Thursday, February 14, 2008

My take on the USA Today article

That's the link to the article in the USA today that many of my fellow pharmacist bloggers are writing about. I don't really feel like rehashing the whole article, but to summarize, a small boy was supposed to get propranolol to help alleviate shaking hands but instead received methytestosterone. How in the world anyone could mistake Inderal (brand name for propranolol) and Methitest is beyond me. Regardless, the boy kept receiving the wrong medication for 2 months before a Walgreens pharmacist caught the error. The author of the article asserts that high volume and poor staffing contribute the prescription errors.

REALLY??? YOU DON'T SAY!!! That was a no-brainer if you ask me. Of course, the fucking corporate clowns of Walgreens, CVS, and Rite Aid are trying to say that there is no evidence that high prescription volume is a factor in pharmacy errors. They said mistakes were (and I quote) "more related to lack of focus."

WHAT THE FUCK DO YOU THINK CAUSES THAT LACK OF FOCUS??? A year ago, my pharmacy was setting store records for prescription volume. That January, our store had a record week of over 3,000 scripts. Then the next week, we broke our record again. When you do the math using the actualy figures (which I've edited out of the post), it comes out to about 37 prescriptions filled per hour. Remember, that's taking into account lower volume days like Saturday and Sunday. A couple years ago, we filled over 700 scripts on the Monday after Easter. It worked out to about 54 scripts filled per hour.

Think about that. 54 scripts per hour is almost a prescription filled per minute. It's awfully hard to focus on one particular prescription when the total filling time (including computer entry, check, filling, final check, and bagging) takes about a minute.

In the article, the President of Pharmacy Affairs for CVS bragged that their error rate was a fraction of 1%. Sounds great, right? Well, let's analyze that percentage. My pharmacy currently fills about 2,500 scripts per week. If we were 99.9% accurate, we'd average about 5 prescription errors every 2 weeks. That's not a number I'd like to live with.

In any case... Other bloggers have already pointed out how understaffing and emphasis on high volume by big chain pharmacies are contributing to these errors. I'm going to also direct some blame elswhere....

Every single customer that walks into a pharmacy and bitches about the wait time for a prescription is partially to blame for prescription errors. Pharmacy is not fast food. If Burger King gives you fries instead of onion rings, it's simply an inconvenience. If a pharmacy gives you the wrong drug, you can die.

This goes for everyone getting a prescription filled at a pharmacy. If the pharmacist says your prescription will take 2 hours to fill, you smile and nod and come back in 2 hours. I don't want to hear you moan in exhasperation and say, "2 hours?!?!?!" I'm using 2 hours as an exagerated example, but the actual time shouldn't make a difference. The wait time we give is the pharmacist's approximation of how quickly he believes he can fill your prescription accurately. It's based on the number of prescriptions you drop off. It's based on the type of drugs on your prescriptions. In addition, it's based upon how many people dropped off prescriptions before you.

I want to punch someone everytime I heard, "Why does it take so long? All you have to do is throw a label on a box!" Once again... this is not fast food. We have to check for proper directions and interactions. We have to double check what we typed into the computer to make sure everything is accurate. Finally, we have to ensure that the product that gets labeled is the correct one. We do this for your safety! We're not trying to inconvenience you. We're trying not to harm or kill you.

When you go for a doctor's appointment, don't you want your doctor to spend as much time as possible with you? You don't want him to look at you for 30 seconds and send you on your way. You want to make sure he's paying very close attention to you. Why the fuck do you expect the pharmacy to be different? Why do you want us to rush your healthcare?

Know what I find really hilarious? I would say more often than not, when I catch an interaction and need to call the doctor to either verify that he was aware of it or to have him switch the medication to something else, customers will complain that they can't have their prescription right away. Are these people fucking insane??? I just told them I spotted a potentially dangerous interaction, and all they can think about is how it's such an inconvenience to have to wait longer. However, these same fuckers would be the first to slap me with a lawsuit if I didn't follow up with the doctor, just let them have the prescription, and they were harmed by it. Fuck you people.

While I'm ranting here... prescriptions for monthly maintanence medications don't need to be filled immediately. I should be able to tell you to come back the next day for your atenolol that you've been on for 10 years. I shouldn't be expected to bang it out in 10 minutes for you.

See... We place so much blame on our employers for forcing this high volume and high stress environment on us. They are a great deal of the problem. However, you have to realize that they're only responding to the demands placed by our customers. They won't tolerate having to wait more than 10 or 20 minutes for a prescription to be filled. Until the attitude of the general public changes, we're going to be forced to rush, and in turn, mistakes are going to be made that shouldn't be.

Basically, my take-home message is that all you people reading these pharmacy horror stories and pointing fingers of blame should pause for a second, take a good look in the mirror, and point that finger right at yourselves. You're attitude is every bit as responsible for prescriptions errors as our employers are.


Carol said...

I've told people that it will be 45minutes or longer. In fact, one pharmacy I worked at had a sign we would put up if it was busy,"Your prescription may take 45 minutes or more to fill". And yup, I had one guy bitch. So I reached blindly behind me , snagged a random bottle off the shelf without looking ,said,"you'll have to sign a waiver that you don't care what pills are in the bottle, and you can have your prescription in 30 seconds" and smiled sweetly at him. He back pedaled immediately.

SparksX7 said...

I love your blog! Everything that I have read over the past week or so from your most recent entries are completely genuine and convey my thoughts exactly. As a future pharmacist and a current employee at Rite Aid Pharmacy as a CPhT I enjoy the fact that this blog exists and I can share a connection that only the workers truly experience behind the pharmacy counter. Keep it up!

pharmacychick said...

Great Post, What makes me crazy is this: in my pharmacy I try like hell to train people to call in at least 24 hours before they want to pick it up, and what does my employer do? Hang freakin signs all over the store telling people "we will fill your prescriptions while you shop" . Just kill me now. I am known for this statement when people bitch about the wait time: I work in two speeds SAFE and pick.

The Ole' Apothecary said...

A colleague of mine used to say, "Half of the time we're slow, and half of the time we're fast. So, we're half-fast."

KC in Fla said...

I've been known to ask these impatient people the following-" Do you want us to fill this RX right? Or do you want it fast? your choice!"
That will usually cause them to back off. That and the sweat that is rolling off me from running between typing/filling/counter/drivethru.
Thanks for voicing what so many have been saying in pharmacys all around!

Gail said...

I've been on several medications for over 5 years now, and I've only had a pharmacist make a mistake once. And we caught it because he was taking the time to show me that they had started stocking a different generic version of my medicine, so my pills would look different. I noticed they were much smaller than what I usually take, and said as much. The pharmacist did a double take, and realized he was about to give me a far smaller dose than I actually take.

I do have to say that while I try to be good and call my prescriptions in a day ahead of time, more often than not I end up calling that same day. But I expect to wait hours, and I try to do it in the morning and pick them up in the evening at least.

I have found, though, that they are usually filled within an hour of two either way.