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Do Speedy Prescription Guarantees Compromise Safety?

Published Online: Wednesday, June 8th, 2011
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By Kate H. Gamble, Senior Editor



During the past few weeks, a number of physician bloggers have raised concerns about advertisements that promote and reward the speed at which community pharmacies dispense prescriptions.

Now, the Institution for Safe Medication Practices (ISMP) is getting involved by asking the National Association of Boards of Pharmacy (NABP) for support in discouraging speed as a primary marketing tool for pharmacy services.

“ISMP believes that prescription guarantees help promote the idea that the dispensing of medications is a ‘quick in and quick out process’ concerned only with counting tablets,” according to a statement. The organization “finds it unacceptable to hold pharmacists to an unrealistic timeframe that can lead to medication errors.”

Rite Aid Corporation advertises a “15-Minute Prescription Guarantee” where up to 3 new prescriptions will be dispensed within 15 minutes or less. If a pharmacy fails to meet the mark, the customer receives a gift card. A number of other chains as well as independent pharmacies have also initiated advertising campaigns that offer similar guarantees to motivate customers.

The problem with these claims, according to ISMP, is that they 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; verifying that the prescribed dose and directions for use are safe for the patient; checking 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.

And patients, according to ISMP, have noticed. The organization has received reports about serious medication errors in community pharmacies where the pharmacist seemed so rushed that work could not be thoroughly checked.

A number of pharmacists have also expressed concerns, according to ISMP President Michael Cohen, who wrote in a recent blog that pharmacists “hate being rushed and feeling forced to cut corners” to meet “unrealistic” demands.

When pharmacists are given ample time to review each prescription, they are more likely catch an error made by a physician and avoid making a mistake when filling a prescription, he wrote. On the other hand, “a rushed pharmacist may never have a chance to do more than quickly find the drug on the pharmacy shelf, count out the number of doses to fill your prescription, print out a label and place it on the bottle, and put the bottle in a bag for pick-up.”

ISMP plans to petition the state licensing boards of pharmacy to help limit “unrealistic promises to consumers to fill prescriptions within timeframes too short to ensure safety.”

It is also requesting 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.”

To read the letter to NABP, click here.
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Lisa   June 8th, 2011 05:06:3305:33:47 PM
If retail stores had enough tech hours there would not be such an issue with waits. but when the tech hours have been cut or the tech is ringing up prescriptions rather than doing tech work, this increases wait time.
Jade   June 8th, 2011 07:06:0707:07:52 PM
I believe that, similar to what the article stated, a big issue here is the public's perception and their expectations. It is very frustrating when the same patients who will wait every morning in the Tim Horton's line up for 20 minutes to get their coffee without so much as a grumble, find it unreasonable to wait for their medications. I think if we can educate the public about what we are actually doing "behind-the-counter" they may have a greater appreciation for the time that it can take to fill a medication.
Brent   June 11th, 2011 08:06:4908:49:01 AM
The bottom line to me is this; We've allowed our profession to be reduced to that of a fast-food franchise. Does any other healthcare provider make such an absurd claim? We give everything we've learned away for free and and stand open-faced in front of the PBM's, the chains and the public without a leg to stand on. Being forced to do anything in an accelerated fashion is foolish and dangerous for the patient.
Bruno   June 14th, 2011 01:06:5901:59:34 PM
The author describes retail pharmacy in its most basic form. Many wish it were that simple. What about all the time attendant to the sorting out patients' Rx insurance conumdrums, the flurry of reports to file with corporate or various government agencies, or the demands of the chain drug industry's newest obsession - vaccinating the public? All this and more with widespread reductions in staffing for pharmacists and techs. Retail pharmacy was getting ugly enough when I left it 25 years ago, but now?
Jim Giddens   June 14th, 2011 07:06:5807:58:24 PM
I as a pharmacdist, retired in 2006 from a major chain, ten years after selling my independent pharmacy to them. I operated a independent pharmacy for over 25 years. Yes, speed should not be a major issue with prescriptions filling as it is. No way to cover the full issue here in reasonable time.
Tech help is important in todays pharmacy world (not in my time). However the more tech help you have, the faster and more prescriptions you have to check that you actually had nothing to do with filling except checking it as it comes by, up to as high as 900 per day. In my earlier years, I did hands on prescription filling. My drug clerk was allowed to run refill labels through the computer (when I finally got a computer) and to ring up the prescription. This meant I had the manufacture's bottle in my hands at least 3 times while filling the prescriptions, giving me plenty of time and chances to catch any mistake I made. Todays tech's are good, but are not pharmacist and do not have the full burden and legal responsiblity as the pharmacist has. The pharmacist are the ones that their career is on the line if a mistake leaves the pharmacy. The chain has already had the pharmacist sign a waiver, in case a mistake is made, the chain is not at fault because the pharmacist signed a paper (to get the job) that he/she will do all this mulitple checking to prevent a mistake from living the pharmacy. The techs also are pressured for time and the pharmacist is so rushed that if he has a doubt about the prescription that needs to take a few mintues to check out, he is inclinded to think, "my tech are ususally right" and let it fly. This just can not be done but it does slow down the filling processess. In the case of the chain I worked for, the computer print out would report me for how many times I did not have the a prescription filled by the time promised by the comptuer. The techs/pharmacist were also told to never tell a customer that waiting time would be over twenty minutes, no matter how many prescriptions were in front of him. Another problem is that techs, realizing the pharmacist is so rushed, oftern time they will consel with patient that is not their legal duty. The pharmacist has little if any time to observe such actions by the tech. Plus everyone behind the prescription counter is wearing a white coat and many times are assumed be a pharmacist and what they say must be right. A pharmacist should also always be willing to look up the correct answer if he/she is asked a question but is not positive about the answer.
The tech will be right probably 99 times out of a hundred, but that could be several prescriptions a day. The pharmacist had better keep his eye on the ball.
The trouble is, the profit is cut so low by low presriptions prices compared to the cost to the pharmacy, the volume is a necessity to the chain.
I could ramble on and on, but I better stop.
Gina Wilkins   June 14th, 2011 10:06:4510:45:20 PM
what to do when the PBM in certain cases owns the chain pharmacy, and i so hate the fact their profits were less than anticipated.
Marie   June 15th, 2011 02:06:5702:57:12 PM
I am a pharamcent who recently retired from Rite Aid. The "15 minute guarantee" was the final assualt on the profession of pharmacy by Rite Aid that forced me to retire early. It is not possible to practice pharmacy in an accurate and safe way under this policy. Not only did they institute this program but at the same time they decreased the support staff and stopped all overtime. After over 42 years in practice I felt I had to walk away. This is not pharmacy I wanted to practice. My parents owned an independent pharmacy and I married a pharmacist. We both worked for an independent pharmacies who sold out to Rite Aid. My values were instilled in me by my parents and I refused to compromise for sake of a dollar. It is unfortunate that big business with, no understanding of the practice of pharamcy, has a major control of our profession. I'm afraid regulations are needed to stifle the quest for the almighty dollar. Regulations are needed to control the number of techs a pharmacist can oversee to the hours worked per shift. Some pharmacist are working 14 hour days with no real breaks if you add in commuting time for many it's a 16 hour day far too long to remain alert. I only hope the profession can continue to be trusted by the public.
PAT   June 16th, 2011 08:06:2508:25:55 AM
I have been a pharmacy technician for over 40 years and am "old school" on how to count and check the prescriptions. My employer is constantly harassing me about how slow I am, as we also have a 15 minute or less time frame. I admit, I am slower than some of the younger technicians, but, I make less mistakes. I refuse to compromise on this. Therefore I am sure I will be out of a job pretty soon. Sad, isn't it ?
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