Wednesday, June 22, 2011

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.


Anonymous said...

"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." ...This is the saddest heartbreak of all, after 35 years in pharmacy the changes in managerial and public expectations is so out of whack with reality I had to retire or jump off a bridge. (chose retirement) With the current over supply of pharmacists I don't see a very pleasant future.

Anonymous said...

Right on! (IANAP, but I agree wholeheartedly.)

By the same token , they ought to rip out the drive-throughs - pharmacies have nothing in common with Mickey D's. Gift cards and $4/free Rxs also need to go the way of the dodo.

Anonymous said...

I'm sorry but Pharmacy is done. There is indeed a glut in many areas now and that does give the "Big 3 or 4" chains the ability to demand whatever they want. After 37 years, I am winding down. 20-24 hours a week and I select the stores. I cannot see myself retired and was not really emotionally ready but with the state of the profession- I give up....

On back nine of my RPh career said...

The saddest part is this fast food atmosphere is what the public wants...For example this is mostly the reason why the Ohio Board of Pharmacy had to reverse their transfer rule back to unlimited transfers between pharmacies. The public DEMANDED to be able to use transfer perks. This "What will you give me if I bring my prescriptions to you?" attitude is a monster that will be very difficult if not impossible to get rid of.

The Board doesn't care about safety unless something goes wrong. Then they make a rule based on the mishap. Standing up for prevention of a mishap is obviously not what they stand for.

Theshinyteapot said...

Wow, as a student who is about to start the pharmD program, I am losing hope in this field. on the other hand I am gaining hope because when I graduate and work in the field I could make a change. I can be a pharmacist to speak up. So, yeah maybe there is a surplus of pharmacists, but the quality of services is not increasing at all. So as long as I can make a tiny change, I wouldn't mind working in the pharmacy field....

Anonymous said...

Used to be (I've been a R. Ph. for 30 years) that the company, state board, and district manager, and later on, the store manager, were all for the pharmacist; we played a positive role for the profession, the company and the public. That has totally been reversed, now, there is no one that will back us up.....not even our so-called professional associations...all they do is tell us to contact our legislature; I was mistaken, I thought professional associations were about giving a 'voice' for the concerns of the profession they represented.....with the current fiscal climate, with less tax dollars being taken in, federal and state support for state boards, colleges of pharmacy, the professional associations 'fill the gap' with guess what? Corporate sponsorship. Each practicing pharmacist needs to understand clearly and resolutely that we are alone, no support and that we are only, I repeat only, as good as our last prescription filled; corporations give 'no quarter'; insufferable staffing?; no training of staff? drive through chaos? doing data entry, counting and verifying? All when giving immunizations? Made a mistake, huh? "Why YOU are an incompetent pharmacist!" corporate will explain to you.

lovinmyjob said...

Right as always, Eric. I know that any time an error is made in my pharmacy and I have to do the "paperwork" on it, I site under-staffing and over-worked as a contributory element. It's not much but what I submit is a legal document and can't be changed, so at least I have documented the issue. All I can say is that we must remember that we are the ones in charge. We are the rate limiting factor in the pharmacy, so we can slow down if we choose to. I know that corp. doesn't like that and they have their stop watches out timing us on everything but what else can we do to protect the public from ourselves?

FreshHospitalPharmer said...


I agree you can slow down and take time to do a thorough DUR and spend time with the patient. BUT, there is a GLUT of pharmacists graduating every year with high debt and they are more than willing to take the spot despite terrible working conditions.

I enjoyed retail pharmacy as an intern throughout school but I did not see it as a safe or satisfying long term career choice, so I went to hospital. The working conditions and PTO are far better and wage is pretty much the same after factoring in differentials.

Working conditions in retail will only get worse.

The Redheaded Pharmacist said...

As usual you've hit the nail on the head Eric. I couldn't agree more with everything you've said here. I think it is high time we start standing up for ourselves or things will just continue to get worse. And the reality is that no one else will stand up for us if we don't do it for ourselves. Thanks for a great post!

bcmigal said...

Ok, I am waiting....folks say we should "stand up". So when is that happening, exactly? I took my blood pressure today after my shift of nine hours and no overlap or lunch. It was 170/100. Could you get to this before I am dead?

Anonymous said...

My question...How are you going to stand up to the chains and convince them to better working conditions? Seriously what is the plan?

Do you not see plenty of new grads and out of work pharmacists drooling to take your position?? For retail bigwigs all they care about is the license and a pulse...

I am just trying to play devil's advocate. I honestly do not see what card retail pharms have to play...

Please tell me, because I do not see it! In reality do you honestly think things will improve?

bcmigal said...

We have passed the point of no return. The chains do not care who the heck you are....they just keep cutting staff and adding micro-tasks. At every staff meeting the point is made that if you can't hack it, we will replace you. Show any sign of weakness and you are history. This job is killing me, literally. So you guys and gals who want to "stand up", please do so soon. Perhaps you can redeem the sanity and lives of your colleagues.

The Ole' Apothecary said...

Exo 5:4 And the king of Egypt said unto them, Wherefore do ye, Moses and Aaron, let the people from their works? get you unto your burdens.

Exo 5:5 And Pharaoh said, Behold, the people of the land now are many, and ye make them rest from their burdens.

Exo 5:6 And Pharaoh commanded the same day the taskmasters of the people, and their officers, saying,

Exo 5:7 Ye shall no more give the people straw to make brick, as heretofore: let them go and gather straw for themselves.

Exo 5:8 And the tale of the bricks, which they did make heretofore, ye shall lay upon them; ye shall not diminish ought thereof: for they be idle; therefore they cry, saying, Let us go and sacrifice to our God.

Exo 5:9 Let there more work be laid upon the men, that they may labour therein; and let them not regard vain words.

Exo 5:10 And the taskmasters of the people went out, and their officers, and they spake to the people, saying, Thus saith Pharaoh, I will not give you straw.

Exo 5:11 Go ye, get you straw where ye can find it: yet not ought of your work shall be diminished.

Exo 5:12 So the people were scattered abroad throughout all the land of Egypt to gather stubble instead of straw.

Exo 5:13 And the taskmasters hasted them, saying, Fulfil your works, your daily tasks, as when there was straw.

bcmigal said... any plagues up your sleeve?

Ryan Lassabe said...

I'm in Louisiana. We of course have zero union protection. Would it be possible left or likely to legislate a 20 minute break where the pharm doesn't have to leave the premises but is entitled to eat or at least rest ? This is what I've been thinking about as a small step in the right direction. 20 min per 6 hours worked ( I work 14s), fill 220 - 320 a day with about 20 tech hours On a week day . ( which was upped only after complaining).

Also what may be useful is to start a data bases store by store that laid out RPG and tech hours.and company algorhythms. Maybe eventually we could get a minimum legal algorhythom passed... it is a data driven world. Sorry for mistype... this is from my phone