Nicholas Hamm

As the opioid crisis rages on (130 people die of opioid overdoses each day), pharmacists face a number of challenges: how do you keep potentially dangerous medications from those who abuse them while not making things overly difficult for the chronic pain patients who rely on them-all while maintaining a busy pharmacy?

While counseling is important, it’s difficult to do when there’s a massive backlog of unfilled orders. To help manage that, pharmacists at the recent NCPA convention in San Diego gave a talk titled “Caring for Patients on Opioids.”

In the talk, Lorri Gebo-Shaver, PharmD, owner of Shaver Pharmacy & Compounding Center in Pocatello, ID; Caitie Brown, PharmD, PGY-1 resident at Pharmacy & Compounding Center; and Shanna O’Connor, PharmD, assistant professor, College of Pharmacy at Idaho State University gave tips on how her pharmacy manages to help patients in the real world.

The first real step, O’Connor said, is to ask good questions. She said that it goes against what’s often done the pharmacy: the pharmacy is busy and pharmacists are overwhelmed, so they stick to largely yes/no questions to help speed along the process. She said in this case, however, it is important to ask open-ended questions that can help reveal a patient’s true situation.

In Idaho, pharmacists are able to prescribe naloxone, which Gebo-Shaver does for certain patients and has them sign a form acknowledging that she offered it to them-this creates a paper trail that helps protect her and her pharmacy, as well as shows the seriousness of the situation to the patient.

Even so, she said that “having that conversation at first is really hard.”

One of those hard questions involves naloxone-as Gebo-Shaver said, “How do you say appropriately what naloxone is for?” She said she compares it to epinephrine, saying that it’s something that can save your life in an accident-perhaps even for someone you don’t know.

She described 1 patient who, when offered naloxone, initially declined. But that patient then returned to her pharmacy the next day with his wife and son who he wanted to attend the training as well. He said that he had a friend recently pass away from an overdose, and was so thankful that the pharmacy was willing to take time to provide education.

), start by looking at pain holistically through a pain inventory. This can help the pharmacist make an informed decision about alternatives. As O’Connor said, “What got us into this situation is that we got very comfortable with very high doses of opioids,” so providing alternatives to those high doses is key.

The important thing to remember, Gebo-Shaver, stressed, is that the pharmacist isn’t the only one able to help. While technician duties vary by state, in Idaho where they are given more abilities, Gebo-Shaver says she sees herself as a quarterback in her pharmacy who is protected and helped out by a defensive line. (For states with weaker technician powers, she advocates reaching out to state boards of pharmacy and advocating for enhanced abilities).

O’Connor pointed to a workflow used to intake a new patient using an opioid monitoring form. With this form (

), as well as checking the state’s PDMP, O’Connor says most of the information can be collected before the patient’s packet gets to the pharmacist. This process also provides paperwork that can pro- tect the pharmacist and create a record showing that patients were given correct counseling.

So, the speakers said, ask yourself questions such as “what steps does your state require be completed by the pharmacist, and what could be done by a technician or cashier?”

Utilizing a process that protects both patients and pharmacists doesn’t have to be time consuming-while it does take time, the speakers stressed that the more a pharmacist does it, the faster it goes.

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 asks pharmacists about their job experiences. In particular, we’re interested in what pharmacists are interested in: what’s the payment like for a pharmacist’s expertise, and how stressful is the job overall? 

As in previous years, we found that pharmacists are well paid, but also stressed out. So what’s stressing you out? The over 1,100 pharmacists

 surveyed cited everything from vaccination quotas to DIR fees to new USP regulations as their biggest concerns. While fewer pharmacists said that their stress levels increased at work this year compared to 2018, the number was still high: 61.08%.

As far as salary goes, pharmacists are largely making close to what they made last year (see Base Annual Salary). Looking at the beginning of the decade, however, the 2010 survey showed that the average salary was lower, with the majority (62.5%) reporting salaries in the $100,000-130,000 range. In 2019, nearly 40% made that amount, while nearly 50% said  they make over that $130,000 mark.

High stress levels aside, pharmacists are still, overall, fairly satisfied with their jobs. More than twice as many (18%) said they were “extremely satisfied” with their job compared to those who said they were “extremely dissatisfied” (9%) and the majority said they were either “very satisfied” or “satisfied.” On top of this, just 22% of pharmacists were looking for a new position in the next 12 months.

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Liability insurance is like every other kind of insurance-you hope you never have to use it, because it usually means something has gone wrong.  

For pharmacists, when something goes wrong, chances are it’s giving a patient the wrong dose or wrong drug-but 

That’s according to the 2nd edition of the 

. The report analyzes claims over several years, from January 1, 2012 through December 31, 2016, that resulted in at least a $1 payment. Claims were included regardless of when they were filed, but must have closed during that time period. 

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Overall, the report looks at 184 closed claims. This is compared to the first edition of the report, released in 2013, that tracked claims over a 10-year period from January 1, 2002 to December 31, 2011. In that 2013 report, just 162 claims were closed-despite a study period twice that of the second edition. 

The total amount incurred in the 2nd edition is $25 million with an average claim of $124,407, compared with a total of $18 million and an average of $101,269 in the 1st-an increase of 22.8%. 

So, where do all of these claims come from? The vast majority of claims are against pharmacists (96.2%), compared to just 3.8% against pharmacy technicians. According to the report, this is likely due to the fact that technicians operate under the supervision of pharmacists, and “therefore, the lower severity of pharmacy technician claims is commensurate with the scope of their licensure.”

The report also breaks down where those pharmacists worked and the average claims in each of those settings: the largest claims came from hospital pharmacies, with an average claim of $273,338 (more than twice the overall average of claims). The lowest average comes from pharmacists and technicians working in homecare environments, with an average payout of just $5,063. 

The most common pharmacy types for claims were, perhaps unsurprisingly, from independent or individually-owned pharmacies (55.4%), compounding specialty pharmacies (17.9%), and national/regional chain pharmacies (12.0%).

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The most expensive claim-though also the most infrequently reported-was failure to identify overdosing with an average expense of $544,600. Other claims with higher-than-average expenses include compounding calculation and/or preparation errors ($324,819), libel/slander ($300,000), and failure to provide instructions ($275,092), to name a few.

Perhaps the biggest takeaway from the report, however, is the most common claims. By far, the most common claims were the result of the wrong drug (36.8%) and wrong dose (15.3%). 

According to the report, a major reason for this is the problem of 

(Table 1). Failure to separate out sound-alike drugs using methods like color separation and tall man lettering accounts for 15.1% of wrong drug dispensing errors. In one claim, a pharmacist dispensed minoxidil instead of methotrexate, resulting in the patient’s congestive heart failure and permanent partial disability.

Other risk factors include failure to check drug against label and actual prescription (9.8%) and failure to review prescription with patient (1.7%).

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 of opioid overdoses each day), pharmacists face a number of challenges: how do you keep potentially dangerous medications from those who abuse them while not making things overly difficult for the chronic pain patients who rely on them-all while maintaining a busy pharmacy?

In the talk, Lorri Gebo-Shaver, PharmD, owner of Shaver Pharmacy & Compounding Center in Pocatello, ID; Caitie Brown, PharmD, PGY1 community-based pharmacy resident for Idaho State University; Shanna O’Connor, PharmD, assistant professor, College of Pharmacy at Idaho State University; discussed how the pharmacy manages to help patients in the real world.

She described one patient who, when offered naloxone, initially declined. But that patient then returned to her pharmacy the next day with his wife and son who he wanted to attend the training as well. He said that he had a friend recently pass away from an overdose, and was so thankful that the pharmacy was willing to take time to provide education.

), as well as checking the state’s PDMP, O’Connor says most of the information can be collected before the patient’s packet gets to the pharmacist. This process also provides paperwork that can protect the pharmacist and create a record showing that patients were given correct counseling.

Figures courtesy of Lorri Shaver, PharmD, Shanna O’Connor, PharmD, Caitlin Brown, PharmD, and NCPA