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DATE 2015-11-01

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MESSAGE
DATE 2015-11-16
FROM Ruben Safir
SUBJECT Subject: [Learn - LIU Comp Sci] so you want to go to Pharmacy School - for
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Pharmacy staffing levels can threaten patient lives
November 04, 2015
By Anna Leon Guerrero, PharmD Cand.

Anna Leon GuerreroAnna Leon GuerreroThe pharmacy profession is in
jeopardy if it does not respond to the immediate crisis of the
understaffing of pharmacies, especially those affiliated with chain
stores. This understaffing has become increasingly apparent with the
recent injunction and monetary fine of $502,000 given to Walgreens for
not providing consultation services.1 This failure to provide counseling
was not an isolated incident. In 2014, Rite Aid was fined $498,250 and
CVS was fined $658,500 for similar failures to consult.1

See also: Pharmacy mistakes, Part 3: State BOPs and public safety

Medication errors

These fines are insignificant compared to the estimated $1.7 billion in
economic losses1 experienced by 150,000 Californians who are harmed
through =E2=80=9Cuninformed and improper use of prescription drugs.=E2=80=
=9D A leading
cause of mortality is medication errors, 21% of which result from
dispensing errors. According to some estimates, in a pharmacy that fills
approximately 250 prescriptions per day, approximately four errors
occur.1,2 Furthermore, a study conducted by the University of Arizona
College of Pharmacy found that the risk of dispensing a potentially
harmful drug-drug interaction rises 3% with every prescription filled
per hour.3

Another study found that for every six errors detected during the normal
verification process, one error slips through and can reach the
patient.4 Errors that slip through can be caught at consultation. During
consultation, 83% of errors are caught before the patient leaves the
pharmacy. 2 Failure to counsel would allow the errors to leave the
pharmacy undetected.

See also: Pharmacist error rate rises as workload climbs

Lack of consultation

The Massachusetts Board of Registration in Pharmacy conducted a survey
in which pharmacists identified reasons for errors. Reasons included too
many telephone calls, overload, too many patients, no one available to
double-check, illegible/misinterpreted prescription, and staff shortage.5

Pharmacists are not finding the time to do the job with which they have
been charged; counseling is not being done. As a result, patients are
more often asked by the clerk to sign a statement waiving their
consultations. The issue of failure to consult would be eliminated if
the staffing were adequate.

Nonprovision of consulting services also contributes to the issue of
medication nonadherence. Only half of the 3.2 billion prescriptions
dispensed in the United States are taken as prescribed. Approximately
125,000 deaths are linked to medication nonadherence annually, with
costs estimated to run between $100 billion and $300 billion.6

Passage of California=E2=80=99s SB493 meant that pharmacists are finally
recognized as healthcare providers. However, the question remains of how
they will perform additional duties that include immunizing, screening
for cholesterol and blood pressure, and counseling on diabetes, tobacco
cessation, and birth control, in the time available.
Time constraints

Chain stores often require pharmacists to dispense 300 or more
prescriptions a day, which translates to 37.5 prescriptions an hour in
an 8-hour shift; that in turn translates to 1.6 minutes per
prescription, during which time a pharmacist must verify the accuracy of
the label, check the patient profile for duplications/interactions,
contact prescribers if any issues arise, call the insurer as needed,
verify that the contents of the prescription vial are accurate, and
counsel the patient on the medication =E2=80=94 impossible!

Despite multiple citations and fines imposed on chain pharmacies, and
lawsuits brought on behalf of the general public, chain corporations
still fail to counsel patients, and the result is a steady stream of
medication errors.

Boards of pharmacy need to step up and enact necessary regulations or
guidelines that will create safe working environments for pharmacists.
Fines, not for the individual pharmacist but for the corporate entity,
should be increased in instances of excessive dispensing and failure to
counsel. Only then will pharmacists be enabled to do what they do best:
provide quality services to patients.

Anna Leon Guerrero is a 2016 PharmD candidate at Touro University in
Vallejo, Calif. Contact her at [email protected].

References

1. Office of the District Attorney County of San Diego. 2015. Walgreens
Pharmacy to Pay $502,200 to Resolve Consumer Protection Case [Press
release]. http://bit.ly/wagfine.

2. Nair RP, Kappil D, Woods T. 2010. 10 Strategies for Minimizing
Dispensing Errors. Pharmacy Times. http://bit.ly/disperrors.

3. University of Arizona Health Sciences Center. =E2=80=9CPharmacists=E2=80=
=99 Workload
Contributes to Errors.=E2=80=9D ScienceDaily. ScienceDaily, 25 April 2007.
Retrieved from http://bit.ly/pharmworkload

4. Grasha, AF. Psychosocial factors, workloads, and risk of medication
errors. US Pharm. 2002;27(4):HS32-HS52.

5. Massachusets Board of Registration in Pharmacy. Medication Error
Study. Massachusets Office of Health and Human Services. www.mass.gov.
http://bit.ly/errorstudy

6. Iuag A, McGuireJ. Adherence and healthcare costs. Journal of Risk
Management and Healthcare Policy. 2014;7:35=E2=80=9344.

The author thanks preceptor Dr. Aglaia Panos for guidance in preparation
of this article.

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  1. 2015-11-02 Ruben <mrbrklyn-at-panix.com> Subject: [Learn - LIU Comp Sci] campus
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  3. 2015-11-03 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Learn - LIU Comp Sci] FSF
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  5. 2015-11-09 Ruben Safir <mrbrklyn-at-panix.com> Subject: [Learn - LIU Comp Sci] UMl anyone
  6. 2015-11-16 Ruben <mrbrklyn-at-panix.com> Subject: [Learn - LIU Comp Sci] DFD stuff
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  9. 2015-11-16 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Learn - LIU Comp Sci] so you want to go to Pharmacy School - for
  10. 2015-11-17 Ruben Safir <ruben-at-mrbrklyn.com> Subject: [Learn - LIU Comp Sci] This is an interesting treatise on Graph
  11. 2015-11-20 Ruben <mrbrklyn-at-panix.com> Subject: [Learn - LIU Comp Sci] campus today
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