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    Should boards of pharmacy set hourly dispensing quotas?

    Ken BakerKen BakerA friend e-mailed me about the failure of employers today to provide enough pharmacists and pharmacy staff to properly and safely handle high prescription volumes in pharmacies.

    He believes this is a major cause of prescription medication errors and proposed that boards of pharmacy essentially set quotas for the number of prescriptions that should be filled in a given time by a calculated number of pharmacists and staff. 

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    Inquiry, not mandate

    I applaud his desire to increase safety and reduce medication errors. I disagree with his assignment of blame. It is not practicable or feasible for the government to determine how many pharmacists and how many technicians are required to fill one prescription or 100 prescriptions.

    North Carolina is often cited as having such a rule, but North Carolina’s rule is retrospective, not prospective.

    When an error is submitted to a state board, it may be reasonable for the board to inquire into the prescription volume and the staff available at the time of the error. This is not the same as setting a quota.

     

    Pharmacist, not boss

    Professional practice does not lend itself to quotas. Instead, each pharmacist and each technician, regardless of the number on duty, must make the professional decision as to the amount of time required to fill this one prescription. The responsibility rests with the professionals filling the prescription.

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    The pharmacist, not the pharmacy, is the professional. Professional decisions can be made only by the pharmacist, not by the boss. 

    It is up to pharmacists and technicians to guard against and reduce the risk of medication errors. The pharmacy’s job is to assist them and to provide the tools as may be necessary, such as a CQI workflow plan, scanners, a safe environment, etc. The pharmacy can suggest times required and can decide how many technicians are hired. The pharmacy cannot make a professional judgment.  

    Kenneth R. Baker, BS Pharm, JD
    These articles are not intended as legal advice and should not be used as such. When a legal question arises, the pharmacist should ...

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    • Anonymous
      With APha pushing MTM, Immunization, etc..,the increase in the number of school of pharmacy we have increased the amount of mandatory job discreption in the retail setting. If we do not meet the metric numbers for filling scripts, number of flu shots, Zostavax, complete a number of MTM cases we will be replaced by the new grads coming out of these schools. Should we not look at the total picture and not only at the amount of scripts. With companies getting software which has make it more difficult to fill scripts and at the same time has the metric system available (what have we become, the drive-through at Dunkin-Donuts). Have we really helped people or have we opened up a can of worms where we will be spending more time filling out incident reports along with CQI's because we are multi-tasking (filling Miss Jone pain medication (first we must check the PMP site to make sure she is not abusing any drugs), Mr Jones is in a rush to get his flu shot (his insurance does not work), doctor on the phone and a customer wants to know where an item is on sale that week, and Mrs Smith left her script for Metoprolol at home and needs a transfer and do you know how important this medication is and I need it now!, and you are the only pharmacist with 2 techs (filled 250 that day). We must look at the total pictue and we must remember that patients health is our number 1 concern.
    • Anonymous
      I hear a semantics issue coming. The author says the professional is to blame, but acknowledges that the management has to be "kept in check" (contradiction ?) He mentions that if all pharmacists "just say no" to faster unsafe speeds, then management would be forced to make work more safe/allow the profession to practice more safely. Here is the chicken and the egg. How many RPh's lose (and will lose) their job over trying to "just say no" to corporate management on speed/lack of patient safety mandates ? Will corporate pharmacy be forced to make common sense safety changes before RPh's get too nervous watching their colleagues who stand up to speed mandates lose their jobs ? No. There are plenty of warm bodies with huge student debt and an insatiable appetite for driving BMW's who will gladly drink the corporate kool-aid and practice unsafely, making the diligent/safe pharmacist look bad with their big metric performances. Solution ? As the author said, "If ALL the pharmacists... Sounds like unionization to me. And we need to have BOP's severely punish corporations in cases where errors are made and there is any documented speed pressures imposed on the pharmacist(s) involved (BOP's are spineless and do not have the profession or the safety of the public in mind) And with all due respect to the RPh who commented, every time I hear some rogue RPh stating how they check huge numbers of prescriptions without errors, I laugh at the narcissism/depth of denial. So you checked approximately 2000 rxs/week for 3 years (approx 300,000 rxs) and never made an error ? Ha, ha, ha, ha.... I needed that chuckle i wager $1000 that you do not go through one day without an error, meaning at least a minor error, not necessarily wrong patient/drug/dose And how many of us have the luxury of checking scripts un-interrupted ? I love the suggestion. Basic neuroscience. I try as much as I can to set boundaries with the techs about not interrupting me more than necessary. But for most of us, constant interruptions are a requirement for keeping our jobs. The only way to fight it is to.... that's right, unionize But that will probably never happen, since too many RPh's are too narcissistic and selfish to put themselves in the same category as the "common" pharmacist They are better than the "common" pharmacist Even if they make more mistakes. Even if they constantly mess up stuff that is not being measured by a metric, so that they can bump up their numbers. All the while the rest of us fix your narc log book errors that you made, fix the problem rxs that happened on your shift that you blew off so that you could bump up your numbers and cause the PDM to ask us, "why can't you do the numbers that XYZ superman RPh does ?" Thanks, jerks..... Keep playing with fire and playing into the hands of the evil empire, sorry I mean corporate management, and one day you will find yourself under the bus...... Please prove me wrong. I am begging you
    • EddieMorales
      I remember in NYC, before I became licensed over 31 years ago, you would first be hard pressed to find a pharmacist who was NOT unionized. As part of the union contract, in the store I was doing my internship, it was stipulated that for 200 prescriptions filled in a day one pharmacist would suffice. If the number of prescriptions was over 200 and under 400, two pharmacists were required. If the number of prescriptions was over 400 per day, a third pharmacist was required. Over 600 prescriptions a day, extra pharmacists were optional. This was reasonable because the pharmacy I was working in did a lot of compounding. In NYC, back then, compounding was routine. Anyway, it seems to me this quota issue seems to be a call for return to a time when a limit was imposed so as to allow a pharmacist to fill prescriptions safely and correctly. Maybe pharmacists should all start by unionizing first, then make this "quota," if you want to call it that, part of the bargain. Although I feel a time limit of checking one prescription per minute is a more realistic approach. I call this a 30/30 checking speed, where I first take 30 seconds to check from prescription to information entered, then another 30 seconds to check from information entered against the prescription. I find this a safe speed to check (one rx per minute) and I feel I'm less likely to make a mistake at this speed. Undisturbed, a pharmacist can safely and easily check 480 prescriptions in an 8 hour period. I know, I've done it, when I at one time worked for Medco Health mail-order. In the three years I worked for them, I never made an error. If all pharmacists used this approach of undisturbed checking rate of one rx per minute, all would improve. The problem is, especially in chain pharmacies, faster and faster with less help is the order of every day.---Rogue Pharmacist, Eddie Morales, www.cvsworker.com
    • Anonymous
      Great, now work retail where interuption are a common occurance (wheres the bathroom, mothballs, coffee on sale this week etc) your number is unreal, now set up the company computer system to fill out the incident and CQI report..Let not forget how in the past a mail order company dispensed coumadin in place of prednisone (someone filled the baker cell with the wrong drug). With that number of scripts being checked and INCIDENT WILL OCCUR!!!! We must always remember patients health is our number one concern not how quickly we can fill scripts. As I tell patients who rush us, "if you get the wrong hamburg at MacDonald you can return you,but if I give you the wrong medication you may not be back to return it...
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