From 2000 to 2009, the FDA received more than 95,000 reports of medication errors, but this report is considered to be a great understatement, as this number was collected from voluntary questionnairs. | Justin Tijerina/The Cougar
Attention to detail is important in any job, but imagine working in an environment where losing focus, even momentarily, could result in harming another person. This is the stress that pharmacy staff members deal with on a daily basis.
In spite of the high stakes of working in a precarious profession where mistakes can often be fatal, pharmacists are pressured to work in an environment where profit has eclipsed accuracy.
Chain retail pharmacies are pushing staff to fill as many prescriptions as possible in the smallest amount of time with the least amount of help. The current pharmacy culture prefers speed to accuracy, which comes from the demands of higher-ups and customers alike. With unrealistic expectations on both sides, pharmacy personnel struggle to fill prescriptions while maintaining patient safety.
Pharmacies are chronically understaffed. Big chains, always looking at the bottom line, want scripts to be filled with the fewest technicians on the clock.
This is unfortunate, since many of the tasks one associates with the pharmacist — typing directions on the bottle, selecting and counting the correct medication and packaging — are actually completed by technicians.
However, staffing is only part of the problem; technician rollover is also a major component, mainly due to pay. Though pharmacies make large profits, they are notoriously bad at paying a living wage to their technicians, who are typically doing a great deal of the work.
Pharmacy technicians are among the top ten most underpaid jobs by US News and World Report. The pay, beginning at around $10 per hour at retail pharmacies, is simply not commensurate for the amount of work and stress related to the position. For the hourly rate, pharmacies aren’t staffing seasoned professionals; they’re having prescriptions filled by inexperienced techs that are willing to work for a pittance.
The equally overworked pharmacists have the added responsibility of overseeing the work of their technicians, for whom they are solely responsible. The pharmacist is accountable for verifying the accuracy of the technician’s work before a script is dispensed to the patient.
The verification step, by far the most important part of the filling process is done in a harried environment of excess stress. A pharmacist is expected to verify scripts while being constantly interrupted to answer the phone, counsel patients, administer immunizations, give transfers to other pharmacies and transcribe new prescription orders called in by physicians, all while maintaining an impossible 15-minute wait time for scripts and never taking a moment to pause.
It’s not uncommon for pharmacists to work 14-hour days (8 a.m. to 10 p.m.) with no meal break. No, it’s not legal, but it is the rule in pharmacy practice — not the exception.
This means that if one goes to the pharmacy in the evening for a prescription, it is most likely being completed by a pharmacist who has been on their feet for 10 hours, has only eaten what can be consumed in handfuls over their computer and is now physically and mentally exhausted. Add in the pressure to push scripts through as quickly as possible, and one can see this is a precarious situation.
Patients have been conditioned to expect prescriptions to be filled while they wait. This expectation is due, in large part, to the presence of the drive-thru window. Although it’s meant to be a convenience, the drive-thru has diminished the integrity of pharmacy practice by lowering it to the level of fast food service, while simultaneously setting a dangerous precedent for speed.
“I have gone home and said a prayer asking God to please not let me have made any mistakes that could have caused harm to a patient.”
– Texas pharmacist Bill Bradshaw
Not every script that enters the pharmacy can be filled in a moment’s notice, even if it is dropped off at the drive-thru where customers want the speed of a fast food restaurant. The pace expected in the drive-thru, the area most prone to mistakes, is not consistent with care and attention to detail required of the filling process. Unfortunately, no matter the point of service in the pharmacy, speed is revered and accuracy becomes just a detail.
In an interview with KHOU, Texas pharmacist Bill Bradshaw acknowledged the pressure to fill prescriptions faster and with little qualified staff and the fear that comes with the magnitude of the job.
“I have gone home and said a prayer asking God to please not let me have made any mistakes that could have caused harm to a patient,” Bradshaw said.
The fear expressed by Bradshaw is of incorrectly filling a prescription, known in the pharmacy world as a “misfill.” When pharmacists are expected to satisfy filling expectations implemented by management for a particular number of scripts within an allotted time, misfills will certainly follow.
It cannot be debated that with an increase in speed comes a decrease in accuracy. It seems obvious enough, but for the corporate chains, the risk associated with a misfill here or there doesn’t outweigh the increase in revenue generated by by fill quotas.
In other words, profit has become more important than patient safety.
Claudis Alston of Tomball is all too aware of the devastating, life-long repercussions of an incorrectly-filled prescription. According to USA Today, Alston went blind in his left eye following a misfill in which he received ear drops instead of an eye drop prescription; he is currently suing CVS Pharmacy for his loss of eyesight.
Darwin Ta, a pharmacy technician and a recent UH graduate who is now applying to pharmacy school, suggests that it may be possible to begin to change the current pharmacy culture by educating the patient and, in turn, altering their expectations.
Justin Tijerina/The Cougar
“Even though the patient may want their prescription immediately, what they don’t realize is that the pharmacist and their support staff are already occupied with a myriad of other tasks,” Ta said.
“It’s important that the customer be educated to understand that the reason that their prescription may not be able to be filled on the spot is for their own safety. Pharmacies should be known for their accuracy, not for their lightning speed.”
The big-money pharmacy business is not likely to improve without the grassroots efforts of pharmacists who are prepared to become advocates for the changes they wish to see. It’s encouraging that those such as Bradshaw and Ta are willing to express how they feel, considering pharmacy employees are typically very closed-mouthed and hesitant about expressing grievances.
Despite the current state of the pharmacy world, Ta still plans to attend pharmacy school and is optimistic that he and his fellow classmates will be able to improve the pharmacy protocol, but knows that it’s not a feat that can be accomplished overnight.
“The way that pharmacies currently operate is due to an evolution that has taken place over the last decade or so,” Ta said. “Although I am new to the field, I have firsthand knowledge of how things are run. I believe that an initiative has to be taken to change the path of pharmacy practice.”
Hopefully, the culture of pharmacy business will allow pharmacists to work in a setting that acknowledges them as the consummate professionals they are with adequately trained and paid technicians and realistic fill times. Pharmacists need to reclaim their profession.
Opinion columnist Jonathan Bolan is an English graduate student and may be reached at [email protected].
Very accurate description of what is becoming a real danger. Its getting bad.
As a pharmacist I can tell you the more skilled/experienced pharmacists are currently leaving the larger retail chains as quick as possible – CVS/Walgreens/etc will pay for this terrible model sooner or later – they will be left only with the techs/pharmacists who cant get work anywhere else – customers will begin to notice. Will be no one to blame but the pushers of the more scripts with less resources mantra. It is so obvious at the store level, it makes you wonder how on earth corporate does not see the future – blinded by increasing stock prices i guess. Those stocks are going to fall off a cliff in the not too distant future due to a problem that could be easily fixed with a relatively small increase in personnel costs. I liked my job at this very large chain in the beginning(only a few years ago), but there is absolutely no time to perform my duties safely anymore and I am getting out ASAP. I suggest you take your scripts to an independent pharmacy.
Yes ideally I would love to leave my stressful chain job and work for an independent. Problem is majority of them in my area have been closing down bc they were bought out by the larger chains. When speaking with the owners they said reimbursemt rates from insurances companies are what they used to be. Unless these independents find other ways to make an a better income again I’m scared for the future.
You are so right. . I just left an independent and went to a big chain because the independent could no longer afford to have pharmacists on overlap. It would be great to work at an independent….but like you said they are closing and can’t compete with mail order and such.
The real numbers: you have an average of 20 seconds to answer each drive through call(as well as every phone call), and 3 minutes per transaction. This is one of your monthly metrics. If your average is 24 seconds, and the transactions take longer than 3 minutes, you will be having a conversation with your district manager about your really bad service.
I’ve been a technician for 6 years, I’m the lead tech at my store and I am VERY good at my job, however the conditions over the past few years have deteriorated to levels that made me start to hate my job with a passion. Regardless of not being paid enough, the work has become unbelievably strenuous and we are pushed harder and harder to just pump out prescriptions as fast as possible, I go home physically and mentally exhausted every day from the workload.
hallelujah (as a current pharmacy technician for 6 years) , finally an accurate article that educates people about the pharmacy… thank you for this article!
This is a sad state of affairs. CVS prides itself that it has never had a judgement against it for an error. They always settle out of court. So they admit wrong doing yet don’t want a record of it. How manyeople must get hurt before this culture is corrected.
The pharmacy staff are put in a dangerous position every day and the corporate heads sweep it under the mat.
Greed kills and it needs to be stopped.
I notice no customers/patients weighing on this discussion. This is because the vast majority of customers do not care about accuracy, they only care about speed. They don’t understand medicine or its dangers, and they think whatever medicine they get will be “good enough” and “safe”, even if its not correct. If they are injured, they view it as winning the lottery & will sue for a big pay-out. Things are the way they are, because that is exactly what customers/patients want.
Wow, Amen. This article is a dead ringer, but I still doesn’t cover it all. The retail model is as bad as this article makes it out to be. You know what the top criteria I was judged on? How many loyalty cards I scanned, how many customers gave me a 10/10 (9/10’s do not count), and like a call center, all of our waiting stats (aka how long the phone went unanswered and Rx turn around times.) Let’s not forget the worst, the amount of available hours to schedule staff was based on the amount of scripts SOLD, not the ones we transferred, or the ones we put back because you took too long to come, or because your insurance didn’t cover them, only the ones we ring out at the register. These hours change on the fly and we would have to shave hours of off schedules that were already made and understaffed because there were a couple of slow days.
I’m a tech, and you know the worst thing I saw was that my pharmacists at…let’s call the business “Smallbeans,” that did not comply with this business model were threatened by corporate figures and district managers who are not pharmacists by things like transfers to stores that were farther away, denial of PTO, schedule changes that directly interfered with family life such as daycare or the death sentence that is “becoming a floater.” I saw a district leader tell a pharmacist who shared custody with her kids that she would be switching stores and weekends to work the same weekends as her husband (who worked for the same company) and as she began to cry heavily and explained about not seeing her kids they told her “sorry, if you want to keep your job you’ll do this.”
I cannot fathom how we got to the point were medical professionals like pharmacists are being bullied and harried by people who are not medically literate. Is that why you went to pharmacy school? So a 9 to 5 ,never works weekends, makes the same amount of money as you do, gives gift cards and forces you to call patients and apologize their early norco script wasn’t filled, manager can tell you that your phone calls are taking too long? Can you imagine if nurses, NP, PA,PCA, or MD’s were treated like they worked as a cashier at Target?
This is why I prefer working at an independent. The owner doesn’t put any unrealistic expectations on you and the #1 thing is patient safety. If the patient isn’t willing to wait, they can take their scripts elsewhere. Yes, I get paid a little bit less than the chains but I’m actually able to eat a proper breakfast and lunch, sit down when I want to, go to the bathroom when I need to, and not be mentally exhausted at the end of the day.
This article lies about wages. Two years again, the maximum rate in which I could hire a pharmacy technician was $8.12. If anything, that rate has gone down since.
You kidding. 13 is the avg in texas
I get paid only 10, which is minimum wage where I work in CT. The burger flippers next door at McDonald’s make the same amount I do, and the burger flipper managers get paid MORE than I do. But I’ve just got people’s lives in my hands. Nbd. It’s not like I actually have to be good at my job.
Can we please print this and hand it out to all our complaining customers?
worked retail for 8 yrs, have quit and never looked back. Once a pill pusher, always a pill pusher.My advice to my fellow pharmacists, get out while you can