Today was my last day working with the CVS Pharmacy staff. They have all been so sweet and helpful and made my experience there really worth-while! They even got me a present today filled with little gifts and a balloon! They were all so wonderful in helping me when I was struggling to find a drug, or to load information at drop-off, or filling prescriptions. On my last day, I was filling prescriptions with ease and talking to Vu about what school he went to which was Xavier University in New Orleans. He studied in the College of Pharmacy for six years and we talked about how it now takes seven years for a student to receive the professional degree of Doctor of Pharmacy, or Pharm.D degree, to become a licensed pharmacist instead of six years like when he was in college. We also discussed the cost of schooling for six years was only possible for Vu through scholarships and financial aid and knowing that it is going to take seven years of schooling for myself is still quite daunting for me to think about. He assured me that the schooling was harder to go through than the job is and that it would be worth it in the end. Today, Vu also offered me a job as a pharm tech trainee where I would get on-the-job training at the CVS Pharmacy and I have already applied online through CVS in hopes of starting very soon!

On Friday, because the pharmacy is slower on Friday nights, we had a little more time to go over the detailed processes of loading a prescription at drop-off, going through production, watching Vu verify the drugs, and ringing up the patient at the end. The drop-off station is the most important station because, like I said before, if you input the wrong information here, then the whole prescription is filled and sold incorrectly. So today I learned how to add new patients to the system who are considered "transfers" from another pharmacy. Learning the different drug codes, origin Rx codes, and other random codes proved to be a challenge because remembering which code goes on which line was pretty difficult when there seemed to be over 100 lines to have information put in. After all of that information was correct, I would have to scan a picture of the prescription into the computer so it would save with that patient's new profile and then every single prescription is saved and put into a box to keep in a back room. This CVS actually has prescriptions that have been saved for ten years now all in boxes from floor to ceiling in that back room. After filling out the patient's profile in drop-off, I could pull up the newly typed prescription label from another computer and print the labels. These labels told me what drug I needed, how much of it I needed, and sometimes it told me where in the pharmacy to look for it. The process of printing a label and filling a prescription had become the easiest part of the job since it was the most practiced part of my duties while interning at CVS. After this stage called production, I would give the pharmacist, Vu, the prescription for verification since a pharmacist is the only one who can verify prescriptions and the only one who can do consultations with patients. Once the drug is double-checked and verified by Vu, he puts the medicine in a bag, staples another prescription label to the bag, and puts it in the alphabetically organized shelf to wait for the patient to pick it up. Since I wasn't working for CVS, I was only interning, I wasn't able to touch the registers to ring people up but I was still able to watch. Today was mostly about repeating this process to really get a good handle on it and I feel like I definitely have.

Today I finally received my Technician Trainee License issued by the Texas State Board of Pharmacy! I was able to actually touch the drugs, touch prescriptions, touch the computers, etc. First, one of the pharm techs went over the exact process of production: which is the station where you physically fill a prescription. On the computer is a database of patients who are scheduled to pick up their prescriptions and the order of the patients depends on the time of day that they are going to pick them up. You highlight the next patient that you want to fill, print out the labels that you would find stapled to your prescription bag and the sticker that is on the bottles with the patient's name, the drug name, the dosage, and other information. These labels contains every vital amount of information necessary for a pharm tech or pharmacist to complete the process of filling prescriptions to verifying them. I was taught to look for the name of the drug on the label, go find it on the shelf while making sure it's the correct strength(mg or mL), bring it back to the counter, count by 5's to accurately count out the correct dosage, grab a bottle and lid to put it all in, and then take the sticker off of the label and put it on the bottle. After all of this is completed, I put the rest of the label and the filled prescription in a basket and handed it to the pharmacist, Vu, so that he may verify the prescription. The process of verification is when the pharmacist scans the label of the prescription I just filled and the patient's information and his or her prescription information pulls up. Here Vu can check that I filled the correct drug and the correct dosage to the correct patient. Even further, Vu checks the patient's medical history to ensure that this prescription is compatible with any other medicine the patient may be taking and to ensure no allergies conflict. An additional check that Vu does is when the label is scanned, a picture of the drug or nasal spray or birth control pops up and Vu physically checks to make sure the picture matches what is in the bottle. Only the pharmacist may verify prescriptions by doing this process and that is so the patient can't come back to the pharmacy saying that he or she received the wrong drug or the wrong amount or make up a reason why that prescription isn't his or hers. On these prescription labels, some drugs are labeled with a "c" by the bar code which stands for control. This means that this specific drug must be counted twice for accuracy before the patient can take it home. Some drugs also have the words "fast mover" on the label which simply means that it is a drug that is commonly used or prescribed. These drugs are sometimes placed in the "top 200" category of inventory - meaning that a pharmacy considered 200 drugs to be fast movers - but because this specific CVS pharmacy is a larger store, they have a "top 300" section that contains these "fast mover" drugs in a spot close to counter. Later, Vu showed me how to take a patient's prescription and log t in to the database. First you have to create a new account for patients who have never filled with CVS before by plugging in their name, date of birth, and contact information. Adding the doctor's information and drug information to the profile allows the pateint's prescription information to be pulled up by any computer in the pharmacy. I learned today that insurance can cause problems for people who fail to provide any or it doesn't line up somehow with CVS. For example, there a young man today wanted to get his prescription but when Vu typed up his insurance information to keep on record, an invalid signal popped up on the computer showing there was a problem with his coverage. Vu asked him if he had another card in case that one had expired and he did have a second one. Vu tried that card but it was still invalid, so he called the insurance company and asked if this young man was still covered and the insurance company responded yes he was, but not with CVS. Vu told the young man to try Walgreen's or another store, but then explained to me that patients always think that when they aren't able to have insurance cover the cost of their prescription, they blame the pharmacy even though it has no control over that information. Overall, I learned a ton about the production and verification of prescriptions and I am so glad to be actually working in the pharmacy.

On Tuesday, my license still had not been received and I was limited again to what I could physically do. However, one of the pharmacy technicians showed me around the pharmacy and explained that all drugs were organized by the name of the drug, not the brand name. She also showed me how they mark new inventory and how important it is that nothing goes miscounted for. I was able to see the station where pharmacists or pharm techs can dispense water into a bottle that is only filled with powder for drugs such as amoxicillin. She then showed me the step by step process of what happens when someone brings in their prescription form their doctor: first, a pharm tech takes the prescription from the patient, takes a picture of the piece of paper that scans onto the computer that she is working at, then she types up the patient's name, drug, dosage, doctor, and other information. Once all of the information is typed and the prescription is scanned, the patient is in the system. Then another pharm tech or pharmacists can pull up that patient's information from a separate computer, go grab the drug, dispense the correct dosage, and put it in a bag with the correct labels. The pharmacist will then need to verify that the amount dispensed and what drug was dispensed is correct according to the prescription. This is where the scanned picture of the prescription comes into play so that the pharmacist can see exactly what the doctor prescribed in the doctor's handwriting. So today was filled with more interactiveness for me even without my technician trainee license. I also learned that one of the pharm techs didn't go to school for pharmacy at all but actually received on the job training from CVS and then took the state-required test, the PCAT, that is required to be passed in order for someone to be accepted into pharmacy school. This pharm tech at CVS however, used it to deepen her knowledge in her field of work as she had originally intended to go to school to study elementary school teaching (which she had trouble finding a job for). Today was a little more successful for me even without my license and I was glad that I learned a lot more about the daily processes.

Today I arrived at CVS Pharmacy to work with my mentor, pharmacist Vu Tran for the first time. He was very helpful prior to this day in telling me exactly what to expect: what to wear, what my tasks would include, and when I could come in each day. Before even starting my first day however, I had to fill out a background check and complete a fingerprint analysis to confirm that I was able to obtain a pharmacy technician license. This process can take up to three weeks or more and I have been waiting for my results for almost three weeks now to confirm that I do not have a criminal record of drug abuse or a history with drugs of any kind. So I began today knowing that my participation would be limited in what I was allowed to do without that license. Without the license, I was not allowed to touch any pills, any pill bottles, any prescriptions, or almost anything else for that matter. All I was allowed to do was sit behind the counter and ask questions all day long. I was able to watch Vu and the other pharmacists fill prescriptions, consult with customers, ring up sales, and interact with hospitals for prescription verification. Watching these processes was helpful for me to see how the daily responsibilities were handled. I also learned about the different classes of drugs ranging from class 1 to class 6: these classes are defined by the addictiveness of the drug. So a class 1 drug would include drugs similar to heroin and the classes move to the less extreme from there. Today unfortunately, I was not able to participate in many of the hands-on tasks but I was at least able to see the first-hand processes of daily work.