If you want improved working conditions in the pharmacy, you're gonna hafta help.
Bob StoutI agree with Dennis Miller that workload is the No.1 issue affecting pharmacy today [see “State BOPs and public safety,” August 5, www.drugtopics.com] . Companies focus exclusively on the business of pharmacy, not the practice of pharmacy. Over the last 15 years especially, this has led to practice settings that are unsafe and do not allow pharmacists to use their skills and knowledge to positively influence patient therapy and care.
Dennis argued that boards of pharmacy are ultimately to blame for pharmacy errors, citing their inaction when they should be fighting for better working conditions. That’s where I take exception.
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I tried for years to get on the Board of Pharmacy in New Hampshire to address these exact issues, and in September of 2012, I was appointed by Governor Lynch. One of the first things the board did was to bring stakeholders together to talk about the barriers at work that prevent pharmacists from properly performing their duties.
We focused on five workload-related issues very similar to those proposed in Oregon. We wrote the rules, had our public hearing, and moved toward approval. The Joint Legislative Committee on Administrative Rules (JLCAR) threw out the five proposals, stating that the board did not have the statutory authority to write these rules.
The board proceeded to attack these problems from a different angle. Our first move was a total rewrite of our rules for pharmacy technicians. Two years of work have produced a requirement calling for yearly training on data entry for all noncertified technicians, a minimum of 80 hours of training before a technician can be counted as staff, and an expansion of duties for New Hampshire-certified technicians, enabling them to give more assistance to our already too-busy pharmacists.
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Second, we tried to require certification within two years of employment for all technicians. But again our authority was challenged; certification could not be mandated, it had to be voluntary. So we hope the expansion of duties and the yearly training requirement will move us toward more qualified technicians.
Third, we worked with legislators to draft language to expand our rule-making authority with the introduction of HB 141. After two years of hard work, we were able to get this bill passed through the House. When the bill crossed over to the Senate, we were able to educate many senators on the challenges in the marketplace.
Unfortunately this bill was taken under advisement by the Executive Departments & Administration Committee for further consideration this fall. We have worked through the summer to garner enough support to get it passed.
In my opinion, the biggest problem is the lack of effort by pharmacists and pharmacy groups to get involved and effect change. Dennis is correct in saying that by the time we appear before a committee, lobbyists for the chains and PBMs have already met and talked with every representative and senator on the committee, making their case for why the bill is a bad idea.
Where are the pharmacists in this process? New Hampshire is a small state, and legislators are influenced by their constituents. How many pharmacists write, call, or meet their elected officials? That is where the battles are won and lost. Educating legislators can effect change. At present, legislators mainly hear only one side of the story.
We recently rewrote our Standards of Practice rules, which affect pharmacists every day. We received one written comment from a pharmacist - a friend of mine, whom I shamed into responding - while every major chain and PBM weighed in on the changes.
I understand that, in today's marketplace, many pharmacists are reluctant to speak for fear of retaliation. However, that does not hold water when we talk about supporting good ideas by contacting elected officials and educating them on what we all face today.
How can we singlehandedly move things forward when the people we represent are silent?
Robert J. Stoutis vice president of the New Hampshire Board of Pharmacy. You can e-mail him at firstname.lastname@example.org.