Following Poor Locums

[admin]

Hi Locums

Are you fed up with following a locum from the day before, who left you a stack of work because that chapter in his book just had to be read?

Seriously, I am finding myself following on from people who just don't care, don't work, and just leave most of it for somebody else.

Does this happen to other people too?

[Linnear]

It happens to me all the time. But it's not just locums.

I've met plenty of lazy managers and plenty of managers that have too much paperwork to do to get the actual Rxs done.

But I think lazy locums are the worst because they give the rest of us a bad name.

[admin]

It happens to me all the time. But it's not just locums.

I've met plenty of lazy managers and plenty of managers that have too much paperwork to do to get the actual Rxs done.

But I think lazy locums are the worst because they give the rest of us a bad name.

Yeah I follow lots of lazy managers, but there are a lot of locums who are just useless and lazy. They always seem to do alright though, as the agency always sends them to the easy shops.

[Linnear]

When I first qualified I had a beauty shop in the middle of Exeter. No surgery collections, just a nice brisk walk in trade.
(I also fancied the senior assistant - bonus!)

Then I was told that I had to move to another shop, ave 300 Rxs daily with no dispenser. 5 Manrex homes etc.etc.etc.

And all because they had a pharmacist that was having personal problems and every shop she was moved to went down the pan!

(The pharmacy had a bottle of Whisky in the cupboard from when a Dr prescribed Brompton's mixture a few years before and the senior assistant had to take to marking the bottle because she would stay on after work and she would neck some!)

I was basically penalised because she couldn't do her job properly!

All good fun eh?!

[Zoggite]

Here's my rant of the day:
patient comes in today with handwritten Rx for "Transtec patches 35mcg/hour, one every seven days"; dispenser informs me that said patient had already presaented same Rx yesterday, but locum (Polish, only signed off on nov. 1st...) refused to dispense it as patient's date of birth wasn't on Rx, so sent patient back to surgery. Never even mentioned the fact that Transtec patches are only licensed for use twice a week, and that if the Dr wanted the once-a-week ones he should have p'bed BuTrans patches...
So what do I do? send the poor patient back to the surgery again, or dispense a CD against a faxed new Rx?

[admin]

Here's my rant of the day:
patient comes in today with handwritten Rx for "Transtec patches 35mcg/hour, one every seven days"; dispenser informs me that said patient had already presaented same Rx yesterday, but locum (Polish, only signed off on nov. 1st...) refused to dispense it as patient's date of birth wasn't on Rx, so sent patient back to surgery. Never even mentioned the fact that Transtec patches are only licensed for use twice a week, and that if the Dr wanted the once-a-week ones he should have p'bed BuTrans patches...
So what do I do? send the poor patient back to the surgery again, or dispense a CD against a faxed new Rx?

I hate ones like this. If you know the Dr really well and know you'll get that script, most pharmacists I know would give the patient the patches. However strictly speaking it's illegal to do a CD from a faxed script.

So what do you do? Send a patient in obvious pain back to the surgery again (not in their best interests) or break the law?

Answers on a postcard...............

[Steve G]

At least the Rx actually had a proper dose on it. I've seen so many for fentanyl recently that are just 'use every 72 hours'.

[admin]

Steve

I read your blog tonight - nice one. Thanks for the mention, but the link didn't work properly (I think it went to the old first page). Any chance you could change it to www.pharmacy-forum.co.uk ?

Thanks

[Steve G]

Steve

I read your blog tonight - nice one. Thanks for the mention, but the link didn't work properly (I think it went to the old first page). Any chance you could change it to www.pharmacy-forum.co.uk ?

Thanks

Thanks, and sorted.

[Zoggite]

...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?

[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]

Working with poor locums

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.