Saturday, April 19, 2014
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Prescription speed-ups leading to errors

Speed should not be a primary determinant 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 when they need a prescription filled.

Prescription speed-ups leading to errors

by Michael R. Cohen, R.Ph.

Speed should not be a primary determinant 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 when they need a prescription filled.

As noted in a previous blog, some pharmacy chains have played this up to help market their prescription services. Last year, one chain, Rite Aid, promised to fill up to 3 prescriptions in 15 minutes or give the patient a pharmacy gift card if they didn’t make the mark. Soon, some other pharmacies responded in like manner.

When pharmacists are given time to properly review each prescription, they are more likely to catch an error – whether made by the prescriber or during the pharmacy dispensing process itself. They are also more apt to spend time with patients to make sure important prescription information is provided. But a rushed pharmacist may never have a chance to do much 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. 

Now pharmacists themselves are confirming this. Nearly 700 pharmacists responded to a survey we conducted this summer in cooperation with the American Pharmacists Association (APhA).  They worked in chain, independent, or grocery store/mass merchant pharmacies as staff pharmacists or managers. The survey demonstrated how policies and procedures related to guarantees to fill prescriptions within a certain time frame are linked to medication errors. 

Almost two-thirds of pharmacists reported that their pharmacy offers time guarantees, ranging from one prescription per hour to 10 prescriptions in 10 minutes (i.e., 1 minute per prescription), with the most often cited guarantee of 15 minutes to fill one to three prescriptions.

Nearly half of the pharmacists said they are penalized if they do not meet the advertised time guarantee expectations, which most often is due to multiple causes including taking care of insurance issues, clarifying the prescription with the prescriber and providing patients with information or other services such as immunizations. Twenty-three percent said they were incentivized through salary bonuses for meeting the time guarantees.

What is worrisome is that eighty-three percent of pharmacists whose pharmacy offers time guarantees reported that this was a contributing factor to dispensing errors and almost half of them felt this contributing factor was significant. In fact, 44 percent of pharmacists working in pharmacies with time guarantees reported a dispensing error they were personally involved in, which was directly attributed to rushing to fulfill the time guarantee. Of the pharmacists who were involved in dispensing errors related to time guarantees, 37 percent did not report the error or errors.

Pharmacists responding to the survey were sometimes given incentives for meeting time goals, but more often they are punished for not meeting them. Yet, the reasons for not achieving the goals are clearly associated with ensuring prescription accuracy, educating patients, providing wellness care, and maximizing pharmacy benefits to promote patient adherence to prescribed drug therapy—all crucial elements to promote patient safety.

At the end of the survey, pharmacists were asked if they favor or oppose regulations from state boards of pharmacies that would prohibit the use of time guarantees or promises. Overall, the majority of respondents (71 percent) favored regulation.

The message that time guarantees sends to patients is this: while it rightfully communicates that your time is important, it can promote unrealistic expectations implying that speed is always possible without sacrificing accuracy. It can also perpetuate an undervaluing of the pharmacist and his or her role in safety. It’s already disheartening that patients have little understanding of what a pharmacist does to ensure the appropriateness and safety of prescription medications.

In the end, the unrushed pharmacist will be the accurate pharmacist, and the unhurried patient will be the safe patient. 

You can read the full report on our website, including many of the comments offered by participating pharmacists. 


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About this blog

Check Up covers major health events in our region and offers everything from personal health advice to an expert look at health reform. Read about some of our bloggers here.

For Inquirer.com. Portions of this blog may also be found in the Inquirer's Sunday Health Section

Michael Cohen id the president of the Institute for Safe Medication Practices in Horsham.

Daniel Hoffman is the president of Pharmaceutical Business Research Associates (PBRA) in Glenmoore, Pennsylvania, a healthcare research and consulting company specializing in key account positioning and messaging.

Michael Cohen
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