I typically don't fill out online surveys. But this one came from a pharmacy association that I respect in the state I graduated. It also happened to be on a topic I'm pretty passionate about. The title of the study for which the survey provided data was "Evaluation of pharmacy metric and workload factors impact on patient safety."
For those not otherwise aware of it, pharmacy "metrics" are a mechanism used by various chain pharmacies to monitor different elements of the prescription-filling process in an effort to encourage a "go faster at any cost" atmosphere in the workplace.
These metrics include things like the number of flu shots administered, the number of follow-up phone calls to encourage refills or prescription pickup, or even compliance with a guaranteed prescription turnaround time (like three prescriptions in 15 minutes).
The survey, distributed by the good folks at the Connecticut Pharmacists Association, asked questions such as:
- How many prescriptions per week are filled at your store?
- How many pharmacist hours are there per week at your store?
- How often do you have time for a meal break?
- Have you personally ever been involved in an error related to workload?
The survey is a good attempt to address the concerning issue of pharmacy errors and how metrics might play a role. The actual questions and research are being conducted by Lauren Schlesselman, PharmD. I appreciate her efforts, and I hope the survey answers help the cause.
Nevertheless, much more is going to be needed to help persuade boards of pharmacy, chain pharmacy leadership and payers that pharmacy workflow needs a vigorous and global overhaul if errors are going to be substantially reduced.
Not too many weeks typically go by in between some breaking news about a terrible and tragic error that occurred in a pharmacy. No pharmacist ever goes to work planning to commit an error and/or harm a patient. It has to be the most stomach-turning, nightmarish possibility that exists in our profession.
I think every pharmacist's heart skips a beat when a patient calls and says something like, "These pills look different than last time." Thankfully, such calls are often simply the result of a manufacturer change and not due to dispensing the wrong drug.
Metrics — the deliberate measurement of specific "quantity" performance guidelines — put added pressure on pharmacists, which inevitably results in less time available to accurately check prescriptions and counsel patients. It is not, however, the measurement itself that is the problem. The problems arise when these metrics become unreasonable standards that can only be achieved by cutting corners on patient safety.
Why do mistakes happen? This is the million-dollar question. There is no single right answer. But pharmacists who are rushed and distracted because of imposed metrics are surely more prone to making mistakes than when adequate time is allowed to review prescriptions, dosages and patient profiles.
But metrics alone can't be blamed for all the pharmacy errors. The reality is that the average retail pharmacist is expected to analyze prescription orders under circumstances that few other medical professionals would tolerate.
The enormous number of distractions faced by the pharmacist in the average day is simply overwhelming. Some software systems are terribly outdated and inefficient. Computer drug interaction analysis is often substandard and inadequate to equip the pharmacist to make a reasonable assessment and recommendation. The list goes on and on.
I have always believed that an informed patient is our best defense against pharmacy errors. As pharmacists, we need to encourage patients to read the literature we provide, ask questions and make sure their medication makes sense.
Metrics, as they are frequently used in pharmacy today, are a mistake. They are a poor substitute for true leadership, mentorship and a vision for excellence. Quotas cannot replace quality.
Pharmacists today need to speak out and speak up. Our patients deserve it.
