Investigative Report Leads to Changes in Illinois

AFTER AN INVESTIGATION CARRIED OUT by the Chicago Tribune, Illinois Governor J.B. Pritzker’s administration pushed for new state regulations that would require adequate breaks and reduced workloads for pharmacists.¹

During the 9-month investigation in 2016 involving 255 pharmacies,
the newspaper’s goal was to assess how many pharmacies would dispense dangerous medication pairings without consulting with the patient. More than half (52%) of these pharmacies failed the test and dispensed the medications with no warnings about possible adverse effects.¹

Why is this such an immediate health risk?

Hazardous drug interactions are the cause many hospitalizations each year. The pharmacists’ role as the final barrier between the community and a risky drug combination is essential and continues to grow.

Approximately 20% of Americans take at least 5 prescription medications, according to the journal Mayo Clinic Proceedings.² As more patients continue to add medications to their regimens, pharmacists are tasked with an increasingly important role to assure internal consistency and compatibility among the mix.

Contributing to this public health threat is the increasing number of tasks pharmacists are expected to do despite many interruptions. Not only do they verify prescriptions, but they also address questions, administer immunizations, and assess patients’ drug histories.¹ With all these responsibilities, along with the prescriptions continually rolling in, it is easy for pharmacists to feel overwhelmed. What changes can be made to address this situation?

State officials created a task force to assess and identify where the shortcomings in the system are and how they can be dealt with.³ One of the recommendations was to mandate breaks for pharmacists, especially if they are working a long shift.

For every 6 hours worked, pharmacists have a 30-minute meal break and an additional 15-minute break. When working a 12-hour shift, another 15-minute break would be added.

The task force rejected proposals to pay pharmacists triple if the employer does not provide a break.¹

The task force also expressed concern that pharmacists were not being compensated appropriately and noted that until the pharmacist payment model is refined, there would not be sufficiently large improvements in the quality of care.³

As for the overwhelming workload, the new recommendations require pharmacies to allow sufficient time for duties to be performed and also recommend that the tasks of a pharmacy technician be expanded. For example, techs can transfer prescriptions or, after completing a certified training course, give vaccinations.

Philip Burgess, RPh, the task force chairman, emphasized that the goal of the changes was to “improve patient care.”

One organization that wanted the recommendations to go further
was Teamsters Local 727,1 which advocated for an 8-hour limit on shifts. Twelve-hour shifts are common for pharmacists and can lead to drowsiness and difficulty maintaining focus.

Former Illinois Governor Bruce Rauner, who was in office when the Tribune report was published, acted to require pharmacists to counsel patients on medications that were new to them if there was a switch in doses, including counseling on possible drug interactions. When Pritzker took office in 2019, the task force expected would be action toward broader changes.¹ So, where do things stand?

As of January 1, 2020, legislation revising the Illinois Pharmacy Practice Act (Public Act 101-0621) was implemented. It not only extended the changes advocated by Rauner until 2023 but also implemented some of the task force recommendations on to improve patient safety. This act states that pharmacists must get a 30-minute meal break and a 15-minute break for a 6-hour shift, along with an additional 15-minute break for 12-hour shifts. It also requires pharmacies to keep records of pharmacists’ breaks. It did not, however, limit shifts to 8 hours, and the limit remains at 12 hours.⁴

Enforcement of the new rules is performed by state inspectors after grievances are filed by pharmacy employees and even patients.¹

Pharmacists play a huge role in helping combat the rising public health issues related to appropriate medication use.

It is imperative to ensure that they can do their jobs to the best of their ability to keep patients healthy and safe.

AUTHOR BIOS

Lauren T. Friedrich is a PharmD candidate at the University of Kentucky College of Pharmacy in Lexington.

Joseph L. Fink, III, JD, BSPharm, DSc (Hon), FAPhA, is a professor of pharmacy law and policy and the Kentucky Pharmacists Association Endowed Professor of Leadership at the University of Kentucky College of Pharmacy.

REFERENCES

1. Long R. Illinois pharmacists would get breaks, more time to get prescriptions right under patient safety plan spurred by Tribune investigation. Chicago Tribune. October 25, 2019. Accessed March 25, 2021. https://www.chicagotribune.com/investigations/ct-illinois-pharmacies-prescriptions-breaks-reform-20191025-eztzoiawurdz7ipiw5vjmayi5q-story.html
2. Nearly 7 in 10 Americans take prescription drugs, Mayo Clinic, Olmsted Medical Center find. News release. Mayo Clinic. June 19, 2013. Accessed March 25, 2021. https://newsnetwork.mayoclinic.org/discussion/nearly-7-in-10-americans-take-prescription-drugs-mayo-clinic-olmsted-medical-center-find/
3. Balick R. Illinois legislature to consider mandatory breaks, simplified workload for pharmacists. American Pharmacists Association. October 29, 2019. Accessed March 25, 2021. https://www.pharmacist.com/article/illinois-legislature-consider-mandatory-breaks-simplified-workload-pharmacists
4. Illinois Health and Hospital Association. New pharmacy workplace rules enacted by Public Act 101-0621 (SB2104). January 27, 2020. Accessed March 25, 2021. https://www.team-iha.org/files/non-gated/quality/pharmacy-practice-act-member-memo.aspx?ext=.