The January 31, 2020 New York Times published a lengthy and alarming news article entitled “How Chaos at Chain Pharmacies is Putting Patients at Risk”.
The Times wrote:
In letters to state regulatory boards and in interviews with The New York Times, many pharmacists at companies like CVS, Rite Aid and Walgreens described understaffed and chaotic workplaces where they said it had become difficult to perform their jobs safely, putting the public at risk of medication errors.
They struggle to fill prescriptions, give flu shots, tend the drive-through, answer phones, work the register, counsel patients and call doctors and insurance companies, they said—all the while racing to meet corporate performance metrics that they characterized as unreasonable and unsafe in an industry squeezed to do more with less.
“I am a danger to the public working for CVS,” one pharmacist wrote in an anonymous letter to the Texas State Board of Pharmacy in April.
“The amount of busywork we must do while verifying the prescriptions is absolutely dangerous,” another wrote to the Pennsylvania board in February. “Mistakes are going to be made and the patients are going to be the ones suffering.”
This will sound familiar to all of us who are pharmacists, but perhaps new to Times readers will be the “aggressive performance metrics at CVS and Walgreens”.
In Missouri dozens of pharmacists surveyed by their state board stated that the focus on metrics was a threat to patient safety and their own job security. “Metrics put unnecessary pressure on pharmacy staff to fill prescriptions as fast as possible, resulting in errors”. Of nearly 1,000 pharmacists who took the survey, 60 percent said they “agree” or “strongly agree” that they “feel pressured or intimidated to meet standards or metrics that may interfere with safe patient care”.
The Times article addresses real safety concerns for patient safety and hints at the stress and danger pharmacists are placed in. The article does not suggest any solutions.
My Related Thoughts
I hope that you have some new ideas to remedy the problems identified in The Times article because I would like to hear them. For what my opinion is worth, I suggest a number of areas to address, all of which are important:
- Outlaw performance metrics that reward pharmacists solely for filling more prescriptions per hour. The danger of this kind of metric is obvious.
- Reward pharmacists that practice safely.
- Chains should stop requiring pharmacists to sell customers immunizations, tests and procedures and refills. Using a Pharm D as a huckster to sell products takes time away from safely dispensing prescriptions. You cannot do two things at once.
- Abolish for the most part at-will employment of pharmacists. Instead, pharmacists should receive bonafide employment contracts for a reasonable term where pharmacists during the contract term can only be fired for good cause.
- Pharmacists at chain pharmacies have long needed real, bonafide aggressive union representation.
- A pharmacist union at chains is the only way to protect pharmacists from age discrimination—a huge problem for pharmacists.
- Employ safety engineers to make the pharmacy workplace safer for patients and safer and healthier for pharmacists.
Safety is not common sense, but is the subject matter of learned profession of human factors engineering. The goal is safe dispensing while minimizing harm to the bodies and minds of workers.
Advising Patients or Selling Products?
Some other thoughts I have are not directly related to reducing prescription error but, it is time to address these concerns as well. Chains should not use pharmacists to market vaccinations and health products. The reason chains have pharmacists implore patients to get vaccinated and refill their prescriptions is because pharmacists were among the most trusted professions in America. And a pharmacist endorsement used to mean something in terms of adding credibility to a product or service. The pharmacist is clearly more than busy just trying to accurately dispense prescriptions and advising prescribers on drug interactions and drug usage. Corporations should discontinue making pharmacists pester patients to buy products. Corporations should substitute real huckster “health professionals” such as Gwyneth Paltrow (women’s health), Jillian Michaels (nutrition products) and Dr. Oz (for everything else).
Pharmacists must safeguard their own profession from having its public image cheapened by merchandising. If we sell health products directly to the public in the same fashion as Gwyneth Paltrow and Kylie Jenner then it will be a very long trip back to regain the professions’ integrity with the public.
Decades ago, wise pharmacists tried to divorce the pharmacy from merchandising to elevate our status and utility but tragically their message was ignored and now lost. Business people see patients quite differently than health professionals do.