Drug Shortages: Yes, we are really out of that. Use something else....

...or Fuck Off!!

Is it so hard to conceive that there could be massive drug shortages? If you knew the amount of legal bullshit, corporate greed, and just a lack of control/regulation in the health care industry, you would probably be glad that it's not worse. Injectable drugs that have become staples in institutional settings are now scarce in the market place. Drugs like Reglan, Zofran, Toradol, etomidate, Compazine, and Vitamin K are virtually non-existent within hospitals. Here is a list of reasons why:

1.) The FDA is slow. They can't approve new drugs fast enough. They also can't inspect facilities that have to be approved for making injectable medications soon enough either. The truth is, that there are probably around a dozen plants around the country waiting to start the production line, but they can't until the FDA gives them the go ahead.

2.) Corporate consolidation. Let's say one company buys another company or merges with it. Let's also say that these two companies are the only makers of injectable ondansetron, but they decide that they only need one plant to make it, not two. This cuts the supply in half, while there are no other manufacturers that step up to meet the demand for this product.

3.) DEA red tape. Each year, every drug manufacturer has to register to make a certain amount of controlled substances with the DEA. They cannot make more than this amount without approval. Even if they asked for approval, the DEA is also slow. There is no expedited process for this. If one manufacturer decides to stop making one product, the other manufacturers cannot just make extra to make up for it. There will be a shortage until the next year starts over.

4.) Piss in a bucket. A drug manufacturing plant in Ohio found human urine in an unmarked container in their laboratory. They have had to shut everything down, clean it, recalibrate it, and are now awaiting FDA inspections. As I said above: the FDA is s l o w.

5.) FDA red tape. When a company is bought out by another, all of their assets are transferred over, as well. This goes for thousands upon thousands of vials of midazolam that is sitting in a warehouse somewhere that has to get new labels for their new manufacturer. The only problem is that the FDA hasn't given them a new NDC number to slap on those labels. Meanwhile, we are on our very last lap with midazolam.

6.) What's in it for me? Some drug manufacturers just simply assess the situation that some drugs are just not profitable any more, due to lack of demand. Examples: sodium pentothal (truth serum) and codeine (for injection).



Closing Remarks: My take on this shortage situation is not worrying so much on what to use instead of these agents on backorder, but worrying how this is going to impact pharmacy practice. We are going to have to use more time procuring drugs or substituting drugs that we will not have time to set up proper foundations of our practice in the "new" health care system that is coming soon. Computerized order entry by pharmacists will be the thing of the past. Will we be shoved back down in the basement of the hospital to be "gophers" again?

Thank you FDA, and thank you Mr. Obama.

Back from my coma....

Wow!!!
I've been away for too long of a time. Let's see what has happened since then: I've been denied two promotions, I've been commended for great things, humbled beyond imagination, and had a baby. I was just too demotivated to post anything during that time, but I have woken from my slumber. I am ready to get back on the horse.

The History and Future of Nursing...

A long, long time ago, when English was the primary language of physicians (mid-60's), nurses were allowed to go to junior colleges in order to get the Associate's Degree in Nursing (ADN). This was because there was a shortage of nurses (just like there is now). About a decade later, the nursing organizations had determined that this was a mistake. Knowing that it could not be undone, they made an attempt to relabel the two different classes of registered nurses as the following: Professional Nurses (with a Bachelor's Degree) and Technical Nurses (with an Associate's Degree). This, of course, offended the ADN's and spawned a debate that still rages on today. Recently, a little bird told me that there is a move to push the ADN's out of hospitals around the country.

The truth of the matter is that the big difference in the two programs is that the BSN programs incorporate more outpatient/community related material and have some written papers that are not required in the ADN programs. The ADN programs accept more minorities and males, whereas, the BSN programs are usually 80-90% white females. There are also more older (+25 years of age) students in the ADN schools, as well.

The removal of ADN's from the more intense work in the hospitals is being promoted by some powerful individuals within several of the nursing organizations. The only reason that it hasn't been acted upon is: 1). There is no feasible way to define what a Professional nurse can do versus what a Technical Nurse can do, and 2.) Hospital pay is lower for nurses.

From my own observations, here is what I have to say:
BSN's are spoiled little GIRLS that got drunk on a weekly basis with their sorority sisters. They have an inflated sense of entitlement, and their usable knowledge of medical knowledge is very lacking. Because of their immaturity as a person and a nurse and their crappy work ethic, they lack the ability to be superior than the less educated ADN's.
ADN's are hard working WOMEN that had to work while they were in school. They often already had a child or two, and some of them were married. They are almost always mature and rely upon themselves.

Who is a Professional Nurse?

One of my wishes came true...

An ICU nurse that is stupid, yet an arrogant bitch has been promoted. Since she is terrible at her job, it was a perfect idea to move her up and out of our way. She is now walking around, reviewing charts, and trying to look important. My only regret is that she took a job that a much better nurse could have had.

Held back by our own kind...

A certain couple of units got together recently to put together a rounding team. They wanted a pharmacist to be on it. They had a certain pharmacist in mind (that already covers the area anyway). The plan went to pharmacy, and was shot down. Not because of staffing reasons, but because the clinical pharmacists didn't want a pharmacist who hadn't had a residency be on the rounding team. Even though this guy knows a shitload more about this specialty than the other clinicians.

Total fucking bullshit!

The fact of the matter is that it wouldn't have got approved anyway, based on staffing hours, but it didn't even get that far. Our management has gotten past the part of "Mushroom Management", and has went to the "Fuck us in the Ass" management.

Counterintuitive...

I had been caught up with my workload the whole evening, and after getting paged a numerous amount of times, I had to take a lunch (late, by the way). When I got back to my work, I was well over 30 minutes behind. The pages stopped. What the fuck?

From now on, I will be behind on my orders, so maybe I won't get paged as much.

Again, I wish I were a CRNA...

http://finance.yahoo.com/news/Specialist-nurses-paid-higher-hmoney-2327465018.html?x=0

The above link will further prove my longing to be a CRNA rather than a pharmacist.

I came for coffee, but met a douche instead...

Those who follow my posts probably know, by now, that I am a connoisseur of pussy coffee. Latte's in general (I'll drink regular coffee, but not black). I like coffee in my cream. My wife brought me something from the Joe Muggs in the Booksamillion store nearby a few months ago, I have been trying to duplicate that taste at home, with no avail. I went in today, and asked for the biggest caramel iced latte he could make me. I obviosly was not familiar with their menu, so I probably am not a big customer of theirs. The prick at the cash register then asked me if I wanted a discount card, so I ignored him. He asked me again, and I said "I just want the coffee I ordered." He then asked me if I wanted to two free magazine subscriptions on the behalf of Booksamillion, I said bluntly, "NO."

I love your crack-like chemical that you put in your latte's, but I am going to have to give them up. I'm going to just make my own, or go to Starbucks, where they don't ask me anything, except if I want an extra shot, because it was taking so long. I can deal with Starbucks; I can't deal with douche barristas.

I feel like I'm preaching to myself...

I am tired of all the lack of comments written on my blog, despite the handful of people that read it. I have really never made my blog really public (advertised to other similar bloggers), but I think that I might in the next coming weeks. I want to see if it sparks my interest in making posts if someone actually gives some feedback. The only feedback I get now is a tech or pharmacist who knows about the blog telling me in the hall "oh yeah, I read [past tense] your blog." I am thinking to myself at this point, "Was it any good or am I a part of a fucking joke I don't know about?"

I should say to them, "I saw you through your bathroom window last night." I know they would be thinking of me as a stalker or something (that's the point), but deep down they really would want to know if I got a rise out of it or not.

Nothing to wipe off the sweat...

This is off topic (again, as always). My gym is now charging a $5.00/month charge for towel service. They obviously can't do 2 loads of laundry a day, without losing money. I know the economy hasn't fully recovered, and they might be a little short on cash. Why don't they just up the membership fees? Why do I have to go up there and sign some fucking sheet to approve another $10/month (because my wife is on my membership) to go against my payroll?

Fuck them! I'm going to wipe my sweaty hands and forehead on their drywall. I'm going to put handprints on the mirrors, and I'm not going to make any attempt to wipe my sweat from their machines. I might even spit on the floor. I would teabag their equipment if I could get away with it.

Dr. Sulu

Dr. Sulu is not his name, but he is a physician. He comes in about noon everyday he is to work. He looks around, and talks it up with the nurses on the unit(s) he covers. He goes to lunch at 2 pm, and comes back a little after 3 pm. He usually has addressed maybe 20% of the TPN (total parenteral nutrition) bags to be started by this time, and he usually only has 45 minutes to get the rest done. He never does have them finished by this time. Here's the problem.

We outsource our TPN's to a place that delivers them from an hour away, so you can see there is a time constraint here. We have to get the orders in by a certain time, or we will have to make each bag ourselves, which is labor intensive and cost-inefficient. I like to go up there and try to see if I can get the information from the horses mouth, so we can get stuff done a little faster. Everytime I go up there, he will look at a chart, and then chat with a nurse about nothing for 10 minutes. We always 2-3 TPN's that have not been addressed by the time we have to send all of our orders, so we tell the place to make the same bags that they made yesterday. He then changes all but one of them, and we have to make 1-2 of them ourself. Remember that we also have 1-2 that the outsourced company made also (extra money down the fucking drain).

Why is it this way? Because nobody over me gives a fuck. That's why. They might care a little, but Dr. Sulu has been here so long, nobody has the balls to say anything about it. There is nothing but dead weight above me in management, and I say let the dead weight sink and drown. Someone needs to breathe new life into our pharmacy administration.

Don't mess with pharmacists...

You don't fuck with a pharmacist, especially a retail pharmacist in Alabama.

This is something that was sent to me over a week ago:

http://blog.al.com/spotnews/2009/12/pharmacist_charged_with_killin.html

I went to school with Bart at some point in my life, and we have had mutual friends. I have never known him, but I do know some things about him. He had a temper, but he was not the kind of person you think would shoot a cop in the face. I initially thought that drugs or alcohol were involved, but that has been ruled out publicly by the investigators. I've heard several rumors about either him or his wife knew the police officer, but nothing has been made public. The truth is that there HAD to be something else going on for this to have happened.

No matter what happened, one thing is clear: There was absolutely no reason for it. Nothing that can be brought to the public's eye will change the fact that Bart ruined his family and the family of the police officer.

If their are any cops reading this, ask your perp if they are a pharmacist, because they go postal more than postal workers do. Trust me on this one.

For the pharmacists that read this, never talk back to a cop or piss him/her off. No matter how bad a day you've had, know that a cop can do about anything to you if provoked. Never bring a gun in your store, and never shoot to kill (UNLESS YOUR LIFE OR OTHER'S LIVES DEPEND ON IT).