Bruce Redd

[Bruce Redd @BruceRedd6]

As a pharmacist who once worked in a retail pharmacy, this makes me shake my head. I chose a different professional path, some of those reasons are outlined below.  1. Medications are prescribed "off-label" very frequently (some estimates 20-25% overall). Medication treatments would be paralyzed without "off-label" use. "Off-label" means that the FDA has not formally accepted a drug study to prove a drug effective. For some drugs for cancer treatment, the use of "off-label" drugs is higher (40-50%) because the possible benefits of use can greatly outweigh the risks of the drug itself. Medications for pediatrics are prescribed "off-label" at an even higher rate (50-75%) because, in part, general "drug studies" on children are not ethical. However, a lot of drugs used for pediatrics are used only after they have a good safety record for adults.  2. Politicians. In states like California during the COVID pandemic, the governor-appointed state board of pharmacy decided to place restrictions state wide for Hydroxychloroquine. This was a political decision that was not made by pharmacists. I don't blame prescribers for being angry about such restrictions. It was the politicians decisions who made it so difficult.  3. Insurance companies. I have "refused to fill" exactly two prescriptions in my career; both were poor forgeries for controlled drugs. Insurance companies have rules they set for coverage. Example: a ICD diagnosis must be provided to the insurance company for the pharmacy to be paid. AND the ICD diagnosis must match what the insurance company will accept or no payment is issued. And the more expensive the drug, the more additional information may be required by the insurance company. A few failed claims to insurance companies can easily cost the pharmacy several thousand of dollars.  4. Big pharmacies like CVS and Walgreens impose all kinds of rules that are not patient- or pharmacist- or prescriber- friendly. Many of the rules and restrictions are to prevent the pharmacy from having insurance company claims rejected. Big pharmacies like CVS maintain close political relationships with state governments. So when the state governments "suggest" policies, the big pharmacies like CVS turn that into policies for employee pharmacists. COVID era "policies" to not fill certain drugs was the pinnacle of this invisible state regulation.

[Bruce Redd @BruceRedd6]

Addendum. No, I have never worked at this hospital. Some X posts are saying that the pharmacy was repackaging mepivacaine or bupivacaine because of a shortage. 1. Drug shortages happen all the time 2. Spinal anesthesic drugs must be "preservative free" and so if the pharmacy really was repackaging it into vials for use in the OR, the solution would likely not be kept sterile without a preservative... Don't have any inside info, but repackaging by the pharmacy seems extremely unlikely.

[Bruce Redd @BruceRedd6]

When I was in pharmacy school as a a student I worked in the “OR satellite” for about three years. Supplied medications to anesthesiologists and surgery staff. Never once have a need for Potassium phosphate in the OR. Any orders for Potassium phosphate for anywhere in the hospital were ALWAYS compoundes in the pharmacy and delivered to the care are. Potassium phosphate NEVER used intravenously or injected into a person’s spine, ALWAYS added to a large volume IV fluid. I have never seen Potassium phosphate stored in any hospital except in the pharmacy "IV room" where IV's are made. Totally inexplicable to me why Potassium phosphate was even made accessible to OR personnel. Pharmacy’s big stupid mistake.
Look at the labels for mepivacaine vs. Potassium phosphate. Anything pop out on the label that anybody would/should notice before injecting it directly into somebody's spine? Especially an anesthesiologist?
1. Potassium phosphate is a 15ml glass vial with a grey rubber top sealed with an aluminum clamped top. Notice the boxed warning right below the drug name: “FOR INTRAVENOUS USE ONLY. CAUTION: MUST BE DILUTED.”
2. Mepivacaine comes in a prefilled syringe cartridge without a needle. No need to draw up mepivacaine; just attach a needle an inject. Nothing like the packaging of Potassium phosphate vial at all
"The pharmacy" will rightfully receive the blame. This was a really stupid thing to do. The anesthesiologist who actually pulled the Potassium phosphate out of the box, ignored the warning right on the label with the drug name, drew up the fluid from the glass vial, and injected it into the spines of MULTIPLE human beings also has lots of the blame.

[Bruce Redd @BruceRedd6]

@ZeekArkham Schumer and Dems are patronizing and paternalistic. But mostly just plain corrupt. Loved your response.

[Kassy Akiva @KassyAkiva]

🚨President Trump just issued a new threat to Hamas.

"Release all the hostages now, not later, and immediately return all the dead bodies of the people you murdered, or it is OVER for you."