Pharmacy International

What it must feel like to be a student and travel to a foreign country to study in your profession.  Not only must you be at the “top of your game” when it comes to your field of study; but you must also have the skills to communicate in a foreign country.  The effort it must take to learn the language so that the most basic of verbal communication will not be an issue.  You must also posses the ability to adapt to the incredibly foreign customs.  Not moving too fast so as to create an unexpected issue you need to work yourself back from, and not moving to slow so as to create a disproportionate communication gap. 

This process takes a special and unique individual.  Our family has had the incredible opportunity of having not only one, but three individuals who posses this critically unique skill stay with us for the last two days.  Luka is studying pharmacy at the University in Ljubljana, Slovenia, while Helena and Noura are studying pharmacy at the University in Barcelona, Spain.  Both Luka and Helena are in their final year of studies and were accepted to an exchange program so they may study pharmacy for four weeks at the University of Arizona Medical Center in Tuscon, Arizona.  Noura will be moving into her second year of pharmacy studies and joined her cousin for a fantastic adventure to America.
These three students landed in Los Angeles a few days ago and stayed with a host they found on a “couch surfing” website.  First off, I can’t imagine what that must feel like, signing up over the internet to sleep on someone’s couch in a foreign country.  They had a fantastic time in L.A., and then they took a nine hour drive up Highway 1 to Santa Cruz, arriving late Thursday evening.   Amazing, just like that, they rented a car in L.A. and with nothing more than a smart phone and a GPS, these three students found their way to our front door in Santa Cruz. 

Thursday evening my wife, Susie, prepared a beautiful welcoming dinner.  We ate and talked well into the evening.  It is so great learning about where they come from, their ideas and dreams, and sharing our thoughts on life and pharmacy.  Friday I had the good fortune of having all three come and visit me in the community pharmacy that I practice in.  It was nice showing them around the pharmacy and introducing them to my co-workers.  I was grateful at how welcoming my co-workers were to my new friends.

Friday afternoon my wife and daughter took Luka, Helena and Noura down to Capitola Village.  This is a beautiful location where they all ate slices of pizza while sitting on the esplanade watching the summer tourist season in full bloom.  As if that wasn’t enough, when I got home from work we all packed up and headed down to the Santa Cruz Beach Boardwalk to listen to a band at the summer concert series.  Fantastic!  We took a blanket and sat on the beach listening to one of my favorite 80’s bands on a quintessential Santa Cruz summer evening.


Because we hadn’t eaten enough that day, we stopped at our favorite burger shop on the way home and picked up some fantastic food to feast on.  We created a nice spread around our back yard fire pit, were joined by a few more friends, and laughed and talked well into the late, foggy night.  Everyone has such fantastic stories about their life, where they have been, who their families are, and the life they lead today.
I am writing this as if it is past tense; however it isn’t.  Our friends are still here through the rest of the day and will be heading up to San Francisco this evening on another Couch Surfing adventure with a new host.    I wanted to get this written down while the excitement of the visit is still inside me, rather than the sadness of the departure.  It is an interesting feeling one gets, as if time-stands-still, during a visit like this.  Tonight our friends will be on their way, and the clock will start ticking again.

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Community Pharmacy and Controlled Substances

The other day I had a patient come into our pharmacy with a prescription for a controlled substance (C  II) for pain control.  This was a new patient for us; however, the quantity of medication did not seem unreasonable and the prescriber was a local physician who I am very familiar with.  The patient stated they had been to a local chain pharmacy that they had been going to for the past couple years.  The pharmacy had told them that it is their new policy to phone the prescriber with all controlled substance (C II) prescriptions.  For one reason or another, the pharmacy was unable to get ahold of the physician and needed to leave a message for the physician to call them back.  The patient took the prescription and left.

The patient, bewildered and confused, then presented at our community pharmacy.  After a short discussion with the patient, I understood the reason they were taking their pain medication and had a reasonable history of their pain treatment.  I then logged on to the narcotic verification tracking website to check the history of narcotic usage of this patient.  As stated, the patient had been going to the same chain store pharmacy on a monthly basis for the last six months.  I then called the other pharmacy to see if there was some other issue I was missing.  The other pharmacy stated it was their policy to call the physician with each new narcotic (C II) prescription, and that was it. 

I, as a pharmacist, performed Due Diligence with regards to this prescription and this patient.  I determined that a legitimate need for the medication existed and that the prescription was legitimate.  The Drug Enforcement Agency has strict guidelines with regards to the verification process; however, unless warranted, the regulations do not dictate that the pharmacist must phone the doctor back with each and every prescription.

This issue stems from a legal case that ended in June of 2013.  One of the chain store pharmacies’s agreed to pay a fine of $80 million dollars for allowing millions of controlled substances to reach the black market.  The stores, located in Florida, had an unprecedented amount of record-keeping and dispensing violations.

The backlash to this legal case is that many chain pharmacies have now implemented egregious controlled substance verification campaigns that go far beyond the required verification process.  Systems that go as far to not fill a maintenance pain medication for a patient who has been coming to their pharmacy for months, for no other reason than the simple fact that the prescribing physician is not available for a phone call.

I am a community pharmacist, I have a code of ethics I follow, and I have state and federal  laws I need to heed.  Patients understand that if they come to our pharmacy, they will be treated as an individual.  They will receive appropriate medication counseling, and, at times, they may be asked as series of questions in order for us to gain an appropriate history.  At times, patients may be expected to wait for a short while if we need to contact their prescriber.  

If a patient shows up in our little community pharmacy with a prescription for a controlled substance from a physician who is located in another city, the patient better be prepared to wait.  I will need to go through every step of the process to assure all of the DEA requirements are met with regards to the prescription being legitimate, including having a discussion with the physician on the phone.  As mentioned earlier, this process is called Due Diligence.

Community Pharmacy is a practice, it is not a technical position where you get your orders filled.  Community Pharmacists work long and hard to assure that every prescription filled is appropriate for the situation it is being prescribed for. 
I have said this before, and I will continue saying it.  You have a choice which pharmacy you go to.  If you are unhappy with your current pharmacy, take an afternoon and visit four or five of the community pharmacies in your town.  Walk in to the store and see what it feels like.  Is a pharmacist available for questions?  Does the pharmacy department look like they have enough help to get the work done?  What is the general feel of the store? 

Stand in line and ask to speak to the pharmacist.  When the pharmacist comes over, let them know you are interviewing different pharmacies to see which store might work best for you.  You will know when you have found the right community pharmacy!

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Medication Adherence and Health Information Technology

Medication adherence is a multi-billion dollar issue.  Why are patients non-adherent to their medication, and what attempts are currently being made to help patients become adherent.  Health Information Technology plays an important role in the development of appropriate strategies when addressing adherence issues.  Please take a moment to read my article at the RxEconsult website discussing this topic.

Please comment with any ideas you may have on how to best improve patient medication adherence.
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Bullying In The Workplace

As my friend and fellow pharmacist for the past 17 years, Carl Washburn, Pharm.D. has always stood his ground when it comes to clinical, appropriate, legal and fair pharmacy practice.  Even though Carl has retired, he continues to maintain his pharmacy skills through regular relief work in both the in-patient and out-patient pharmacy setting.  It is our good fortune to have Carl as a guest blogger for AudibleRx.

In my 40 plus years working in health care, I have been both the perpetrator and victim of bullying.  The hospital corporation I worked for spent considerable resources to remove this behavior from its employees, staff and leadership.  This is why I found the recent article in the Wall Street Journal, “disheartening”.  Bullying of any type is bad behavior.  The fact that it was rewarded is even more discouraging. 
The recent news stories relating the tragedies to young adults caused by bullying are heartbreaking.  In health care, the results of bullying can affect more than just the victim.  Bullying can affect patient safety.  I remember a discussion of a study, while I was in pharmacy school, where interns and residents were instructed to make erroneous orders and then aggressively challenge anyone that questioned the order.  The findings showed the aggressive behavior would have allowed the error to reach the patient a majority of the time. 

Whether you work in a small community pharmacy, a chain store or in a large health care facility, bullying behavior must be identified and removed.  Only through collaborative, respectful and appropriate communication and behavior between all members of health care, will the best and safest service be given to our patients. 
Please read the complete article at the W.S.J. How Workplace Bullies Get Ahead.

I worked in hospital pharmacy from 1969 through 2011 and was the Pharmacy Director of a community hospital for the last few years before I retired in 2011.

Carl Washburn, Pharm. D
Contact at

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Summer of '85

It is interesting how certain songs, smells or other distinctive situations can evoke memories of past life experiences.  Over the past few days, a combination of events has brought back a specific memory from my time in pharmacy school.  Maybe it is the intense heat of the past few days, or maybe it was a conversation I had yesterday with a pharmacy technician who has been accepted to pharmacy school and will be starting in the fall, I am not sure; however, this particular moment in pharmacy school was a summer that seemed to last for years.

The Doctor of Pharmacy program is considered a four year post graduate program.  The school that I went to took these 8 semesters and fit them into three years, which meant that the first two years we also had a summer semester.  Stockton, California is in the heart of the Central Valley.  During the summer, temperatures rise.  I was born and raised near the Pacific Ocean so I was accustom to having the natural air conditioner system that the ocean provides during the warm summer months.  This was not the case in Stockton.

For me, the third semester of pharmacy school was the most difficult.  As I recall, the third semester was the culmination of all the chemistry, biology, anatomy and physiology ground work.  I have memories of walking out of the auditorium that summer to 100+ temperatures at 2 in the afternoon, only to feel the heat long enough to walk across to the library where I would stay until dinner.  Exiting the library at 6 p.m. the temperature was still well into the 90’s.  I would be back at the library by 7 p.m. and stay until closing. 

Riding my bike back to my room at 11 p.m. I would have thoughts of past summers, swimming and vacationing, wondering and questioning myself what the heck I was doing here.  Would this summer ever end and more importantly, would I pass my classes?  The summer of 1985 was definitely the longest 3 months of my life.    

Yes, both the summer and I passed and moved on.  Fall came and we started the beginnings of clinical training, having laid all the ground work the previous three semesters.  Here I am, many years later, living back in a coastal town.  We have had some serious heat the past few days, none of which compares to the intense summer heat of the California Central Valley.  Fog is blanketing the sky this morning as the ocean’s natural air conditioner cools the temperature.

As far as summer vacation goes, the past week AudibleRx has taken some time off.  We put our 20 foot sail boat in the water for a week and have been lounging in the harbor, taking day trips out into the bay.  As you can see below, we are towing my nephew and his son in their small sail boat out for a race.  This too is a summer to remember.




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