Accuracy takes back-seat to speed in drive-thru pharmacies
http://thedailycougar.com/2014/11/19/accuracy-takes-back-seat-speed-drive-thru-pharmacies/
From the article:
Attention to detail is important in any job, but imagine working in an environment where losing focus, even momentarily, could result in harming another person. This is the stress that pharmacy staff members deal with on a daily basis.
In spite of the high stakes of working in a precarious profession where mistakes can often be fatal, pharmacists are pressured to work in an environment where profit has eclipsed accuracy.
Chain retail pharmacies are pushing staff to fill as many prescriptions as possible in the smallest amount of time with the least amount of help. The current pharmacy culture prefers speed to accuracy, which comes from the demands of higher-ups and customers alike. With unrealistic expectations on both sides, pharmacy personnel struggle to fill prescriptions while maintaining patient safety.
Pharmacies are chronically understaffed. Big chains, always looking at the bottom line, want scripts to be filled with the fewest technicians on the clock.
However, staffing is only part of the problem; technician rollover is also a major component, mainly due to pay. Though pharmacies make large profits, they are notoriously bad at paying a living wage to their technicians, who are typically doing a great deal of the work.
Pharmacy technicians are among the top ten most underpaid jobs by US News and World Report. The pay, beginning at around $10 per hour at retail pharmacies, is simply not commensurate for the amount of work and stress related to the position. For the hourly rate, pharmacies aren’t staffing seasoned professionals; they’re having prescriptions filled by inexperienced techs that are willing to work for a pittance.
The equally overworked pharmacists have the added responsibility of overseeing the work of their technicians, for whom they are solely responsible. The pharmacist is accountable for verifying the accuracy of the technician’s work before a script is dispensed to the patient.
The verification step, by far the most important part of the filling process is done in a harried environment of excess stress. A pharmacist is expected to verify scripts while being constantly interrupted to answer the phone, counsel patients, administer immunizations, give transfers to other pharmacies and transcribe new prescription orders called in by physicians, all while maintaining an impossible 15-minute wait time for scripts and never taking a moment to pause.
Filed under: General Problems
I hear this echoed from pharmacy employees everywhere. I want to know at what point do we take action?
Should we have an electronic RX dispensing machines instead? Scan your RX, it checks a database to see if legitimate, would eliminate doctor shoppers, pharmacists who think theyre God, thanks to DEA, if alls ok, out comes your RX. There goes everyone’s job, except an armed guard at the machine. Surely there’s a better way & I truly think the US should look to other nations, like Portugal & how they’re successfully handling the “drug issue” & adopt those same policies. I’d rather see the DEA out of work, THE reason for this “war on patients” & why the refusal to do as other nations are doing successfully. They see their job ending, as it should. Who, among avg ppl, works & fails, yet keeps their job for 40 yrs? They never cared much about ppl overdosing in the past & suddenly they care soooo much? The “caring” is fake, when is the last time you heard any message about “don’t mix drugs with alcohol, to help save lives? It is the reason for many, many, if not most OD’s, but that part of an OD death isn’t reported, just the “drug” part. (Sorry so long, I get so angry at this “attacking” helpless sick people, it’s the lowest of low)
This situation is certainly not unique to drive-thru. We were told in a conference call that “waiters” are not to be any longer than 15 minutes. Had 2 flu shots, 4 waiters, phones ringing, and was scolded by the DM for telling 3rd flu shot person that the wait would be 20 minutes. Tech who found a better paying non-pharmacy job (what a surprise) left in June and has not been replaced. Unfiled RX copies are sitting in a basket (so much for “readily retrievable”) because no one has time to put them away. Due to inadequate staffing, pharmacists type, fill, verify, cashier, answer phones, call insurances companies, scan, put away and place orders, make adherence calls, and (oh, yes) counsel.
We already know that speed not safety is the priority. Does the public care? Not really, as long as the error is not with their prescription. As much as I hate to be a cynic, I do not see this changing in my lifetime.
It’s ridiculously unsafe in retail pharmacy these days. It’s nothing like I had trained for. So much has changed since graduation in 96. Sad!
The patients always complain their doctor only spend 5 or 10 min with them if that and yet they call us everything in the book at the top of their lungs if we tell them it will be 30 min to fill their prescriptions correctly…because we end up having to cover the docs rear for either the escribe screw up, allergy, you name it..we end up fixing it.
Patients do not understand that we would rather have them wait 1 extra minute to get their prescription correct than have them land in the ER or worse.
Too true!
I fell in love with this profession as a junior in high school when I did a job shadowing project under an independent pharmacy owner. I worked for years as a technician (for no where near $10/hr.) and loved my job so much I pursued pharmacy school. I graduated with my Pharm.D. and entered the work force full of motivation to help my patients live healthier lives. After 4 years as a pharmacist I see myself becoming a totally different person. I work for one of the major chain pharmacies and I have seen the dark underbelly of our profession. My whole experience began by being thrust into the position of PIC immediately following my graduation with very minimal training. Being the motivated learner I am I did everything I could to learn all the ins and outs of my new job but it soon became overwhelming. My boss is not a pharmacist nor a technician so I am being told how to do my job by someone who has no idea what it is like to actually stand in my shoes. I work 13 hour shifts with no lunch break and minimal bathroom breaks. We get NO holidays off. We had a hurricane come through my area about a year after I started working and a day after landfall my boss forced me to go open the store back up even though all the areas in our town were flooded and there were cops out stopping people from driving around. He then called me after I took down metal shudders with our store manager in the driving wind and rain to tell me to close it back up again because he didn’t realize how bad it was (even though I told him how bad it was). When I was pregnant with my first child I got scolded for sitting on a stool while checking prescriptions (I was at least 7 months pregnant). Because I have children he has blown off all aspirations I have of moving up in the company (I know that’s why because he point blank said it to my face). These are just a few of the ways we are abused on a daily basis by the companies we work for. I think that is why my patience wears so thin with patients who are crabby because my threshold for abuse has been met! I am an extremely patient person and I am very empathetic towards others, but when all that patience is being used to not flip this company double birds as I storm out the door there is none left for that patient who is very sick and rushing me through my job. What they have turned me into makes me sick. I don’t sleep at night because I worry about what I filled that day and whether I was too distracted. I replay interactions with patients and wish I had more patience with them. I want my life and my profession back!!
I took a tech job about 18 years ago with a major chain, part time when I was raising my kids even though I have an advanced degree in science. I wanted to work but wanted to be there for my kids also. It was great, I liked the work became certified nationally and enjoyed the customers. I was very good at my job.
I left this spring because I was afraid that all the distraction and stress that is now part of retail pharmacy was likely to lead to a tragic error. Since I had no say in changing the system I felt morally unable to remain in the system. I was not alone, in a very short time all the nationally certified techs left my store. They have not been replaced as of this time. So all the stresses are still there and they are attempting to continue with less experienced help. Many of the best pharmacists I worked with in my 18 years have left the profession or gone to work for independent pharmacies. Retail and pharmacy is a very dangerous liaison.
Currently I still hold valid licences nationally and locally and I miss working but unless I find an independent that needs help (and the chains have driven many of them out of business) I do not see myself back in this field.
what a great article! One could add “conference calls’ while the pharmacist is verifying. That is always fun!
And try doing that while having to pump because you are nursing your 7 week old baby because you HAVE to go back to work but really never even have 35 seconds to run to the restroom let alone 15 minutes of uninterrupted privacy
Target is the worst!
This is all so true, I have worked for cvs for over 15 years, and have seen it steadily decline, I feel times were a little better with Tom Ryan at the helm, but it is all about the almighty dollar now. We are a busy store, about 2800-3000/week. I go in at 630 in the morning anymore just to get a head start on my crazy day there. So it ends up being fifteen hours plus when it’s all done, but with budget cuts constantly, huge staff turnover, that’s the only way I survive my days. I honestly don’t know if and when it will end, I see no end in sight right now. It does make me sad. I’m only 37 now, but I’ll be totally burned out in five years if this keeps up. I’ve worked in a retail pharmacy since age 16 and I love what I do, but it’s not the same job I got into all those years ago. I get so tired of big brother watching and criticizing every move I make and throwing metric after metric at me. And oh yeah, what little bonus I may get is based off of all those metrics. It is gonna take something seriously bad happening with huge public outcry before anything will change. Until then the bottom line is all that matters.
I can totally relate! I am only 34 and I can’t imagine doing this into my 60’s or more! I feel the burnout already and it just makes me sick because I love helping my patients and what my profession is supposed to be. Try to hang in there…… good pharmacists who care need to take this profession back. I just hope that the public gaining more knowledge about what really goes on behind the scenes will make some sort of difference.
My concern is the constant cutting of technician hours. Are the corporate boneheads really thinking that they are saving a ton of money? Honestly, none of us us techs make the big bucks and do not get a year end bonus. I have tremendous respect for pharmacists (my daughter is one) and do everything possible to make my pharmacists job easier. But every week, there are cuts in our hours, but still make us promote flu shots, auto refills, corporate credit/debit cards as well as call their MD for refills, etc. And don’t forget the daily ordering, unpacking the order and all the inventory control. What do they want from us? I can’t do it all.
and also keep up with ce every year for our certification
I have worked as a Certified technician for over 8 years. I have to agree with a lot of these problems, but the pharmacist is not the only one being pulled in so many different directions. As a technician you are required to take, input ,and count medications, but on top of all this you are to answer the phone,wait on drive-thru, wait on in store customers, and help customers find items in the store. As you are doing all these things you still have totes of medications to put on shelves, out of dates to pull, and patient and doctor calls to make. Many times you can not return to your first job for 5 to 10 minutes, by this time you have to basically start all over again to ensure you do not make a fatal mistake such as inputing the wrong medication or wrong dosage to a miscount. Many times being pulled in so many directions creates conflict within the pharmacy. Technicians are graded on how fast they get a prescription to the pharmacist, how fast they wait on the customer and make sure they are encouraging the customer to use cards for discounts, convincing them to give donations amongst many other unnecessary things. Medication no longer seem to be a priority, but what you can sell. Due to all this staff become frustrated and many times there is conflict between them which leads to many leaving the profession. The most important thing retail pharmacy’s can do is quit expecting technicians to also be cashiers, Hire individuals to run cash registers. Less mistakes in medication and cash. If they are allowed to do what they are hired for there would be less mistakes and less turnover in the profession. Therefore pharmacist have an efficiently run store.
I have been a technician for 18 years and I love my job. However I do not love the way retail pharmacy is ran. Everything that everyone has commented is so true and so right on the money. I love my job because I like to help people get better with medicine not harm them and with the way things are ran, it is very difficult and often impossible to do that. I enjoy being around customers and telling them about their medications because honestly if they don’t hear about what we are giving them from us then they don’t hear about it at all and when they get home they have no idea about what they are about to put into their body. They start reading about it when they get home and with the little bit of information that is on the leaflet that’s when all their questions begin. If I didn’t work in a pharmacy and already know then I wouldn’t have a clue because we don’t have the time to explain. The last time I checked I don’t remember pharmacists going to school to be basically be a doctor? I thought they went to school to help people and educate people with medicine? When I leave the doctor’s office for myself or my children I am basically told “We will send in your prescriptions to your pharmacy.” That’s it. No explaining what they are giving other than “antibiotic” or “something for pain”. I, myself, don’t like that and I believe that is where us as technicians and pharmacist do this job is so we can tell them how their medicine will help them feel better. I am sorry but in real life pharmacy we can’t do that. Pharmacy has gotten totally out of control with the things that are expected of us and the things that are actually needed of us. Pharmacy patients need PHARMACISTS not blood pressure checkers, flu/pneu/tdap/etc… shot givers, flu clinic doers, and whatever else that requires them to “take classes on”. They have taken classes already. Classes on medications not on how to shoot people with needles. The sad part is, at least I think for me, is that I don’t believe it will ever change and that breaks my heart because all I want to do is educate and help people get better with medicine.
Steve, you’ve pointed to precisely the reasons I left community practice after 20+ years: 8 dark months with CVS showed me how totally hijacked my beloved profession has been by narrow-minded, corporate MBA’s who only see numbers instead of people.
BTW. in many stores techs don’t start at $10, but rather at minimum wage. Their raises depend on the store pulling off every single metric, plus the evaluation from Supervising Pharmacist. And at best you can expect 25c per our raise once per year(that’s maximum raise). Usually it’s like 10-16c per hour.
Lets break it down to real numbers. The tech budget is calculated by the chains based on the amount of prescription the store fills. Something like 1 tech hour for every 12 scripts(not actually filled, but sold). Lets take the store I used to work at. We used to fill around 2500 per week. With my pick up rate around 95%, we sold around 2375 Rxs each week. That gives you around 198 tech hours. The pharmacy was open 87 hours per week(14 hour shift with single pharmacist). That gives you 2 techs at all times, plus one more tech for a few hours a day. AND you were required to send one of the techs home, if you could not reach that Rxbudget for the week. With that amount of staff you need to cover: Drop off station, Production station, Pick Up, Drive Thru, and inventory management(one day per week you MUST make your main order, and another day you MUST put the delivery away, that’s 18-20 huge containers. PLUS: you must order from the outside vendor every day, PLUS all flu and other shots, PLUS all doctor calls(hundreds per week), PLUS all patient compliance calls(must make at least 2-3 attempts – that’s another metric).
We did not have a robot or any other pill counter, everything was done manually. With one of my techs covering the Drop Off (she also called to verify some of messed up esripts)and another one jumping between the Pick up and Drive Through, as a pharmacist I was doing complete production, plus verification, plus shots, plus MD (and sometimes patient) calls. Yes. It was 14 hour shifts without a single break.
One of pharmacy’s biggest problems is that it is a profession that is perceived as dealing in a product and not a service, and many of the chains are doing their best to make this a reality. We need to somehow make the patients and the employers understand that this is not the case and our training makes us a lot more valuable than our ability to count to 60 by 5 as quickly as possible.
Ive been a pharmacist for a couple of years, and I am giving the profession a few more years to change before moving to a different field. Going to put me a few years behind life-schedule, but there is NO way this current retail model provides any kind of safety and the under-staffing of the pharmacy is ridiculous – would leave immediately if not for student loans. (And we are one of this large retail chain’s ‘better’ stores)
Ashley..the whole point of the counseling law is to EDUCATE the patients on the medications they are putting in their mouths. APhA slogan KNOW YOUR PHARMACIST, KNOW YOUR MEDICINE. Yes, I agree they should be reading the labels when they’re taking it, BUT do you probably had no idea how many elderly or others use devices such as medisets filled weekly by a family member or a homecare agency to keep track of the numerous meds they do take so they’re not reading labels every time.. The whole point of my comment was if the discussion was done with the patient at time of pick up most of the errors I’ve been reading about would have been caught such as wrong bottles in the bag. And again the point of ‘show and tell’ method during couseling is things like the generic being changed, the patient could be told why the pill is different, thereby possibly cutting down the number of phone calls you recieved about pill changes in your very busy day
But who the heck has the time to do that every time…no one!
Totally agree this would cut down but it’s not feasible. Do you work in retail. Have you worked in retail in recent years? If so you know we struggle to get things done as it is. There simply isn’t enough time not enough help. Period.
Also many working 12 hour shifts with no lunch or dinner break.
I’ve been a tech for 15 years, and still haven’t come close to $10 an hour. For the amount of stress that I endure, it’s not enough.
I’ve been a tech for 15 years and haven’t come close to 10 an hour. For the amount of stress I endure, it’s not enough. Something has to change..soon!
Bingo! I’ve been a tech over a year and still not making $10/hr!
Many commentators i’ve seen on some of these recent story sites, including pharmacy staff put the blame the patient for not checking their stuff. One pharmacy staff comment was ‘we do everything but put the pills in their mouths for them, they need to take responsibility for their own meds’…..My comments had to do with enforcing OBRA90 rules which included counseling, using ‘show and tell method…many of these errors would be caught before they walked out the door.
if a customer doesn’t check or know what pills they are putting in their mouth they are partially to blame. I don’t work in pharmacy anymore bc the pay sucks but how many times people say I need the round white pill to refill. I was glad when customers called and said my pill is a different color or shape from last time I just wanted to make sure it’s ok. blame the CEOs of these big companies. Tom Ryan used to know that struggle as he was a pharmacist before taking over cvs. idk about merlo but they don’t care it’s all about the money
Gosh, this reminds me of my husband’s late aunt who took what she called “her heart medicine,” she had no idea what it was & believed if she missed a pill, she would immediately have a heart attack. Then the pharmacy got them from a different manufacturer or supplier & they were a different color. She threw a screaming, literally screaming fit, if they weren’t the other color, she would die. Even the Pharmacist had a difficult time explaining it to her! She refused to educate herself in the least about her meds, condition, anything, so I understand & agree the person needs to put some effort into their care! I surely don’t just put anything blindly into my mouth, but there’s those like hub’s aunt, no matter how hard you try, they won’t listen.
Steve — this article tells it like it is. 100% on the money.
a recipe for disaster
Yes, a recipe for disaster is right! How many stories I’ve read in just the last month of people finding different pills in the same bottle, RX w/someone else’s name on them. That did happen to my husband, instead of his BP meds, he got someone’s Seroquel, a psych med, I believe. Thankfully he caught it in the parking lot & didn’t take any! Shorting of RX amounts seems to be increasing a lot- are our pharmacy personnel bigger “druggies” than they suspect everyone else to be? Be vigilant & count your RX amounts before you leave, cause once out the door, you’re the thief, not the “we don’t make mistakes ever” crew behind the pharmacy counter.