Daniel Shifrin, R.P., M.S. is a recently retired pharmacist who enjoys sharing his insights about hospital pharmacy. He is proud to own one of the largest collections of Pharmacy Stamp First Day Covers.
Five Day-to-Day Times That Inspired Quotes and Made Common Events Anything But
“Integrity is the ability to do what’s right, even when no one is watching.”
One of my bosses used to say that. He was the Dean of a career school where I taught students to become pharmacy techs. I also worked in career services, where I helped my students find jobs.
My boss felt that a person’s reputation was everything (my wife feels that way, too). Thus, my boss thought that integrity, or the ability to do what’s right, was essential. He practiced integrity in everything he did. And he strived to make certain that we (his staff) practiced it too.
Throughout my career, I’ve often attributed quotations to the situations at hand. Sometimes I’ve borrowed them from somewhere. Other times I made them up. But regardless, they made the circumstances easy to remember.
Here are some of my favorites:
“It’s mine, mine all mine.”
I was coming back from a meeting. There were a lot of people running in and out of my department. “This isn’t good,” I thought. I ran in and found several doctors and nurses on the floor around one of my staff members.
One of my pharmacy technicians told me what happened. It seemed that this pharmacist was just talking, when she collapsed on the floor. My staff quickly dialed the hospital operator and initiated a 'code silver’. A code silver is a when an employee or patient’s family member is in distress. Calling a code silver signals a team of doctors and nurses to respond to the situation.
It was hard to keep my staff members far away. Everyone was watching. It was almost like rubbernecking on a highway. Everyone needed to look and see what was happening.
Finally, one of the doctors called out, “We’re going to transport her to the Emergency Room. We need a stretcher.”
“I’ll get one,” I said as I dashed out to a nearby nursing station.
Fortunately, they had one in the hall. I ran up to the nurse behind the desk.
“We had an employee collapse in the pharmacy department,” I exclaimed. “The code silver team is there right now and they’re taking her to the ER. I’m taking your stretcher.”
The nurse replied, “You can’t.”
“You can’t take our stretcher,” said the nurse, “We have a patient going to the OR this afternoon and need it to transport the patient.”
I couldn’t believe what was being said.
“I have an emergency situation where an employee needs to be transferred to the ER by the code silver team,” I stated.
“I understand what you are saying,” answered the nurse, “But I can’t just give you our stretcher. I can call my head nurse if you’d like. She’s at a meeting right now. Maybe she’ll say it's okay to take the stretcher.”
I was wasting valuable time. Finally, I said, “I’m Dan Shifrin from the Pharmacy. I have an employee in distress who needs to be taken to the ER. And I’m taking your stretcher.”
I ran to get the stretcher. The nurse called after me a few times, but it didn’t stop me.
As I wheeled the stretcher down the hall, I turned and saw the nurse. She was furious! She was quite animated as she spoke to someone on the phone. But I didn’t care. I needed the stretcher.
Eventually the code team used the stretcher to move my employee to the ER. They transferred her to an ER bed and hooked her up to a monitor. The “borrowed” stretcher was cleaned and returned to the nursing unit within the hour. It was available to transport their patient to the OR that afternoon.
My employee was transferred to a regular nursing unit from the ER. She was discharged after a few days. As for my “taking” the stretcher, there were no repercussions. Nothing was ever said to me.
I’ve often wondered why people at work were so possessive of their supplies and equipment? It’s not like they owned them personally. And it’s not just the nursing staff!
We had eight toner cartridges for our printer. Yet, we were reluctant to give up one to a department that had none. Were we afraid that if we depleted our supply that we wouldn’t get any more? Perhaps we were practicing the Daffy Duck Theory (“It’s mine, mine all mine.”). Maybe we feared that if everyone found out that we had a supply that we would become the go to people if ever there was a need.
That happened to me once. A sales representative called to borrow a drug for another hospital. He assured me that the pharmacy manager said it would be returned in two weeks when the other facility got their supply.
After two weeks, the sales rep was nowhere to be found. And the other hospital’s pharmacy manager never returned my calls.
I never lent that hospital or that sales rep medications ever again.
“These meds I want stat, the others I need immediately.”
Remember the story of the boy who cried “wolf”? The boy yelled “wolf” when there was no emergency. This annoyed everyone so much that the boy lost all credibility. Afterward when there was an emergency situation and he yelled, no one believed him.
People cried “wolf” at my hospital also. Only it didn’t involve the word “wolf”, it involved the word “stat”.
A stat is something that is needed immediately. In other words, stop what you’re doing and work on this, because I need it now. It can be used in any part of the hospital. In the pharmacy, it always refers to medications.
To me, a stat medication is reserved for a crisis mode. A visitor collapses on the floor and needs a medication stat. A person is in dire pain and needs a stat medication. A patient is seizing and requires a stat dose of a drug.
Now I’ll admit, many times the stat medication may not be available on the nursing unit. Someone may have to run to the pharmacy to obtain the medication. But it should be filled and given promptly.
Unfortunately, throughout my years of working in various hospitals, I’ve discovered two problems with stats:
1. Stats are assigned a time limit. People like to assign time limits to their procedures. Like many hospitals we practiced Quality Assurance or QA. We used statistical data and measured what we did. We’d cite improvement in most cases and draw impressive charts and diagrams.
Thus, my pharmacy defined a stat as an emergency medication which had to be filled and administered to the patient within thirty minutes. This was not an unreasonable time expenditure. Many facilities use thirty minutes as the time limit to measure stats.
In my pharmacy, I measured our stat completions on a monthly basis. The first month, only 64% of our stats were filled and administered within thirty minutes. Our stat completion rate rose to 82% the following month. And to 94% the next month. From then on it hovered over 92%. This resulted in a great QA project!
But think about it. A patient goes into cardiac arrest. Now it may be acceptable to be within the thirty minute time frame to satisfy the QA project. But taking thirty minutes to fill and administer the medication is simply unacceptable when it comes to helping the patient.
Perhaps we should have measured the success of a stat by how well the medication helped the patient. This is better than whether it was filled and administered within a thirty minute time period.
2. Stats are abused. A nurse came to the pharmacy with a medication order. She wanted us to fill it stat. There were fifteen medications listed on the order.
“Which medications are stat?” I asked.
“They’re all stat,” she replied.
“Yes, but which ones do you need right now?”
“All of them,” she answered, “they’re all stat.”
Was this an abuse of what a stat is? I certainly thought so.
Several months later, the pharmacy redefined our stat rule. In order to prevent abused stats, a medication order was only a stat if the physician ordered it as a stat. In other words, it had to use the word “stat” in the order (ie Morphine 10mg IM stat, then every 4-6 hours for pain).
This worked for a while. Until one day, a nurse came to the pharmacy. She had a medication order with about a dozen medications on it. And with every one of them, the physician had written stat. (Aspirin stat, hydrocortisone cream stat, antacid tablets stat, etc.)
I’m sure the nurse wanted to administer her medications promptly, because she had other things to do. And I’m certain that she enlisted the aid of the physician to write for these medications as stat.
But were these true stats by definition of the word? Hardly.
And that is why we never reacted when we heard the word stat. We didn’t give it the impact it deserved. Because the term stat didn’t carry the urgency that it once did.
“The schedule always works out.”
It’s not the Joint Commission. It’s not technology. It’s not even supplying medications to patients. So what did my staff consider the most important thing in the pharmacy? The schedule!
I made a six-week schedule for 57 staff members. This allowed my staff to plan their lives. For the upcoming six-week period, my staff knew when they worked, when they were off, and when they used their holiday and vacation time.
I also made a weekly assignment schedule. This schedule allowed my staff to know whether they were assigned to the IV room, the chemo area, or to work on a specific nursing unit. Generally my staff members rotated assignments so this schedule changed every week.
Now I’ll admit that there were holes in my schedule. There were times when I was short staffed on a particular day. Or I didn’t have enough people to work on the weekend. But it didn’t prevent me from going live with the schedule. I posted it- holes and all. Because once my staff saw the holes, the openings that needed to be filled, they grabbed them. And the reason why is that (most times) the holes represented overtime. These were open shifts, where a staff member could get paid time and a half for working.
In addition, even though my schedule came out six weeks in advance, not a day went by that somebody didn’t make changes. I didn’t mind switches. As long as the place was covered, I was happy.
Most switches were simple. (I’ll work your Tuesday and be off Wednesday. Then you work my Wednesday and be off Tuesday.)
But there was one woman who was the master of the multi-person switch. She made these massive switches. They usually involved six or seven people swapping shifts over a two week period.
It always reminded me of the baseball trades involving three or four teams. In these trades, Team A sent players to Team B. Then Team B sent players to Team C. Then Team C sent players to Team A. And everybody’s happy.
Her switches were much more elaborate. For each day, she would have three columns: 1) the person involved in the switch, 2) what the person was originally scheduled for, and 3) what their new (switched) assignment was.
So a typical day for one of her switches might look like this:
Person Original Assignment Switched Assignment
Person A Days Off
Person B Days Nights
Person C Nights Days
Person D Off Nights
Person E Nights Days
Again this is just one day of her switches, imagine what five people switching ten days of assignments would look like.
I didn’t know what amazed me more. Whether this woman’s switches were perfect and the changes she made covered all the shifts. Or that she was able to get a plethora of staff members to agree to massive shift changes over a two week period.
It’s impossible to go through thirty years of schedule making without ruffling some feathers. And I did. But for the most part, I made my staff happy. And that was my primary goal.
“Opportunity always involves some risk. You can’t steal second base and keep your foot on first.”
This quote is from a framed picture that sits on my desk. It is from a motivational product company called Successories. It’s a baseball player sliding into second base. Thus, the opportunity is leaving first base and sliding into second base. And that’s where the risk occurs. Because in order to achieve second base, you have to leave first base.
I’ll admit, like most people I wasn’t a big proponent of change. In fact, many times I’d rather stay with an unpleasant situation rather than make a massive change. I subscribed to the phrase, “I knew what I had, but I didn’t know what I was getting.” Thus, I stayed where I was.
However, sometimes I wanted to (or needed to) leave my comfort zone. And I realized that by doing so, it would be risky. But when the opportunities exceeded these risks, I knew it was time to make a move.
Previously I wrote about my first job, I was working as a pharmacist in a small retail pharmacy. I was making good money and working decent hours. It was a nice store and I worked with a good group of people. And there was no pressure— there were no benchmark numbers that I needed to achieve.
I hated my job after the first five months. And yet I was reluctant to leave.
Until one day when a friend called me and wanted to know if I knew of any pharmacist who wanted a job in her hospital. Now she wasn’t particularly asking if I was interested. And I wasn’t particularly looking to leave my job. So it was a big shock to both of us when I blurted out, “Yes, me”.
At the time, I knew nothing about hospital pharmacy and the hospital my friend worked at. But I was willing to step outside my comfort zone and interview for this position. I was hired shortly thereafter.
In his book, Indispensable, Barker discusses the “lack of personal accomplishment” as follows:
“I felt like I was running full sprints without a finish line.”
“Lack of personal accomplishment feels like you are given tasks that will never be completed. You’re told, “Run”, without there being any indication of when you can stop. You’re on a proverbial hamster wheel of work. Clock in, run the wheel, clock out. Nothing changes. Work feels meaningless, leaving you empty at the end of the day.”
I didn’t realize at the time that I was experiencing a “lack of personal accomplishment”. But I’m glad that I was able to address it. So when the opportunity arose, although the risks were there, they really weren’t much of a deterrent. And thus, I was able to take full advantage of the opportunity involved.