Accuracy takes back-seat to speed in drive-thru pharmacies

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.

This is unfortunate, since many of the tasks one associates with the pharmacist — typing directions on the bottle, selecting and counting the correct medication and packaging — are actually completed by technicians.

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.

It’s not uncommon for pharmacists to work 14-hour days (8 a.m. to 10 p.m.) with no meal break. No, it’s not legal, but it is the rule in pharmacy practice — not the exception.

This means that if one goes to the pharmacy in the evening for a prescription, it is most likely being completed by a pharmacist who has been on their feet for 10 hours, has only eaten what can be consumed in handfuls over their computer and is now physically and mentally exhausted. Add in the pressure to push scripts through as quickly as possible, and one can see this is a precarious situation.

Patients have been conditioned to expect prescriptions to be filled while they wait. This expectation is due, in large part, to the presence of the drive-thru window. Although it’s meant to be a convenience, the drive-thru has diminished the integrity of pharmacy practice by lowering it to the level of fast food service, while simultaneously setting a dangerous precedent for speed.

“I have gone home and said a prayer asking God to please not let me have made any mistakes that could have caused harm to a patient.” – Texas pharmacist Bill Bradshaw

Not every script that enters the pharmacy can be filled in a moment’s notice, even if it is dropped off at the drive-thru where customers want the speed of a fast food restaurant. The pace expected in the drive-thru, the area most prone to mistakes, is not consistent with care and attention to detail required of the filling process. Unfortunately, no matter the point of service in the pharmacy, speed is revered and accuracy becomes just a detail.

In an interview with KHOU, Texas pharmacist Bill Bradshaw acknowledged the pressure to fill prescriptions faster and with little qualified staff and the fear that comes with the magnitude of the job.

“I have gone home and said a prayer asking God to please not let me have made any mistakes that could have caused harm to a patient,” Bradshaw said.

The fear expressed by Bradshaw is of incorrectly filling a prescription, known in the pharmacy world as a “misfill.” When pharmacists are expected to satisfy filling expectations implemented by management for a particular number of scripts within an allotted time, misfills will certainly follow.

It cannot be debated that with an increase in speed comes a decrease in accuracy. It seems obvious enough, but for the corporate chains, the risk associated with a misfill here or there doesn’t outweigh the increase in revenue generated by by fill quotas.

In other words, profit has become more important than patient safety.

Claudis Alston of Tomball is all too aware of the devastating, life-long repercussions of an incorrectly-filled prescription. According to USA Today, Alston went blind in his left eye following a misfill in which he received ear drops instead of an eye drop prescription; he is currently suing CVS Pharmacy for his loss of eyesight.

Darwin Ta, a pharmacy technician and a recent UH graduate who is now applying to pharmacy school, suggests that it may be possible to begin to change the current pharmacy culture by educating the patient and, in turn, altering their expectations.

“Even though the patient may want their prescription immediately, what they don’t realize is that the pharmacist and their support staff are already occupied with a myriad of other tasks,” Ta said.

“It’s important that the customer be educated to understand that the reason that their prescription may not be able to be filled on the spot is for their own safety. Pharmacies should be known for their accuracy, not for their lightning speed.”

The big-money pharmacy business is not likely to improve without the grassroots efforts of pharmacists who are prepared to become advocates for the changes they wish to see. It’s encouraging that those such as Bradshaw and Ta are willing to express how they feel, considering pharmacy employees are typically very closed-mouthed and hesitant about expressing grievances.

Despite the current state of the pharmacy world, Ta still plans to attend pharmacy school and is optimistic that he and his fellow classmates will be able to improve the pharmacy protocol, but knows that it’s not a feat that can be accomplished overnight.

“The way that pharmacies currently operate is due to an evolution that has taken place over the last decade or so,” Ta said. “Although I am new to the field, I have firsthand knowledge of how things are run. I believe that an initiative has to be taken to change the path of pharmacy practice.”

Hopefully, the culture of pharmacy business will allow pharmacists to work in a setting that acknowledges them as the consummate professionals they are with adequately trained and paid technicians and realistic fill times. Pharmacists need to reclaim their profession.

Opinion columnist Jonathan Bolan is an English graduate student and may be reached at [email protected]