Rebekah Wahking, PharmD,MBA Candidate

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 

 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.

 Obviously, this is not an ideal situation, and a state representative in Illinois is trying to change it.

 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.

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.

 However, every state has different types of working restrictions in place.

 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.

 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.

 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.

1. Roe S, Long R, King K. Pharmacies miss half of dangerous drug combinations. 

chicagotribune.com/news/watchdog/druginteractions/ct-drug-interactions-pharmacy-met-20161214-story.html

2. Barrett J. Proposed state bill seeks to alleviate workplace pressures for pharmacists. 

pharmacytimes.com/news/proposed-state-bill-seeks-to-alleviate-workplace-pressures-for-pharmacists

3. Long R. Pharmacy lobbyists object to workplace rules proposed by city council. 

chicagotribune.com/news/watchdog/druginteractions/ct-drug-interactions-city-council-met-20170418-story.html

4. Allen M, Pierce O. Medical errors are No. 3 cause of U.S deaths, researchers say. NPR

npr.org/sections/health-shots/2016/05/03/476636183/death-certificates-undercount-toll-of-medical-errors

Articles

Balancing Prescription Safety and Cost

Employment issues are high on the list of conundrums lawmakers face. These include noncompetition clauses, commonly known as noncompetes, in employment contracts. Noncompetes are legally binding contracts that hold the power to prevent professionals from seeking similar employment opportunities in their field of expertise.

Since the Mobility and Opportunities for Vulnerable Employees (MOVE) Act was introduced at the federal level in 2015, many officials have questioned the appropriateness of noncompetition clauses. This congressional legislative proposal, if passed (a move that appears unlikely), would “… prohibit employers from requiring low-wage employees to enter into covenants not to compete…”

 In pharmacy, this law would mainly apply to hourly technicians and interns making less than $15 an hour (or minimum wage, whichever is higher) and prevent any future restrictions on time between work, location of work, or scope of work.

The details of what is legally acceptable in these agreements can vary from state to state.

 In 2016, state level action was taken during in Illinois, Massachusetts, and New York to address use of these clauses. California, North Dakota, and Oklahoma already have laws against them.

 This state-level legislative activity begs the question: if many states are willing to enact laws against noncompetes, why is the MOVE Act expected to fail at the federal level?

As many individuals might surmise, this issue is not cut-and-dry, and affects more employees than many would suspect. In 2016, 15% of college graduates and 14% of employees with a salary less than $40,000 were subject to limitations in their employment agreements. With this portion of the workforce affected, this issue can have far-reaching effects.

There are valid arguments on each side of the issue. Supporters of noncompetes believe they encourage competition, emphasize the importance of appropriate training to prevent employees from leaving their positions, and prevent trade secrets from being shared among competitors. The opposition believes noncompetes diminish employees’ rights to switch jobs for better pay and benefits, as well as prevent employees from finding new positions for which they are qualified.

 “Positions” emphasizes the fact that candidates may be precluded from employment at multiple jobs. If the contract is broken, former employers are entitled to seek a court-ordered injunction to ensure the agreement is not breached again.

According to an e-mail alert directed to antitrust attorneys working in the health care field, with careful examination, noncompetes could play an appropriate role. The limitations they set are most suitable for employees who have access to proprietary information or delicate trade secrets. Along those lines, restrictions of less than 2 years and that do not specify locations are more likely to be positively received by the courts. The author of the e-mail alert suggested ways to avoid legally unfavorable restrictions by using alternative contractual provisions, such as restricting use of intellectual property.

 In any legally binding agreement, all alternatives should be evaluated for use.

Although technicians and interns may not possess trade secrets warranting a noncompetition clause, their patient relationships are important for employers to protect. The same is true for pharmacists, even though they would not be affected by this particular piece of legislation. Patients tend to gravitate toward those they trust. Therefore, if long-time staff members leave a pharmacy for one that is nearby, patients could follow. Whether this warrants a noncompete clause is debatable. Before signing a contract bearing such a provision, all employees, including technicians, interns, and pharmacists, would be wise to consult an attorney to be certain of the terms and implications of the agreement.

, a native of Lexington, Kentucky, is a third-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. 

, 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, Lexington.

Fink III JL. Pharmacy law brief: non-competition agreements in pharmacy practice. 

Mobility and Opportunity for Vulnerable Employees Act, S1504, 114

 Congress (2015). congress.gov website.  congress.gov/bill/114th-congress/senate-bill/1504. Accessed March 1, 2017.

AHLA Practice Groups. Authorities increasing scrutiny of employee noncompete agreements [e-mail alert]. Washington, DC: American Health Lawyers Association; June 27, 2016.

Employment issues are high on the list of conundrums lawmakers face.