Day 19: Tuesday, October 29 - Irish Prescriptions 101

Well I realized I talk so much about their prescriptions that I got the okay to HIPAA-fy them and share with everyone:) 

First things first though... Blister packing!  Here's an idea of how tedious this can be for the poor pharmacist to check...

All the medications can look sooo similar so it is verrryyyy time consuming to check to make sure all the right medications are in every right spot... This is only 13 medications... But some are twice daily so in total there's 19 pills per day the pharmacist has to verify... 28 times!!!!!  Makes sense that it may take a while to do... It's so important to have the right medications in the right spot at the right times... And if even one little pill goes into the wrong spot it can make a huge difference!!!  Some medications more then others...

So in Ireland as I talked about there's many types of prescriptions...  I wanted to show what each looked like and exactly the verifying process then a second review process.

To remind you, the payment schemes are as follows:

GMS - General Medical Services
DPS - Drug Payment Scheme (€144)
HT - High Tech
LTI - Long Term Illness
GR - GMS Repeat

This is the typical receipt for a patient on DPS, DR, LTI, or Dental schemes.  For DPS, LTI, and Dental - they must sign a copy for us to keep and submit..... and for DR, or private, they just get one with our stamp on it to use for tax purposes... It is invalid without a stamp from us!!

Now for GMS patients they present with this type of a script. If it is their first time we have to verify their GMS number with a patient letter on the system.  This is similar to Medicaid except their number is on the internet and very easy to verify... Once it's in their...each med is €1.50- with very veryyyy few exceptions.  Until December, they had a new budget announcement so the cost will now be €2.50--- everyone is going mad about this!!!!  So literally we input this prescription then charge them however many meds is on the list times €1.50.... That simple!!!!

After it's entered... You must verify them and split it like this... You keep one stack, and submit the other for reimbursement.  Everything in the computer must match what's on the prescription and you check to make sure you are billing for the correct number of medications.  Remember their reimbursement for this scheme is very different.... It's €5 for the first 150 prescriptions, then goes down to 4.50, to 3 to 2.50 and so forth... So it's absolutely horrible reimbursements... So you must be totally accurate!!!!

Now this pharmacy also serves as a methadone clinic and fills/supervises. This prescription -- the top tells you how many supervised visits is required and The total volume the patient will get.  Then the bottom portion the pharmacist fills out with how many they supervised and how many was as take away. And signs it to confirm.  The pharmacy GMS number is required along with the drug code.  This is treated as a GMS type of prescription so we must split it and verify them the same way.

Private prescriptions... Doctors have the same hard to read handwriting here!!  The patient essentially just pays the pharmacies cash price for the prescription which can get pretty pricey.  The mark ups can be upwards of 50%... Once we fill it we turn it around and stamp it with our stamp and write "dispensed 29-10-2013 1/12" meaning filled today for one month supply. Then give the prescription back to the patient iffffffff they have repeats.  If the prescription is finished they store them in a basket for 3 years.

Here is the rare nicely typed one that everyone is always excited to see!!!

And another hard to read one... Isn't it kind of scary that if a pharmacist misreads one or something?? It's really frowned upon to interrupt a physician who's working here... It's incredibly rare for a pharmacist to get clarification from the doctor and I've never seen an interaction check up.. Or compliance/adherence even cared about... So interesting.

So sometimes patients bring in multiple copies of a GMS script...post dated to when they can fill it again.  Some have 6 additional copies they leave with us... I guess it is kind of like a refill... But the date on the script is just clearly a month later-- I think that's illegal in the states.  Regardless a patient comes in a says they left a script here and we grab it to fill!  Easy!

For private scripts.. Some have "repeat x6". Their prescriptions  are only good for 6 months here.  In this case some patients ask to leave the script here to fill monthly.  When we fill it we just add on to our dispensed number... So it previously said "dispensed 29-10-2013 1/12". We'd fill it 29-11-2013 and write the same thing down the back until the prescription was finished.  If they want all 6 months at once- that's totally fine and usually saves them money in the long run.  Many people do this for birth control!  If they want one one month but 4 the next- that's fine!  It's very laid back in that respect! The computer doesn't document who leaves scripts here... They just sit in these black boxes!!!

Now these are the GR prescriptions.  They have 6 papers total- 5 pages carbon copied and are GMS scripts that are valid for 3 months (3 refills) I'm not sure why you'd do this over post dating scripts but it depends on the physicians preference!

Prescription 1- copy 1

Prescription1- copy 2

Prescription 1-copy (month ) 3.

Now can you read month 3 ... NOOOOO... This is awful and sooo dangerous... If the pharmacist can't read his how is it a real prescription submitted for reimbursement???  The reimbursement people don't see copy 1/2, so how do they know??  This is soooo dangerous to me!!!!

The prescription claim forms.. These are what the patient signed and gave back once they pay for their prescriptions.. Again we have to verify hem in the computer and then we need to split them up into original and carbon copy for submission and reimbursement.  All prescriptions needastamp and patient signature on the for validity purposes.  Then once they are submitted and we get them back we validate and confirm we were paid for every script listed.

At the ends of the month you get the previous months back to confirm you were adequately paid/reimbursed....

Pretty  intimidating to look at let alone go through too!!! We need to verify we were paid for every script onGMS, DPS, LTI, GR, Methadone and dental! In this book...

Yes, it's very very tedious and it's hard to believe this still exists out there!!! But it is very important and maybe now you can appreciate the time it takes to go through and verify it all...

Oh and here is the dental prescription that is similar to GMS...

Finally wheni say we have orders here are 2 small examples of what they do.

They'll get the order from a vendor and empty the tote to check that everything in the tote matched what they were billed for... The pn they go to the computer and enter it in to check in...

It's very tedious work all of it but it's showed me to appreciate a lot of what we have back home but also it's interesting how different their health care is... You'd think it'd be simpler with all his but it creates it's own problems in itself.  Many pharmacies are severely struggling and pharmacists wages are significantly down.  Additionally they do not do nearly the amount of clinical services being pushed back home.  Flu shots and immunizations  are a mega loss for pharmacists... They counsel but just basic information.

I fact it seems the students are the motivated ones doing a to of counseling and educating tithe patients--- VERYYYY similar to home too with the young and motivated part!!  However, there's no push for adherence at all... But then the pharmacists all know every one of their patients and have a sincere relationship with them!!

Now for an interesting story... A man from Kerry walked in the pharmacy and heard be talking and goes American? I said haha yes.... He immediately goes, " republican or democrat??! ". It's so interesting the different social norms here!!!  

Then a patient called demanding her scripts right then because it's easy to put a sticker on a bottle... Sounds familiar right??  

Same problems... Different country even!!! 

After work I met with Cayla so she could FINALLLY get some brown in her hair:))). It still looks verrrryyyyy blonde but it's probably because she has sooo much hair.... It's super cute and I really like it!!!  

Then we of course got dinner while we were here:). 

Another great day at the pharmacy where I learned so much... I love it there and I'm sooo sad I only have 3 days left here:(. I'm definitely going to miss everyone..

Irish Word of the day:  rasher = bacon, the part you cut & eat... haha!!  Their bacon here is very big, looks a lot like ham!

Bank Holiday: Monday, October 28 - Paddywagon tour to Kilkenny

Paddy Wagon Tour day!!

We left the house at 8 am sharp so we would be on time this tour without having to run down the streets with the marathoners....  but we missed the first tram by 1 second, literally.  So the second tram comes at 826 -- greaatttt.  Oh well, we got to city centre by 840:)  As we walked down the street, we realized the Dublin Marathon was occurring very shortly because there was sooo much activity - from music on the streets to balloons being handed out to the kids - it seemed like so much fun!! 

9:00 am:  Depart Dublin for this award winning and brilliant day trip with our 100% Irish Tour Guide

-we got lucky this time ... John F, our tour guide, he brought his adorable little son, 'Buster' or his real name - James.    John is usually found singing on a Day Tour from Dublin! He loves Kilkenny with a passion like no other guide.  - so we were extra lucky this time!! :)  Also, he used to be in a band, so he entertained us with some singing along the way & never stopped talking as he shared so much history and information about Ireland & Kilkenny!!  It was an incredible learning experience about their history today!!! 

And the marathoners goo off!!!:)  

It was an insanely beautiful day when we left and the drive had great views:)  It was supposed to rain, but we definitely got very lucky!!  

10.45: Glendalough is the scene for the Braveheart wedding scenes. It really is one of the most beautiful visitor sights in all of Ireland. It's renowned for its magnificent scenery and is full of a rich and varied heritage in terms of history and archaeology. You will have time to explore the deep valley with its ruined monastic city and even take the easy walk through the woods to the magnificent Upper Lake, be sure to bring your camera! A real 'Kodak moment'! Well, they did not have to tell us that twice...

We loved it here - it was slightly more windy then it normally was, but it definitely was not cold, and it was still a breath taking place!!

This waterfall thing was flowing into the street- leading to a flooded street!!! 

Apparently, this upper lake is as still as can be and looks like a mirror!  I mean, that would have been cool - but the waves made it even cooler I thought!

There was so many amazing colors of fall mixed with the green of Ireland - it was seriously beyond breath-taking here:)

We had an hour and a half at this lake, so Cayla and I went for a little hike:) 

These pictures just do not do the lake and hike much justice - it was so unbelievably beautiful...and

The field in-between the upper & lower lake!

On the other side of the lake - equally amazing views!

I wish this one would have lightened, but the sun was shining so strong, haha, I cannot complain!

The lower lake!

The lower lake with sheep!!! 

We sprinted back to the bus to make the depart time:)  Of course, we made it perfectly on time!!!  And we started the journey to our second destination!

Quick Photo stop:  It was incredibly windy here, so he laughed as he said go out take some pictures, I won't give you a time limit because you'll be back soon!  It was Wicklow mountains first:)

If you're a fan of the Hollywood Blockbusters 'PS, I Love You' and 'Braveheart' then you will now officially be on the set! You'll totally understand why Mel Gibson (an Irish passport holder!) chose the Wicklow mountains to be the Highlands of Scotland and Glendalough to be the spot for the wedding scene. And then of course there are all the romantic scenes from 'PS I Love You', this is where Hilary Swank met Gerard Butler for the first time. How romantic! 

The bridge on PS I love you:) 

After we crossed the bridge, we made it to HOLLYWOOD!!! whoooaaa:)  We had to stay in the bus though to avoid running up to all the famous people for pictures ;)

So many cool fields with sheep!!!:) 

I am very very proud to say that Cayla ate her first Peanut Butter & Jelly Sandwich!!!! This is the biggest thing ever!

The Brownshill Dolmen is a portal tomb dating from c.3300 – 2900 B.C. These are the ancient burial chambers of our royal ancestors. In our myths and legends these are known as Druids' Altars. It has a very large granite capstone measuring 4.7 metres x 6.1 metres x 2 metres. The capstone rests on two portal stones, a door stone and a prostrate slab. The dolmen or cromlech is a type of pagan sepulchral monument. The capstone is the largest to be found in Europe. It has been calculated to weigh over 100 tons. 

An amazing thing about this was it started pouring after leaving Wicklow Mountains & the Bridge in PS I love you --- So he said we would have to stay in the bus to avoid being drenched -- BUT as soon as we pulled in to this place, the rain stopped & a rainbow came out:) 

We wondered what the crop was in here--but forgot to ask:(  We learned that they planted pine trees, not indigenous to the area, but they prevent soil erosion so it has been helpful for them and their fields!  

This rock is apparently >100 tons!!! and It was moved 20 miles by human foot years ago as a tomb stone!  Crazy!!!!

I wanted my picture with the rock, but Cayla did not really care too...she preferred the fence and the field behind her.....seriously -__-

These boots did such a good job lasting me throughout this trip...but on this trip and hiking the mountains caused them to bust:(  the heal fell off and the metal base poked out!!!   RIP boots:( 

Lunchtime: Arrive in Kilkenny city. Roam the picturesque, windy, and cobblestoned streets. Check out the gardens of Kilkenny castle or consider going inside and taking a tour of its palatial interior for a small optional fee. You have time to wander and find the Black Abbey or possibly go down to see the cathedral of Saint Canice. You'll have free time in Kilkenny - plenty of time to have a gourmet lunch, check out the Kilkenny Design Centre, and a find a nice cosy pub and have a pint of Kilkenny in Kilkenny. 

This was the lunch spot highly recommended by our bus driver and Buster:)  I invited a girl who was traveling alone to sit with Cayla and I.  Turns out she is 21 years old traveling from London - she is originally from Connecticut & studying in college in California (outside LA).  Even more crazy, she did our Eurotrip kind of a thing, but ALONE!  and She went to Costa Rica to work at a turtle conservation alone also!!  She is quite brave, I am not sure I could do this all alone!!  I am very happy with Cayla coming with me:)   

I tried my first cup of Irish coffee....

It'll be my last:) 

I finally climbed the cathedral like I'd wanted when we originally went to Kilkenny - it was actually rather dangerous climbing it - so much so that people younger than 12 are not advised to climb it!!!

The views definitely made it very worth it though:) 

...as you can guess that at this elevation, it was very windy!!!

This is the tiny stairwell back to the ladders....

There are 9 ladders like this to climb to get to the top!!!!

Kilkenny is a very small but cute city - I do love walking around here, especially with this amazing weather!! 

The river leading to the castle .. :) 

And it was time to head back at 4:30:(  What an amazing day - we have been so lucky with the weather and our tour guides and everything!!!  Great final Paddy tour to take!!!

When we got back, I was sooo tired that I took the pictures from Cayla & 2 Benadryl (diphenhydramine) and went straight to bed!!!  I just would loveeee my cough to go away....

Irish Word of the day:  bold = naughty!!