Pharmacists write in, Part 2: Why mistakes happen

August 26, 2015

Here's more of what blew up Dennis Miller's mailbox.

Dennis MillerDo pharmacists feel that discipline by the state board of pharmacy is effective in deterring future errors?  Should the pharmacist’s name be published in the state board of pharmacy newsletter for all the pharmacists in the state to see? Readers were vocal on this subject and plenty more.

To see what the first 10 said, go to: Pharmacists write in: Worst mistakes, Part 1

Official actions

Pharmacist 11: A pharmacist who admitted having made a few mistakes stated, “Like you, I didn’t need official discipline. I kicked my own butt way harder than anyone else would have.” 

Pharmacist 12: “I'm with you. I don't think publishing my full name is necessary. I beat myself up all by myself. I think a focus on the details surrounding the mistake would be more useful for others. Besides, it is shame enough to know that anyone who verifies my license online will see a Y next to Board Discipline.”

Pharmacist #13:  “I would much rather deal with the wrath of the pharmacy manager or the DM and a few irate patients than sit on a witness stand. I'd rather stay late and finish than try to cram 14 hours of work into a 12-hour shift and risk someone's well-being.”

Pharmacist #14: “I was reprimanded by the board for a HIPAA violation. The student/technician, unbeknownst to me, was helping a customer at the out window. He asked the man who was picking up his prescription if he also wanted the one for his 27-year-old daughter. He said yes. Turns out it was for birth control and the daughter contacted the board because she said she did not want her father to know she was on birth control. I never knew any of it happened until I got a Fed-Ex letter from the board. I had to review HIPAA policies and sign a paper saying I did. No big deal. The fact [is] that I took the hit and couldn't have known it happened because I was busy at my workstation. But of course I was the pharmacist, so it was my responsibility to know everything that was going on.”

See also: My most serious pharmacy mistake

The public

Pharmacist #15: “One time a patient yelled at my coworker for an error for so long that I stepped in and said if you want 100% of the prescriptions filled perfectly, you would have to get Jesus Christ down here to fill all these scripts.” 

Pharmacist #16: “I have caught hundreds of errors [made by doctors] in my 25 years in the profession, and you know what? I have never gotten one thank you from a doc. One time I caught 65 units of immediately acting insulin given qhs. The doc laughed at his error.”

Pharmacist #17: “I always tell customers that rush us, ‘If you get the wrong hamburger from McDonald’s, you can return it, but if I give you the wrong drug, you may not be back.’” 

 

Script volume

Pharmacist #18: “150 scripts in a store, with you constantly being interrupted with phone calls, as we do in a hospital is a killer. Sometimes if the phone is ringing off the hook, 80 scripts is too much.”

Pharmacist #19:  “It has been my experience that as pharmacies approach 20 prescriptions per hour or more, corners get cut. Maybe a drug interaction gets bypassed or a dose for a given patient is overlooked. I disagree that one pharmacist and one technician constitute adequate staffing, unless you have a dedicated cashier. I agree that staffing is the key, because you may have the best system and technology in place, but if you don't have proper staffing, then it all fails.”

Pharmacist #20: “One thing that rarely gets mentioned is how many of these prescriptions are new prescriptions and, out of all those new prescriptions, how many are for new patients? We all know that a new prescription takes a lot more concentrated effort to process than a refill prescription. Add on to that the work involved in processing a new patient and one prescription becomes as labor intensive as three or four!”

Working conditions

Pharmacist #21:  “Oregon actually wrote workplace rules that have had a significant effect on pharmacy workplace conditions. It isn't as good as it could be, but it did eliminate/constrict a number of contributing factors to workplace stressors.” 

Pharmacist #22: “Washington State did a similar survey to Oregon’s in 2014 and, not surprisingly, got the same results.”

Pharmacist #23:  “An attempt to do something about breaks and lunches for pharmacists was tabled, as it was determined to be a Department of Labor issue (pharmacists classified as "professionals" and not subject to break regulations). As will always be the case, it'll take a death or two (or three, or four, or five) before any changes come from regulators.”

Pharmacist #24:  “Corporate wouldn't let me include “limited help in Rx, high stress environment, and company time metric negatively affect my focus and accuracy” in my statement to the state board of pharmacy.”

Pharmacist #25:  “I have three jobs. I work for a very large corporation that has specific policies regarding errors. Our DM has told us more than once never to report an error. I work part-time for an independent who thinks ISMP & MERP are routinely accessed by personal injury lawyers trolling for cases, and he will not allow us to report to them. I also work for a very well-known national placement agency. They are squeaky clean in everything they do, a very class act.”

E-stuff

Pharmacist #26: “What concerns me currently is techs bringing in e-scripts without checking anything, putting that much more pressure on the verifying pharmacist to catch a prescriber error. The chances for error are increasing at an alarming rate with e-prescribing, perhaps warranting a study.”

Pharmacist #27:  “I wish the general public could learn that the chains want prescriptions filled fast - correctly is a nice afterthought. If they only knew that chains have a meter that’s timing pharmacists. A prescription may be in the green, but then the phone rings, you need to ring up dish soap and get the drive-thru; now you have seconds to check the prescription before the meter goes red and you get a bad grade. The sad thing is too many pharmacists are more worried about the bad grade - and if that is not a priority for you, you’re considered a bad employee. And the attitude is: If an error happens, maybe no one will notice or the chain will give the patient a gift card.”

 

Next-gen pharms

Pharmacist #28:  “I am not impressed with the young PharmDs.  They are cocky and most of them are lazy. Right now, the kids go into it for the money. Every student [I work with] answers that they applied to pharmacy school because of the salary.” 

Pharmacist #29: “The problem I see is that many of the new graduates are not anal enough and do not understand that they need to be on top of their game all the time. But that is our generation’s fault, for telling our kids how great they were when they were growing up.”

Pharmacist #30: “If older pharmacists are just too slow to pick up the pace and keep up, they should go work for an independent pharmacy and fill cash narcotic prescriptions. I've watched your generation of pharmacists in action. The PIC of my current pharmacy is like that. The customers love his "aw shucks" attitude, but he doesn't know how to do anything for himself. I will enter the pharmacy to find him staring at the bar code on the side of a stock bottle wondering why it doesn't scan. I have to inform him that, while it is ciprofloxacin 500 mg, the bottle he has is extended release. His reply to that is ‘There's an extended release ciprofloxacin?’”

The right stuff

Pharmacist #31: “Pharmacists are the most cowardly group of professionals I have ever known. They will work 70 hours a week, no help, bitched out by bosses, can't go to the bathroom or have lunch break, and just keep going.”

Pharmacist #32: “Why are we so afraid to unionize or to stand up for ourselves as a whole? Why is it OK for the BOPs to be stacked with people whose financial wellbeing is in direct conflict with ensuring public safety? The problems with the “profession” stem from greed and, to a large degree, fear. We are to blame for our mistakes, solely based on the fact that we allowed ourselves to be taken advantage of by greedy corporations and others in the healthcare field.” 

Pharmacist #33: “We have to take back pharmacy, and that will never happen till we unionize!” 

Dennis Milleris a retired chain-store pharmacist living in Delray Beach, Fla. He welcomes feedback at dmiller1952@aol.com. His books Chain Drug Stores are Dangerousand Pharmacy Exposed are available at Amazon.com.