Take it from me. After focusing more than 35 years of my professional life on medication safety issues, and reviewing tens of thousands of medication error reports sent to our reporting program, speed should not be a primary factor when selecting a community pharmacy. But that's exactly what people seem to want most from their pharmacy – to get in and get out fast.
If you get Consumer Reports, the May issue features a section on "Best Drugstores." I was stunned to read that a primary determinant in rating community pharmacies was how fast you can get your prescription filled. While Consumer Reports actually called this factor "speed and accuracy," it was defined as, "the factor most closely tied to satisfaction" and "reflects how long readers had to wait for service at the pharmacy counter and whether their medications were ready when promised." There was no actual rating for accuracy, which, in fairness, would have required a scientific study, which was beyond the scope of the report. What a disservice Consumer Reports has committed when it comes to consumer safety!
There's no question that speed is a desirable quality among consumers when choosing a pharmacy. The pharmacy chains cleverly use this knowledge to market their stores. For example, you may have seen a recent Rite Aid Pharmacy TV advertisement that promises customers a "15-Minute Prescription Guarantee" to dispense up to three new prescriptions within 15 minutes or less. If the pharmacy fails to meet the mark, the customer receives a $5 pharmacy gift card.
I don't want to single out Rite Aid because we've seen similar campaigns by other pharmacy chains, with gifts ranging from cash coupons to free movie rentals, meals, and so on. One CVS billboard read, "Get in/Get out"—with nothing else except the CVS Pharmacy logo. If you read the fine print, the Rite Aid ad mentions that "prescriptions requiring ordering, prescriber contact, third party assistance, professional services, or prescriptions presented immediately before or during a Pharmacist lunch break" don't count. Still, the message from pharmacy chains is clear. It's all about speed. I get it; you don't want to wait.
But please keep this in mind: speed reduces safety. You may recall, about 20 years ago Domino's Pizza guaranteed that customers would receive their pizzas within 30 minutes of placing an order, or they would be free. The company later settled lawsuits brought by the family of a woman who'd been killed by a speeding Domino's delivery driver and another suit brought by a woman who was injured when a speeding Domino's delivery driver ran a red light and collided with her vehicle. The 30-minute guarantee was soon dropped.
Again and again, here at the Institute, we hear from consumers who tell us of medication errors that harmed them or a family member. What is a chief cause? Rushed pharmacists unable to take the time to thoroughly check their work. Here's just one example of typical of reports we receive:
"Prescription volume was high. The pharmacist was rushed and constantly interrupted while filling my prescription. The wrong strength tablet (50 mcg) of the right drug (Levoxyl) was dispensed to me in a retail pharmacy (chain) setting. The correct strength was 75 mcg.
Sadly, we also hear from families or their advocates after fatal medication errors. I always wonder if the pharmacist who dispensed the wrong medication felt rushed and/or pressured to fill prescriptions within unrealistic timeframes that can lead to cutting corners and inevitably, medication errors.
If you talk to pharmacists themselves, they'll tell you how much they hate 15-minute (or 10-minute, 19-minute, or any preset timeframe) "promise programs." They hate being rushed and feeling forced to cut corners to meet their company's unrealistic promise. Do a Google search on pharmacists and 15-minute promises, and you will see some of the chatter about it. They feel it jeopardizes public health by discouraging them from spending enough time to:
1) check the patient's history and other medications that have been prescribed
2) verify that the prescribed dose and the directions for use are safe for the patient
3) check that the patient is not allergic to the prescribed drug
4) check to make sure the new prescription medication is safe to take with previously prescribed medications
5) make sure the patient has not been prescribed more than one medicine that serves the same purpose
6) call the prescribing physician's office to discuss a safety concern or clarify a barely legible or incomplete prescription
7) thoroughly double check the medication and label after the prescription has been filled to be sure it is correct
8) educate the patient about the proper use of medications when picking up filled prescriptions
9) perform any other critical task that promotes safety.
Today's prescriptions medications are much more sophisticated than those used a decade ago. Thus, a simple mistake could lead to serious harm. Given enough time to critically think about each prescription and employ high-tech computer software, your pharmacist can capture a mistake that your doctor has made when prescribing the medication and avoid making a mistake when filling the prescription. But a rushed pharmacist may never have a chance to do more than quickly find the drug on the pharmacy shelf, count out the number of doses to fill your prescription, print out a label and place it on the bottle, and put the bottle in a bag for pick-up. These rote tasks may take only 15 minutes or less to carry out, but working at this speed clearly leaves no room for the pharmacist to ensure accuracy.
You can contribute to your own safety by allowing your pharmacist the time necessary to complete each of the functions mentioned above—without distractions. Whenever possible, drop your prescriptions off in the morning and pick them up later in the day. Or, call the pharmacy a day ahead of time for refills. Use interactive telephone systems for renewals. Making sure your medicines are safe and effective takes time.
You can learn a lot more about what goes on behind the pharmacy counter in pharmacies that want you to make safety, not speed, the primary determinant when making a choice in where you have your prescriptions dispensed. I highly recommend clicking on the link above to read an article on this topic.
As an organization, the Institute will also be pursuing the state licensing boards of pharmacy to help limit unrealistic promises to consumers to fill prescriptions within timeframes too short to ensure safety.
For more on ISMP's consumer website, go www.consumermedsafety.org.