make mistakes (150 bicarb in 1/2NS?? lol) (incorrect pre packing procedures and getting kcl w an asa label)
Your docs make mistakes (2000mg q12 vanc on an esrd pt with a bmi of 45 + Zosyn 4.5 q6)
Your nurses make mistakes (y-site compatibility, missing doses, losing meds, etc)
The issue is noticing the problem and taking initiative to fix it. Unfortunately, either by ignorance, not correctly verifying, or just plain laziness can lead to sub optimal care for our patients.
It’s not easy though. I easily go through 500-1000+ orders a day, while calling doc/nurses, double checking techs and other pharmacists work. It can be stressful, and it’s easy to put blinders on and just keep hitting approve, but the pharmacists who look at that 4th 40meq kcl bag of the day for 1 patient without a lab drawn in 18 hours and calls the provider to see if maybe they want to draw a lab before the next admin. Those are the pharmacists doing a good job. This can go for the retail folks too who have to put up with way more shit than I.
What percentage would you say of your peers take the initiative in the way you describe? Is this a teachable skill or an inherent part of someone’s personality?
75-80% of the time. All the staff I work with will take initiative at some point, but some do it more/better than others. I have a certain level of trust with some co-workers that I do not with others.
As an example, We have 15ish pharmacists on staff (non-admin) and 25-30 techs… There are probably 5 or 6 pharmacists and 1/3 of the techs, that when I come in (rotating schedule btw) and I see “those people” are working I know I need to buckle down and really scrutinize what is going on.
Now, like I said in the first post, everyone makes mistakes. Including myself. But I think there is a difference between the mistakes and how they are handled.
There is this mentality of “I didn’t do it, So it isn’t my problem”. When really we should be looking at it as an “institution problem”, or its everyone’s problem! For example, the other day a doc called about starting a bicarb drip on a Hyperglycemia patient. We have a policy on hand to do 150 bicarb in 1L Sterile water. However, this one pharmacist doesn’t like using sterile water (because of HYPOtonic concerns), so instead talks the doc into doing a 150 bicarb in 1/2NS (well this makes it a HYPERtonic soln now and the patient only has a peripheral port AND their sodium is already 141)… OK well when it got to the IV pharmacist, they shouldve said WOAH what it going on here! Instead they let it through because another pharmacist did the order and it isn’t theyre problem if something goes awry. I would have called out there and said WTH are we doing? this isn’t policy! and got it changed.
In the grand scheme, the ordering pharmacist did talk to the phsycian and got the okay, but in the real world physicians are not as infallible as they are portrayed, and our pharmacist gave an inappropriate option for treatment, which the physician trusted was an okay treatment plan. Was the patient injured by a single infusion? no. However, it was a continuous infusion and when I saw the nurse was asking for a refill to start the 2nd dose, I said WTF is going on here and started digging.
Let me say though that this is a national problem, not just my hospital. Also, the things that usually go through when they shouldn’t is stupid things that never effect the patient. When it comes to dangerous medications, we have different procedures for checking of orders, or it goes through a specialist pharmacist first (eg: chemo pharmacist, pediatric pharmacist, critical care, infectious disease, etc you get the point). It is more of an annoyance on my part because I usually take the time to fix a problem when I see it, and other will let stuff slide because theyre not the ones who’ll get the variance, and it won’t hurt the patient anyways.
Just for posterity sakes, if you are curious, what is a “mistake that doesn’t effect the patient”?
Example: We have a NICU and those little babies will be put on continuous infusions sometimes like dopamine to improve their cardiac functioning. So, all our NICU orders are standardized to the weight of the baby to determine the size of the order. So let’s say that the order calls for 0.06ml/hr. That is 1.44ml/24 hr period. So, we would most likely send a 3ml syringe (to allow for titration). Well when the order is sent electronically to the pharmacy it always come stock as 1ml, and we have to change it to the appropriate size. If it isn’t then the nurse will be calling for refills more often than needed based on titration (1ml = 16.6 hour infusion). This is a mistake that is counted towards us.
Is it teachable? sure, pharmacy school rammed it down our throats. However, being short staffed makes people cut corners, and that become the learned state in those situations.
A little off topic but some of your comments reminded me about the HBO documentary “Savior Complex” about a young American woman in Uganda treating babies for malnutrition with no medical training. She was just giving them IVs willy nilly without consulting doctors.
Our hospital pharmacy has a white board for updates and statistics tracking that has a section called “Good Catch.” Let me tell you, some of the things I’ve seen on that board…THANK YOU for sparing us. (KCl labeled as asa? As a critical cardiac care nurse, I am duly horrified.)
Trust me, so are we. Typically, the reason for the mislabel is due to the machine that is used for pre-packing from stock bottles. For the most case, standard meds are given their own containers for the machine, but when there was a KCL shortage going around something happened where a standard container was used for a non-standard medication and they didn’t make sure the old container was cleared before adding the new medication.
That being said the pyxis pharmacist checking, should have looked at EVERY pre-packed med (100 per batch typically) and see that they all looked correct (eg: no doubles, empties), and would’ve seen the size mismatch between the 2 meds lol. We have some great techs though and one of them caught it as they were doing their pyxis load.
Love my crit care nurses though! We have 5 ICUs (+ ER/Trauma) and most all those nurses typically have their stuff together, which makes my job much easier, when I gotta call with questions! So, thank you for being on the ball!
I mean my second thought after sheer horror was that I’d definitely notice this baby aspirin is uhhh…a giant horsepill? That would seem very odd. But like on my end what am I supposed to do to verify, lick it? 😂
And we appreciate the shit out of you right back. The number of times we’ve had something going down and called pharmacy: “Hey I have a stat order for…” to be interrupted with: “It’s already verified.”
Seriously, thanks for everything you do for us.