I arrived to the pharmacy promptly at 9 am. There was definitely not nearly as big of an order today, if there was, I have no idea how it would have fit on any of the shelves!! But we did need to catch up on inputting it into the computer. So I input all the drugs from the order into the specific supplier and then sent it so I could check it in. Their computer system looks an awful lot like Microsoft office screens, so it is pretty user friendly from my perspective! After about 2 hours of entering the orders in to ensure proper future ordering and inventory, I completed more blister packs that were needed for later in the day.
I wanted to start interacting with patients today - so I started greeting some patients and taking the prescriptions from them. It is so different here in that GMS - General Medical Services - is the insurance I guess similar to Medicaid from home.. they have €1.50 copay per each medication. GMS then reimburses the pharmacy a certain amount + the reimbursement rate (~€5) regardless of the cost of medication! This is absolutely crazy to me because some medications can cost an upward of about €50 for the pharmacy to even bring in, but then again some only cost €0.30 to bring in so in the end he said it somewhat balances out. After the first so many prescriptions, the reimbursement goes down to €4.50, then down to €4, then down to €3 and so forth! Even more crazy!!
There are some patients who have private insurance, and even with this, the maximum amount they pay in €144. I was reading a general memorandum from the Secretary General in the Irish Pharmacy Union and it was saying, 'Change is inevitable, Change is constant.' From reading this, I learned many pharmacists are greatly concerned regarding their businesses because huge additional demands and the economic impact regarding the ongoing implementation of generic substation and reference pricing. So basically if a drug costs x amount, and varies between 6-12%, they will only reimburse the pharmacy about 8% meaning a pharmacy with not that good of buying prices will severely suffer. The letter goes on to express how some countries recognize the true value of a pharmacist and when a government realizes this and the services a pharmacist can provide, it helps tremendously. They mentioned engaging with countries such as Canada, the UK, Australia and New Zealand to learn and try growing to alleviate the current situation in Ireland. This is so interesting especially with seeing everything going on in America!
SOO many boxes !!
Well, one of Alldhe's friends came in because they needed to have a valve replacement, so they were getting a mechanical valve and required warfarin therapy initiation in the near future! He sat down and I wanted to observe her counselling technique and see how it is completed here. It is so incredibly similar to how it is in America. Discussed what to look how for, how it works, what if he misses a dose, INR checks, etc. His question was regarding alcohol consumption - also very similar to American questions ;) We discussed the side effect profile and contact sports. He was very thankful in the end and he left with a pamphlet.
When he left, a drug rep from Co-Q-10 and Vitamin D came in to discuss the products and new recommendations. This was way interesting. She was a PhD nutrition graduate - so very bright and knowledgeable. She had a padfolio with laminated slides- which I found slightly humorous because most people have iPads or a tablet of some sort. Well this was a really neat presentation!!
Co-Q-10: Highly recommended for energy here! 30 mg for people >25 years old, just once a day; 100 mg for people >45 years old, just once a day; and 100 mg activated for people >65 years old, once daily. The reasoning for the increases in the PharmNord aspect is because it #brings your cells back to your 20's - energy wise! very interesting!!
Vitamin D: dissolved in oil so it is easily absorbed from your stomach. They recommend everyone to have a 1,500IU - and apparently everyone in Dublin should be taking this due to the lack of sunlight in this area -haha- without concern of the blood levels of it!
For my lunch today, I FINALLY had my peanut butter and jelly sandwich! I have been waiting for this meal for weeks now! It was quite delicious and it was worth the wait:) For dinner, we are making hot dogs! I also could not be more excited - kind of funny but I think those are my 2 favorite foods (aside from steak and tacos) - okay I think I love all food!
After lunch, I checked the order in to the computer & began attempting to type in prescriptions - I am going to try to share names of medications here:
1. Anxicalm: Diazepam
2. Nytamel: Zolpidem
Cute, right?
From here, a patient came in because we gave her a Aerochamber mask vs. a Babihaler mask. Well we tried explaining to her that it needed to be the aerochamber to ensure it fit the inhaler we were providing. Well this situation is SO similar to something that would happen in America. The patient was quite upset because we did not give her exactly what the doctor wrote because the doctor knows exactly what the baby needs. The physician's office was in shock when the patient called and said she got the aerochamber instead. So now the patient wants the prescription back - never even tried the aerochamber - and the baby has been without medicine for 48 hours. Even if they gave her the babihaler - it would not fit the inhaler. She did not want to hear this. Allbhe did a wonderful job handling the situation remaining calm and relaxed throughout the whole time.
We all deserved a cup of tea after this patient left the pharmacy. I agreed to try my first cup of Irish Tea:) It is rather amazing, actually. I think I found my new favorite drink!! I had it without sugar, and then with some sugar - both are SOOO amazing!!! I am pretty excited to like this now:)
I left here around 6 pm, and Cayla and I made some hot dogs for dinner - 2 each - with vegetables, and bread, and mashed potatoes. haha! It was so amazing it put us in a food coma and we went to bed happy:)
Irish Word of the Day: Garda = means police officer here because it comes from the term 'keeper of peace' :)
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