I’ve been a tech since 2009 but I have always worked in retail. I am about to switch to a new job working in an inpatient hospital pharmacy, just wondering if there are any techs or pharmacists out there willing to give some advice or tips on how to be a good hospital tech.
LostToApathyPharmD:
Every hospital runs a little differently, but I do a couple things to save myself a little time:
1.) If I have to deliver an IV to a floor, I’ll check the Pyxis pick list for that unit real quick and bring up those items with the IV so that the scheduled runs are a little more manageable.
2.) If I’m making an IV for 500mg of ertapenem, rather than throw away the other half of the vial (500mg), I’ll just throw the contents in another bag of 50ml NS and label it appropriately for the pharmacist to check. If we happen to use it, great – we avoided having to reconstitute another vial of Invanz, saving time and money. If we don’t use it within the time it expires, no big deal. We’re only out a 50ml bag of NS.
3.) When I’m restocking the Pyxis, I keep an eye out for empty cubies or matrix slots or places that I can tell have less than the par amount. Sometimes nurses grab an extra vial or tablet or something for whatever reason, and this can add up and cause the Pyxis machine to think it has more in it than it actually does. Then you get a call from the nurse saying the pocket’s empty when the machine thinks it has enough. It’d be best if the nurses would document everything they took, but unfortunately, from my experience, that’s too much to ask sometimes.
4.) LOOK AT WHAT YOU’RE PUTTING INTO THE FRIDGE. Is it an acyclovir IV? Don’t fucking do it. Shit doesn’t belong there. I only stress this because I got fucked over by another tech the other day.
5.) Depends on hospital policy If an IV is due within the next 15-20 minutes, I’ll leave it out on the Pyxis rather than putting it in the fridge. Most nurses let the IVs come close to room temperature if they can before starting them. You’ll help them out.
6.) Bad IV room technique can be hard to correct. Learn it right the first time.
travieza:
Is it difficult to make the IV solutions? Also, was it difficult for you to learn your way around the hospital? I constantly find myself getting lost. In your experience, is it complicated to restock the Pyxis machines or just time-consuming?
Theobroma:
In my experience, it takes about six months in the IV room to get fast. Don’t rush it. It takes time for everyone, so don’t get frustrated.
Also, if you want something to reconstitute without foaming, hold it in your (gloved) hand and make slow, gentle figure 8’s with it. Keeps the liquid moving without shaking and lets the liquid contact the powder on the sides of the vial.
Another tip for minimizing foaming: aim the stream of diluent at the side of the vial, not the cake of powder.
As to learning your way around the hospital: I’d say it takes a month or so to really get familiar with each floor, and about a year until you easily recall the names of the people you talk to on each unit. That’s when someone can call the pharmacy and say, “Hi, Bob, this is Becky.” And you can reply, “Hey, Becky! How’s life in CCU? What can I do for ya?”
And yes, it’s complicated to restock the Pyxis. The more you do it, the better and faster you’ll get. Just remember, everyone was a noob once.
LostToApathyPharmD:
As to learning your way around the hospital: I’d say it takes a month or so to really get familiar with each floor, and about a year until you easily recall the names of the people you talk to on each unit.
Agreed. Make the effort to learn the names of the staff on the floors. Especially the nurses. Anything to lessen the “Us vs. Them” mentality that tends to pervade interactions between the pharmacy and nursing staff.
DesteradoCPhT:
You have any experience making carimune at all?
Theobroma:
Sure. For IVIG, we have an auto-swirler, if you know what I mean. I don’t know what the machine is actually called. But since that comes as a cake at the bottom of the vial IIRC, it’s not as hard to get the powder off the sides.
You still get IVIG in lyophilized form? We haven’t had that around for years.
DesteradoCPhT:
We are very che….I mean cost effective where I work. Most of our IVIG is carimune. No auto swirling here. Good old righty and lefty do the swirling. We have an old compounder too. Like 1990 old.
narco_panda:
It’s not too difficult to make IV solutions. As with everything else, practice makes perfect. It’s really important to maintain good technique. Scratch that, it’s the most important thing. When I learned, I was taught two things. 1. accuracy and sterility are everything when it comes to IVs. And 2. when in doubt, throw it out. If you make a mistake, or even if you think you might have made one, don’t be afraid to discard it. Yeah, tossing a daptomycin vial may seem like an expensive mistake, but an even worse one would be sending a contaminated IV out to a floor. However, if you take your time learning how to make IVs the right way, this should be a very rare occurrence.
EmperorXenuCPhT:
I work as a retail tech and I FEEL like if I want to move up in the world at all, looking to switch to a hospital setting is the obvious choice. Would you say this is true?
Additionally, if I’m going to be honest, I’m kind of clumsy. It really isn’t all my fault. I have a sort of very mild, undiagnosable neurological condition that causes me to have poor dexterity. The closest the doctors have gotten is just diagnosing me with dysgraphia. When I make a mistake or drop something in retail, it isn’t really a big deal. How much worse is it in a hospital setting? I don’t want to move to a hospital if I’m going to be a money pit or if I’m going to be accidentally killing people.
countsby5CPhT:
Where I work there is definitely more room for growth than in retail. Maybe that depends on the system you go with though. I’d say my hospital is a bit more progressive than others though.
Dexterity is really probably going to come into play if you do IVs or Chemos. Filling Pxyis or prepacking or working as a decentral tech doesn’t really require tiny movements.
Give it a try and really look into it. See if you can job shadow someone. It never hurts to look!
narco_panda:
To be honest, I am not sure. I’m a pharmacy student working part time at a hospital, so I don’t really know what possibilities are out there for techs. I can definitely say that compared to retail, you will have many more responsibilities, but I can’t comment on career advancement. Sorry!
Also, making IVs require some dexterity, but without knowing how bad your condition is, it’s hard to say if it is a problem, or if you can just get enough practice/experience to make up for it. In the past, I’ve helped train a new tech in making IVs. To be honest, she was very clumsy, but after a month or so, she became used to the process. Would you be comfortable with your ability in handling syringes and needles?
LostToApathyPharmD:
IVs, with a couple exceptions, aren’t ever particularly difficult. Sometimes you need to be very careful not to introduce bubbles into the solution (Emend, amphoterrible B are a couple of examples), but those just come with practice and careful compounding.
My hopsital’s really small so I can’t really comment on it taking a while.
Restocking Pyxis machines is more time-consuming than it is difficult.
Theobroma:
Upvote. Come work for us, please.
On edit, I see you’re a pharmacy student. In your state, are you still a tech, or are you an intern now?
LostToApathyPharmD:
My badge says intern and I’m classified as an intern on payroll. But we’re not scheduled separately from the technicians. We really just work per-diem to fill in holes.
berniemac7483PGY2:
Who uses only 500 mg of ertapenem? 1g all the way 🙂
LostToApathyPharmD:
CrCl < 30. But it not all that common, I just mention it because the cost of half a vial vastly outweighs the cost of 50ml NS. Holds true for other pricy drugs
badger17Pediatrics:
Or pediatrics, everything is mg/kgs so small and odd sized doses are common
stackered:
Know that about 30% of your orders, whether it be IV, PYXIS, or floor stock – will be reorders due to nurses literally not even checking. They will say they checked the med room, but they didn’t. Don’t remake stuff and waste stock, call them and make them check, especially if you have it logged – or go up to the floor and find it.
stackered:
Oh, for sure there are times when they call and actually need it. It comes down to learning your formulary and just being up to date on how things are working. But its really annoying to remake banana bags because they didn’t look.
travieza:
So if someone doesn’t check and I just send it up there assuming they don’t have that medication, wouldn’t that result in a surplus of that med on the unit? Are these returned by the unit staff or does the pharmacy have to periodically go through the med room and remove extra stuff?
stackered:
yup. but its super annoying for things that aren’t premixed, easy to make/find, or are in low stock… also its super annoying to carry down 3 of the same IV down for the same patient when you go do your returns, then get a call 15 minutes later looking for it when it was there all day…
all I am saying is – it will help you reduce the workload for you and others a lot if you remind nurses to look first or give them a minute to find it /deliver it when you are sure you made something already. you will surely have a love/hate, mostly hate relationship with nurses in your hospital…
Theobroma:
It gets returned to pharmacy and you get to credit it. If it’s expensive, on shortage, or hard to replace, and especially if you put it there yourself and you KNOW it’s there, you go up and show the nurse where it is.
anotherbrick47:
Remaining as patient and helpful as you can when dealing with a hasty individual on the phone is a huge help.
Recognize that, whether your hospital uses Pyxis or Acudose, the machine’s inventory will almost always be too short or too much.
Always be the first to jump up to deliver something. Your techs will appreciate it. Your pharmDs will appreciate it. Your nurses will comment on the speedy delivery and appreciate it (then lose the drug so you have to deliver it again), and the patient will appreciate it.
Nurses request things as STAT when the drug clearly is not. Ibuprofen…is not stat. Aspirin…is not stat. The flu vaccine…is not stat. If your hospital uses a pneumatic tube system, quickly learn which drugs can and cannot be tubed. A lot of refrigerated drugs cannot such as Ocreotide, Neupogen, and Dornase.
Learn the proper technique for diluting Daptomycin (Cubicin). Slow and steady. It foams like a boss and can average 10 – 30 minutes before fully diluted.
Last, treat your pharmDs extremely well. You should bond quickly with them as most will have retail experience and similar horror stories.
travieza:
This answers my previous comment asking about cubicin.
So far what I get from this thread is keeping the nurses happy is key haha.
Theobroma:
In hospital pharmacy, your “customers” aren’t the patients. It’s the nurses (and occasionally the docs). When you get lectures about customer service, it’s always about the nurses.
jonathanp63:
I just got hired as a technician at a hospital last week and I absolutely love it. I have worked in iv and ltc in the past. Brush up on brand name drugs. Shouldn’t be much of an issue since you’re in retail. Get ready to walk a lot more. At our place we make runs to each floor and stock Omnicell machines at nurses stations every hour. There are other responsibilities as well but just try not to get intimidated by it. It’s a fairly big changeover. Also be ready to learn computer software (meditech, omnicell…)
Good luck!
travieza:
Thanks for the luck, I’m going to need it!
simbabweAsst:
Nurses will be pissed off at you for stuff you don’t have control over.
Drugs get misplace, lost, ect. Refill them.
Everyone senior to you isnt your boss. I dont let anyone tell me what to do or how to do it anymore, unless I hear it from my actual boss/bosses.
Your co-workers will be know it alls.
Girls like chocolate and cake.
Cluster_Derp:
Girls love chocolate and cake.*
simbabweAsst:
If you want your female coworkers to like you. Bring in cake and chocolate. Seriously.
Cluster_Derp:
Triple chocolate cake with extra chocolate on the side. Being the only male on our staff its the little things that keep you on their good side.
PawlsToTheWall:
If aseptic technique really matters to you, you’re going to be very aggravated by your coworkers terrible technique. This includes the senior techs, who haven’t learned the newer USP 797 revisions. I’ve seen techs pulling vial caps with their teeth, predrawing syringes outside the IV room, working with holes in their gloves, singing into the hood without even a mask. It gets worse. This is always a difficult issue, as most people take the criticism personal
Theobroma:
!!! You’re joking! Any of those things would get a tech fired in our pharmacy. any of them!
doctorwatsondoctor:
In my old hospital, I had to raise hell just to get the other techs to wear gloves in the IV room. I never once saw anyone else actually gown up.
DesteradoCPhT:
That’s madness. I work at a home infusion company. Gloves, mask, bouffant cap and gown every time I set foot in the IV room.
I get yelled at if I don’t alcohol everything that goes into the hood, crazy that people use their teeth to take caps off….
travieza:
I have no idea what aseptic technique is. I guess I’ll learn soon enough, for now I’ll google to satiate my curiosity.
seb101189Inpatient:
You’re going to get a lot of calls about missing meds, and as others have stated it’s ok to tell them it’s in the pyxis or we just sent it (if that’s actually the case), but being nice makes a huge difference. You’d be surprised how many techs have no telephone manners and it gets the nurses pissed who will in turn take it out on you. A little kindness goes a long way, and after sending 20 meds for the 2nd or 3rd time, it’s easy to get frustrated at the next nurse who legitimately doesn’t have something.
Theobroma:
Tip: you can’t tell them it’s in the pyxis or we just sent it unless you check and be sure that is actually the case. I’ve worked with a tech who just said that because it got the nurse off the phone. Not wise…
countsby5CPhT:
Personally I think inpatient is kind of boring compared to retail. But- I’d much rather have a boring day than get yelled at all day. The pace is very different.
Make sure you double check your expiration dates. Make sure you also double check your syringes. It’s easy to make dumb and costly mistakes.
Check the patient bins when you can’t find something! Nurses have a lot to do, so give them a little bit of slack.
Good luck! Some people like it way better than retail!
travieza:
At work today I had a guy who was yelling and screaming and threw his empty Klonopin bottle at me because I told him his prescription had expired.
Boring, here I come!
Thanks for the luck!
countsby5CPhT:
Patient hissy fits are universal I see! I’m sorry. People are so obnoxious.
It’s sooo worth it to work inpatient. I surely don’t miss the days of screaming patients. Plus the money is usually better too. Retail techs really should get paid more than they do for putting up with people’s bullshit.
Let me know if you have any questions as you go along. I’d be happy to help.