Every pharmacist’s nightmare: Returning home after a hectic workday only to realize they overlooked consulting a patient about a potentially hazardous interaction or made an error while filling a prescription.
Employees at various chain pharmacies across the nation have disclosed to CNN the pressing predicament they face: a steep upsurge in prescription demands, vaccine administrations, and assorted services alongside an insufficient workforce. This imbalance is impeding the workers’ ability to diligently execute their responsibilities, consequently fostering unsafe conditions that jeopardize customer well-being.
The escalating workloads, coupled with employee burnout, often culminate in a higher likelihood of errors. However, when a pharmacist commits a mistake, the consequences are far-reaching, extending beyond the immediate error. The implications encompass potential legal liabilities, as pharmacists can be subjected to malpractice lawsuits, and the outcomes of these errors can lead to life-threatening circumstances. Moreover, these errors frequently embroil pharmacists in protracted legal battles, endangering their professional standing and livelihoods. The magnitude of these errors isn’t solely measured in immediate repercussions but has far-reaching implications that profoundly affect both pharmacists and the individuals they serve.
A safe workplace
A 2022 survey conducted by the National Community Pharmacists Association illuminated a pressing concern shared by nearly three-fourths of its respondents: the distressing lack of time to effectively carry out vital clinical duties and ensure comprehensive patient care.
This growing apprehension and stress among pharmacists have reached a tipping point, prompting some professionals to stage walkouts from CVS and Walgreens pharmacies in the recent autumn. The noticeable trend of operating stores with only one pharmacist manning the counter throughout a strenuous 12-hour shift has set off alarms within the pharmacist community. Michael Hogue, CEO of the American Pharmacists Association, voiced the collective anxiety prevailing among pharmacists, pointing to their dwindling confidence in guaranteeing a secure environment for patient care.
Shane Jerominski, a pharmacist with extensive experience at renowned chain pharmacies like Walgreens and CVS, echoed the intense pressure faced by pharmacy professionals, expressing profound concerns about potential errors in such overburdening circumstances. The labor-intensive task of prescription fulfillment encompasses a multifaceted process that far exceeds the common misconception of merely dispensing pills into containers.
The role of a pharmacist extends well beyond the physical act of filling prescriptions. It encompasses meticulous scrutiny of prescriptions received from doctors’ offices for potential errors, verifying prescription details against patient profiles, assessing probable drug interactions, navigating insurance billing intricacies, and offering extensive patient counseling. This demanding routine involves addressing medications not covered by insurance, requiring effective coordination with physicians for prior authorization or alternative medications. This intricate workload must be managed alongside diverse responsibilities such as administering vaccines, addressing customer queries, and offering guidance on over-the-counter medications.
Within this intricate web of responsibilities, the risk of errors looms large, each carrying potentially dire consequences. The NIH’s recent study highlighted that an estimated 7,000 to 9,000 individuals lose their lives annually due to medication errors in the United States. Additionally, hundreds of thousands of patients experience adverse reactions or complications, often left unreported. These errors not only impact lives but also pose a significant economic burden, amounting to over $40 billion annually in managing patients affected by medication-associated errors.
Karl Williams, a distinguished professor specializing in pharmacy law, ethics, and counseling at the Wegmans School of Pharmacy, shed light on the psychological toll faced by pharmacists. The fear of inadvertently overlooking critical patient information during a hectic shift often leads to post-shift introspections filled with dread. The concern about potential harm to patients, irrespective of legal implications, significantly impacts pharmacists, prompting some to contemplate leaving the profession. The emotional burden of such scenarios resonates deeply, leaving a lasting impression on the well-being of pharmacists and their commitment to delivering optimal patient care.
Legal consequences
The implications of errors made in pharmacies often transcend mere moral implications for pharmacists, delving into legal complexities that pose significant challenges.
According to Williams, pharmacists can be legally liable for any harm stemming from medication errors, irrespective of the company they work for or the legal resources it might possess. He emphasized that this liability is attached to the pharmacist’s professional licensure and is not nullified by the employer’s legal representation. The pharmacist remains accountable for these situations despite the company’s legal defense efforts.
When errors are reported to state boards, individual pharmacists are typically the ones facing disciplinary actions rather than the larger pharmacy chains. This pattern emerges because individual pharmacists are perceived as more accessible targets in such scenarios.
Nevertheless, large corporations tend to support individual pharmacists in most instances. Fraser Engerman, a spokesperson for Walgreens, highlighted the company’s staunch support for its pharmacists in nearly all situations, emphasizing their multi-tiered prescription fulfillment process designed with numerous safety checks to mitigate human errors. Engerman also stressed the company’s comprehensive reporting system to swiftly identify root causes and implement procedural enhancements to prevent future errors.
Representatives from CVS and Walgreens emphasized that patient safety remains their foremost priority. Amy Thibault, a CVS Pharmacy spokesperson, underlined their adoption of a ‘Just Culture’ framework within the healthcare industry, fostering an environment that encourages colleagues to report errors without fear of punitive repercussions. Thibault reiterated the significance of creating a protected environment to facilitate the reporting of errors and enhance patient care.
However, Thibault declined to comment on CVS’s internal legal policies, underscoring the company’s focus on prioritizing a protected environment for employees to ensure error reporting and subsequently improve patient care.
Chain pharmacies grow
Around 70% of prescriptions in the United States originate from major retail chains like Walgreens, CVS, and Walmart, as highlighted in a 2019 report by the Drug Channels Institute. The significant market share is divided among these key players, with CVS accounting for about 25% and Walgreens contributing another 20%.
Professor Gina Moore from the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado notes that major pharmacies usually offer liability insurance coverage to their employees. While pharmacists might face individual responsibility in cases of severe negligence, such instances are infrequent.
However, pharmacists also confront what Karl Williams, an expert in the field, terms “administrative liability.” In cases where a pharmacist faces a lawsuit, the details of the case become public. Subsequently, the pharmacy licensing body receives notification and holds the authority to take action against the pharmacist, potentially revoking their license and effectively terminating their career.
Despite many pharmacies internally tracking medication errors, there isn’t a federal mandate compelling them to report these errors. However, if a pharmacy or patient does report an issue, the National Practitioner Data Bank collects and stores information concerning civil and administrative liability cases.
This information is accessible to various entities including employers, insurance firms, and other concerned parties. Pharmacists who face legal action might face exclusion from participating in federal government healthcare programs like Medicaid and Medicare. Such exclusion effectively terminates their career prospects, even if they retain their licensure. Being barred from involvement in Medicaid and Medicare also prohibits their employment within pharmacies.
Becoming a pharmacist typically entails over four years of post-undergraduate study, an investment that can cost students more than $200,000.
Absolutely no flexibility
Tony Bertolino, the managing partner at Bertolino LLP, based in Texas, specializes in representing pharmacies and pharmacists and has witnessed a common trend among his clients—errors often stem from the fatigue resulting from extended work hours.
He underscores the gravity of even the smallest mistake, such as miscalculating medication or dispensing the wrong type, emphasizing that such errors can lead to severe repercussions, potentially culminating in tragic outcomes like fatalities. The environment in which pharmacists operate is marked by intense pressure to swiftly and accurately process prescriptions, a factor that can contribute significantly to lapses.
However, Bertolino highlights a critical aspect of pharmacy regulations—a stringent approach to liability, irrespective of the challenging working conditions.
“In the realm of pharmacy regulations, there’s no room for considerations related to intent. Whether a law is violated or a rule is breached, there’s little margin for leniency,” he states firmly. “The pharmacy board holds all involved parties accountable—the pharmacy entity, the pharmacist, and even the pharmacy technicians. Each individual involved could face consequences and reprimand.”
This relentless enforcement of liability underscores the high stakes in the pharmaceutical field, where any misstep, no matter the underlying cause, can have far-reaching and dire consequences, affecting not just the individual pharmacist but the entire pharmacy team.
Strikes and union action
A formal drive for unionization, supported by the International Association of Machinists and Aerospace Workers (IAM) and advocates for pharmacy labor, is presently in progress.
The initiative aims to encompass employees working within CVS and Walgreens pharmacies, with intentions to extend its reach across all retail pharmacies in the United States.
“We aim to empower pharmacists and pharmacy technicians in bringing about the changes they seek, particularly within the domain of corporate retail giants where the challenges are most pronounced,” remarked a senior IAM Healthcare official, outlining the objectives of the effort.
A Walgreens representative expressed their engagement with concerns voiced by their team members, stating, “We are dedicated to ensuring that our entire pharmacy team receives the necessary support and resources to maintain exceptional patient care while prioritizing their own well-being.”
CVS informed CNN about their focus on developing a comprehensive plan adaptable to various markets, emphasizing their commitment to sustaining the delivery of high-quality care that patients rely on, particularly in regions where additional support may be required.
Change is coming
Absolutely, here’s a more detailed expansion:
In the landscape of medication error reporting, the lack of a federal mandate is prompting various states to take proactive measures. Virginia, in a bid to fortify pharmacy operations, introduced regulations this year focusing on the elimination of quotas and enhancing pharmacy staffing levels. These regulations, currently in force until March 2025, aim to alleviate the mounting pressure on pharmacy staff and enhance patient safety. Similarly, Ohio is in the process of proposing rules designed to ensure that pharmacies maintain adequate staffing, recognizing the pivotal role staffing plays in reducing errors and ensuring quality care.
The recent enactment of AB 1286, the Stop Dangerous Pharmacies Act, in California signifies a landmark step toward stringent regulations. This legislation necessitates corporate chain pharmacies to adopt a transparent approach by mandating the reporting of all medication errors while simultaneously enforcing the maintenance of appropriate staffing levels within their premises. These proactive measures serve as a preventive mechanism to address the prevalent issues plaguing pharmacy operations and, ultimately, safeguard patient welfare.
Despite these legislative strides, the pace of change in the pharmaceutical landscape remains gradual, potentially exacerbating the ongoing shortage of qualified pharmacists. The American Association of Colleges of Pharmacy (AACP) reported a decline in new pharmacist graduates, with 13,323 individuals graduating in 2022 compared to 14,223 in the preceding year. This notable decline, the most substantial since 1983, underscores the potential challenges in replenishing the workforce and meeting growing demands in the pharmaceutical sector.
Meanwhile, there has been a significant uptick in demand for pharmacists, as evidenced by the surge in job postings. The AACP revealed that there were approximately 60,882 job postings for pharmacists during the initial three quarters of 2023, indicating an approximate 18% increase from the corresponding period in 2022. This soaring demand reflects the persistent need for qualified professionals in the pharmaceutical realm, accentuating the pressing need for systematic changes to address workforce shortages and sustain quality patient care across the industry.
