Balancing Prescription Safety and Cost

Imagine the following scenario: A community pharmacist is working a 12-hour shift. She is 8 hours into a busy day, is the only pharmacist on duty, and has taken only one 5-minute restroom break, with no lunch or time to rest her feet. A patient presents 2 prescriptions, and the fatigued pharmacist misses a contraindicated drug—drug interaction.

This problem is all too common, according to the Chicago Tribune. In fact, a group of reporters there tested the theory. They found that half of community chain pharmacies and upward of 70% of independent pharmacies in their area made this mistake when a reporter posed as a fictitious patient at a random pharmacy. No chain is immune. The one with staff members who failed to catch the dangerous interaction the least still failed 30% of the time.¹ Obviously, this is not an ideal situation, and a state representative in Illinois is trying to change it.

State Rep. Mary Flowers has introduced a bill that would limit pharmacists to a maximum 8-hour workday, with mandated breaks and a limit on the number of prescriptions that each can dispense. In addition, Representative Flowers included protection for anyone who reports a business not complying with these standards. However, opposition is widespread, ranging from lobbyists supporting pharmacy businesses, the governor of Illinois, and even the executive director of the Illinois Pharmacists Association. Gov. Bruce Renner thinks that the bill would increase costs without changing safety. He has proposed a different body of changes to pharmacy practices, which would require that pharmacists counsel for new and changing prescriptions. Meanwhile, Garth Reynolds, the executive director of the Illinois Pharmacists Association, said that the prescription quantity limitations could interfere with patients who require multiple prescriptions to be dispensed at once.²

Although this issue has come to public attention in the Chicago area, no place is immune. Minnesota has already passed a bill requiring breaks for pharmacists working 6 hours and prohibits a workday of 12 or more hours. This bill is expected to take effect this summer. Likewise, Chicago is considering implementing a similar ordinance in addition to the state bill.³ However, every state has different types of working restrictions in place.² Also, each state has different requirements for safety checks, which may be completed as fast as possible because of high prescription demands.

Pharmacists in the Chicago area feel “overwhelmed” and “pressured” to meet demands and quotas.³ This is not surprising, because pharmacists who have worked in a community practice will describe the same feeling. There must be a balance between prescription safety and cost-saving efficiency. Changes must be implemented. The results of a 2016 Johns Hopkins University study showed that medication errors are the third-leading cause of death in America, ranking it above respiratory disease.⁴ Sure, working restrictions could cause the cost of prescription preparation to increase, but how much money would it save overall in the long run? Medication errors require extra time to address patients’ needs and correct the problem. Moreover, they usually merit an investigation into how the error happened, causing resources to be pulled away from care. Certainly, this type of legislation could change the flow of pharmacy practice and how shifts are scheduled. However, this is not necessarily a tragedy, considering the fatigue of pharmacists and the rate of errors. Careful consideration should be taken in evaluating the balance of cost versus safety in pharmacy practice and the changes that this type of legislation could produce. What is the value of a human life?

Rebekah Wahking is a fourth-year PharmD student at the University of Kentucky College of Pharmacy as well as a student in the MBA degree program at the UK Gatton College of Business and Economics.Joseph L. Fink III, BPharm, JD, DSc (Hon), FAPhA, is professor of pharmacy law and policy and the Kentucky Pharmacists Association Endowed Professor of Leadership at the University of Kentucky College of Pharmacy, Lexington.

References

1. Roe S, Long R, King K. Pharmacies miss half of dangerous drug combinations. Chicago Tribune. December 15, 2016. chicagotribune.com/news/watchdog/druginteractions/ct-drug-interactions-pharmacy-met-20161214-story.html. Accessed May 10, 2017.

2. Barrett J. Proposed state bill seeks to alleviate workplace pressures for pharmacists. Pharmacy Times®. February 9, 2017. pharmacytimes.com/news/proposed-state-bill-seeks-to-alleviate-workplace-pressures-for-pharmacists. Accessed May 10, 2017.

3. Long R. Pharmacy lobbyists object to workplace rules proposed by city council. Chicago Tribune. April 19, 2017. chicagotribune.com/news/watchdog/druginteractions/ct-drug-interactions-city-council-met-20170418-story.html. Accessed May 10, 2017.

4. Allen M, Pierce O. Medical errors are No. 3 cause of U.S deaths, researchers say. NPR. May 3, 2016. npr.org/sections/health-shots/2016/05/03/476636183/death-certificates-undercount-toll-of-medical-errors. Accessed May 10, 2017.