Choose a prescription drug that has a generic available. Choose three different types of pharmacies. Examples: 1.Large chain pharmacy such as Walgreens, CVS, Eckards, etc. 2.Grocery store associate pharmacy such as Publix, Krogers, etc. 3.Privately owned local pharmacy 4.Pharmacy associated with a “big box” store such as Target, Walmart, etc. 5.Online pharmacy (must be in the United States)  Do not use any drugs on the pharmacy’s four dollar or other special price list. If the pharmacy has a “club card” or other special way of getting lower cost, do not use this cost.  Compare the cash cost of the brand and the generic making sure that the dose (milligrams, micrograms, etc.) and number of pills are the same.  Example: Synthroid .05 milligrams and levothyroxine .05 milligrams, prescription for 30 pills.  For over-the-counter products, use identical products including formulation (liquid, capsules, etc.), dose (mgs per tablet, mgs per cc, etc.) and size of packaging (20 tablets in the box, 90cc fluid in the bottle, etc.). Try to avoid products that contain multiple ingredients like cold preparations as these are hard to compare due to differing quantities of ingredients within each product.  Example: Benadryl (brand) 25 mg per capsule, 25 capsules per bottle and diphenhydramine (generic) 25 mg per capsule, 25 capsules bottle.

  

1-I give you a lot of credit for reporting those cases. I can imagine it was not an easy thing to do, but as nurses we always advocate for our patients. It is very important to be aware of those that are at higher risk for abuse, such as women, specially pregnant women, and children. You mentioned many victims come to the ED seeking help and we must always be alert for any signs of abuse. I was once told a story about a woman who the nurse suspected was a victim of abuse but the woman’s husband refused to leave her side. The nurse (we are very smart!) asked the woman for a urine sample and the nurse put a note inside the bathroom asking her if she needed help and the woman was indeed looking for help. As nurses we wear many hats and we are able to help our patients in so many ways.

  

2-The fact that surprises me the most is how many men are victims of physical violence, stalking and rape. Although, I always knew this was possible, it is not heard of as much as women being victims of physical violence, stalking and rape. I think it is very important to bring awareness to the public that this occurs more often than we think. By bringing awareness, victims can feel comfortable coming forward and seeking help. Men are thought of as “tough” and often as the abusers. Anyone can be in this terrible situation and in need of assistance, so we can never assume what someone else may be going through.

  

3-I consider myself very fortunate for never having had to be faced with domestic violence, child abuse or elder abuse at work. For those that have had to experience this, I can imagine how difficult that must have been. I have reviewed the policy and procedure manual at my current job for child abuse. According to the policy and procedure manual Case Managers are by definition of New York State  Social Services Law mandated reporters. A maltreated child is someone “whose physical, mental or emotional condition has been impaired or is in danger of becoming impaired as a result of the failure of his parent or other person legally responsible for his care to exercise a minimum degree of care. “ Some indicators of child abuse include: bruises in different stages of healing, unexplained burns, old fractures, bite marks, consistent hunger, lack of supervision, bruises on buttocks, inner thigh or genitals, conduct disorders, fear of parents, unusual sexual knowledge, substance abuse and many more. When child abuse is suspected, it is important to gather as much information as possible. Case managers collaborate with the multi-disciplinary healthcare team and case management will then initiate referral to Child Protective Services (AC.P.S).