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Another Crack Unveiled

Last month investigative reporter Ellen Gabler posted a very in-depth, well-researched article in the New York Times revealing allegations that chain pharmacy practices are an endangerment to the American public. The article heavily focused on CVS, though it did discuss other chain pharmacy institutions as well. Many pharmacists wondered if this was our big breakthrough- our chance to finally reach the public with an outcry of desperation. Aside from a hasty and widely-criticized press release response from CVS though, not much has immediately changed, and many feared that the discussion would simply die down over time, and the window of opportunity would quietly close.


Ms. Gabler, though, was not finished. Today she published a new article, At Walgreens, Complaints of Medication Errors Go Missing in which she details events that apparently unfolded after Walgreens contracted with an external consultancy firm to review "how employees used the computer system" and later move on to "improving the pharmacy’s computer system."


In the course of this process, the consultancy firm visited several pharmacy locations and engaged with the store-level employees in order to gain a better understanding of how users interacted with the system on a day-to-day basis. Their initial report of their findings indicated that extreme pressure, stress, and a push to meet the metric of "promise time" resulted in pharmacy employees sometimes skirting safety measures - a valid observation if you are trying to evaluate how users interact with a system.


However, top officials at Walgreens asked that these findings be removed from the report prior to it's final presentation at the Deerfield, Illinois headquarters in order "to help ensure that the report appropriately focused on the most relevant aspects of the technology and user experience."


On my initial read-through of this article, my first thought after reading this portion was concern for the pharmacists who actually spoke with the consultants at the referenced eight Walgreens pharmacies - if Walgreens is aware of which pharmacies those are, and they almost certainly are, the employees working on the days in question may soon unwillingly find themselves seeking new employment. For some other reason, of course.


The article moves on to further discuss errors and understaffing complaints at other chain pharmacy locations, circling back again to CVS. This time we hear from an Oklahoma Board of Pharmacy Inspector who spent three and a half hours in a particular CVS location to audit their operations after a serious dispensing error led to patient harm. He found an egregious error rate of 9.5% after reviewing 200 prescriptions. What's not reported is how many of those errors had already been documented by any internal reporting systems CVS may have. It is mentioned that many errors never make it to the reporting stage simply because there is not enough time for staff to complete the process, especially for errors that are considered to be minor.


The "lead pharmacist" at the location in question told the investigator that each pharmacist employed there was already working 20 to 30 extra uncompensated hours every week just to keep their coworkers afloat after his pleas for increased staffing were denied. If there are 3 pharmacists there, that's up to 90 hours of pharmacist labor that CVS is essentially getting for free - 3 people doing the work of at least 5, and that's just to accomplish the bare minimum. It doesn't account for how many labor hours they would need to adequately complete the legal requirements of dispensing that are often brushed aside due to time constraints (namely counseling and DUR investigation, tasks that ONLY pharmacists are legally allowed to complete).


The article also comments that on the date of the dispensing error that prompted the investigation, the pharmacist on duty was responsible for completing 194 prescriptions in the space of a 6-hour shift - approximately one Rx every 2 minutes. Perhaps if the pharmacist had adequate technician staffing and was solely responsible for verifying and counseling on those prescriptions that may not be so bad. But when calculating in time the pharmacist likely spent on other tasks and interruptions, you would find the actual time he would have had available to spend on accuracy checks, safety checks, and patient education to be much, much lower than 2 minutes for each prescription.


CVS is quoted as stating that they "looked 'forward to addressing the allegations' at [an] upcoming hearing, adding that 'our record of patient safety is outstanding and we are committed to continuous improvement.'" This record, however, is not reported in any quantifiable manner, and even if it was, a quick look at the FAQ of the Institute for Safe Medication Practices makes it clear that "counting reported errors yields limited information about how safe a medication-use process actually is. It is very possible that an institution with a good reporting system, and thus what appears to be a high error 'rate,' may have a safer system."


In closing, the article reviews several responses to last month's article including a letter from Larry Merlo, a statement from CVS, and another letter from the founder of a Facebook group for Pharmacist Moms.

My final observation after reading is that much like the first article, when I ventured to the public comments section as I inevitably do (and usually inevitably regret), I was surprised to see an overwhelming lack of comments attacking pharmacy personnel. Most readers seem to sympathize with our situation and reserve their outrage for the system and and the shot-callers creating and enforcing it.


I sincerely hope that this vein of reporting is continued and results in a deep, critical look at the current pharmacy situation - please keep it up @egabler! Pharmacy employees and our patients desperately need your voice to reach the ears of America.


#pharmacistanonymous #pharmacycarematters #medicationsafety #patientcare