Community Pharmacist Roundtable, Part 1

Welcome to our community pharmacist roundtable, part 1 of 2. We spoke to some amazing pharmacists, the kind we all strive to be, the kind who can multi-task, stay calm, and know exactly what to do in every situation. These pharmacists have experience in a variety of pharmacy settings and have valuable advice to share.

Let’s meet the members of this roundtable:

Cynthia Barrera, PharmD: She graduated from the University of the Incarnate Word Pharmacy in 2015 and is a pharmacist in charge (PIC) for a growing community chain pharmacy.

Aakash Gandhi, PharmD: He graduated from the Philadelphia College of Pharmacy in 2017 and is a floater pharmacist for a large chain.

Ashley Gulyas, PharmD: She started out as a technician, then attended Wingate University and graduated in 2013. Gulyas has a total of 15 years of pharmacy experience and is a PIC at a Walgreens.

Michelle Taylor Harmon, PharmD: She graduated from Hampton University in 2003 and has been a pharmacist for 14 years. Harmon is a PIC in a busy grocery store pharmacy.

Eva Kasbohm, PharmD: She graduated from the University of Florida in 2007 and has been a retail pharmacist for 10 years in 3 different states.

Whitney Rae Kinder, PharmD: She graduated from the University of Kentucky in 2006 and is a PIC for a high-volume Walmart in Oregon.

Chara Reid, PharmD: She graduated from Midwestern University in Chicago in 2004 and is the manager of pharmacy services for a specialty pharmacy program. Prior to that, Reid worked for Walgreens as a PIC for 20 years.

Larry Riggi, PharmD: He graduated from the Albany College of Pharmacy in 2013 and is now a PIC at a high-volume Rite Aid.

Sarah White, PharmD: A 2015 graduate of Wingate University, she has been a pharmacist for 2 years and is the PIC at an independent pharmacy in Kenly, North Carolina.

Question: How do you train technicians? Is it difficult to hire and train technicians in a busy pharmacy?

Kinder: I generally place a job listing on Indeed.com, then I call them in for interviews. The last 2 times, I hired 3 at a time, and 2 of those 3 have worked out both times. We started a new system where all 4 of my trained techs have a specialty area, like input, fill, order, register, that they oversee and act as the point person for the new techs. They rotate through the various areas until fully trained. It’s working pretty well

White: I had a fabulous lead tech who really took ownership of training new and current techs. My biggest contribution was providing feedback about quickness and correctness of the work they were doing. Once a week, I ran a report that had input accuracy/speed/ percent of following [standard operating procedure] and another report about filling, and I would go over [that] with the new tech, so we could both see their strengths and areas to improve. Once they had the report, we would decide what their area of focus for the week would be. Techs really appreciate honest, data-driven feedback about their job performance.

Gulyas: I have them shadow me and all my techs for a while. I spend 1-on-1 time with them, so they know the “why” behind why we do some things the way we do. I get my techs to show them new things. I feel like it’s better received when it’s peer to peer.

Harmon: I schedule new techs on my shifts until they complete their Learning Carts and Technician University modules. Then I pair them up with another tech to learn each station. I prefer to have them work with me until I am confident they are ready. It does put extra pressure on me, but it is important for me to do it this way.

Question: How you do recognize your techs for doing a great job?

White: I held monthly staff meetings while at my chain job and had a “paper plate award” for the person my staff pharmacist and I thought had excelled that month. Winning usually came with some kind of award (picking lunch time for a week, Starbucks 1 morning, something small). You’d be amazed at how much harder people will work when they realize they are being recognized.

Kinder: I try to tell them "good job" whenever I see someone doing something extra. I also buy coffee every 2 weeks to thank them for their hard work. This way, I get extra caffeine and they feel appreciated.

Gulyas: Figure out what makes them excited. One tech loves it when I buy lunch. Another loves verbal praise. Another loves when I do some of her chores. And of course, lunch on me sometimes.

Riggi: I buy lunch or coffee occasionally. When someone does a good job or handles a situation well, you always have to praise them in the moment. Let’s be honest: We couldn’t do our job without our techs. I also like to let them see me doing some things that some pharmacists may think is above them, like ringing registers or drive thru, checking in the order, cleaning. Things like that show that we are equals, and that can go a long way. It helps when you have to ask them to do something they may not like to do.

Gandhi: As a floater, I don’t work with the same techs often. I thank them and help with pickup when I can.

Barrera: I try to get lunch, especially after a hard week and let them know that I appreciate their hard work. I also give recognition cards.

Question: How do you deal with a difficult doctor or doctor’s office staff person, generally, and when they disagree (ie, you call them about a severe drug interaction)?

Riggi: In situations where the doctor is being stubborn and the patient may be in harm's way, I find the best way to handle it is to give the patient all the information you have and explain the situation. If it’s a severe drug interaction, I print the report and explain to the patient that I expressed my concerns about this interaction to the doctor and they still want to fill it. I explain the ramifications of the drug interaction and explain that I’m not comfortable filling it even after discussing with the doctor and they may want to discuss with the doctor as well. Usually, when you explain you have their best interest at heart they understand. If you give the patient all the information and explain the severity of it, in most situations [they) are beyond grateful and understand we are just doing our job. Educating the doctor and patient is of utmost importance and in the end, I think if it will cause serious harm, I will deny filling the prescription.

White: I got this awesome advice from a professor during pharmacy school: “Document everything, because if you didn’t document it, it didn’t happen.” I remind my techs this on a daily basis. This goes for conversations with doctors about interactions, conversations with patients about copays, you name it. If a doctor’s office is being rude, I make sure to write down who I spoke to and a summary of the conversation, including quotes if something is particularly important. Sometimes, if you ask someone to repeat a rude statement “so I can document this accurately,” they will generally either apologize, backtrack, or re-word what they said. I’ve found that asking people to repeat things often alerts them that what they’ve said is incredibly inappropriate, and I like to give them the opportunity to walk it back. We’re all human and we all say things we don’t mean when frustrated.

Harmon: Fortunately, it's been a long time since I’ve dealt with rudeness. If I feel like they are being rude, I just remind them that we are both there to take care of the patient. As for drug interactions, I will let the patient know my concerns and let them know I’ve spoken to their doctor and what his/her stance is as well. I then let the patient make the decision on what to do.

Gandhi: Document who you spoke to and what was said. I make sure it’s on the new prescription or re-scan the original hard copy and explain the situation to the patient as well. (Note: this is especially important in a paperless situation, so the documentation is scanned into the computer).

Question: How do you deal with a medication error?

Kasbohm: Always report it. Never sweep it under the rug or try to hide it. An error is usually a symptom of a system failure, so people need to learn from it. When it comes to dealing with the patient, I always acknowledge the error and apologize sincerely and make it right however I can. I also think it’s important not to place blame on the employee that made the error to the patient. I will always just say, “I’m sorry an error has been made” and make it right. And I also explain to them that we take medication errors seriously and will report it and discuss [it] in our monthly meeting about quality issues, so hopefully they feel more comfortable continuing to use our pharmacy.

Gandhi: Agreed, everyone makes mistakes. The important part is to learn from it and prevent it from occurring again. Apologize to the patient, report it, and make sure I don’t make the same mistake again.

Gulyas: Own it, apologize profusely, make sure [the] patient is safe. Report it, make it right, compensate the patient. See if it could have been avoided. Talk to the whole team about the incident. It can and will happen again if you don’t take it seriously.

Harmon: Own it. Report it. Learn from it.

Question: What is your favorite reference to use at work and why?

Gulyas: Clinical Pharmacology. I love the detail. The information on pregnancy and lactation is very thorough. I love that the reference is right there and linked for quick access if you want to read further. It is the perfect amount of information for an advanced practitioner like ourselves. It has become my 1-stop shop and so easy to search.

Gandhi: Micromedex helps me counsel patients and usually has the [information] I need at a fingertip.

Riggi: We are given Clinical Pharmacology, and that is usually significant as a reference, interaction checker, and pill identifier, but sometimes you just need Google to get something done.

White: We have Facts & Comparisons, which I feel is very thorough and almost always has the information I need.

Barrera: I use the Lexicomp subscription I purchased on my phone. For more complex or more detail, then Clinical Pharmacology, for sure.

Question: What is your response to patients who are upset about their copay?

White: That they need to call the 1-800 number on the back of their card. I will always try my best to find a manufacturer card and will even call the 1-800 number with them. If after that they still aren’t satisfied, I refer them to their prescriber to find something more affordable.

Gulyas: I remind them, “We don’t set your prices. That’s a negotiated price with your insurance company. We send the claim electronically, and they send us back a price. Any other questions will have to be directed to your insurance company.”

That is it for part 1 of this roundtable. In part 2, we will discuss working without enough help, pharmacy hacks, dealing with difficult patients, and more.