Many companies didn’t like this arrangement and wouldn’t do business with our hospital. But some did. I didn’t know if they didn’t know any better or believed the promises that my administrators made. But there were many companies that wouldn’t ship the products that my hospital needed.
All I remember is that we were always on credit hold. As an Assistant Director of Pharmacy, I had my contacts in the finance department. I had an uncanny ability to work with my finance department contacts and get some monies in order to get my orders released. On any given day, I often found myself begging and pleading with my finance people to pay something— pay anything. I was lucky. My contacts in the finance department would work with me. They’d pay the bare minimum so we’d get the drugs we needed.
From time to time, I went to national pharmacy conventions. The exhibit floor at these conventions featured an array of companies touting their new medications and technologies. In addition, many of these companies took orders and did business right there with the directors and managers that attended the convention.
My pharmacy needed a new supplier of albumin. The company that we had used wasn’t shipping because we had an outstanding bill and weren’t paying on a timely basis. At the convention, there were several suppliers of albumin. I approached each company and asked them what their best price and terms were.
I told each vendor about my hospital’s poor financial status and their inability to pay on a timely basis. I then explained that I wished to use their company as the sole provider of albumin in my hospital. I calculated that my pharmacy used about a dozen cases of albumin each week or about fifty cases per month.
Most of the vendors I spoke with were in awe of this potential order. Therefore, I reminded them of my hospital’s inability to pay their bills. I told the vendors that I had a better-than-average relationship with my finance department workers, and thus I could get monies on a regular basis. It may not be the exact amount that they (the pharmacy company) wanted at the time or by a certain date. But it would be a partial payment (with more to come). I reminded the vendor that a partial payment was better than no payment since there would be more money forthcoming.
If the supplier was receptive to this arrangement, I would sign the order right there on the convention floor. Then they could begin shipping products immediately. However, there was one caveat. The only thing that I requested was that they could not refuse to ship products or place us on credit hold. For, if they did, 1) I’d start buying from another supplier because I needed albumin, and 2) the original supplier would never get additional money. Because if my finance department did have money available, I’d designate that it would go to the new vendor (because they were shipping products) and not the old vendor.
Obtaining Non-Departmental Supplies
Perhaps the biggest problem with my hospital’s unique financial blueprint came with obtaining non-departmental specific supplies. In these cases, it was difficult to determine one specific area responsible for getting these items that everyone used. With some items, it was easy. Pharmacy purchased medications, dietary purchased food, and housekeeping purchased cleaning supplies.
But when it came to office supplies and computer paper, there wasn’t one department that was responsible for ordering and maintaining a stock of these items. Thus, every department was sort on their own and tried to obtain them any way they could. And unlike the pharmacy’s medications or dietary’s food items, the finance department never made it a priority to get the office supply vendor paid. Furthermore, no one made sure there was an alternative office supply vendor. Thus, the office supplier put the hospital on credit hold and wouldn’t ship any more office supplies.
It was at that point that I realized that hospital departments were extremely possessive when it came to what they have. Even with smaller, insignificant items (i.e., boxes of paper clips, bags of rubber bands, inexpensive pens), departments began hoarding them and were reluctant to share. This was regardless of how many they had.
After all, if the department gave away a box of paper clips, that was one less box that they had. What would happen then if the department needed paper clips one day and couldn’t get them? Why should they give away one of their many boxes of paper clips?
Some departments would lend us these items but expected that we would return them someday. (That never happened). Still, others tried a barter system (“We’ll give you a box of paper clips, but you have to give us two reams of computer paper.”) Sometimes, my pharmacy agreed to the exchanges. It depended on how badly we needed the items. Other times we didn’t.
Of course, I could always buy items such as rubber bands or paper clips from the local stores. That way, my pharmacy didn’t have to give up anything. I know that teachers have been doing this for years. Using their own money to buy things for their class. But it never seemed right that they (nor I) should have to pay for these items with their own money.
There were certain items that my pharmacy department truly needed. These items were off-limits when it came to the bartering exchange. Items like toner cartridges for printers. My pharmacy had to have a printer cartridge, or we couldn’t print prescription labels. So my boss and I took turns purchasing them from the local office supply store. And we never let other departments have them. Conversely, other departments had their essential items as well. And they weren’t going to give them away either.
Possession ruled the departments of my hospital. Nobody was giving up anything!
Getting A Stretcher
It happened unexpectedly. One of my female pharmacists collapsed on the floor. A staff member called for the Rapid Response Team. As stated in a previous article, the Rapid Response Team is a group of individuals trained to handle patient, visitor, or employee emergencies in the hospital.
The Rapid Response Team arrived quickly. The pharmacist did not need CPR or any life-saving measures. The Team felt that the pharmacist fainted due to heat, stress, or something minor. They wanted to bring her to the emergency room in order to have more tests done.
“I need a stretcher,” shouted one of the workers.
“I’ll get you one,” I said as I dashed out of the department.
The pharmacy was located on the first floor. There was one patient floor at the far end of the first floor. But more patient rooms were located on the second floor and above. I figured I’d run upstairs, go to a nursing unit, grab a stretcher, and hurry back to the pharmacy.
I arrived at 2 east, a 32-bed patient area on the second floor. There was a stretcher sitting in the hallway. I could have taken it— after all, it was an emergency. However, I felt it was only proper to let the nurse at the nurses’ station know. In hindsight, I should have just taken it. I pushed the stretcher to the front desk of the nurses’ station, where a nurse was sitting.
“There’s an emergency in the pharmacy!” I exclaimed, “ I’m taking your stretcher!”
“You can’t,” replied the nurse, “It’s our stretcher!”
I was momentarily dumbfounded by this response. (Of course, it’s their stretcher.) I paused before speaking.
“One of my pharmacists collapsed in the pharmacy!” I yelled, “I need to take this stretcher to transport her to the emergency room.”
“But it’s our stretcher. We might need it later,” said the nurse.
I opened my mouth to reply, but nothing came out. I couldn’t believe I was arguing about this and wasting valuable time.
“I need to take this stretcher, NOW!” I exclaimed.
“I’ll have to ask my head nurse,” replied the nurse, “She’s in a meeting right now and will be back in an hour.”
But it didn’t matter what the nurse said because I was taking the stretcher. As I proceeded down the hall, I could hear the nurse yelling, “Come back with our stretcher! Come back with our stretcher!” I ignored her and kept going.
I brought the stretcher to the pharmacy. The pharmacist was transported to the emergency room. Later that day, I brought the stretcher back to 2 East. The nurse, whom I had spoken with, was no longer there. But everyone at the nurses’ station knew what happened.
I must admit that I was quite annoyed by this incident. I felt that an emergency circumstance always took priority over a floor’s possessions. Imagine being denied taking a crash cart or an AED defibrillator for someone because it belonged to the nursing unit. I felt I was justified in taking the nursing unit’s stretcher.
Lecturing About Chemo
I was presenting a lecture on chemotherapy products to a bunch of nurses. I was discussing how chemo products were considered hazardous preparations. Thus, precautions had to be taken in case of spillage or breakage.
There is a product called a chemo spill kit. The kit contains special garb and booties, absorbent cloths, leak-proof bags, and warning labels. The product is designed to specifically contain and label a chemo spill. It also is used to protect anyone needed to clean the chemo spill.
I opened a chemo spill kit and showed everyone its contents. I then created a make-believe chemo spill. Next, I helped a volunteer put on the specialized gloves, gown, goggles, mask, and booties in preparation for cleaning the make-believe spill. Finally, the volunteer proceeded to clean up the make-believe spill using hazardous cloths, bags, and labels.
I always ended my lecture the same way. And I couldn’t believe what I needed to say. But I said it regardless. This is what I said:
“ I want to reiterate how dangerous a chemo spill can be. If someone comes up to your unit, tells you that there has been a chemo spill, and asks for your unit’s chemo spill kit. Do not hesitate— GIVE THEM YOUR SPILL KIT!
Don’t say, ‘I’ll have to ask my head nurse. She’s at supper right now. But she should be back in a little while.’ GIVE THEM YOUR SPILL KIT!
It’s similar to someone coming up to your unit and telling you that they need your crash cart for a person who’s having a heart attack. You wouldn’t say, ‘Come back when my head nurse returns from her meeting.’ You’d say, ‘ Take the crash cart!’
It’s the same thing with the chemo spill kit. GIVE THEM YOUR SPILL KIT!”
It’s a shame I had to say this. It should be common sense. But I knew differently.
Continuing To Hoard
The people in my hospital still continued to hoard. Perhaps it was due to low budgets and the inability to get what was needed. For other departments, it was purely a lack of equipment. Still, many departments hoarded items leaving others without these items. Was it really necessary to have four staplers on a nursing unit desk and six more staplers in a closet?
In some cases, it was just laziness. There were nursing units that kept five boxes of acetaminophen tablets at the nursing station with an additional five boxes in the medication cabinet. This way, they never had to run to the pharmacy for acetaminophen tablets.
Hoarding happened in my pharmacy, too. My pharmacy techs knew that the person who took the last ibuprofen oral syringe out of the bin had to make more. Some pharmacy techs would hoard (and hide) ibuprofen oral syringes so they weren’t depleting them from the bin. This way, they never had to be the person who took the last one and had to make more. I put a stop to this type of hoarding.
But our department was not the only one that acted this way. Many departments overstocked and hid things from one another. These departments were very possessive. I often said they subscribed to the Daffy Duck theory, “Mine, mine, all mine!”
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.