I normally don’t put IMO at the front of posts but … I wanted to increase the probability of this one being read… this article compares three very different Rx dept and how they function… Both of the chain pharmacists mention substance abuse in one form or another and technician staffing issues and or justification to come in early – off the clock – to get things together for the day. The independent pharmacy/owner apparently doesn’t worry about either because she determines staffing levels and most likely knows her pts and has a “working relationship” with the local doctors. While these stories are suppose to be anonymous.. From what is said, I am pretty sure that one is a BIG BOX STORE and the other one is one of the two largest chain stores. The points out the “interference” that the Pharmacist has to put up with from the non-pharmacist store manager and how data driven and time sensitive the whole process is. Legally, the non-pharmacist store manager has NO AUTHORITY in the Rx dept, but healthcare – especially the chains – in nothing more than a FOR PROFIT BUSINESS… Get them into the store… get their money… and get them out… and if the Pharmacist complains or files a complaint.. she will find herself “sitting on the curb” and we have a serious and growing surplus of Pharmacists… so the majority of chain pharmacists just shut up and go along… This article just reinforces my normal suggestion to use a independent pharmacy … here is a link to find one by zip code http://www.ncpanet.org/home/find-your-local-pharmacy
https://www.drugstorenews.com/insights/in-this-issue/in-the-trenches-behind-the-counter-with-3-pharmacists/
What keeps a pharmacist up at night? Sounds a bit cliché, doesn’t it? But retail pharmacists are confronted with many different issues throughout their day, from dealing with patients to company and government regulations that can make the job a bit tougher.
Although retail pharmacists across the United States work in many different settings, many face similar challenges. Drug Store News talked to three pharmacists — without identifying them or their employers — to capture a day in their work life and explore challenges they experience, as well as solutions.
Here is what we learned:
Case 1: Independent pharmacist near Seattle
At this bustling independent pharmacy, the pharmacists all focus on non-sterile compounding for the local community. The pharmacist said that many competitors focus on marketing and compounding for out-of-area patients, as well as local consumers, but employees at this operation focus on building relationships with local doctors and serving the community.
The independent employs a distinct, high-tech process for filling prescriptions. A technician performs data entry, including resolving insurance rejections, and then a second technician processes the prescription out of the packaging queue. No paper or labels are printed until the script is ready to be filled, reducing unnecessary use of paper. The second technician is located at a station that has a tech solution called Eyecon, which uses infrared technology to store pill images and ensures accuracy on filling, as well as RxSafe.
RxSafe is a tower containing a large portion of the inventory that can store up to 1,200 stock bottles. Once the label is printed, the technician scans the label, and the RxSafe sends out the stock bottle of medication. Eyecon scans the label and stock bottle for accuracy. It will alert the technician of an error by flashing red, even if the correct drug is scanned, and there is a distraction, and the wrong drug gets poured onto the counting tray.
At this operation, the pharmacist employs the use of a hanging bag system. By the time the prescription reaches the pharmacist for verification, it already is in the bag. This has saved a lot of time in the bagging process and allowed them to eliminate baskets. She has had success purchasing these bags at a better price by searching online for hanging library bags, which can be found at a larger variety and at better pricing. The pharmacist said the system “keeps things looking neat,” and that it is a “seamless process that eliminates a few extra steps.”
What is her favorite aspect of independent pharmacy? “The connection with customers and prescribers,” she said. Once the pharmacy began compounding, doctors started to view it in a more clinical light and started asking a lot of clinical questions they never asked when the pharmacy did not compound. Now, she said, they are viewed “as colleagues, someone who can help solve medical problems.” She enjoys the family environment of her independent pharmacy and being her own boss. She also enjoys the benefits of being a member of Professional Compounding Centers of America, which has a network of 30 pharmacists she can call for help if she needs assistance finding an answer to a tough question.
The pharmacist noted that it is important for independent owners to be alert to the possibility of employee theft. She told of a technician, who worked at the store and was later discovered to have been stealing from the company in a number of ways. This technician processed prescription refunds onto her own credit cards and opened fake charge accounts. At one point, the credit card company was alerted because thousands of dollars were being refunded onto her credit card.
The company, recognizing that this often is caused by employee theft, contacted the pharmacist and the employee’s stealing was uncovered. She noted that this employee was an otherwise star worker, often proudly pointing out ways that she had helped make money for the pharmacy. The technician worked hard to be her right-hand woman, she said.
The pharmacist said that a red flag with this technician was always printing unnecessary financial reports for her job description. She explained that by doing so, dishonest employees can gain access to information they use when developing their strategy.
The independent pharmacist stressed that since internal theft can be very damaging, owners must take extra steps to protect their assets. Employees should not have charge accounts nor should be able to create or edit charge accounts for others — only a very limited number of trusted employees should be able to do so, she said.
She also recommended that registers should be password protected. Only the pharmacist should be able to authorize a discount, price change or refund. She noted that proper security on the register is just as important as learning how to operate it.
A nice niche that she has carved out for the independent operation is bringing in high-end vitamin lines that cannot be found in chains. She started with Thorne vitamins and expanded to several others, with the store now carrying multiple lines of vitamins that typically do not sell to chains. She described it as an “additional revenue source and clinical service,” that the pharmacists enjoy and that helps the pharmacy stand out.
As is the concern with most independent pharmacies, she noted that insurance reimbursements have gone down, but she is “hopeful that PBM reform will come and is somewhat encouraged for the future.” The pharmacist advised fellow pharmacists to get involved with or donate to state and national pharmacist associations to help them promote and fight for the profession.
Case 2: Pharmacist working for a national retail operation for the last 15 years, and is now working in a high-volume store located in the Philadelphia area
At this chain, pharmacists work 10-hour shifts. The pharmacist said she arrives 30 minutes early — by choice and on her own time — to “get in and get settled.”
When she arrives, she knows that her resolution queue awaits and will only grow longer if she doesn’t work on it, undisturbed, before opening time. The resolution queue includes all prescriptions that must be addressed, such as prior authorizations, doctor calls and any troubleshooting issues. She explained that there could be 80-plus items in the queue when she arrives, and there is not a specified time when the prescriptions are due.
Generally, though, the system ranks prescriptions by priority — those due in the next 30 minutes, two hours or 72 hours. If a pharmacist starts to fall behind, the items will turn yellow to signal a deadline getting closer, or red if they are past due. Technicians and pharmacists must be efficient in watching priority and keeping prescriptions in order, she said.
At this operation, technicians are expected to fully answer phones and perform all data entry. She explained that they try to “create an environment leaving the least distractions for the pharmacist because no one else can do what I do.” A policy called “three before me” encourages technicians to collaborate and problem solve by asking three other people — if available — before asking the pharmacist. Usually, another technician can help solve the problem, allowing the pharmacist to concentrate on verification and clinical matters.
Prescriptions are checked in two stages. After the technician performs data entry, the pharmacist does a four-point check, verifying the accuracy of the data entry — patient name, drug/strength, directions, doctor. Any mistakes must be sent back to the technician to correct — pharmacists are not allowed to fix mistakes.
Once the prescription passes the four-point check, it can then go to the fill queue by time priority. After the technician prepares the prescription, the pharmacist visually verifies the prescription by looking at the pill image and comparing it with the pills in the bottle. The technician then bags the prescription.
Prescription input is always a priority over the dozens of prescriptions that are due in 72 hours. “We don’t have the payroll to work three days ahead,” she said, noting that the filling process is all about “minimizing distractions for the pharmacist.”
Pharmacists are required to counsel patients on all new prescriptions at this chain. The pharmacist explained that often, patients will decline counseling, saying they have taken that medication before. However, she encourages them to step over and speak to her for a brief moment, when she can check the patient profile on her computer. Sometimes, a dosage change by the doctor that was unintentional is discovered, and this extra step provides an important opportunity for this pharmacist and her colleagues to evaluate the drug(s) and clear up any questions.
At this retailer, there is a drive for immunizations, and pharmacists are expected to consult with patients about available and appropriate options being offered. Like many other pharmacy retail chains, there are quotas that pharmacists attempt to meet with regards to immunizations. There also is a very big focus on medication therapy management, with pharmacists required to sign on daily to ensure patients are adherent and the company is compliant with insurance requirements.
This pharmacist’s favorite part of the job: “The biggest joy is making a difference for a patient,” she said, explaining that the world is motivated by time and money. Since the chain offers low prices, it makes a huge impact on a patient when she is able to help them save $200 to $300 per month, and they are extremely grateful.
Her least favorite part of the job: “Without a doubt, the opioid epidemic.” She checks the prescription-monitoring program for controlled substances. At the chain, pharmacists must establish a doctor-patient relationship and ensure that it is an appropriate relationship, gathering such information as diagnosis and date of last visit. She said it sometimes is difficult to have these conversations with the doctor and the patient, but they are necessary in using figuring out whether a prescription is appropriate.
The pharmacist “takes every prescription on a case-by-case basis,” looking at the history, consulting the doctor if necessary and checking the PMP. For example, she would not call a doctor for a child on a low dose of Adderall, but if a patient is on a very high dose of oxycodone, she would make the call. With the opioid epidemic at an all-time high, she said pharmacists need to take the time and responsibility to take every step necessary.
Many times, she will refuse to fill a prescription of high-dose narcotics, and she feels confident that her company supports her professional judgment.
What would she change, if given the opportunity? “We are pulled in too many different ways, and everyone expects everything in 10 minutes or less.” Also, she would increase technician help and/or lower expectations — she finds it nearly impossible to perform all the daily tasks. She explained that if a pharmacist is filling 300 prescriptions in 10 hours, plus immunizations, counseling, MTM and checking PMP, it can be difficult to stay afloat.
Case 3: A pharmacist-in-charge at a low-volume national chain store in South Carolina
An interesting concept that this chain employs is called workload balance. Pharmacists use a tool that allows them to check data entry, but if they are caught up on their work, they will check data entry of other stores in the chain across the country. Like other major pharmacy retailers, this operation has a two-part checking system — first, the data entry is reviewed and then the pill image is verified.
Because of the lower volume at the store, the pharmacist has a budget of just 70 technician hours — down from 140 just 18 months ago. Because the technician is busy with data entry, register and drive-through, the pharmacist must do all production by herself because, when there is only one technician working with her, they are both “at capacity.” Additionally, due to the lack of enough help, the pharmacist often finds it difficult to find time to do other tasks, such as making the schedule and completing adherence calls. “We’re all stretched thin, that’s just how it is,” she said.
The pharmacist remembered a time when she took a 20-minute meal break, and there were only 10 prescriptions pending. When she came back, a customer was yelling at her technician and 45 prescriptions were in the queue. It took her three hours to catch up.
On top of all of the catching up she had to do, the store assistant manager came to the pharmacy to tell her to check her tasks, which were showing as incomplete in the company’s computer system. She explained that it is challenging that store managers are not pharmacists, but that the pharmacist reports directly to the store manager. “They just don’t get it,” she said. “Our direct report has absolutely no idea what it’s like to be a pharmacist.”
She also told of a time when a patient became very ill due to a drug interaction that was not picked up by the computer. Although this would have happened to any pharmacist, the store manager wanted to fire the pharmacist. She had to explain that the system failed, not the pharmacist. She would like to see better cross-training of store managers and have them spend more time in the pharmacy, learning how to complete pharmacy tasks and understand a little more about what the pharmacy staff does.
So, what is the favorite part of her job? “I really like helping people.” She gives patients her full attention when giving recommendations. “I always walk the patient to the shelf,” she said, explaining to the patient why she is selecting that particular product. She enjoys teaching the patients and giving them ownership. Although it is her favorite part of the job, she doesn’t get to do it as much as she likes.
One challenge at this pharmacy is dealing with the over-the-counter sale of syringes. State law and company policy require pharmacists to sell syringes to any patient without a prescription. On one hand, she knows that providing easy access to syringes is helpful to prevent such diseases as HIV and hepatitis for patients who have substance use disorders and use syringes to inject.
On the other hand, customers who buy these syringes are using them in the bathroom, leaving needles sticking out of the garbage cans. Store employees also have found needles in the parking lot and on shelves throughout the store. This presents a danger to employees and other customers. Despite talking to management and the human resources department about these issues, they persist. “They give us thick gloves,” she said. The pharmacist hopes that by continuing dialogue and problem-solving, sharps containers will be required to be sold with syringes, and/or sharps containers will be placed in the store bathrooms.
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