SEPTEMBER, Edition # 33 , 2001

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May I attempt to keep this little corner of Computachem anchored to the coal face?
My contributions are my own thoughts and observations of what is happening in Pharmacy RIGHT NOW, and offers opinions on if we can/will achieve the goals to which other contributors encourage us to aspire.
I have said before that working as a Locum Pharmacist in a different pharmacy every week, is not the bludge I used to think it was.
Most Pharmacists think we are paid too much, and some try to get their pound of flesh by expecting us to work at the same pace, and range of duties as they do - forgetting that the environment is strange to us, and we are unfamiliar with their systems, customers, and staff.
There are seven or eight different dispense systems out there, and you expect us to seamlessly jump from one to another. The staff sometimes will not accept that we are going to be a lot slower at script processing than they are.
Personally, I do not look on script processing as something I should get tied up with.
The next hurdle Pharmacy has to jump, is the mandatory issue of CMI.
After that (or perhaps now!), Pharmacy will have to embrace DMMR -domiciliary medication management reviews.
As a locum pharmacist, I am starting to review which pharmacies I will be able to work in.
I have heard lots of stories about stressed and "inadequate" locums, but I can start to understand why.
I have said - that, as a general rule - Quality Care accredited Pharmacies are good and structured places to work in. I look forward to bookings from these guys. However, only about 20% of all pharmacies are Accredited. The other 80% function over a broad range of standards and systems.
I am a strong advocate of the Pharmacist Advice model.
There is a big push for pharmacists to counsel - like REALLY counsel - not the "take this with food , and take the whole course. That will be $3.50 please" stuff! The supply of CMI - through that big Govt-paid-for laser printer - dictates (I think) that the forward pharmacy model will have to be adopted.
Government is not going to make us print out CMI, and then allow us to thrust it at the patient - perhaps even through the staff.
So, to be able to handle this initiative properly, you have to have a proper counselling area, which is NOT the shop counter. You cannot balance six sheets of paper on your wrist, while doing a stand up counselling. You cannot talk with a patient about the CMI at the shop counter. You must have a patient counselling desk, and you WILL need a computer terminal on it.
I am not preaching what SHOULD be done, knowing that I will never have to do it. I tried to do Pharmacist Advice for six years, and I was involved in discussions in 1994, as a trial site with experience, when CMI was first proposed.
So I have been there, done that myself.
Let me tell you, it will be a whole lot easier to do if ALL pharmacies are forced to adopt this workflow.
So I will favour pharmacies with a forward pharmacy setup.
That setup also fixes the problem I have, struggling with dispense software, as well as assembling the scripts, as well as counselling. The result of being expected to practise that way is that something has to suffer, and it is inevitably the counselling.
I need to tell you that I CAN handle all seven or eight dispense systems while the techo is at lunch or morning tea, but I am a lot slower than she is.
I also have a problem in some pharmacies with the crazy alphabets in the dispensary - you guys know where to find items, but it makes a reliever's life hard in your pharmacy.
I have worked in a not-yet-accredited pharmacy where I did a fair bit of the dispensing from start to finish, but the team spirit and training was in place, so that if I got taken away to talk to someone in the middle of a script, someone would fall in behind me, and seamlessly take over.
It was much less stressful for me to know that would happen without the need for me to call anyone to take over. I like to work with a team spirit like that. I can work that way, but I still prefer sit down forward pharmacy, where I can talk to people and have access to my laptop and my printer.
At the other end of the scale, is the pharmacy with the hopelessly fragmented staff, the filthy dispensary sink, and the hopeless systems, and unprofessional standards.
There are a few of these!
I worked at one who stored the S8s in a fairly large floor safe in about 15 carrier bags, tied at the top. Different strengths of MS-Contins were in different bags. When an S8 arrived, out with all the bags, untie the top, look inside, find what you want - which was inevitably in the last bag, and then stuff the whole lot back in the safe, only to go through the whole exercise again 10 times a day. This guy did this day after day, week after week, month after month, presumably because he didn't want to afford a wall safe.
Absolutely zero systems!
A very inefficient operation.
A fairly good indicator for me is if I feel I need to tell patients that "I am only the locum pharmacist" - I would not want them to think that I owned a pharmacy like this!
Another good indicator is if I feel I have to wash my hands about 20 times a day. The chipboard shelving with the painted edge is another giveaway.
Any would-be purchaser will see that, and think "REFIT!!"
Another indicator of a problem pharmacy, is if I CAN handle all the dispensing without any help.
This usually means we do 50-60 items per day.
These pharmacies often sell newspapers and scratchies, and do Methadone (badly) to get even more profitless turnover.
They will not survive, and are probably dead already but don't know it.
On the subject of Methadone, I landed in a pharmacy in an area where it was obvious there would be Methadones, and there was only me and a junior, on a Monday morning, with 20 "clients" about to invade. I got through, but I know of a locum who closed the pharmacy at 9.30am in a similar situation!
Most pharmacists manifest the four walls syndrome - I know I did, in my own business - I thought I was GREAT! I thought I was the only one who knew how to do it right. Now I have experience in other pharmacies, I know there are many who are a lot better than me - certainly better business managers - but there is an even larger number who are much worse than me!
C'mon fellas - let's lift our act.
You WILL go broke if you don't, and the Guild PSA etc are going to allow, and encourage it to happen for the greater good.
One last question is "will I have any work next week????!!!
Someone out there MUST disagree with me …. Take a shot through the Forum.

Lighten up with a joke first!

There was a group of people, one woman, and five men rescued from a burning building by helicopter (one of the unaccredited pharmacies I locumed at).
There they are hanging by a rope beneath the chopper when the pilot says,
"we have too much weight, we'll crash unless I unload one person".
Wow - what a dilemma - who is going to let go to save the rest?
No one volunteers, the pilot gets more anxious and says
"I can't hold her with this weight".
The woman speaks,
"I will let go to save you men folk"
Momentary stunned silence, then the men start clapping.....

(ed. Ah yes, the girls are too clever for us blokes again.
For revenge, fellas, organise a BBQ - think back to last edition joke and finish off that bottle of wine).
Ends
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Editor's Note:
With a unique brand of humour, a capacity for expecting the unexpected and a high degree of professionalism, it is obvious that Roy is providing a first class service as a locum.
I am sure there are a number of prospective employers who would like to meet him. He now has a website located at:

http://www.computachem.com.au/locums/RoyStevenson.html

You can arrange more information, and a locum booking, from this site.

Roy S.Stevenson Ph.C. M.P.S.,
Locum Pharmacist
40 Northminster Way
RATHMINES 2283.
Tel 4975 5548 Mob. 0402 406 691 Fax 0249 75 2334
ABN 11 585 465 385

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