Browsing the archives for the Jp Enlarged category.

This Can Make a Difference. Give it some time.

Jp Enlarged

Give us some help.   We CAN win

We Need Anything And Everything You Have On “PRESCRIPTION ERROR STATISTICS”.

Do NOT send in a Comment. Send to

I cannot stress strongly enough how important this is.

Pharmacists generally believe that the risk of dispensing errors is increasing. In one survey, this view was held by 82% of pharmacists.18 A number of reasons for errors are cited by pharmacists in surveys and studies designed to examine the causes of errors, including high prescription volume, distractions, shortage of support personnel, look-alike/sound-alike drug names, inadequate opportunity to counsel, illegible handwriting, and fatigue. It is well known that the volume of prescriptions has been on an upswing.

Most Common Causes of
Errors Cited By Pharmacists
1 Too many telephone calls (62%)
2 Overload/unusually busy day (59%)
3 Too many customers (53%)
4 Lack of concentration (41%)
5 No one available to double-check (41%)
6 Staff shortage (32%)
7 Similar drug names (29%)
8 No time to counsel (29%)
9 Illegible prescription (26%)
10 Misinterpreted prescription (24%)
Many pharmacists intuitively believe that job stress can have a deleterious effect on their performance. One analysis of stress has suggested that it may have four different adverse effects on the cognitive system, which may increase error rates and interfere with error detection.16 Stress may increase the rate of information processing and may lead to exceeding the optimal capacity for processing information. Thinking about stressful events may distract attention away from critical tasks. Stress may lead to alterations in work patterns and shortcuts that may promote inaccurate behavior. Stress may also cause cognitive systems to default to responses that emphasize past habits instead of recently learned adaptive strategies.

In addition to contributing to dispensing errors, an increased workload also increases the likelihood of dispensing a medication that could cause a drug–drug interaction. A survey of pharmacists in 18 metropolitan areas revealed that drug–drug interactions increased with pharmacy or pharmacist workload, increasing by approximately 3% for each additional prescription dispensed per hour.24 The authors attributed this to a reduction in the time available to assess potential interactions.

The relationship between workload and errors is not simple. Some studies have failed to show a correlation between higher workload and higher error rates. One study failed to find an association between the rate of potentially serious errors and increasing work volume in a high-volume, hospital-based, outpatient pharmacy.25 Nevertheless, this study detected variations in the error frequency depending on the time of day, with peak error occurrence noted during the lunch hour and the hour before closing.

In another research report, pharmacists were found to be most vulnerable to making an error when they were less busy, or during a dramatic shift in the number of prescriptions presented (i.e., going from high to low and vice versa).16 This was especially prevalent in high-volume settings. One explanation provided is that when pharmacists are especially busy, their mental faculties are highly engaged, and they are very focused on their tasks. During slower periods, boredom may contribute to lack of attention and more errors. The author emphasized that workload alone could not predict a pharmacist’s performance, although he acknowledged that working at a faster pace increases job-related tension. The author concluded that the quality of a pharmacist’s performance was also determined by personal attributes, such as how the pharmacist perceived and responded to workload conditions. Pharmacists who were more satisfied with their jobs and the quality of their breaks made fewer errors even though they filled more prescriptions per hour than those who were less satisfied. Other sources of stress also contributed to errors. For example, pharmacists who reported high levels of stress in dealing with third-party payers made more errors than those reporting less stress.

Other factors in addition to sheer workload volume have an impact on errors. The Massachusetts Board of Registration in Pharmacy conducted a retrospective pilot study in an attempt to identify causative factors associated with medication errors.26 The study revealed that pharmacists perceive a number of different elements as causative factors for medication errors (TABLE 2)

Now, you are talkin’. Throw the rest of the bull shit excuses in the garbage can in the offices of the MASTERS OF THE UNIVERSE.

THIS NEXT IS A SERIOUS QUESTION. NEW WRITEN PRESCRIPTION FOR Budesonide 3 mg tid. The veteran, competent pharmacist dispensed Risperdal 3m mg qd. Can any of you even imagine, invent how this could happen? The patient is a 92 year old female. I don’t get this one. If the Rx was typed by a technician, what happened? If it was typed by the pharmacist, what happened?

Do you agree that this error would have been discovered and corrected in the counseling process?

The pharmacist says to the patient’s daughter, “This medicine for your mother’s schizophrenia has side effects.”


We have a duty to warn. Legal, professional & ethical duty.

If this woman is harmed, should the pharmacist pay or should his employer be held accountable for the standard of care that ignores he pharmacist’s duty to warn? As fact, counseling is seen as an unnecessary and time consuming event that causes the employer to be at a competitive disadvantage.

Have we allowed our industry to sink this low? Where profit is king and MBA non-pharmacist Masters of the universe ruin our profession?

You can get it back, you guys. Just practice pharmacy and dare them to tell you that, for example, you cannot counsel because it is an unnecessary time-waster.

No Comments

A Cancun Vacation At Forest Labs Corporate Condo. Yeah, sure, Ah Huh.

Jp Enlarged


An old Doctor who could have saved Minnie if he would have known about drugs.

An old Doctor who could have saved Minnie if he would have known about drugs.

I was working when the technician said that there was a pharmaceutical rep who wanted to talk with me. I will always take the time to talk with a detail person. They disrespect us by not coming around enough. When there is a new drug, it is pathetic that we have to learn about it in a magazine ad or scramble when we see the fist prescription. This person had something else in mind.
He shook my hand and then asked an odd question: “Are you the only “older “ pharmacist who works here?”
I answered that if he wanted “older”, I was the one.
Then he blustered, “I want you to cease and desist from telling patients they should use citalopram instead of Lexapro.”
“Oh,” I said, a bit amused. “You do, do you.”
His face was red. “Doctor XXXXX told me that some of his patients have been asking for the change and he has been complying. You have to stop or….”
“..Or what?”
“Lexapro is a superior drug. You have been telling patients that citalopram is just as good.”
“And cheaper. I always advise a cash-paying patient or those with high brand name copays to switch.” I looked at him. “Or what? What are you going to do about it?”
“Listen, buddy. Therapeutically, they are Sam and Bam and you know it. Lexapro is on the market basically as a patent extension. Forest is notorious for this. Read The New York Times. Forst is all over the place and none of it is good.”
“You have to stop.”
“I’m a pharmacist, man. I consider it part of my job to save people money when I can and this is an ideal opportunity. Anti-depressants are flaky therapy for most people diagnosed with moderate depression anyway.”
“What do you mean…flaky?” This guy was ready to come over the counter after the “older” pharmacist. I would welcome that. Forest could be paying me for the rest of my life. I should have said “Yada Yada Yada, Pants on fire.”
“You are frikkin’ brainwashed, man. Lexapro is basically a placebo for the majority of patients. You already know that. Certainly Forest has primed you how to counter reams of articles that say that.”
“Shut up,” he said. He was out of ammunition.
“I will tell you what. I will stop urging patients to switch from Lexapro to citalopram if you will do one thing and it is not a pizza.”
“I’ll get you a pizza, two if you want.”
“I said NOT A PIZZA.”
“What is it then?”
“You send my wife and me to Cancun for a week in January. You pay hotel and air fare and we’ll buy our own food.”
“What are you a wise guy?”
“I’ll go wherever Forest has a corporate beach house.”
“Fuck you,” he spat.
I told him that my name is David Stanley and he wrote it down.

Document Details Plan To Promote Costly Drug

The New York Times

The pharmaceutical industry has developed thousands of medicines that have saved millions of lives, but it has also used its marketing muscle to successfully peddle expensive pills that are no more effective than older drugs sold at a fraction of the cost.
No drug better demonstrates the industry’s salesmanship than Lexapro, an antidepressant sold by Forest Laboratories. And a document quietly made public recently by the Senate’s Special Committee on Aging demonstrates just how Forest managed to turn a medicinal afterthought into a best seller.
The document, ”Lexapro Fiscal 2004 Marketing Plan,” is an outline of the many steps Forest used to make Lexapro a success. Because of concerns from Forest, the Senate committee released only 88 pages of the document, which may have originally run longer than 270 pages. ”Confidential” is stamped on every page.
But those 88 pages make clear that one of the principal means by which Forest hoped to persuade psychiatrists, primary care doctors and other medical specialists to prescribe Lexapro was by finding many ways to put money into doctors’ pockets and food into their mouths.
Frank Murdolo, a Forest spokesman, said the company was ”aware” that its marketing plan was circulating around the Senate.
”We’re aware of it but I can’t give you any other comment on it,” he said.
In February, federal prosecutors in Boston announced a civil lawsuit against Forest claiming that the company illegally marketed both Lexapro and a closely related antidepressant, Celexa, for use in children and paid kickbacks to doctors to induce them to prescribe the medicines to children.
It is illegal to pay doctors to prescribe certain medicines to their patients. It is not illegal to pay doctors to educate their colleagues about a medicine. In recent years, federal prosecutors have accused many drug makers of deliberately crossing that line.
Lexapro was the sixth drug in a class of medicines that includes Prozac, Paxil, Zoloft, Luvox and Celexa. Forest licensed Celexa from Lundbeck of Denmark and introduced the medicine into the United States in 1998. But because Celexa’s patent life was relatively short, the company quickly developed a new version of Celexa by tinkering with the molecule in a way that is standard in the industry. The company called the new medicine Lexapro and introduced it into the United States in 2002.
Forest’s executives and paid consultants have long implied that Lexapro is superior to Celexa and other antidepressants. But the Food and Drug Administration did not require Forest to test this theory in any statistically valid way. The F.D.A. views the two medicines as so interchangeable that the agency recently approved Lexapro’s use in depressed adolescents based in part on the results of a study Forest conducted using Celexa.
Lexapro had $2.3 billion in sales in 2008 even though generic versions of Celexa and every other drug in the class sell for a fraction of Lexapro’s price. For example, a month’s supply of 5-milligram tablets of Lexapro costs $87.99 at, compared to $14.99 for a month’s supply of a generic version of Prozac. Forest has recently been raising the price of Lexapro to make up for a decline in its use.
Many doctors say they believe that Lexapro is the best antidepressant, so they prescribe the drug despite its cost.
It is impossible to unpack all of the reasons for these prescriptions, but some industry critics say one reason could be the money doctors make from Forest. Psychiatrists make more money from drug makers than any other medical specialty, according to analyses of payment data. And Forest gives more money and food to doctors than many of its far larger rivals. Vermont officials found that Forest’s payments to doctors in 2008 were surpassed only by those of Eli Lilly, Pfizer, Novartis and Merck — companies with annual sales that are five to 10 times larger than Forest’s.
Forest’s 2004 plan for marketing Lexapro offers detailed information about how the company planned to direct this money to doctors.
Under ”Rep Promotional Programs,” the document said the company planned to spend $34.7 million to pay 2,000 psychiatrists and primary care doctors to deliver 15,000 marketing lectures to their peers in one year.
”These meetings may be large-scale dinner programs with a slide presentation, small roundtable discussions or one-on-one advocate lunches,” the document states.
Under ”Lunch and Learns,” the company intended to spend $36 million providing lunch to doctors in their offices. ”Providing lunch for a physician creates an extended amount of selling time for representatives,” the document states.
An entire section of the marketing plan, titled ”Continuing Medical Education,” outlines how the company intended to use educational seminars for doctors to teach them about Lexapro. The Senate’s Special Committee on Aging held a hearing in July on whether industry funding of medical education classes leads to tainted talks.
”At our recent hearing we asked the question, ‘Is the line between medical education and marketing blurred?’ ” said Senator Herb Kohl, a Democrat from Wisconsin who is chairman of the committee on aging. His panel was given the Lexapro document by the Senate Finance Committee, which has long been investigating drug maker marketing efforts. ”These documents show that for these companies, there is no line,” Mr. Kohl said.


Procedure vs. Essence. I believe that a battle is being waged at WAG over this.

Jp Enlarged

Walgreens wears the white hats. I have believed that for awhile, but when WAG went mano a mano with Express Scripts, they did more for our industry than any company ever.

The dispute about how the prescription-providing industry will move forward is long over. It ended in a virtual deadlock. However, the issue of money has tilted the game in favor of those who defend the bits and pieces like Wait Times, Metrics and the Low-Profit (18% GP) High-Volume business model.
These are the PROCEDURE people. They say that the PROCEDURE model has proven itself, over and over. The most important thing is putting out lots of product by using the correct PROCEDURE. The PROCEDURE will guarantee that pharmacists do not deviate from a winning plan. If they resist, bully them with the dreaded write-up, below the line performance reviews, with new pharmacists (Robo-dispensers) begging for jobs put them on the list for termination. The PROCEDURE will eventually calm the ESSENCE people. They throw in MTM, BP screenings, Hemoccult programs, immunizations and they say, “See what good boys we are. We are all about professionalism, the ESSENCE. This is what you want, isn’t it?
The PROCEDURE people are not usually pharmacists. They hold powerful positions that did not even exist when pharmacists (ESSENCE) were directing the profession. The PROCEDURE people (Call them Masters of the Universe) crunched numbers and came up with some radical new business strategies, but they have neglected patient care, the ESSENCE of any medical profession. I suppose had they paid attention to the fact that pharmacy is a profession and not just another variety/grocery/big box store department they may have had something that could be worked with. Alas, they don’t get it and they never will. Not a pharmacist, never a pharmacist and unable to think in the retail box that was perfected by a dying breed..the DRUGGIST. I mean totally incapable of getting what DRUGGISTS did to satisfy the patients and make a damn good living with the moderate to high profit (40% GP) Low Volume business model.
Those who still emphasize ESSENCE, argue that the Masters of the Universe are defined by their business school beliefs. The ESSENCE people, like me, reject the idea that a pharmacist is a fucking drone, run by a productivity program at the company’s headquarters. When you turn a profession over to business school Fanatics of the Universe, you have done nothing to advance the PROFESSION. The Masters of the Universe are all about profit. The patient be damned. The major pharmacy retailers (Chains, Groceries, Big Box) have been allowed to subvert the profession and worse, the Boards of Pharmacies have sat back and watched. If your mandate is to protect the public from dangerous pharmacy practices and you do not even wink at violations of counseling laws because the PROEDURE leaves no time, are you a hypocrite or a fucking hypocrite.
The important thing is to get people like that out of power, even if it takes a program designed to OUT the BOPs to the public. The goal is to weaken the PROCEDURE, by nearly any means.
It was all ESSENCE when I was a new pharmacist. My goal was to get a job with Horton and Converse, a real pharmacy chain in Los Angeles. Horton and Converse ran operations that would cause any ESSENCE pharmacist to get over-excited, but the stores were small, with a small OTC out front and a huge pharmacy in the back. Of course, a decent size pharmacy counter with like three typewriters. One counter back was a large compounding area. They were 24 hour operations. This is a 50 year memory. I did not get a job with Horton and Converse because every new pharmacist applied. I was told, “You are new from Ohio. Frankly, we will hire California graduates first.” I went to work for Thrifty Drug Stores up in the San Francisco Bay Area. My first job in a PROCEDURE based store and the PROCEDURE in 1965 would be to die for in 2014.
The events of the last 50 years have vindicated the PROCEDURE people. Population growth. Many more drugs. In 1964, the choices for blood pressure with a diuretic and either hydralazine, reserpine or a combination. Today.. count them and count the patients who are on two or three. Third parties. With only a copay, drugs are cheap. The boomers. Every single thing says to the PROCEDURE folks that their way is the only way. The ESSENCE pharmacist, forever, will say, “Patient care is the most important thing. This is pharmacy we are talking about. Not dispensary. No pharmacy no need for the pharmacist. A dispenser in the PROCEDURE model could be a well-trained high school graduate. I have harped in the past…. The law that you be ready to go to the barricades to make sure it is sacrosanct is the one that says, A PHARMACIST MUST BE PRESENT WHEN A PRESCRIPTION IS SOLD. What do you think will happen if you let that one get away? If you believe that the PROEDURE Masters of the Universe will NOT find a way to get rid of you then you are the guy who believes that the stripper will change her ways after you marry her.
PROCEDURISTS have shown that they can run effective and profitable departments as long as they keep the sword over the head of the pharmacists. “You want the job, you make the metrics sing.” You know what, they lack the mental equipment to govern a profession. They aren’t pharmacists to start. But, once they have the power, they are always going to centralize that power and undermine creative thinking in the stores. Once the PROCEDURISTS got the power, they subverted any review from the pharmacists in the stores. Do you think that $25.00 gift cards for a transfer would be the gold standard promotional tool if pharmacists got to sign off? Not my bet.
The Masters PROCEDURISTS have built a tight-knit cadre of mid-level managers that is resilient. (The also did not exist 30 years ago). The ESSENCE crowd has not a chance in hell unless someone wakes up and points “Look, the emperor has no clothes.” When I read that in the Wall Street Journal of the USA Today with statistics of probably harm due to non-counseling, I know that the PROCEDURISTS can feel their rear ends pucker up. I honestly believe that, in marketing pharmacy, that incompetence is built into the intellectual DNA of the PROCEDURISTS. Oh, there are pharmacists among the PROCEDURISTS.
The ACPE, The NABP, the APhA, the Boards of Pharmacy and the Colleges of Pharmacy have not handled this situation particularly well. The schools have shown disgusting deference to the money bags, the big prescription-sellers. They want good relationships with the PROCEDURE people who can write a whopping nice check for that new laboratory. Put on a nice shiny brass plaque. THE WAL-MART DISPENSING LABORATORY. The ESSENCE people cannot compete. They are much better preceptors however. They must teach these kids about what it takes to be a DRUGGIST. It is the only hope for pharmacy.
The status quo is bad. Most of you have absolutely no practical idea how to make things better. You all believe that you will end up on the float team, have your hours cut or out of a job. Small thinking. With so many ESSENCE fans still out there, what is the problem? You could overwhelm the PROCEDURISTS when enough of you get together and slow down and actually practice pharmacy. The numbers alone would rattle some cages. You are not going to do it alone though.
If the brand new pharmacists lose the traditions of pharmacy, and I like to call it THE WAY OF THE DRUGGIST, it is all over.
If you keep your feet on the floor in a pharmacy department all week long, you cannot deny that all that I have outlined is the distillation of what we are facing as we enter a period of incredible growth in the number of prescriptions filled. The companies need you. The procedurists are also theorists, They have never called a doctor with bad news for any egocentric practitioner. “You made a mistake.” They have never stood at the drive-through with the woman who thinks it is DRIVE-UP-AND-WAIT pumping poison fumes into the pharmacy. Procedurists can’t even count pills legally.
My call is to just PRACTICE YOUR PROFESSION. Your way. You have discretion.


Is C.V.S. Run By Goats?

Jp Enlarged

Employee Promotional from company handbook

How stupid is this? First they (CVS) have a regular training where they hand out the employee handbook. Then they tell you that what you have been waiting to get for years (uninterrupted 30 minute meal break and an additional rest break of 15 minutes) IS NOT FOR YOU BECAUSE YOU ARE A PHARMACIST. CAN YOU IMAGINE WAG ENGAGING IN THIS KIND OF AMBIGUITY? This is begging for trouble. CVS exposes this all by themselves. Why mention it if you are not going to honor #12? This can only be trouble, man?

I simply needed another job and saw a store which I think won’t be too bad. However just what I’ve seen compared to other companies has been shocking (keep in mind I was already very well prepared).

So the basics are as follows:
1. I take a position with CVS and get scheduled for regular training at the business office with others (pharmacy and non-pharmacy)
2. During this we are handed a binder with powerpoint slides to follow the presentation
3. I get the employee handbook
4. On slide #12 of the presentation comes what I was waiting to see. And this is not exact, but what I’ve got from my best memory.
• All employees, including minors, must take one 30-minute meal break for shifts worked over x number of hours. (I think 8?)
• In addition, all employees must take one 15-minute paid break for every x number of hours worked.
5. This is all the slide included. I don’t recall the exact hour numbers because I was more focused on who this was regarding. NO one employee group was singled out. i.e. Exempt employees, salaried, full time, management, pharmacy, professional, …or pharmacists. Trust me, I read every word three times and confirmed with the pharmacist sitting next to me.
6. Slide #12 was NOT included in our handout.
7. Verbal instruction from the trainer was “this obviously doesn’t apply to our pharmacists”

This is frustrating to see, but even more so in my state. A statute exists which requires employers to provide these breaks uninterrupted and away from work. Only a handful of states require this and my state requires the two 15 minute breaks as well. The slide CVS presented follows the law in our state to the letter.

The answer I always hear when this is discussed is that “oh, well, we’re exempt.” I simply let them know that FLSA does not have anything to do with break periods and being exempt is unrelated. This is always a surprise to whoever is talking about the exemptions.

Also I recorded the entire training presentation since I thought it might be interesting.


Jay Pee is Asking for Some Help. Information Please!

Jp Enlarged BRAIN ATTACK is modern name for STROKE

I had the ‘Brain Attack’ at around 4:00 AM, January 11, 20214. The modern designation of ‘Brain Attack’ to talk about an ischemic stroke seems about right to me. My brain was attacked. I did not get the significance until later. My left hand was not very useful. I used up all of my Medicare Physical Therapy benefit. About 15 sessions. I came out with a hand that worked like it was supposed to about 90% of the time. I felt good. I believed that the left hand was the ‘stroke’. Not so.

I should have known. The label ‘Brain Attack’ was meant to ride on the same neurological pony that ‘Heart Attack’ has rode forever.

Some time in the late weeks of April, I began to notice residual effects that I do not like. I use a cane now, when walking. It is meant more for balance and steadiness. A flat surface with some traction and I am good. Get me off the path and onto the green lawn and the cane is not much help. Too many soft spots and small rocks.

I have lost some leg strength and that could be the post-polio muscular atrophy talking. I’d love to get some leg strength back, but I’m not holding my breath.

I think just like before, but when I have a fully formed thought my ability to express it is affected. I can slur my words, especially when I am tired. I stumble over words that I have used regularly for decades. I completely lose favorite words like
INTERMITTENTLY. I hang with it for awhile, all the time watching the face of the poor person I am talking with. They struggle along with me Some seem to be horrified. Then smile and use ONCE IN AWHILE.

I point at my head, laugh lightly, and say, “It is perfect up here.” I point at my mouth, “Not so perfect here”. I have little problem typing my thoughts and pen on paper is no problem at all.” I call this “Fuzzy Thinking”.

I do not expect this to continue. I hope not.

Sleep. I can sleep anywhere, any time. That is no shit. Any Time. I fall asleep in minutes at bed time, but I wake up too soon. I put my book down at 10:00 PM last night, was awake before midnight. At 1:48 AM, I wanted it to be 4:48 AM, so I could get up. Early is good, but any time before 5:00 AM is too early. I probably checked the time 5 times. The 5th time was 5:05 AM.
Victoria calls my day time sleeps NAPS. I suppose that NAP works since my night time sleep is interrupted so often.

I guess I have episodes of sleep apnea. I have been told by bed mates for 40 years that I stop breathing at night. It did not bother me. I am asleep after all. It bothers Victoria. It keeps her awake and sends her to the guest room. I did a sleep study test and the recommendation was a sleep study titration. I paid my $300.00 copay. I talked with Kenny, the center manager, while he wired me up. It too 50 minutes, you guys, with 47 placed sticky electrodes. The results came in an ill-advised phone call. I expressed my displeasure about being called by a clueless nurse. I will keep this short. I was told that I have the common obstructive apnea and central apnea WHICH MEANS… MY BRAIN STEM FORGETS TO TELL ME TO BREATHE. That spooked me. My Brain forgets to do an autonomic function? Ged oudda Here.

Have any of you heard of that one? I do not like the idea of having to use a combo CPAP-VENTILATOR MACHINE. Called an Auto-Servo machine. I do not have a lot of confidence in the people who have had responsibility for my case. I may just move on outside the Intercoastal Medical Group.

There are other issues, but I don’t want to intrude anymore. I expected to have to work my left hand, but all of these subtle post-stroke issues bother me more than the big ones.

If you know anyone who has ‘Brain Attack’ recovery strategies, please share. Tell me the stories. Jay Pee

« Older Posts
Newer Posts »