What?! I am lacking two green-apple-flavoured condoms? Outrageous!

This is a pretty amusing first for me. Called up my wholesaler today to say that I have received a box of 144 Durex Select Flavours condoms that only had 135 condoms (Ha!)

He and I could not keep a straight face when I said "I am lacking two strawberry, two banana, two orange and three granny-smith-apple-flavoured condoms"

Below is the offending box of condoms

Pharmacy Audits - teaching you how to hold a spatula

Every community pharmacy in New Zealand gets routinely audited every 4-5 years. I totally understand the need for quality control in community pharmacies. We deal with many drugs that could potentially kill people if given wrongly.

That being said, this current audit which I participated in recently shows that common sense and pharmacy audits are often mutually exclusive. Below are some of the things that came up:

(1) The hand washing basin in the dispensary is too far from the paper towel dispenser. It is three foot steps away.

(2) The dispensary Ibuprofen 200mg tablets (Nurofen, Advil etc.) cannot be repackaged down for personal use or to sell. This is despite the fact that it is the same strength of tablet as the ones you get from supermarket. Why? Because some bureaucrat at Medsafe decided to classify this particular packaging as "prescription only medicine"

(3) The wooden handle on the spatulas (that we use to make individualised dermatological creams) has tiny cracks on it.

Ahhhh bureaucracy at its best.

How to increase your paid holiday from 4 to 5 weeks

Jason decided to open the door and join the photo shoot
as this is the first time the hot cousins have decided to visit in 6 years

Unfortunately there is a caveat to the promise of this article. Your 5th week of holiday will have to be spent sitting on the toilet, taking a dump.

Someone once told me "I always take a dump at work, because I'd like to think that I am getting paid for taking a dump"

I hate public toilets with a passion so unfortunately this strategy won't cut it for me but it got me wondering about the real monetary cost (for the business) of a person taking a dump at work.

Lets assume you don't take any holidays and work the full 52 weeks at a normal 9 to 5, Mon-Fri job. You know, cause you just sooo enjoy what you do and would love nothing but to work the full 52 weeks.

5 working days a week X 52 weeks = 260 days worked per year.

And lets assume you eat a lot of fibre and keep up with your water intake so your average dump-taking time is around 10 minutes a day. 

This is (relatively) good news for people who suffer from Crohn's, Ulcerative Colitis or IBS as time spent on the toilet can be infinitely more, hence increasing the "time paid to dump". Perhaps one consolation from the myriad of things you have to suffer through, like that person who was on Xenical but still went out and ate Maccas. Enjoy shitting your pants I say.

260 days X 10 minutes = 2600 minutes paid for taking a dump

2600minutes / 60 minutes = 43.3 hours paid for taking a dump.

Jesus christ, you just got paid a full working week, by doing nothing more than adjusting your bowel motions.

The State of Pharmacy - Summer 2013

In the spirit similar to that of The Oatmeal's State of the Web, I present to you, State of Pharmacy:

Because, apparently, eating real celery bought from your local supermarket is just not good enough.

What do you call a black person selling drugs?

The Anti-Joke Chicken:

Pharmacy Memes

Here's a few to start off the feature and no, it is not pronounced as me-me. More will be updated in the Pharmacy Meme section.

5 types of Rate-Limiting Assholes

Ever wonder why when you queue in the shortest line at a supermarket, the line next to you (that is three times longer) is going so fast that the last person in the said long line is finished before you? Or why you, without any trolley, can't go through an aisle without feeling like you are in one of these? Or why you can't get your one item Amoxycillin script as quick as a morning quickie?

It is likely, you have encountered a Rate-Limiting Asshole (RLA) listed below. Anyone who knows a bit of chemistry will remember the concept of Rate-Limiting Step; RLA is similar, only that it's an asshole that slows down an entire process that should only take 5 seconds.

(1) More than 12 items in the  "12 items or less" queue

I come from Mars and 12 = 30

These people need no explaining. Stuff you. Period. I came down here to buy some quick washing detergent cause I ran out of clean undies to wear and as I proceed with my emergency laundry, bang! out of washing powder. Shops should enact the policy of asking "Hi Sir, so which 12 items would you like to buy today?"

(2) Wrong pin/wrong card/not enough money/paying by cheque

69 people have been sentenced to death in Djibouti for paying by cheque

Cashier: "Sorry, it says wrong pin"
RLA: "oh no, I am sure it's that pin, maybe I clicked credit instead of cheque"
Cashier: "wrong account. Just choose the account you did the first time but press the pad hard when doing the pin."
RLA: Proceeds to press and click ok even though only 3 numbers were entered as the pin.
Cashier: "now your card is locked and you have to go the bank to unlock it."
RLA: "no no, I'll just try again"
RLA: "oh no, it's bounced again, do you take cheque?"

(3) Voucher Fiend

Several kids have died of starvation whilst waiting for the person in front to find the right voucher

You know the type. The one that stands there and digs through what seems like a whole wallet that is dedicated to the storage of loyalty cards and vouchers. After what seems like a million years, the person pulls out a coupon that was issued when Caesar was murdered on the lower steps of the portico.

(4) High maintenance

This picture needs no caption

Can I please get this particular slice and this one and that one, no, not that one, this one slice of salmon and can I also get it bagged separately in 4 different bags. All said whilst pushing an *empty* double pram!

or

Can I please pay this lot using my card but this lot using cheque and I also want $100 cash out at 9am in the morning in $20s, $10s, $5s, $2s and $1s.

(5) all of the above

Imagine a combination of the above and you will agree with me that some people just need a high-five in the face with a chair. A very succinct pictorial description of this is provided here by The Oatmeal.

Let's Count More Tablets

A lot of people think that all we do is count tablets. Well, that misconception is about to become even more real with the advent of even bulkier packaging.



Pharmac's way of saying thank you: Out with the old (RHS) and in with the new (LHS)


Your patient needs 360tabs? Psh, don't be lazy and count out only 140 from a full bottle of 500. Let's actually count 360! Lazy pharmacists.

Condom-Stealing Phantom Strikes Again

This is a sequel to the case of the walking condoms. $3 for 144 condoms is apparently not enough a deterrent to condoms being stolen.

Do you see the empty space next to the durex extra safe? Yep, that used to be occupied by durex pleasuremax. No sale history on that either so where did it go? Judging by the amount of Avigra scripts we do, I guess I shouldn't be surprised. At least they are practising safe sex right?!

Cee Lo Green spotted!

I see you pumping heaps of blood round the body I love and I am like Beta Block you.

Iridology! Because western medicine is too mainstream

A typical Iridology eye chart for the left eye

Not so long ago I saw news about pharmacies offering Iridology services. Whilst I can understand the need to diversify and make your pharmacy *unique* to the public eye (ha!), offering what is tantamount to a palm reading service is contentious at best.

The most recent case underscores the importance of seeking a second opinion (and no, not from a homeopath).

Top 3 things you need to know about the new Blood Glucose Meters starting 1st Sept 2012

Courtesy of  http://www.caresens.co.nz/page/caresens-meters.aspx 

Oh Pharmac how we love you changing the funding list like we change our undies.

This change, starting 1st of Sept 2012 however, is not at all minor. Based on the fax notification from Pharmac, there will be three new listings for the meters. Here are 3 things you need to know about this change.

(1) LCD back light for testing at night (CareSens N POP, see picture above)

(2) Manual and automatic coding. You know how when you use the Accu-Chek meter you have to insert a new chip into the meter every time you start a new box of test strips? (you should know!) Well, the CareSens II requires you to manually enter in the code every time you open a new box of strips whilst the other two better looking meters do that automatically.

(3) Patients who are already on Accu-Chek meters will continue to be able to receive strips fully funded until 1st March 2013 although it makes sense to start newly diagnosed patients on these new meters.

Wouldn't it be helpful if there was a side by side comparison of those meters? Well, click away!

Bear in mind though that the last meter in that chart (CareSens POP) didn't appear in Pharmac's fax notification as a new listing so I am not sure if that will be one of the options.

UPDATE: Pharmacists can switch people who are on old meters without a prescription. Every pharmacy should've received a prescription look-alike pad named "Pharmacist Claiming of Blood Glucose Diagnostic Test Meters". Process that as you would a prescription and Toniq has assured me that it will adjust it automatically so that no co-payment will come up.

Disclaimer: While every care has been taken to ensure this post is free from error, I do not warrant its accuracy as I am not an omnipotent and omniscient make-believe. Oh, and also Pharmac changes its mind faster than I can count to 90 tabs.

The Endless Phone Loop

How many operators does it take to put someone through to the right number? Two, apparently.

I had to call Novartis today as I discovered a colleague had left out, not one, but *two* Sandostatin LAR 20mg injections on the shelf, in room temperature, for what looks like a full 48 hours. The two fridge item injections have a total cost of about NZD $5600 excluding GST.

Not knowing its stability, I called (datasheet had nothing). Initially I followed the telephone prompt (press 1 for blah blah) and reached Medicine Information. I was straight away met by a voice mail (with an Australian accent) that kindly informed me that no one is at the desk so I should leave a message.

The patient is waiting at the counter so leaving a message is a no go. I called again to go to the operator.

"Hi, I need some urgent info about one of your pharmaceuticals and I have already tried Med Info without much success"

"sure, I'll put you through to someone in NZ so they can help"

ring ring

"Hi, is this fire or emergency?"

"err, I think I was put through to you by mistake."

"no fire or emergency?"

"no"

"good"  #click

Called back again and behold mother jesus I am talking to the same operator.

"Hi, I think you put me through to 111 or some sort of emergency line" (hey, Screw.You.)

"oh really? sorry, let me try again." (Am I going to get "fire or emergency" again? Lets hope not.)

"Hi there Carolyn speaking, how can I help?" (That's more like it)

"Hi I just need to know how long can Sandostatin LAR stay out of the fridge?"

"Umm is this a human product?" (say what?)

"yes"

"Sorry, you've actually come through to the animal division"

"That's great, please put me back to the operator"

"Hi there, Sauvignon Blanc speaking" A different operator. Not her real name but at this point I no longer care.

"Hi there, one of your colleagues put me through to the animal division for information regarding to a human product, can I please just speak to someone that can look up some info for me."

"Sorry about that, I am gonna take a short cut and put you through" (does that mean I get to talk to the big dog now?"

#and finally had a civilised discussion about pharmaceutical stability# For those of you who are interested, it is stable for 2 weeks out of the fridge at a temperature of less than 30ºC, at which point it has an expiry of 6 months

Moral of the story? Keep fridge items #gasp# in the fridge. Cause if you don't, a cute kitten is killed, by me, to eat, just to teach you a lesson.

3 things to take away from these amazing 3D Olympic visualisations

An Olympic Special today as it has nothing to do with drugs.

The New York Times has constructed the following eye-opening visualisations by comparing all 116 years of Olympic athletes in 100m Sprint, 100m Freestyle and Long Jump.

Just some of the facts to take home:

(1) The fastest 16yo sprinter in America today can win a Bronze in 1980.

(2) 100m Freestyle was held in open waters in 1896 and 1906.

(3) Long jump results is still relatively the same (unlike the other two sports that gained improvement over time) with Bob Beamon's 1968 record still holding strong even against today's athletes.

The New Zealand Formulary

If you are a health professional in NZ and are still using MIMS as your drug reference then you should probably be sodomised. Ok, a bit over the top but all jokes aside, NZ finally has its own version of BNF.

Not only does it have clinical information, it also provides PHARMAC and Medsafe info as well. For all the relevant links, see the New Zealand Formulary tab near the top of this page.

When you are using it on your computer (ie PDF version), don't be a chump and scroll through the pages when you are only trying to find information about one particular drug. Press Ctrl + F and type in the drug name and cycle through the relevant bits quickly. Unfortunately I don't think e-readers have that option.

LTC Assessment Tools - Education Evenings

For all the New Zealand Pharmacists that wants to know more about the LTC assessment tool and its application in a community pharmacy, you'll want to attend these education evenings. There's one in Lower Hutt tomorrow, make sure you don't miss out.

You'll find that I have added a tab above which provide links to extra LTC resources as well as PSA information. It pays to know the details of the PSA (dispensing ratios etc.) even if you are not a pharmacy owner (the new government paying method will indirectly influence an employee's pay/benefits. To think otherwise would be naive.)

Regardless of your views on the new Pharmacy Services Agreement, it pays to jump in the deep end and start swimming. The sooner you do, the sooner you can get across to the other side.

Indian Water laced with Quinine

Being not much of a drinker, I found this little gem particularly amusing whilst shopping in Big Carrot Town.

Want some fresh water from the Manawatu River? Not strong enough for you? How about some dysentery-causing indian tonic water (fresh from the Ganges) with a touch of Quinine.

At least you know you will be cramp-free whilst enjoying a bout of diarrhoea.

Top 5 Traits of a Beneficiary

Following on from the similar theme of identifying some typical patient characteristics, I will devote the whole post to people who are on "couch-sitting grants". No, I am not talking about people who just happened to be made redundant or the ones that came down with a debilitating illness in need of financial assistance. I am talking about the ones that seems to be getting the dole in perpetuity.

• They are always in a hurry. They come into the pharmacy sometimes up to 2 to 3 times a day, they got no job, yet they always need to be somewhere like the road runner. Solution? They just have to wait in line like everybody else.

• Sense of entitlement. "I am a human being, I deserve to be looked after by the government (whilst making no effort to look after myself), I deserve good (and free!) things and if I can't afford my cable tv then I will go on a current affair show and make a soundbite about how my eight children are not getting looked after"

• Asking to pay later. "Cool, I'll pick up 3 months worth of bread* and come back and pay the $3 tomorrow." What's that? You don't do that at the supermarkets? Alrighty then, I'll have your drugs on my shelf until you can pay for them. It's nostalgic to think that it wasn't so long a go that I would readily let them "pay later" because I know how important the medicines are... until I got sandbagged enough times for the reality to hit me like a moving train.

• They complain. Although not an exclusive trait, the complaints they come up with is baffling at the best of times. "Hi, can you please complain to PHARMAC that the Allopurinol tablets dissolve too fast in my mouth hence too bitter and even though it's quarter the size of a 10c coin, I am unable to toughen up as an adult and just take it so I can prevent the searing, unbearable pain in my toes."

• Finally but not least, dirty biohazardous prescriptions. Even though it might've just been written today, it looks like they have gone home, used it to clean their pet hippo's butt after performing a satanic blood sacrifice over it. Makes for a lovely mental image doesn't it?

A disclaimer before I finish: I do appreciate that a pool of unemployed labour is inevitable in any variations of capitalism. So no, this is not beneficiary bashing and me telling people to "just get a job"; this is a mere observation of what I have encountered (and still encountering) on a daily basis.

*Most medicines in NZ are fully funded at $3 charge per 3 months lot, hence the analogy here.

A Young Girl's Dream

A young girl "dreams of going to Tokyo to sample the food."

Nothing wrong with that right? Not really, considering the girl we are talking about is Britain's fattest teenager.

"How has it come to this?" was the question she asked herself when the local council built a special ramp just to rescue her out of her house in a 100,000 pound operation.

Hate to be the Captain Obvious here but nobody ever just *suddenly* got fat. Devouring crisps, chocolates and 2L of coke daily is not a 24 months cellphone contract, you have heaps of time to back out.

Oh, and she likes reading Fifty Shades of Grey.

This picture correctly summarises my feeling on this issue, without reservation

The Case of the Walking Condoms

Apparently businessmen are more horny than university students

I work in a CBD pharmacy and my clients are mainly suits and corporate people. Yesterday, I received an MPSO* from the medical centre next door for "variety of condoms." Feeling generous, I gave them a mixture of Durex Confidence and Durex Select (oh yes, NZ government fully funds flavoured condoms!).

It turns out, they just put them in the toilet and let patients help themselves. End result? Some wishful-thinking businessman took the whole 144 condoms before midday today. Seriously, I've seen free condoms last longer at student health when I was in varsity.

*Medical Practitioner Supply Order is essentially a prescription from a GP clinic that allows the pharmacy to provide the clinic with some basic essential drugs, flavoured condoms included.