Chaos at Chain Pharmacies

It’s every pharmacist’s worst nightmare…making a serious prescription error while they are rushing to fill prescriptions for waiting customers. Yet this nightmare becomes a reality all too often, even more so now than in the past, as the computer age has everyone accustomed to instant customer service. Many pharmacists believe that even one Rx error is too many.

Last Saturday the New York Times published a front page story titled:

“How Chaos at Chain Pharmacies Is Putting Patients at Risk”

In letters to state regulatory boards and in interviews with The New York Times, many pharmacists working at chain pharmacies like CVS, Rite Aid and Walgreens described understaffed and chaotic workplaces where they said it had become difficult to perform their jobs safely, putting the public at risk of medication errors. They struggle to do all of the following things, while racing to meet corporate performance metrics that they characterized as unreasonable and unsafe in an industry squeezed to do more with less:

• Fill prescriptions
• Administer vaccinations
• Tend the drive-through
• Answer phones
• Work the cash register
• Counsel patients
• Call prescribers' offices
• Call insurance companies
• Handle inventory

Michael Jackson, chief executive of the Florida Pharmacy Association, said the number of complaints from members related to staffing cuts and worries about patient safety had become “overwhelming” in the past year. Regulating the chains can be difficult; Florida’s nine-member state pharmacy board includes a lawyer for CVS and a director of pharmacy affairs at Walgreens. Pharmacists are often afraid to speak up, fearing retaliation. The chains deny that their pharmacists are under extreme pressure, yet their bonuses are often tied to the number of prescriptions they fill and call lists completed.

CVS accounts for one-fourth of the United States’ total prescription revenue and dispenses more than 1 billion prescriptions per year; Walgreens captures about one-fifth. The chains declined to provide data about the numbers of mistakes made, and much of the information never becomes public because companies often settle with their victims out of court, requiring a confidentiality agreement. A CVS form that staff members use to report errors asks whether the patient is a “media threat”. The last study made public was in 2006; it concluded that pharmacy mistakes harm 1.5 million Americans annually.

“A fatigued and distracted pharmacist in a fast-paced, chaotic environment is much more likely to make an error. The harm from such an error ranges from being a slight inconvenience to being fatal.”

--An anonymous Texas pharmacist

https://www.nytimes.com/2020/01/31/health/pharmacists-medication-errors.html

What can your members do to prevent errors?

Take an active role in your health

• Compare prescription information from your prescriber to the medication you pick up at the pharmacy/ prescriptions delivered to you (if using mail order).
• Familiarize yourself with drug names, dose, dosage forms, and directions to help identify a possible error before it impacts your health.
• Access pharmacy apps and digital tools where you can review your pertinent prescription history.

Ask your pharmacist

• One of the most important responsibilities your pharmacist has is patient consultations
• Utilize them as an expert source of information regarding your prescriptions. This allows your pharmacist to take another look to review your prescription to ensure there are no errors.

Utilize free resources

• Carefully read and examine your prescription label; it contains information about the appearance of the tablets/capsules/liquid etc. 
• Cross-reference that to what appears inside the vial.
• Do not assume it is a change in manufacturer or supplier. Free websites like www.drugs.com  and www.WebMD.com  can help identify drugs.