Trays and Methadone

Salam warahmatullah.
Today is Sunday, 31st of August. Happy 51st Independence Day, Malaysia!..and Farewell Sha'ban, Ahlan Wasahlan ya Ramadhan!May this Ramadhan sharpen the saw which will continue to work even after Ramadhan, Aamin.
Tomorrow is Monday, 1st of July. 1st of Ramadhan. and first day of not working after 8 weeks of being full time worker at Cohens Chemist. Faster than an eye blink, that's how time flies.
Before hand, let me update on 2 things that I've promised to you readers in the previous entries - Substance Dependency Module ( SDM ) and Monitored Dosage System ( MDS ).

Substance Dependency Module.
As what the name suggests, this module is devised for those who are dependent, or to make it clearer, addicted to a certain drug. There are many drug addicts out there, who wish to stop, to start a better life, but using willpower alone is not enough. Without helps from professionals, quitting would lead to pains - the pain to resist the temptations, and the pain to encounter the withdrawal symptoms - Muscle tremors, etc. That's why, here in the UK, most towns will have their own Community Drug Clinics, eg in Manchester and Stockport, where I worked. Those who wish to stop abusing drugs are encouraged to visit the clinics, for consultations with trained doctors. To help these patients to overcome their withdrawal symptoms, doctors would normally prescribe two types of controlled drugs - Diazepam ( Usually 5 & 10 mg ), and Methadone 1 mg/ml liquid ( Sugar Free or non Sugar Free mixture ). These patients will then take the prescriptions to the local chemist to get the medicines dispensed. And they need to come themselves to pick the medicines. If they are unable to come by themselves, they need to provide a short letter, stating the name of the name of person who come for them. And these letters are to be kept by the chemist, as a record.
These drug clinic patients would normally get a prescription for two weeks supply. So, if they need to take 4 Diazepam 5 mg tablets everyday, over the course of 14 days, they should be supplied with ( 4 x 14 = 56 tablets ). However, to prevent abuse, they are not given 2 weeks supply as a whole, they need to come and take their medicines EVERYDAY ( Excluding days which the chemist is closed such as Sunday and Bank Holiday ).If they don't come on the a particular day and turn up the next day, they will not get the supply for the previous day, they MUST COME on the days which they are instructed to, otherwise they'll miss their medications.
Likewise, the medicines prescribed for them are carefully chosen based on level of addiction. If a new patient require methadone, doctors would normally prescribe NON SUGAR-FREE METHADONE liquid, which they should take orally, and warn them on potential dangers of abuse. If they inject this liquid straight into bloodstream, they'd die because of the sugar. Afterwards, over time, the patients would be assessed on their addiction levels, if they are getting better, doctors might put them under SUGAR FREE METHADONE ( A new patient is not prescribed with this liquid to prevent them injecting to obtain a faster effect ).Throughout the course, if the patients follow the instructions and advices correctly, they might not need to come everyday, and even stop completely. That's how it works. You can't force a drug addicts to stop in one go, it's too painful, they really need professional consultations. That's where you need empathy, doctors!..
However, some people might not be satisfied with this service, not because it's inefficient, but because it uses NHS fund. Most of these patients come from low-income family, get Income Supports, get Income-Based JobSeeker Allowance, which exempt them from paying for their medicines. And these Controlled Drugs ( CD's ) are expensive. This means, taxpayers pay for these patients' medicines, which some would think unfair - working all day, struggling to pay for all kind of mortgages and insurances, and on the other side of community, some drug abusers are enjoying their medications for FREE. Aperkah???..
But, thinking it deeply, if the taxpayers don't help these patients, they might ruin others' lives with all kind of crimes, these scare people. And if these drugs addicts recover, they'd contribute to the community in all possible ways. And, we'd never know, if one day, our own children, close friends need this service..
Pros and Cons, nothing is perfect, we just need to minimize the risks.

Monitored Dosage System ( MDS ).
Everyone in the chemist, and even the patients, refer this system as `Tray (s)'. As the name suggests, tablets are placed in trays according to the time which the patients are suppose to take them. Interesting, but very tedious to prepare, need to be extra Careful.

An example of a tray. Picture taken from :
http://medicinesincareexpert.files.wordpress.com/2008/03/j0390523.jpg

This service is given for FREE for elderly patients who fall under Disability Act - such as poor vision, unable to hold their tablets properly. Those who are not entitled to this act but having problems with their medicines intake can also use this service, but with a payment of 3 GBP per week, which is not bad at all.
There are four times which patients would take their medicines - Breakfast, Afternoon, Evening, and Bedtime. The dispensers would pop out the tablets from blister packs or pour the loose tablets from their container, and place them in the correct spaces with the correct quantity. Descriptions of each tablet's appearance ( eg colous, shape, markings, scorings ) must be noted clearly and correctly. The pharmacist will the check these trays ( which means, going through each small space ) to ensure that correct tablets are dispensed. It's just SO TEDIOUS, take so long time.
I did try to prepare a tray, ONCE. Jose the supervisor would normally prepare this, but one day she showed me from the start on doing trays and let me prepare for one patient. Thanks Allah, I prepared the tablets correctly upon being checked by Sarah, the pharmacist. But, preparing the trays just make me sick - sick of thinking how miserable life would be if we don't take extra precautions with our health and lifestyles when we are still young. Imagine, for the patients whom I prepared his trays, I guess he has at least high blood pressure and diabetic.And with the conditions ( and other conditions that I don't know ), he takes about 9-10 tablets during breakfast, 4 tablets in the afternoon, and 5-6 tablets before bed.Argh, I'm sick seeing those tablets, I don't want to take so much when I get older. Maka, jagalah kesihatan, supaya tak perlu makan tablet banyak-banyak bila tua. ( Tu pun kalau sampai umur tua ).

Tomorrow is Monday. 1st of September.1st day of Ramadhan. 1st day of not working.With some scripts left untouched on Friday 29th Aug, I shall miss those yellow,white, and red baskets.

Anyway, Ahlan Ya Ramadhan! Mari mengejar pahala sebanyak-banyaknya.

Thank you. Full Stop. Wassalam.

p/s : I really need to go somewhere outside Manchester before the school starts. Any suggestion?

Kitaran hidup yang memenatkan.

Salam warahmatullah..
Saya dah berjanji dalam entry yang lepas yang saya nak tulis pasal MDS dan SDM, dan dah beberapa kali saya cuba tulis dan masuk draft, tapi tak pernah habis. Maaf, saya terlalu letih sepanjang seminggu dua ini. Rakan dispenser saya tidak datang kerja selama seminggu ( sehingga saat ini ) kerana masalah kesihatan dan masalah peribadi, yang bermaksud, kerja saya dua kali ganda!Kadang-kadang, tak sempat nak mengemaskan stok barang-barang yang sampai seperti biasa sebab prescription tak pernah henti datang. Ya, in one way, it's an advantage, sebab saya dapat berlatih dispensing lebih banyak, but still, I hope my mate get well soon.

Bila dah kerja nih, balik rumah lepas makan, asyik rasa nak tidur ja. Esok pagi pergi kerja balik. Macam tu lah hari-hari, Isnin - Jumaat. Hari minggu bangun lewat, tengok TV, masak-masak, keluar window shopping kadang-kadang. Dalam musim cuti nihlah saya dah belajar masuk kedai-kedai yang tak pernah saya masuk sebelum nih, seperti Habitat, Laura Ashley, British Home Stores, House of Fraser,GAP, Warehouse, River Island ( masuk jerlah, belinya tak jugak ).Kadang-kadang bila berada dalam kedai-kedai mcm tuh, tertanya-tanya jugak : Hello, where is Nadiah?
Rutin saya jugak berubah, termasuklah benda-benda yang saya baca. Hari-hari naik bas kul 7.30 pagi, sambar akhbar Metro percuma atas bas, makan Frozen food Morisson ( Fish pie with creamy and cheesy sauce, jacket potato with mature cheddar cheese, omelette with cheese, semua benda-benda menggemukkan ), baca majalah Closer dan Celebs yang pharmacy manager beli, sembang pasal TV program kat Channel 4 seperti Gok Fix & Gordon Ramsay's Kitchen Nightmare ( Dulu tk ada TV di hall dan tak pernah tengok, kecuali X-Factor dan Britain's Got Talent ). Kesimpulannya, banyak benda yang saya tak pernah buat, saya belajar buat, secara tak langsung.
Tapi bila fikir-fikir balik, kitaran hidup sebegini, walaupun nampak relax, tapi sangat membosankan,memenatkan, dan tak bertujuan apa-apa di akhirnya.
Kerja mcm nak mati dari isnin - Jumaat, pagi - petang, waktu malam balik dinner sambil tengok TV sebelum tidur, esok kerja lagi, weekend stay in bed until 12, pergi AMC Cinema, ronda-ronda Trafford Centre & Manchester Fort, have free drinks on Saturday Nite ( not me )..Nikmati weekend selepas penat bekerja!!..
But...............FOR WHAT??

Kerja mcm nak mati. Hujung bulan duit keluar bayar mortgage. Padahal memang takkan duduk rumah tuh sampai kiamat.
Enjoy the weekend! Drinks at 1GBP. Teguk sampai exceed recommended unit. Pastuh bila addicted kena amik Antabuse ( Disulfiram ) ( Anti Abuse drug for alcoholism ). Membazir duit NHS yang subsidi ubat.Teruk lagi masuk rehab.
Let's shopping, it's summer sale!!..Last sekali masuk carboot, takpun charity shop. Fashion changes, ok?
Mari baca Closer!! The hottest Celeb Mags!..buat apa? Do those celebrities care about you?Yes if you add to their fame, join the Fan Club and you'll get the chance to enjoy exclusive holiday with your beloved celebs! ( ini kat Malaysia ).
Ready Eat Meal Make Easy.Berkapal-kapal pilihan makanan, microwaveable. Masuk saja microwave for 10 minutes, and they are ready, hot and tempting. Tak pun Chinese TakeAway.Full of MSG. Nanti bila tua-tua, bersedialah untuk makan Bendroflumethiazide, Lisinopril, and all kind of Statins - to lower your cholesterol ( Atorvastatin,Pravastatin, Simvastatin - which means you can't eat grapes or its' flavour during the course of any of these tablets ).

Kenapa saya rasa penat?Orang lain enjoy jerk.
Well to be honest, I did enjoy as well, tapi untuk apa segala enjoyment tuh?
Sempatker saya untuk menikmati segala hasil kerja yang nak mati tuh?
Pergi tengok wayang, release tension, window shopping, buy something for yourselves, yes in one way, it did make you happy, but will the happiness last forever?Till hereafter?..
Stay with your partner for 5 years, get a son to strengthen the bond, then have a grand wedding at town hall.Some choose not to hold a wedding until they got enough money for that function. Hello, you need money untuk lepas kahwin, bukannya majlis kahwin.Tujuan buat kenduri sebab nak bgtau orang kata kita dah kahwin supaya nanti takderlah tak pasal-pasal kena tangkap basah sambil pegang surat nikah, tapi sekarang nih banyak orang buat kenduri sebab nak SHOW OFF apa benda yang dia ada, seperti rumah yang lawa dan bekas hantaran yang berkilauan. Xder masalah pun nak lawa-lawa, saya pun nak lawa-lawa, but if those actually menyusahkan nak buat kenduri kahwin, buat nikah kat masjid jerk then hantar poskad dan gambar kat orang kampung : SAYA DAH KAHWIN, JANGAN PANGGIL JAWI KE RUMAH SAYA. ( Eii jangan buat tau benda nih, kurang ajar namanya )..

Penatlah. Kenapa banyak orang nak pilih cara hidup yang memenatkan dan memeningkan kepala nih?
Yups, coz we are trapped in it. We don't choose, we were already born into that net, we grow in that net.
But now we know how to use scissors, don't we?So, guntinglah segala jala-jala yang melingkari hidup kita, and see the life in a bigger perspective. The world is so small, so short, and better be prepared for the bigger life.

Thanks. Full stop.

p/s : Maaf kalau terkasar bahasa.

Third Week - Almost Halfway.

Salam warahmatullah..
Today is Friday, 8th of August 2008.
Like an eye blink, I've been working for a month, and I've got merely 4 weeks left at the Chemist..
There are so many things that I need to learn, so much about the people in the Chemist that I need to know, and 5-6 Counterpart Course Modules that I need to go through..
Anyway, obviously, I've learnt more things that I did in the first week!!..

I think, entering third week was the most interesting part, since I started to work on things other than merely labelling, dispensing, and shelving off items.
Karen, the shop coordinator, came from warehouse for routine checking - just to check whether we follow the shop's Standard Operating Procedure ( SOP ) or not. In the same time, she brought something from warehouse for me : The Assistant Log In Badge!..

Previously, I would work at the counter sometimes, mostly dealing with taking in prescriptions.
As what I mentioned in the previous post, most patients who come to the chemist are exempted from prescription charge, which costs 7.10 GBP per item.So I would just ask the patients to sign at the back of their scripts, checking all the required details, and pass the scripts to the dispenser. However sometimes there would be paying patients. I couldn't take in these prescriptions since I've got no identification badge to access the cash register. So do if patients want to pay for GSL and OTC medicines, I just could not serve them. That badge enables me to deal with the cash, HAHAHAHAHA..but there's no chance of cheating, coz at the end of the day, all the sales record are transmitted directly via Cohens Intranet to the Warehouse. Lagipun, saya kan budak baik?

Then the most challenging task arrived : Answering the phone call.
`Why would you feel nervous, you spoke very well in the interview? '
Well, both are different, really.

Cohens, as other community pharmacies, provide repeat prescription service. This applies to patients who take medicines on regular basis, such as the Statins, Levothyroxine, and Bendroflumethiazide. Firstly, patients would need to register with the chemist if they would like to use this service - totally Free Of Charge.These patients already have list of required medicines that they obtain from their GP's at the first place. Next, around 5 days before the
patients run out of their supplies, they will call the Chemist to order what they need. The Chemist, who also has a copy of their repeats, will take the orders to the Surgery. In the case of Cohens Chemist at Cheadle Heath, the surgery is few doors away. If the patients' doctors are not within walking distance, then Cohens will use its' driver to send the order. The surgery will then prepare the scripts, which in turn based on the Patient's Medication Record ( PMR ). If a patient already have a full pack of dispersible Aspirin which can last for 28 days, and he/she order another box the week after,this usually (not all the time ) shows drug abuse, and GP would normally reject that order. GP's would take up to 42 hours to prepare the scripts ( They are busy with other patients too ). The Chemist would the collect the scripts and prepare the medicines. In Cohens, patients can choose to collect the medicines themselves or use the free delivery service, which operates in the afternoon, Monday to Friday.

So, the first step in repeat prescription service is to take the order!!..
When patients call for their orders, there is one important thing that I must get right, otherwise the call will take such a looong time : their SURNAMES.
All the repeat forms are kept in a file, and they are arranged alphabetically based on the surnames. I've a few times mistaken the patients' names : Thorley & Horley, Henshaw and Enshaw, etc. At the end, I just ask them to spell their surnames, senang cerita.
The next bit is to get their orders right. This is alright, most of the time, the patients just understand what I say.But....................

I picked up a call from her lady who order for her husband and herself. At the end of the conversation, I'd just go through the list of ordered medicines again. And, she happened not to get what I said. And even apologize, saying that she's a bit deaf. And ask me to pass the phone to someone else. I passed the phone to Jose then.
Jose then went through the list of medicines again, my voice was apparently louder than hers on phone.When the conversation ended, Jose just turned to me, nodding her head :

`I know sometimes it's quite difficult to get what people are saying because of different accents that we use. But to be honest, you spoke exactly the same way as me. I don't see why she can't get you'..

Never mind. At least I knew that I said things correctly.But till now, I seldom pick up phone calls, unless if Sarah, Jose, and Mo are really occupied. I still feel nervous, to be honest.

Next : Monitored Dosage System and Substance Dependency Module. In the coming entry.

Maas Salamah, Ilal Liqa. C ya then!!..

Many thanks. Full stop.

p/s : I've noticed that some people have found the previous entry( and maybe this entry too ) when they google for information about Cohens Chemist.Bare in mind that I wrote based on my own observations and experience, which might not match the ideal or perfect descriptions of services as explained in Cohens Official Website itself.Please always refer there.