Frustrated with pharmacy

There are times when I get frustrated with my profession, as I'm sure you do too. This blog has enabled me to make connections with pharmacists from all over the world. A few months ago I had an email conversation with a fellow pharmacist who is frustrated. I was actually looking into other career options at that time.

The following is copied/pasted from one of the emails. I have permission to share this from the other pharmacist.

What are your thoughts? Are you as frustrated with your profession as this pharmacist is?




My quest is to get out of pharmacy too. I went back to graduate school at age 53 and got a Masters in Mental Health Counseling with an AODA concentration. I graduated 3 years ago and have had to stay in pharmacy to pay the bills for graduate school. My wife is about to start a job as a nurse and if I could find a job at $60,000 per year I'd be gone tomorrow. I've done AODA counseling as part of our graduate training. The satisfaction I get from working with alcoholics and addicts is way beyond any satisfaction I have gotten from pharmacy. Plus, we actually use much of what we were taught in school. What a novel idea. With the economic downturn, finding an AODA job in my area (NE Wisconsin) is tight but I keep looking and hoping. Good luck in your quest. Do you know why they call it the "Asheville Project"? OK, neither do I but one of the reasons has to be because it never ever came close to reaching the controls necessary to qualify it as a study. That pharmacy would trumpet it as "evidence" of anything is further proof of how little proof MTM has as a viable model. In graduate school, I had to take a stats course and several research courses. "Asheville" as a study would have little internal or external validity because there were so many variables that were not controlled (confounders) and its widespread applicability (generalizability or external validity) to other practice types is extremely low. To answer your question as to where the MTM model came from, it was a paper Hepler and Strand wrote in approx 1990 about pharmaceutical care and its application, MTM. Only someone in pharmacy would consider it even a remotely possible practice model. Unfortunately, all pharmacy schools subsequently did. Now we have Doctors taking orders from Med Techs--they had to come up with a degree appropriate to all the new responsibilites pharmacists would have--hence, the 6 yr. PharmD. If I was a PharmD, I'd be pissed.

Prescriptions per hour

I recently posted a poll that asked the following question:

How many prescriptions can a pharmacist fill safely per hour (including counseling)?


The results did not surprise me:

• 0-10 (10%)
• 11-15 (44%)
• 16-20 (30%)
• 21 or more (16%)

The majority felt that 11-15 scripts per hour was the safe level. At that rate, you have 4 to 6 minutes per prescription to verify the accuracy of the prescription label, check the patient profile for duplications/interactions, contact prescribers if any issues arise, call the insurer if needed, verify that the contents of the prescription vial are accurate, and counsel the patient on their medication.

Not included in this 4 to 6 minute span are the interruptions that a pharmacist must deal with. A patient asking for an OTC recommendation. Phone-in prescription from a prescriber's office. Phone ringing from a patient phoning in refills (I actually think that there is a rule somewhere that requires a pharmacy to have two more phone lines than people working in the pharmacy).

But back to what we actually do. We rely on the DUR software to help us check for interactions, but a recent study from the University of Arizona found that the software systems are flawed (link here). That means that we, as pharmacists, should dig through a patient's profile each and every time that we fill a prescription to check for interactions. That takes time.

Another part of the prescription process that take time is counseling. From my experience and observations, pharmacists fail at this horribly. I watch how pharmacists counsel patients on their prescriptions. 95% of the time "counseling" is simply the pharmacist reading the label to the patient. OBRA '90 gave us specific points that we are to cover when we counsel the patients.

OBRA ’90 Counseling Points:

• Name of drug.
• Intended use and expected action.
  
• Route, dosage form, dosage, and administration schedule.
• Common side effects that may be encountered,including their avoidance and action required if they occur.
• Techniques for self-monitoring of drug therapy.
• Proper storage instructions for the medication.
• Potential drug-drug or drug-food interactions or other therapeutic contraindications.
• Prescription refill information.
• Action to be taken in the event of a missed dose. (source)

To inform a patient on all of these points, time is required. Two or three minutes, per prescription, is what I feel is adequate to ensure that the patient understands what I am saying. Then you need to allow time for questions from the patient.

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So I found it amusing recently when upper management decided to change the guidelines for the number of prescriptions a pharmacist should fill on an hourly basis. I'll just say that, prior to the change, we were at the higher end of the volume spectrum of the poll. The new guidelines call for an increase of 25 percent.

I contacted my state board of pharmacy, whose mission statement states that it is to act...in the public interest to pursue optimal standards of practice through...legislation, licensing and enforcement to see what their take on my employer's changing guidelines were. The response from my pharmacy board was that no prescription volume limits have been or are being considered. Apparently my pharmacy board believes that a maximum time of two minutes, 24 seconds per prescription is the optimal standard of practice.

Eric Cropp lost his pharmacist license permanently due to a dispensing error. He was in a situation where there was too much work to be done with inadequate staffing. The little girl who was undergoing her last chemo treatment ended up dead from the error. So when he speaks about the rapid pace of pharmacy and the potential for error, I'm paying attention. He was quoted in a recent internet article as saying "We want to stress the fact that everybody's got to slow down and treat each patient like they're a member of your family...Healthcare is so fast and crazy sometimes we start to miss the fact that we're taking care of a human being, not running an assembly line."

If only the management of the pharmacy chains would think the same way.

Summer safety

I posted this on Twitter a couple days ago. After mulling it over in my head, I decided that these Tweets were worthy of their own blog post.

This will be short and to the point. And it may save suffering for your patients over this summer.

Feel free to print this out and post it at your pharmacy for your patients/customers to read.

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This is the sun. If you can see it, put on some sunscreen.












For the folks who get poison ivy every year. This is what it looks like. DON'T TOUCH IT!






Now that I have said that, go outside and enjoy the summer.