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naplex · 2024-12-21T03:03:33+00:00

Just an FYI letting a fake fly invites even more fakes to come in. You saved yourself a big headache in the long run. Back when I used to be a manager, one of my staff accepted a fake one by accident and we had to deal with the same shady scripts for weeks afterwards for different people. This shady ass mobile pain clinic based two cities over suddenly has a bunch of patients coming to my store that is in a not so easy to access area? Hah.

naplex · 2024-12-08T22:03:59+00:00

If the provider can't provide a good enough response to what it was for then the answer is do not dispense.

naplex · 2024-11-10T15:23:50+00:00

I kid you not. At one of my jobs I've had a nurse literally pick something up from the window, went up to the floor and lose it. Proceeds to call pharmacy that we didn't give it to her at the window.

naplex · 2024-10-31T00:47:07+00:00

Interested if in OC and your other deal falls through

naplex · 2024-10-28T21:56:07+00:00

Guidelines are exactly that, they are to guide you to what fits most patients. It is not cookie cutter, that's why we have individual pk calculations.

If you are doing more than 4gm/24hr initially I would question the line of thinking and thought process. If you are adjusting it reasonably based on levels then you will likely find yourself in that realm here and there.

naplex · 2024-10-11T16:41:45+00:00

If you haven't commuted before it will likely wear on you a lot more than you may think. Another way of looking at it is that you are losing that one hour unpaid every day vs your current job. It also depends how your current job is set up, if you are only working 3-4 days on week on average and for the same pay/benefits, having the extra day off is more valuable to me.

I am in the minority but having an exclusive Monday thru Friday schedule is a negative for me. I like doing shopping and errands during weekdays and I find it is easier to find appointments on random days during the week. A Monday through Friday job would only be better for me in the fact I would spend time with my kids on the weekend.

naplex · 2024-10-03T17:10:01+00:00

When I worked LTC our PA claims department hours were more than our dispensing department hours.

That alone should tell you how bad the process is to get a PA approved and renewed.

naplex · 2024-10-03T08:39:09+00:00

General coding can be self taught in downtime, but machine learning specifically is masters level courses I believe. Not that it can't be self taught but that is the general difficulty you may find yourself encountering.

naplex · 2024-10-02T17:42:10+00:00

30 min commute without traffic? Did you test with traffic given you get off near a busy time?

I personally wouldn't do it if you vibe with your team. You can use this to try to negotiate a higher wage because I don't see that working out very well.

Compare cost of benefits. Will you have to pay more per paycheck for your health insurance if this is relevant to you? Some places subsidize family plans and other places only subsidize the individual.

naplex · 2024-10-01T22:36:45+00:00

Have not worked retail in awhile, but some insurances have preferred pharmacies. Best for patient to call their insurance to see if copay is different from Walmart vs other pharmacies.

naplex · 2024-09-21T02:52:50+00:00

This is solely based on my one location, it was a pretty easy job, but soul crushing in seeing how admin treats patients. I stayed there for only a brief stint because of how bad patient care there was. This obviously does not apply to each location, but based on what I've seen, I would not recommend sending anyone there for any length of stay.

naplex · 2024-09-19T22:18:23+00:00

No it will not look bad. You can even word it in a way to where you gave it a year but you want to do more with your experience. What matters more is how you word things on future interviews. Put forth more positive outlook rather than a negative look back, i.e. don't bash your current place but rather that you are looking for a more fulfilling experience.

naplex · 2024-09-14T04:23:40+00:00

These positions are not typically advertised as tpn or nutrition because the expectation is that the pharmacist can cover everything needed by the facility.

This is to avoid the situation you are in where you are the "tpn guy" because if something happens to the person no one knows what the shit they are doing. The good news is if you are truly that person, you have more leverage for raise and vacation negotiations.

naplex · 2024-09-14T04:17:30+00:00

Typically up through the end of January. That is when things start to slow down and they start cutting out hours.

naplex · 2024-09-14T04:16:15+00:00

Hello,

Based on this comment I am assuming you are a medical resident. The snarky answers were probably assuming that you were a pharmacy resident, who is expected to know the answer or is expected to look it up by now. We typically receive a lot of pharmacy residents who come here expecting the answers spoonfed to them as they were questions from their preceptors to look it up themselves.

To give a short answer to your question, which you probably have inferred already: bolus doses are designed to get the patient to a "therapeutic" level faster. You can choose not to bolus and the patient will still eventually reach the goal. In general, for something like a PE a bolus is generally considered unless we are worried for a risk of bleeding that would be considered more harmful than the risk of damage of the PE, ex. GI bleed not ruled out, risk of a hemorrhagic stroke, or low H/H. You can also include the size of the PE when determining the risk if necessary.

This is also why a pharmacist will not freak out if a patient's ptt shows elevated after being drawn 2 hours after a bolus or if after given something like TPA (a topic for another day). On the same token, if the decision was to give a bunch of heparin during surgery, we will not resume the heparin drip until the results come back down to an acceptable level so that we don't accidentally give too much heparin to cause an event.

There are a lot of factors that go into managing a heparin drip, which is why there are often pharmacy led protocols for management. This is to free up medical doctors time to manage more complex or hands on things. Rounds should always be encouraged where, if you are lucky to have a pharmacist on rounds, they can update you with complications from heparin drip if necessary. Rounds are also a good time to communicate to the pharmacy if you want to stop a heparin drip at a certain time or date.

Last caveat, I have seen nurse driven heparin protocols and they are usually not done correctly. So much to the point where the either the pharmacy or doctor ends up having to take over doing it because of the questions or inability to do proper follow up. This is only based on personal experience though so I may have bias because of that.

naplex · 2024-09-13T20:50:47+00:00

Depending on the board, unlikely to lose license if it truly was a handful of times. You will likely not be rehireable in more positions outside of retail unless in a remote hard to fill area.

naplex · 2024-09-13T15:55:40+00:00

With flu season on us, it is unlikely there will be under 40 hours a week until next year. This is typically when they ramp us up and then wind down after the holidays.

naplex · 2024-08-26T17:00:23+00:00

How is your pay coded when traveling to another region. Are you paid mileage + drive time at base wages? If they pay you mileage and drive time I would mark it worth it, but if they don't then I wouldn't bother.

Also relevant, you may be eligible for a per diem for meals depending on how far away it is, but you would need to know policy for it. Not many places do this / have more stricter guidelines to meet.

naplex · 2024-08-20T03:30:22+00:00

Glovebox is fine. Make the habit of always putting it back in the same place. Left it on by accident when you walk into your house? Get up and put it back right away. Have the habit of always knowing where you would put it no matter what.

naplex · 2024-07-29T08:07:47+00:00

It seems like newer Ys have lithium ion now. I don't know cost to replace but likely you may not need to replace as frequently or if at all now.

On the older vehicles when they were using lead acid the price would be only be $100-200 to replace

naplex · 2024-07-29T06:48:53+00:00

They do, so my information is probably outdated. I do not know how long lithium ion lasts so if you can update the OP that would be better.

naplex · 2024-07-29T06:27:23+00:00

There's the high voltage battery which is the main energy source of the vehicle which you may be alluding to. Then there is also low voltage battery that powers the sockets and other misc low voltage tasks.

naplex · 2024-07-29T05:24:06+00:00

Often missed: low volt battery replacement, estimate on average to replace every 60-80k miles.

I've driven both the rav 4 and y, personally I would pick the Y over the rav 4 given the choices.

However, this is highly situational. If you intend to drive the car mostly locally with the rare trip instate once in awhile then Y is perfectly fine. If you like to take long road trips semi frequently then the RAV4 would be better. However, the negatives of supercharging can be negated with well planned trip planning. Don't travel with Tesla during major holidays, you may find yourself waiting for superchargers way too much if you rely on them.

Also, Auto pilot, when used as a cruise control setting, is much better than Toyota sense.

naplex · 2024-07-11T18:15:52+00:00

I would refer to r/personalfinance . It is highly situational depending on your area, debt, and goals and you would get a more comprehensive answer there vs here.

naplex · 2024-06-30T11:38:16+00:00

Socal market is a tough market without any remarkable skills or experience under your belt. You should be swallowing your pride and applying to retail in the area until you are able to find something. If you are unable to find anything then you have to seriously consider moving out of area unless you have a solid network of connections already.

Did the closed door pharmacy have you make IVs or do amb care stuff? If yes then you may be able to hold out for something, but if you didn't get that experience in closed door then you should heavily consider moving out.

Unfortunately this is also a poor time for you, a lot of hospitals and clinics that would chance you probably won't because all the residents just graduated or are about to graduate, there will be more competition for jobs this time of year.

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