Following Poor Locums

[Zoggite]

Steve,
I too have had a look at your blog, and find it very interesting as I recognise just about all the situations you describe!
With regards to your partner's Rx being handed over to you without any explanation or advice, I thought I'd share with you what I was told in a similar situation by my superintentent Phcist: "Just because a person is handing in and collecting a prescription on behalf of someone else, do not assume that the patient has given you their consent to share any confidential information about their medication with that person"; in other words, if the pharmacist had told you what was on your partner's script, he/she could have been in breach of patient confidentiality rules!
I know, I know; it's totally absurd, you could have read the script on your way to the pharmacy before handing it in, but there you go...!

[Steve G]

Well my partner was actually there with me, so if the pharmacist had wanted to speak to her she could have done. As it was she didn't even get off her chair - the dispenser labelled, dispensed and gave it out.

As for patient confidentiallity, is it breaching confidence to say something along the lines of:

"There are two lots of tablets here, the ones that are taken four times a day may cause drowsiness and the ones that are taken three times a day need to be taken with or after food"?

[admin]

...And following on from my Transtec adventures from yeaterday:
Today's lunchtime hour was taken up by concerted attempts by myself and a very patient and understanding Macmillan Nurse, to try & get some Diamorphine sorted out for a terminally-ill patient's syringe-driver: The GP had issued a Rx for Diamorphine 5mg-ampoules, which we can't get hold of; we 'phoned around all the pharmacies in a 15-mile radius, to no avail; I had some 10mg-ampoules in stock, but we couldn't get in touch with the GP to change the script because the surgery was closed for the afternoon "for staff training"...
So what would YOU have done?

I had virtually the same thing a few months ago. I basically trusted the nurse because when I asked her if she was sure the GP would write a new script for the higher strength (making sure she knew how she was going to get the correct dose etc) she replied "he'll write a script for anything I ask him for, the man is dying afterall".

I thought if this all went bad, then I had put the patient first, and I was told it was probably his last night. I must admit though, that it made me nervous, because the society never seem to understand these things, and just quote the law. I just wish we had some way of bending the rules on these things, and a society that was on our side, instead of having to stick your neck on the block to help someone.

[admin]

Well my partner was actually there with me, so if the pharmacist had wanted to speak to her she could have done. As it was she didn't even get off her chair - the dispenser labelled, dispensed and gave it out.

As for patient confidentiallity, is it breaching confidence to say something along the lines of:

"There are two lots of tablets here, the ones that are taken four times a day may cause drowsiness and the ones that are taken three times a day need to be taken with or after food"?

Steve

I don't think that saying things like that are breaking anyone's confidence and I often ask people to pass on such messages to the person they are picking the drugs up for.

It sounds like the kind of pharmacist I often follow..........

[Steve G]

Here's my rant for the day:

At least when following a poor locum you don't actually work with them. I've had the mispleasure of working with a bloody useless locum over the last two days - giving antibiotics out with no advice for instance. But then today was even worse: a script came down the other day for oxycontin 5mg bd and oxynorm 20mg bd (both typed generically). The locum gave the rx out with no questions asked, despite the fact the bd is obviously a bit strange for oxynorm. If he'd bothered to look at the PMR he'd have seen that the patient has been on oxycontin 25mg bd for ages, so it needed checking out.

I only noticed the Rx had been given out when entering the CDs recieved from the wholesaler (the rx had been repeated from the PMR, so we got a box of oxycontin 20mg and 5mg in). I ended up phoning the GP, and of course found out that the Rx had been messed up by the surgery, so got the GP to do a new and correct rx, went down to the surgery to collect it and delivered the correct drugs to the patient.

And to make matters even worse, this locum was so slow it was ridiculous. I would have been better off working by myself. And even more galling is the fact that he's probably made £400 over the two days (8 hrs per day), while muggins here has earnt £315 (9 hrs/day) even though I did all the bloody work. Some locums give the profession a very bad name.

[admin]

Steve

Ok here's my worst locum job share I have done so far (that I can remember right now). I think I have posted it before somewhere else, and the times may differ a bit, but this is the best I can remember right now.

I was at a store that did an average 800 items a day, 75 methadone clients, and a needle ex scheme. The other pharmacist still wasn't there at 10am so I rang the agency and was told he was on his way.

At about 11.30am a security guard ran into the shop and told me a guy was having a heart attack in the barbers opposite, and asked if I could help. I thought I was just going to loosen his tie, keep him calm, that kind of thing. When I got there, a man was on the floor breathing very shallow, and going blue.

The other locum still wasn't there so I told the staff to close the shop. To cut it short, his heart stopped, and I did CPR for 10 to 15mins while the ambulance got there - this was in the middle of a big shopping arcade, so they had trouble finding the back entrance, hence the delay.

I kept him going, and when they got there the three of us (me and two paramedics) kept him going for about another 10 mins, and they eventually took him away in the ambulance.

I went back to the shop at about 12.20pm to find the locum had turned up at about 12pm. I asked why he hadn't reopened the shop, and he said he didn't like to on his own. I told him I needed a coffee and a fag after that, and he'd have to cope on his own for 10 minutes or so, and pointed out that I had been on my own all morning.

The staff told me he was really lazy, and basically liked to just serve the needle ex customers, and do nothing in between, so I told him I would look after that part of things for the afternoon, and he could check the scripts as I was shaken up after the guy in the barbers. At about 1.15pm or so he asked me if he could have his lunch. I said ok, so off he went and came back at 2.30pm! I told him I liked to eat something in the day myself, and where had he been for so long. He said he had to do his prayers (all of 10 mins or so I believe) in the back room.

For the rest of the afternoon I basically did virtually everything, as he kept making mistakes, so I put him back on the methadone and needle ex. At 5pm he asked if he could go home - the shop closes at 6.30pm. I said to him he might as well, as it didn't seem like he was even there anyway, but I think that went over his head.

I had a peak on the computer when he'd gone and he charged from 9am to 6.30pm (no time taken away for being late, or most of his lunch off the premises) and milage. He had charged about £80 more then me.

To say I was angry is putting it mildly...........

[Asterix]

Steve

Ok here's my worst locum job share I have done so far (that I can remember right now). I think I have posted it before somewhere else, and the times may differ a bit, but this is the best I can remember right now.

I was at a store that did an average 800 items a day, 75 methadone clients, and a needle ex scheme. The other pharmacist still wasn't there at 10am so I rang the agency and was told he was on his way.

At about 11.30am a security guard ran into the shop and told me a guy was having a heart attack in the barbers opposite, and asked if I could help. I thought I was just going to loosen his tie, keep him calm, that kind of thing. When I got there, a man was on the floor breathing very shallow, and going blue.

The other locum still wasn't there so I told the staff to close the shop. To cut it short, his heart stopped, and I did CPR for 10 to 15mins while the ambulance got there - this was in the middle of a big shopping arcade, so they had trouble finding the back entrance, hence the delay.

I kept him going, and when they got there the three of us (me and two paramedics) kept him going for about another 10 mins, and they eventually took him away in the ambulance.

I went back to the shop at about 12.20pm to find the locum had turned up at about 12pm. I asked why he hadn't reopened the shop, and he said he didn't like to on his own. I told him I needed a coffee and a fag after that, and he'd have to cope on his own for 10 minutes or so, and pointed out that I had been on my own all morning.

The staff told me he was really lazy, and basically liked to just serve the needle ex customers, and do nothing in between, so I told him I would look after that part of things for the afternoon, and he could check the scripts as I was shaken up after the guy in the barbers. At about 1.15pm or so he asked me if he could have his lunch. I said ok, so off he went and came back at 2.30pm! I told him I liked to eat something in the day myself, and where had he been for so long. He said he had to do his prayers (all of 10 mins or so I believe) in the back room.

For the rest of the afternoon I basically did virtually everything, as he kept making mistakes, so I put him back on the methadone and needle ex. At 5pm he asked if he could go home - the shop closes at 6.30pm. I said to him he might as well, as it didn't seem like he was even there anyway, but I think that went over his head.

I had a peak on the computer when he'd gone and he charged from 9am to 6.30pm (no time taken away for being late, or most of his lunch off the premises) and milage. He had charged about £80 more then me.

To say I was angry is putting it mildly...........

jesus how much did you get paid for that awful day?

[admin]

I charged my usual £25 per hour.

[grumpy]

Here's my rant for the day:

At least when following a poor locum you don't actually work with them. I've had the mispleasure of working with a bloody useless locum over the last two days - giving antibiotics out with no advice for instance. But then today was even worse: a script came down the other day for oxycontin 5mg bd and oxynorm 20mg bd (both typed generically). The locum gave the rx out with no questions asked, despite the fact the bd is obviously a bit strange for oxynorm. If he'd bothered to look at the PMR he'd have seen that the patient has been on oxycontin 25mg bd for ages, so it needed checking out.

I only noticed the Rx had been given out when entering the CDs recieved from the wholesaler (the rx had been repeated from the PMR, so we got a box of oxycontin 20mg and 5mg in). I ended up phoning the GP, and of course found out that the Rx had been messed up by the surgery, so got the GP to do a new and correct rx, went down to the surgery to collect it and delivered the correct drugs to the patient.

And to make matters even worse, this locum was so slow it was ridiculous. I would have been better off working by myself. And even more galling is the fact that he's probably made £400 over the two days (8 hrs per day), while muggins here has earnt £315 (9 hrs/day) even though I did all the bloody work. Some locums give the profession a very bad name.

I'm not starting a locum/manager war here - because I am both - but I have gone into shops where the manager just seems not to have thought through the working day. Recently, I was in a shop where nothing was ready for the day for the dispense weekly patients and I only learned about them when the patient came in to the shop. Some of them get A LOT of items and it took a long time in an already busy pharmacy. I was told that anytime staff tried to do the installment scripts they were told to stop and that 'walk in scripts were more important' so people weren't waiting for a long time! SO...when they come in to get their installment that isn't them waitng unnecessarily and taking time to do that doesn't slow the other waiters down?! Right! I left a note! Oh dear, makes me sound like the demon locum, 'don't book him, you'll get a note'!

Ok, I should balance this argument a bit, I have followed a locum who was a lazy get, and I got him on the phone and told him - just so happened I had to call the pharmacy he was in. He wasn't taking in new prescriptions after 4.45pm, shop shuts at 6pm. There must have been shed loads of stuff to do, cause the day I got there, no order was put away, surgery scripts were piled high and a guy came in to collect an extempt cream - from three days ago - and it hadn't been made up! Neither had the methadone for the day nor the Sunday - this was a Saturday.

I get a bit 'involved' telling these don't I?! I shall now have some camomile tea!

[Steve G]

I did relief work for a few months after I registered, have been managing a pharmacy since the start of the year and am going back to relief work soon. So I know both sides of the story by now. I guess there are just good pharmacists, bad pharmacists and lazy pharmacists. It is equally annoying when you are dealing with crap left by a regular locum in the pharmacy you manage, compared to going into a pharmacy with a useless manager.