Tuesday, June 07, 2011

Someone Goes To Bat For The Profession. Not Surprisingly, It Is Not One Of Our Professional Organizations.

June 6, 2011

Malcolm J. Broussard, RPh
President
National Association of Boards of Pharmacy
1600 Feehanville Drive
Mount Prospect, IL 60056

Dear Mr. Broussard:

As the only national nonprofit organization focused entirely on efforts to prevent medication errors, we are writing on behalf of the Institute for Safe Medication Practices (ISMP) Board of Trustees to voice our concern about a safety issue that has been illustrated by a wave of recent national advertising—promoting and rewarding the speed at which community pharmacies dispense prescriptions for patients. The National Association of Boards of Pharmacy (NABP) and its members should play a key role in discouraging speed as a primary marketing tool for pharmacy services.

One of the largest pharmacy chains, Rite Aid Corporation, now advertises a “15‐Minute Prescription Guarantee,” where up to three new prescriptions will be dispensed within 15 minutes (average of about 5 minutes) or less. If a pharmacy fails to meet the mark, the customer receives a $5 gift card. Although there are some caveats mentioned in the fine print, the message is clear that speed should be a primary motivator in choosing a pharmacy. This trend is not limited to just one pharmacy corporation; other chains as well as independent community pharmacies have, from time to time, initiated advertising campaigns that insinuate or offer similar prescription time guarantees to their customers.

We have heard from pharmacists who claim that their pharmacy’s management actually tracks pharmacist productivity based on the number of prescriptions they dispense and whether or not they meet time promises. A 15‐minute dispensing claim for up to three prescriptions can jeopardize public health by putting pressure on pharmacists to work as quickly as possible and discouraging them from checking the patient’s history and drug profile; looking for possible drug interactions or duplications and other drug use evaluation concerns; calling physicians’ offices for clarification; and educating patients about the proper use of prescriptions (e.g., meeting patient counseling regulations).

It is unacceptable to hold pharmacists to specific timeframes for preparing and dispensing medications, since any mistakes that occur can have devastating effects on patients. Time limits also help promote the idea that the dispensing of medications is a ‘quick in and out process’ that only involves counting tablets.

ISMP frequently receives reports from consumers about medication errors resulting in harm to them or a family member. All too often they observe that the pharmacist seemed so rushed that work could not be thoroughly checked. Examples of serious errors due to volume and workplace distractions have been published in the ISM Medication Safety Alert! Community/Ambulatory Care Edition newsletter.

We realize that there are many issues that need to be addressed to encourage greater adoption of pharmaceutical care and improve safety in community pharmacy practice, such as reimbursement for counseling. But the reality is that community pharmacy prescription programs and inducements for such (e.g., discount coupons) are detrimental to safety and the practice of pharmacy. We should not be educating consumers that the primary determining factor about where they should have prescriptions dispensed is speed.

Since NABP’s mission is to support state boards of pharmacy in protecting public health, ISMP requests that NABP explore and assist members in employing methods to eliminate inducements to consumers that insinuate or promise prescriptions will be dispensed within timeframes that may compromise patient safety.

Sincerely,
Lou Martinelli, PhD, PharmD 
Chair, ISMP Board of Trustees

Michael R. Cohen, RPh, MS, ScD, FASHP
President, ISMP

Cc:   ISMP Board of Trustees
Carmen Catizone, Executive Director, NABP 
William T. Winsley, MS, RPh, Immediate Past President, NABP

15 comments:

Anonymous said...

I work for Rite Aid. My apologies to all real pharmacists out there. Management tells us to give the $5 card to anyone when we don't meet the time guarantee and not to endanger anyone for fear of time constraints. In other words they are covering their asses as they should. The problem is, THE FUCKING CUSTOMER! I rush EVERYTHING I do just to avoid the animals chirping and snapping at my heals. Could I ignore it and just give the coupon? I could, but I would rather chew off my own foot than have a verbal fight with every other douche that walks in to my store. I am not alone, sure there are RPh's that do the right thing and will fight with the animals in order to do a proper job but there are far more that give in like me. THIS is the underlying true danger of the policy. In a world where people were actually civilized human beings a 15 minute guarantee could work. Unfortunately, we are not living there.

Sibyl said...

I remember getting prescriptions filled in Norway. What fascinated me was that everything came pre-packaged in sealed, counted bottles or boxes. Doctors wrote a prescription for a full box or bottle of the medicine. All the pharmacist had to do was go to the shelf, pull off the box with the right number of pills in it, look you up to check drug interactions, then slap a label on the box and hand it to you. When once, my doctor asked for less than a full box (say a week's worth of medications), it involved arguing with the pharmacy. They had to unseal a box, give me just one of the blister packs in a baggie with a label on it, and hope that they could sell the rest of the opened box.

No pill counting required! I guess that was how they solved the time squeeze problem. All the time a pharmacist spent on my prescription was dedicated to making sure the pills wouldn't kill me.

The other kind of cool thing was that the pharmacy didn't keep my prescription. I did. I could have it refilled anywhere convenient. The back of the prescription would be signed, dated, and tagged for each refill. The computer system linked all the pharmacies so they could see if you were doing anything weird.

Anonymous said...

Sibyl, I see two issues with that-- first, I regularly get "weird" amounts of medications when I go up and down in dosages; it must be a hassle for those who need to change their meds.

Second, I know for a fact that I would lose that dang prescription every time. I already had to explain to my doctor that while it might be convenient for some people to get the next month's prescription ahead of time, it's useless when it's lost...

Anonymous said...

I'm not a pharmacist so it never occurred to me how ludicrous and potentially dangerous Rite Aide's 15 minute guarantee is until I read it here. So when asked to fill out a survey, that was one of the things I said, that as a customer, I'd rather the pharmacist take his time and get it right. Because the guarantee isn't attracting me to Rite Aide; the store's location is.

But perhaps the real problem with the guarantee is that it goes against one of the foremost principles of business: that of managing your customers' expectations to the business' benefit. While searching an aisle adjacent to the pharmacy counter in my local Rite Aide today, I overheard a woman asking if her prescription was ready. The clerk looked and said he didn't see it. When had she submitted it? Oh, the lady said, I just came from the doctor's appointment and he called it in. Even if the doc's PA called it in the second the woman's appointment was completed--which is unlikely--WHY would she assume that in the five minutes it took to drive from the doc's to the pharm, it would be ready? Because Rite Aide lets you think that such speed is reasonable.

Admittedly, if you need a med desperately and all you want is to retrieve it and go home to recuperate, having to cool your heels for an hour or so while the pharmacy makes up your prescription sucks. But how often is this the case? I'd guess, rarely. So yeah, go have lunch or do other shopping or plan to retrieve your script another day. Does EVERY aspect of life have to provide instant gratification?

Bluedahlia said...

Sibyl,
There is one big point I want you and all pharmacy customers to understand. Filling - what you saw in the blister packs and all the pre-packaging you saw in Norway- is the easiest and fastest thing a pharmacist can do in the pharmacy. Please, please re-read Drug Monkey's post about why it takes so darn long to get your prescription. It isn't about counting pills and putting them in a bottle. If only one message was sent to our uninformed customer base, I wish this was it. If honestly, you want a pill counter and that's it, yea, you could probably get your prescription in 5-15 mins.
Thank GOD I spent 7 years and 100k in student loans to stuff product A into dispenser B.....

Anonymous said...

The 15-minute guarantee us Rite Aid's way of showing that the company values the customer's time...however it is very stressful on the staff when there are several people dropping off and waiting...when only one technician is working with the pharmacist...fielding more dropoffs, the drive-thru, the phones, etc. Corporate does look at how many times the rx goes past the 15 minute mark, and they assume a gift card has been given...and they contact the pharmacy manager for an explanation as to why the work cannot be accomplished within the timeframe...

anonymous

TechTard said...

I work for RiteAid. It is not a pleasant experience. The pay is terrible and the working conditions are horrendously stressful. Nevertheless, I try as hard as possible to be kind and helpful to the customers.
Due to my age and the need for health Insurance (which is excellent thanks to our union),I stay there. But it is harder every day.
This McDonalds,have it your way,me first,no personal responsibility,selfish,society is only made worse by these stupid marketing schemes. Fortunately,I live in a state that has shut down the 15 minute crap. But corporate acts as if it is fully operational. It sucks.

Mildly Irritated Pharmacist said...

This is why I'm not going back to chain retail. The industry is driven by idiotic business majors who don't understand the profession. Their thoughts are only of pushing pills out the door as fast (and often) as possible, for the least amount of cost to the company.

But this strategy screws over both the pharmacist (who is overworked, understaffed and undervalued) and the consumer (who doesn't get counseled appropriately, is on the receiving end of errors, and has to suffer huge wait times at some pharmacies).

Rite Aid, CVS, Walgreens et. al have the same incompetent business model, and it won't hold up. Someday, a pharmacy will come along built on customer service and spending the extra $15 an hour on that extra tech the pharmacy needs to function properly. That pharmacy would probably charge a little more than $4 for a generic, but people wouldn't care because they know they'll be taken care of and respected. Not to mention have their prescription filled properly.

Of course, maybe I'm putting too much faith in the consumer. Our society has such an overwhelming sense of entitlement. God forbid your prescription take longer than 15 minutes - I want it NOW, I want my insurance to cover it, and I don't care if 16 Vicodin a day is unsafe because it's MY PRESCRIPTION.

Rite Aid's 15 minute program will die just as soon as a person does from a related medication error (sadly, I'm sure it will happen). Meanwhile, I'm more worried about the rise of central fills, which are the height of stupid business major ideas for pharmacy. Have they ever conducted a study where a central fill saves money? I've seen it implemented in a couple regional pharmacies, and since the central fill is staffed with a bazillion people I fail to see how it saves the company time or money.

Someday, just maybe, we'll have a professional organization that stands up for us... instead of standing up for corporate pharmacy.

TechTard said...

Yes, Mildly irritated, I'm sure you are correct.But sadly I think that the grasping,spoiled throng of customers won't understand that their NEED for instant gratification is the cause of consumer death. Soon the late night attorney commercials will not only be about specific medications. I can hear it now - "ARE YOU THE VICTIM OF CARELESS BIG PHARMACY?"

Anonymous said...

"Someday, a pharmacy will come along built on customer service and spending the extra $15 an hour on that extra tech the pharmacy needs to function properly."

I did get a chuckle out of that. The Rite Aids in my state pay minimum wage. All the good talent gets taken by the local McDonalds.

Anonymous said...

I appreciate your post, DrugMonkey. I wonder what the ISMP would have to say if somebody were to inform them of the "30 minutes or less" expectation for infusional CHEMOTHERAPY at my place of employment, a large teaching institution somewhere in the eastern part of this country. It all boils down to what most of the other posts here say-instant gratification. Who cares if your chemo doses are correct? I mean, these drugs can't hurt you, right? Ugh. Don't even get me started.

Anonymous said...

You'd think your professional organization would take the lead; but members would have to push for it and they may not be able to do it publicly for fear of retribution by their idiot employers. Catch-22. I am not a pharmacist and have a question about one of the comments: what is "central fill?"

TechTard said...

"Central Fill" means that the prescriptions are filled at an outsourced location. You may pick them up at your own store,where the prescription is recieved,entered into the processing system and checked by the pharmacist, but the actual labeling and filling of the presciption is done at a "factory". Football field sized processing centers that fill millions of orders weekly. Saves the insurance company money - and even saves you some too - sometimes.
The problem with this scenario is that you are relying on the US Mail to get that order to your home or pharmacy. Nuff said there. Also,it relies on the accuracy of the person entering the prescription info and the pharmacist checking it. Could be a 16 year old cashier entering the script and an overworked pharmacist checking it.It goes out online to the "Central Fill" pharma and is (hopefully) checked again by a cubicle bound or home-stationed Pharmacist with a 4 second directive to check for accuracy and interactions - (or possible one in India or China or Sri Lanka - whatever is cheaper)and then mailed out.

I particularly don't like the labeling from these Central Fill orders. the print is tiny. We have elderly couples on the same medications - different strengths. It would not be hard to program labeling that picks up same household - different patients. And Run a Color Bar on the label. Pink and Blue. Red Yellow Green. Something so that old people don't take each others meds. because they do.

Anonymous said...

http://www.pharmacytimes.com/publications/issue/2011/June2011/The-Pharmacist-Workload-in-Control-of-Your-Destiny

Just thought I would leave this here. This snide "the workload you face is YOUR fault" piece by an ivory tower academic jackass was enough to cause me to cancel my subscription to Pharmacy Times. I was almost shaking mad after reading it. Enjoy!

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