With recent reports that the Oklahoma Board of Pharmacy is investigating chain pharmacies for inadequate staffing levels,1 as well as a New York Times report on the dangers of understaffing,2 many pharmacists are speaking out about understaffing and stressful work environments, all of which leads to potentially dangerous errors.

A 2015 survey from researchers at the University of Arizona queried 672 pharmacies that filled an average of 18,000 prescriptions from January 2003 to March 2003, totaling 1375 prescriptions per week. During the research period, the number of potentially harmful drug-drug interactions dispensed by each pharmacy averaged 32.1.3

The pharmacies in the study employed an average of 1.2 pharmacies per hour the store was open and each pharmacist filled an average of 14.1 prescriptions per hour. Notably, the researchers found that the risk of dispensing potentially harmful combinations of medications increased by 3% for each additional prescription filled per hour.3

Pharmacists say that understaffing, stressful work environments, and a lack of support are all contributing to these dispensing errors.

Suzanne Soliman, PharmD, BCMAS, founder and president of the Pharmacists Moms Group, said she receives many emails from pharmacists who are frustrated with their work environments but feel unable to speak out.

"They're rushed, [and] I would say some of them are nervous," Soliman said in an interview with Pharmacy Times®. "A lot of the pharmacists that I encounter, they're anxious and depressed and they're suffering from anxiety because they have to do things so quickly."

Soliman sees several possible contributing factors to the understaffing problems, which she said are very widespread.

Although she acknowledged that it has also affected independent pharmacies, Soliman said chain pharmacies are affected the most because they fill a much higher volume of prescriptions.

"[Chain pharmacies] have these high-volume stores, pharmacists are expected to go through and check multiple prescriptions during their shifts, and then they have no one there to answer the phone [or] if there's a drive-through," Soliman said. 

Soliman also pointed to low reimbursement rates, which she said put pressure on stores to improve profits and save money wherever posible—even by laying off staff and minimizing the number of personnel behind the counter.

In a letter to the editor of The New York Times from the Pharmacist Moms Group, Soliman encouraged chain pharmacies to be more transparent about their staffing practices and error rates.

"In an effort to support full transparency, we are asking chain pharmacies to publish all of their metrics for calculating pharmacist and technician hours and ultimately error rates," she wrote in the statement. "We also encourage pharmacies to publish how many prescriptions are filled each month and how much staff they have so that patients can make an informed decision as to which pharmacies provide adequate staffing to suit their needs."4

Understaffing and stressful environments can be particularly dangerous when they result in medication errors. Some pharmacists, however, are concerned that pharmacy chains are sweeping the errors under the rug. A recent report from The New York Times said that staff reports of high stress levels and "unreasonable" expectations were removed from a corporate presentation.5

In an email to Pharmacy Times®, a representative of Walgreens said, "Ensuring that we are providing high quality and trusted pharmacy services to meet the needs of our customers, while also ensuring the well-being of each of our pharmacy staff members, are critical factors in determining staffing needs across our pharmacies."

Soliman said that many pharmacists feel there's nothing they can do individually to solve the problem, but she suggested several broader changes that could help. Providing more staffing is the obvious solution, but the deeper issue is the low reimbursements that result in understaffing, according to Soliman. Encouraging transparency and reforming pharmacy benefit managers is a necessary step to improving the financial situation of pharmacies, she said.

Although it's a difficult situation for pharmacists to be in, Soliman concluded that she's glad the issue is being widely discussed.

"I think it's great that we're talking about it," she said. "And I think that now is the time to really get something done."

REFERENCES
  1. Oklahoma pharmacy board investigating chain pharmacies, staffing levels [news release]. Washington, DC; February 14, 2020. https://www.pharmacist.com/article/oklahoma-pharmacy-board-investigating-chain-pharmacies-staffing-levels. Accessed March 3, 2020.
  2. Gabler, E. How Chaos at Chain Pharmacies Is Putting Patients at Risk. New York Times; January 31, 2020. https://www.nytimes.com/2020/01/31/health/pharmacists-medication-errors.html. Accessed March 3, 2020.
  3. Pharmacists’ Workload Contributes To Errors [news release]. The University of Arizona Office of Public Affairs; May 2007. https://opa.uahs.arizona.edu/newsroom/news/2007/pharmacists-workload-contributes-errors. Accessed March 3, 2020.
  4. Soliman S. Letter to the Editor: New York Times. Pharmacist Moms Group; February 20, 2020. https://www.pharmacistmomsgroup.com/letter-to-the-editor-new-york-times/. Accessed March 3, 2020.
  5. Gabler, E. At Walgreens, Complaints of Medication Errors Go Missing. New York Times; February 21, 2020. https://www.nytimes.com/2020/02/21/health/pharmacies-prescription-errors.html. Accessed March 4, 2020.