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    Pharmacy staffing levels can threaten patient lives

    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 “uninformed and improper use of prescription drugs.” 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’s 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.

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

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    • Anonymous
      I would accept a 50% cut in pay for conditions that promote the completion of my professional responsibilities and personal needs. Sounds outlandish? I already have, but the issue is not just staffing. The root cause most of the problems in pharmacy are pharmacists. We are too passive of a group and need to take charge of OUR profession.
    • Anonymous
      Think hard about what you wish to implement and the consequences of those regulations. The reimbursement is low, our volumes are limited by our local population and demand for prescriptions, and our current infrastructure would require major overhaul (which is expensive) to physically fit more people. The only way we make enough money is through volume. We would have to close pharmacies to increase the volume at neighboring pharmacies. This would boost volume per store and reduce overhead but would require less staff than the staff filling the multiple stores. Our profession is overpopulated which also counts against us. If we keep the same stores and increase staff to meet demand then expect to take a pay cut because the money isn't there. If we didn't have insanely high student debt I would be all for it, but I can't afford to keep up with loan payments and still pay rent, buy food or pay for gas if the pay gets lower. Unfortunately many do not know what they signed up for and feel stuck. Unfortunately you had choices and this is what it led to. If you can't keep up and do the work safely and judge your own pace without feeling the pressure then you need to rethink what you are doing and find a different job description with your degree, retail isn't for everyone.
    • Mr. JMAZUR
      Young pharmacists have to take back the profession. Stop being afraid to stand up and say "no more". It is no longer a profession. It is run by '"bean counter" accountants, non pharmacist district managers and store managers, CEO'S CFO'S,COO'S and other people who do not have a pharmacist license. And if they do they are so out of touch with conditions and don't care how dangerous thing are. You will never last 30-40 years. Stop the madness now. Unite together. Whether you are in retail, hospital, long term care, specialty, mail order, whatever field you are in,it is the profession at stake. You and your staff know it becoming more and more impossible to do the volume and how unsafe working conditions are. As the chains consolidate and become behemoths with 10,000 pharmacy departments, do you think things will get better. As reimbursements continue to declined as the PBM industry consolidate into a few gigantic insurance companies left, do you think things will get better. You will be asked to do more for less and with less staff. United you can make a difference. Stand united in front of state and federal legislators and tell them what is really going on. I know you are tired on your days off, after filling 300 or more scripts the day before, and being told you didn't do enough immunizations. You need to voice your opinions and frustrations. Be angry with a purpose. Write to or better yet make an appointment with your legislators. Go to see them. You have more power than you think. If YOU don't care,no one will,and it will get worse than it is now,if that is possible.
    • Mr. EMorales
      What you describe has been going on for at least 17 years that I'm aware of, but I'm sure it's been going on a lot longer than that. I'm glad that as a newly licensed PharmD you are aware of what's going on. In the past, pharmacy students have been kept in the dark as to what goes on in chain pharmacies. Recruiters woo the pharmacy newbies and paint a pretty picture. Then you get to work for them and find out about the horror. Then it's too late, because you now need the job in order to pay off your $150,000 student loan, need to make car payments, and probably have a mortgage to pay, and the jobs are scarce, and will become scarcer once the 2016 graduates hit the workforce. The highest number of graduating pharmacists is predicted to occur in 2016. By 2018, for the first time in the history of pharmacy, you may see 5 newly licensed pharmacists competing for every single job opening. Who will get the jobs? The newly licensed pharmacists of course, because older or higher paid pharmacists will be let go to accommodate the extra 4 newly licensed pharmacists. As one District Manager once said, "I don't want any pharmacist older than 28 working for me." So the problem you depict is really a lot worse. Those pharmacists working for chains right now need to wake up and join a union, on a national level, so they can make things better for the new pharmacists coming in. I'm Rogue Pharmacist Eddie Morales, posting on www.cvsworker.com in order to get all pharmacists across this country unionized now, before it's too late.
    • PaulGarbarini
      Ms. Guerrero- You bring up a valid point and the fault you note lies at the employer level. Boards of Pharmacy , whose "stated" mission is to protect health, safety and welfare are missing the point on this very important issue. No state imposes a prospectve limit on the number of prescriptions that can be fulled in a certain time period. North Carolina comes close, but usually at the expense of the health of an individual, with only a retrospective review being performed after the harm complained of has already occurred. I don't see, in your analysis, a firm statement of your sources, particularly when you state that half of prescriptions are dispensed without a consultation being performed. Most states only impose this requirement on new prescriptions, some on new and revised prior prescriptions but damned few require it on all prescriptions. So thisn :"fact"- that less than half are consulted, maybe quite legal and consistent with Board regulations. It is imperative for all pharmacists to recognize the statement attributed to the Wobblies in the early 1900's- "Workers of the World Unite". If pharmacists don't unionize, and stand together they will suffer the harm predicted by Ben Franklin o so many years ago.... "We must hang together... for if we do not, we most certainly will hang separately".The chains, PBMS and CMS for that matter don't give a tinker's damn about pharmacists and pharmacy practice- they just want to make pharmacists modern-day slaves and pay little, nothing or, in certain instances, a loss on each prescription filled. They don't want to pay for compounded prescriptions, specialty medications( unless you are in the PBM's own specialty network- and these pharmacies are no different than any other licensed pharmacy- only onwned or controlled by rapacious SOBs who craft phenomenal rebate packages for themselves with manufacturers- why do you think that the Big 3 PBM all have different Hep C therapies- because it is all about getting an ever-increasing share of the pie, a pie filled with money paid by US taxpayers for these PBMs to become tax-fattened hyenas at pharmacy's and society's expense. Nor do they want to reimburse pharmacists for the greatly inflated prices pharmacists now pay for certain generics. All it would take is dedicated group of pharmacists in a chain pharmacy district to strike, have patients go without, refuse to be treated poorly and be paid wages that are beneath us and then, and only then will the rest of the United States stand up and take notice. And any pharmacist who crosses a picket line is indeed a scab and should be t reated as such by his former colleagues forever. Sic Semper Idiotae! Paul Garbarini, R.Ph, Esq. Northampton, MA 01061
    • Anonymous
      I commend you on a great article. Many of us practicing pharmacists have realized these conditions for years---but no one seems to want to correct the problems. Not BOP---not big chain executives--and not pharmacy school faculty. The only alternative is to unionize---and that will certainly cause an uproar---but needs to be done. Thank you.