Peter A. Kreckel, RPh

In the late 1970s, I worked at a paper mill for 3 summers while I was in pharmacy school. Of all my lessons learned running jackhammers in steel tanks, shoveling bark in the woodyard, and muscling cast iron boiler parts, I can still see a sign in the personnel director’s office. It was a sheet of paper that read, “Don’t start vast projects with half-vast ideas.” Say it quickly and it really makes sense.

I can’t think of a more lucid example of a vast project that has been implemented with “half-vast” ideas and implementation than the COVID-19 vaccine rollout. There isn’t a community pharmacist whose day-to-day activities has not been altered by this historic event. Patients call incessantly asking when it is their turn to get their dose of the precious vaccine. Even the leadership in Washington and our state capitals see the community pharmacist as the answer.

The news, whether on the internet or television or in your local newspaper, is chock-full of vaccine stories. Patients read the headlines and pick up the phone and call the pharmacy for information. Small community pharmacies can field 100 phone calls or more a day for patients to be put on the “list.” Forget the internet; most patients, especially the elderly, want to speak to a human, a human who can get them this life-preserving shot in the arm.

We’ve all seen the colossal success in West Virginia, one of the few states to use independent pharmacists to administer vaccines in the nursing homes. In my home state of Pennsylvania, we were ranked in the very bottom of percentage of shots administered versus received in the initial rollout. West Virginia, early on under the leadership of Gov James “Big Jim” Justice, deployed small, independent pharmacies as the best option. My daughter Gretchen Garofoli, PharmD, BCACP, CTTS, and her team of pharmacists, Krista Capehart, Pharm D, MSPharm, BCACP, AE-C; Betsy Elswick, PharmD; Ashleigh Barrickman, PharmD, BCACP; Heather Johnson, PharmD; Ashlee McMillan, PharmD; and Angela Goodhart, PharmD, are mostly responsible for West Virginia’s success. Gretchen was featured on local news channels, NPR, PBS, and even the British Broadcasting Corporation’s (BBC) World News. Capehart has been featured on many news outlets as well and was featured giving Justice his vaccine.

Notice that all 7 leaders from the West Virginia’s School of Pharmacy are women. At the end of the day, they go home and manage their households and take care of Ethan, Luke, Gwyn, Ainslee, Connor, Macy, Lila, and Ava. These amazing women saw a vast project and used their leadership skills and connections to implement the rollout of vaccines to the long-term care facility residents.

Two other women I’m familiar with are Pennsylvania residents and pharmacists. Molly Beimel, PharmD, from my birthplace of St. Marys, Pennsylvania, spearheaded her independent pharmacy’s efforts and pulled off a 1200-dose clinic at the local Catholic high school. Even closer to me is my wife, Denise Kreckel, RPh, who, along with her colleagues at Centre Volunteers in Medicine in State College, Pennsylvania, conducted the same 1200-dose clinic, however, with the Pfizer vaccine. With such precision, my wife handled the numerous storage requirements of this delicate vaccine from dry ice to thawing, reconstitution, and administration. I was amazed to see this 5-foot, 2-inch powerhouse impact the lives of so many in our community. 

Women make up about a quarter of Congress and of Pennsylvania’s state representatives in Harrisburg. On the national and state levels, the rollout of the vaccine has been abysmal. Is there any wonder the amazing success of West Virginia and the clinic success in Pennsylvania are led by women pharmacists? There is no doubt their vast ideas are making up for the “half-vast” vaccine rollout on the federal level. 

Articles

In an opinion piece, pharmacist Pete Kreckel highlights the ways that women have been leading the COVID-19 vaccination effort.

Women Pharmacists Are Leading Successful COVID-19 Vaccination Programs

Ronald Reagan was the most quotable president of my lifetime. The above quote truly resonates with me, especially when dealing with patients. I never use the term “customer” when they are at the prescription counter. They are here for health care, not just for making purchases.

Readers have heard me sing the praises of pharmacy technicians I’ve worked with. These technicians have allowed me to provide optimal patient care and ensure that the pharmacy is run efficiently. 

For example, Darlene worked as my technician for 24 years. She is highly organized, efficient, and a pharmacist’s best friend. Brad was my technician for the past 12 years. He started while in high school and learned the ever-cumbersome pharmacy software we used. He was a rock star at processing prescriptions and allowing me time to handle patient consultations, comprehensive medication reviews, and interventions that proved financially beneficial for my employer. The efficiency of the store didn’t depend on the pharmacist, but on whether Brad was there.

I currently have 2 excellent technicians, Hunter and George. I’ve been on the new job for only 4 months so I can’t take credit for their hiring or training. Both are whizzes with the operations of the system. Doing the paperwork and processing orders are their greatest strengths. Both are very capable data entry technicians as well. They are guiding me, the 62-year-old “new kid” on the block, through the challenges of working for a new employer.

What frustrates me is when I go to several general merchandise stores and I see signs saying, “The CUSTOMER is always right.” If the customer is always right, then who is always wrong? Talk about throwing your employees under the bus. If they are always right, my staff and I are always wrong. If I were an employee for that organization, I’d feel insulted every time I walked past such a sign. If patients tell me their physicians said there are refills on an oxycodone prescription, are they always right?

Of all the giants in the grocery store business, none shines as brightly as Wegmans. Their employees are always happy and helpful. They greet you with a genuine smile and a most caring attitude. Their attitude is their highly trained employees are always right. “Our employees are our No. 1 asset, period,” Kevin Stickles, the company’s senior vice president for human resources, told 

 in 2012. “The first question you ask is: ‘Is this the best thing for the employee?’ That’s a totally different model.”

I can assure Hunter and George that I will use my 40 years’ experience on the bench to guide them so they can have fulfilling careers like Darlene and Brad. As the sun begins to set on my career, I can assure my staff I will never “feed them to the crocodile.” We owe it to our pharmacy technicians to be their strongest advocates.

“If some among you fear taking a stand because you are afraid of reprisals from customers, clients, or even government, recognize that you are just feeding the crocodile hoping he’ll eat you last.” – Ronald Reagan

Advocate for Your Pharmacy Staff

The high school football teams in our area are playing football. Only 250 people are allowed in the stands, including the team, coaches, cheerleaders, band, and parents. Everyone is frustrated. Kids have sacrificed their teen years in the weight room, on the practice field, and in the classroom preparing for their time to shine on the gridiron. Risks versus benefits. Kids playing football regularly have risks of concussion, strains, sprains, and broken bones.

To a kid, the risk is worth the benefits of participating in a team sport and possibly getting their chance to be a “star.” Ask any 9th grader’s parents about the benefits of their kid playing football and you will hear in the conversation the chance of a college scholarship.

Our society seems willing to take a risk if it sees benefits. Immuniza-tions, for example, have a very slight risk but great benefit. Antivaxxers focus on the miniscule risks and pay no attention to the benefits. My mom, who had many friends affected by 

polio in the 1930s and 1940s, marched all 4 of us to the high school to get our dose of Sabin oral polio vaccine when it became available in the early 1960s. Mom knew the benefits.

My dad, a World War II veteran, like millions of others, risked his life for the benefit of his country serving in the US Army. What he witnessed in the European Theater of action, from Northern Africa, Anzio beach, Rome, and Germany was so horrific that he never shared it with his kids. Dad knew the benefits. Back home, the citizens of our country were called upon to ration fuel, sugar, tires, steel, and other necessities for the war effort. A collective effort was made for the common good. They were referred to as the “greatest generation.” The country knew the benefits.

And now, we are asked to wear a cloth face covering, to not only protect ourselves but also to protect oth- ers during the coronavirus disease 2019 (COVID-19) pandemic. I work
in the pharmacy for nearly 9 hours each day and wear my mask the entire time I’m near anyone. Do the masks help? We got off to a rocky start 

with masking when the CDC recommended not wearing them in February and early March. On April 24, the CDC officially recommended wearing a mask. However, folks that choose not to wear the mask simply point to the February recommendations.

On the other end of the spectrum are the “mask police,” who want to call out everyone at the pharmacy who removes their mask, even for a brief moment. Yes, one of my customers did that, stating, “The workers could cough and get COVID all over my pills.” The plastic barrier, the sanitizing of the surfaces every hour, and the abundance of hand sanitizer were not enough.

I’d like to offer a proposal to those mask police out there. Whether you are in academia or management, I’d like all licensed pharmacists to join in unity on October 30 to support their brothers and sisters in community pharmacy by wearing a mask for the entire work day. We community pharmacists will even let you take yours off to eat lunch!

In the absence of rock-solid data to the contrary, wearing a mask seems to be a small sacrifice to protect each other’s health. One of the wiser health care practitioners I work with offered this: “We as a country do not have the collective grit to make large-scale sacrifices for the greater good of the society.” Big benefits...I’m not sure, but definitely a very small risk.

In the absence of rock-solid data to the contrary, wearing a mask seems to be a small sacrifice to protect each other’s health.

Mask Wearing: A Small Sacrifice for the Greater Good

We all know that that Friday afternoons are hectic in the community pharmacy, especially the first of the month. One Friday, after finishing my typical lunch (yes, I take 10 minutes to do that), I called a pharmacy for a transfer for one of our patients. As I was on the phone, I overheard my technicians, Amber and Katie, looking for trifluridine eye drops. I reminded them to check the refrigerator. None there. After I was done with my call, I asked who wanted the trifluridine drops, assuming it was another Thompson Pharmacy. They said it was some eye doctor’s office but could not recall which.

About 7 years ago, my niece Rachel Fritz, who is now an optometrist, stayed at our home while interning at a local eye clinic. I came home after work one day and told her that a Medicaid managed care organization (MCO) denied a claim for trifluridine because the patient used their 6 prescriptions for that month. I called the ophthalmologist and got the medication changed to valacyclovir, knowing Medicaid would pay to treat genital herpes but not herpes keratitis.

“Uncle Pete, herpes keratitis is sight threatening, and you probably saved that patient’s vision,” Rachel said. Herpes keratitis needs to be treated within hours of diagnosis, and waiting 2 days for prior authorization is not appropriate. My techs called all the ophthalmology practices in Altoona, Pennsylvania, and tracked down the nurse who made the request.

I spoke with her, and she said no one in the city had the eye drops in stock. I told the nurse to give me the prescription over the phone and my driver would go to the warehouse to pick up this sight-saving eye drop. I called “Rich,” the representative at Value Drug, around 1:15 PM, and he set the wheels in motion. Less than 2 hours later, my driver, Don, appeared, drops in hand.

When the patient’s daughter came in at that day, she was most appreciative of our efforts. Her 90-year-old mother was a customer of a big-box store, where little effort was made to help this patient. The woman handed me her mother’s Medicare Part D card, and Amber ran the prescription through our pharmacy filling software. When Amber got the approval, her bright smile was absent from her face as she called me over.

Amber informed me that Medicare Part D had paid us $123.02 for this sight-saving eye drop that cost us $189.93, for a loss of $66.91. That’s not counting all the time my techs spent, the mileage and time my driver spent, and time I invested to help this 90-year-old woman get the medication because the big box had no interest in doing so. What should we do? I assured Amber that over the weekend, I would fill out the paperwork to challenge this gross injustice of payment.

My only wish is that the pharmacy team at this MCO could hear my niece say that herpes keratitis is sight threatening and needs to be treated immediately. There was no time to scour other warehouses to find a cheaper generic. This small, 1200-square-foot drugstore will take care of the patients and their problems that the big-box guys could care less about.

Clare Boothe Luce is attributed with saying “No good deed goes unpunished.” This independent pharmacist hopes that this is not the case for the herculean efforts made to help this most needy patient.

This small, 1200-square-foot drugstore will take care of the patients and their problems that the big-box guys could care less about.