Monday, February 22, 2016

Trend In Prescription Drug Errors -- My Thoughts

Recently CBS Boston published an article entitled, I-Team: Report Suggests Trend In Prescription Drug Errors Filled By Pharmacists. Here's the original LINK.

My thoughts are in BLUE.

BOSTON (CBS) — Anyone who has waited in a drug store for a prescription knows a pharmacy counter can be a busy place.

“It’s a high-pace, high-stress environment,” a former CVS pharmacy technician told the I-Team.

She did not want to be identified, but she believes that stress leads to mistakes.

“Somebody gets the wrong strength of medication, somebody gets the wrong number of pills,” she said.

I will tell you that yes, this does happen. What people don't know is that most errors are caught BEFORE they leave the pharmacy. All Boards of Pharmacy want a 0% error rate, and pharmacies are, for the most part, very close to 0%.

The I-Team obtained documents detailing prescription drug errors reported to the State Department of Public Health. Since 2010, pharmacies reported 194 serious drug errors. In one case, an allergy drug was given to a patient instead of a high blood pressure medication. In another case, a patient got something for acid reflux instead of an anti-depressant, and an arthritis drug was given to someone who needed a medicine for seizures.

Like I said, all pharmacists and technicians want a ZERO error rate. When you look at how many prescriptions were filled during this time period, 194... most likely out of millions, results in a statistical zero. 

But that doesn't make any pharmacist feel better.

And there is overwhelming pressure from The Authorities to continue to do more and more with less, and it does cause stress and errors:

The pharmacy technician believes a growing trend in pharmacies is behind all that stress and the errors.  It is called performance metrics, a system used to measure how many prescriptions a pharmacist fills and how fast.  It also counts flu shots and phone calls pharmacists make to patients urging them to fill prescriptions. If the pharmacist falls behind, she says, they’ll hear about it. “You didn’t make all of your 50 phone calls. I want you to write an action plan to tell me how tomorrow you are going to get all of your prescriptions filled, get your phone calls made plus give out x number of flu shots,” she said describing what pharmacists she worked with were told.

CVS would not talk to us on camera, and would not allow our cameras inside their stores, but they did invite the I-Team inside a store to see how the system works. Company representatives told us if metrics contributed to mistakes they would change the system.  


Translation: They'll fire the pharmacist or technician that can't keep up with the metrics and find someone else who can... for awhile.

In a written statement the company said: “The health and safety of our customers is our number one priority and we have comprehensive policies and procedures in place to ensure prescription safety.”

This is really a bunch of crap. Policies and procedures are nothing more than the company protecting itself. When something goes horribly, horribly wrong... the company can say "We're not at fault. It's the pharmacist or tech that didn't follow procedure."

It's IGNORING the real culprit. If the ONE thing that leads to less stress and less errors is MORE help, why isn't the ONE thing to hire MORE help? 'Splain it me, Lucy.

In spite of those assurances, pharmacists are starting to speak out against metrics. Susan Holden is the president of the Massachusetts Association of Pharmacists. She worked under a metrics system at a different drug store chain. “It was very nerve-wracking, very stressful, sometimes tearful,” she recalled.  Holden now works as a hospital pharmacist and she says metrics puts too much stress on pharmacists. “Ultimately, I was afraid of harming a patient,” she said.

This is something EVERY pharmacist thinks about every day.

A survey of nearly 700 pharmacists conducted by the institute for safe medication practices found that more than 83 percent believed performance metrics contributed to dispensing errors.

Susan Holden believes if something doesn’t change, the problem could get worse. “The worst case scenario, it could be a very dangerous prescription error. I think anybody could draw a conclusion about what could happen,” she said.

The National Association of Boards of Pharmacy is urging states to restrict the use of metrics that are proven to compromise safety.  The Massachusetts Board of Pharmacy has taken no action.

Sounds exactly like my state's Board of Pharmacy.


Anonymous said...

Money talks, bulls**t walks.

In the end, the big three will just throw money in the form of middle management bonuses at the problem and simply get more good pharmacists and technicians fired. One major reason why we're powerless to do anything is that middle managers know that there are plenty of new and out-of-work pharmacists that are willing to take a paycut to get hired.

Corporate knows this.

Those a$$hats sit in their corner offices and laugh their asses off when they see stories like this. Why? Think about it. They're in love with numbers, i.e. metrics. Those precious numbers also tell them that a non-zero error rate is an acceptable risk because for them, making money is more important than quality patient care.

Anonymous said...

It's that way with my line of work, too. I work for a large medical transcription company. It's all about metrics--right down to what keystroke combinations we use--and the paycheck is tied to those metrics. If I have a mistake on an audit, it lowers my paycheck. If I'm too slow, it lowers my paycheck. If I have to send too many reports to Quality Control for a second listen because I cannot with 100% accuracy figure out what the dictator is saying because he/she is mumbling, eating, yawning, belching in my ear, driving down the highway with the windows down, watching the big game on TV and dictating between plays, it lowers my paycheck. They talk a good game about patient care, but their actions are all about metrics.

Unknown said...

Damn metric system. That $h!t has never been easy to understand. Give me good old inches and pounds any day of the week.