Thoughts on prescription volume and liability for errors

Imagine if you will the following scenario... district manager calls the pharmacy to speak with the pharmacy manager. A short conversation ensues where the pharmacy manager is speaking in a hushed voice and starts to look frustrated. After the call, the pharmacy manager pulls the other pharmacist(s) aside and tells them that corporate has determined that the pharmacy volume isn't high enough to support the pharmacist staffing and, as a result, pharmacist hours are going to be cut.

Imagine that at the current staffing levels, each pharmacist is verifying an average of twenty prescriptions per hour. That is on top of counseling patients, making OTC recommendations, talking to physicians and nurses on the phone, resolving third-party issues, evaluating DURs, etc... Three minutes per prescription without those distractions isn't that much time.

Imagine that the new staffing algorithm calls for pharmacists to verify (on average) twenty-five prescriptions per hour. Two minutes, twenty-four seconds per prescription. Not counting the distractions. If I look up the word disaster in the dictionary, I might see this as an example.



In the sixteen years that I have been a pharmacist, the profession has devolved from what was once a medical profession that took care of patients to a fast-food operation that wants to see how many customers they can get thru the doors. Pharmacists who work in this environment are afraid to speak up out of fear of losing their jobs.

What has led our profession to this? Several factors come into play.

Corporate ownership of pharmacies is a biggie. When the people who make decisions about the operations of the pharmacy don't actually work in a pharmacy, there is a major disconnect. It's even worse when the managers making these decisions aren't even pharmacists. I've had managers who have been pharmacists and managers who aren't pharmacists. At least the pharmacists have some idea of the realities of the profession, even if they have sold out as they have moved up the corporate ladder.

Declining third-party reimbursements. The argument is that declining margins mean that more scripts must be filled to make the same profits as before. There is a simple solution... stop signing contracts that don't reimburse at a respectable level. Everybody seems to be afraid of turning away people if we don't accept their plan. Hoping to make up for the horrible reimbursements on the prescriptions by selling a extra tube of toothpaste as an impulse buy. I was able to obtain a copy of a third-party contract at my previous employer. The terms for generic medications were AWP- 25% + 1.75 for 30 day supplies. AWP- 50% + 0.00 on 90 day prescriptions. And the employer was pushing us to get the people on 90 day prescriptions. ???

Four dollar/free prescriptions. Apparently the corporates offering these programs aren't afraid of telling you exactly how much they value your training and expertise. Nuff said.

Surplus of pharmacists. Remember 15 years ago when there was a pharmacist shortage? Then all the new pharmacy schools opened up. And now the job market is flooded. Remember how companies used to treat pharmacists well in order to keep them? Now pharmacists willingly accept being treated as highly-trained monkeys in order to remain employed.



Pharmacists need to stop being so timid when addressing issues with the members of management who are making the decisions that are destroying the profession. It's not their license and livelihood that is on the line if a mistake is made. It's yours. If you won't speak up for yourself, who will?

We need to remember that we are medical professionals first and foremost. We are liable for any and all errors that may occur in the pharmacy. Some pharmacists are lulled into a false security when employers say that they will carry a liability policy to cover the pharmacists. The policy that stipulates that all policies and procedures must be followed exactly or else the coverage is not valid. I'm guessing that it takes longer than two minutes, twenty-four seconds to follow the policies and procedures on each prescription.




This is just a thought on the subject, but the next time there is a major error that occurs due to a pharmacist being required to fill too many prescriptions per hour/shift, I'd like to see some other defendants in the courtroom. Instead of just the pharmacist and maybe the corporate being named in a lawsuit, I'd like to see the district manager, regional manager, and everyone up the corporate ladder all the way to the CEO being named in the case. Maybe if the members of management who make these staffing decisions are held just as liable for errors as the pharmacists in the field, we may see some changes.