The Pharmacy Chick

The USA Today published an article focusing on pharmacy errors in the workplace and their relationship to work load http://www.usatoday.com/money/industries/health/2008-02-11-prescription-errors_N.htm. It’s a good read for anybody not our field to realize that there is a damn good reason why your prescriptions shouldn’t be treated like its a race to the finish line. Its also a wake up call to all of us IN the field as to why it should be OK to tell Ms I’m-in-a-hurry to cool her jets and sit down. Nobody wants to be the victim of a pharmacy error, and there are always two victims: the patient and the pharmacist. I have never met a deliberately neglectful pharmacist. No pharmacist wants to hurt a patient, but almost everybody has thrown the dice now and then, gambling that they have done everything correctly when they have a fire burning under their feet.

I try to be respectful to all my patients, whether they deserve it or not (and trust me, some dont deserve much), but occasionally somebody will cross that line and cop an attitude when I tell them it will be over 30 minutes for their prescriptions. They assume “the posture” and usually spit out “THAT long?” To which I generally reply–”This is not a race and I am not serving fast food–I work at 2 speeds, SAFE and UNSAFE, you pick”

One thing that was not mentioned specifically in the article was the concept of interruptions in the workplace, something that probably more frustrating to me as a pharmacist than the workload is itself. It is one thing to have much to do, and plug along one at a time, getting it done. Its another thing entirely to have the same amount to do, but suffer the failure of not getting anything done without at least 2 interruptions. You know what I mean. The inability to bring one single prescription from beginning to end without having to stop somewhere along the line, breaking that line of concentration. I have had days where I have done 200+ rx’s and it has been a breeze, with myself and 2 techs. AND, there have been days where I was ready to stab the next person who interrupts me even ONE MORE TIME.

Even the pharmacy layout condones this. Mos of us work in a fish bowl. Walgreens may not do much right, but they have at least put the bulk of their pharmacy behind a wall. Most pharmacies are open from drop-off to pick-up. I can be seen at every spot in the pharmacy but the cubby hole where our coats are hung. Unfortunately, I cannot work back there….

What I am getting at is this. Every part of the filling process is important, but every part of it is fully in view and completely interruptable. I can be inputting a prescription and hear “ahem, can I ask you a quick question?” I would love to say “NO, I am saving a life here. you must wait til I am finished”. Do Doctors see their patients in the waiting room? Do surgeons perform surgery in the hallway? Do lawyers counsel their clients in the lobby? How many times have you called an office to get clarification on a prescription to be told “the Dr is with a patient, I’ll get back to you when he is done”

Some jobs can be done in the public view, but I am pressed to say that Pharmacy shouldn’t be one of them. Yes we should be available, to counsel, to help, to whatever. But we should NOT be ON-DEMAND. I could never walk into a Dr’s office, my Accountant’s office, my Lawyer’s office (thank God I dont have one), and say “I want to speak them…right now” You would likely be greeted with “AND, do you have an appointment?” If other professionals pace their day and have gatekeepers to shield them from unnecessary interruptions, why can’t we do the same to some degree, to minimize our risks, and maintain our sanity?

Think about it for a minute. Do we really need to be in view 100% of the time to be good pharmacists? If somebody wants to ask a question of a pharmacist, do they really need to hang over the counter and interrupt, creating a potential mistake? We are only human, and humans we will always be.

There is a chain in the city I work in that is all about SERVICE–they even get graded by so called “secret shoppers” to make sure they meet all the criteria from the Hello to the Goodbye. I have talked to their employees and they have told me what a stressful environment it has created. They get points for doing it right and deductions for missing something. For the company, its all about getting 100% on these secret shoppers, and not much else. I doubt that company will ever put a wall up to shield their pharmacists from interruptions.

A national celebrity’s infant child was given a (likely) fatal dose of an anti-coagulant in a hospital recently. Fortunately it was caught soon enought before harm was done and the antidote was administered. I believe the dose was 10,000 times the amount for an infant (don’t hold me to that figure, I dont have it in front of me) I wouldn’t want to be the nurse to did it, and I certainly woudn’t want to have been the pharmacist who sent it up to the floor. It was an error of similar packaging. High profile person+huge mistake=big fallout.

Every mistake is a breakdown somewhere along the workflow route. I truly believe that the fewer the interruptions, the healthier the work environment (including a lunch and break for EVERYBODY) , the better the layout, sufficient labor, and the proper technologies (scanners etc) and the time to counsel properly, the fewer the mistakes.

Now I’ll get off my soap box.

Tags: mistakes, national news, pharmacy life | |