Will Chicago’s pharmacy work rules be helpful or harmful?
Thursday, October 26, 2017
On Oct. 10, the Chicago City Council Finance Committee voted in favor of an ordinance that aims to regulate the amount of work pharmacists are asked to complete. This rule states that pharmacists will only be able to fill prescriptions for 10 patients per hour, and it mandates meal and bathroom breaks.
Signs will have to be posted of pharmacists and technicians who have worked shifts longer than eight hours. It also prohibits the use of productivity quotas and metrics for nondispensing tasks and marketing.
The ordinance is currently held in committee until it can be voted upon in front of the City Council to become law. Even if it should pass, its validity will be called into question as pharmacy can only be regulated by the state and not at the city level, according to the Illinois Pharmacy Practice Act.
This ordinance was sponsored by committee chairman Edward Burke in response to the well-publicized and eye-opening report from the Chicago Tribune last winter that showed poor rates of counseling or pharmacist intervention for dangerous drug interactions. Out of 255 pharmacies tested, 52 percent failed to warn the patient of any dangers or contact the prescriber. Independent pharmacies collectively fared the worst with a 72 percent failure rate. Chains as a group failed 49 percent of the time.
Most — but not all — of the chains stated renewed efforts at improving their training and processes in response to the report. Pharmacists contacted after the testing frequently cited expectations that prioritize speed.
The legislation is undoubtedly a step in the right direction toward improved patient safety, which is the ultimate goal of the pharmacy profession. Eliminating quotas and nonclinical metrics will go a long way in having pharmacists focused on safety rather than corporate statistics. Having breaks will aid in keeping pharmacists fresh and attentive.
However, many issues will arise in implementing and enforcing these rules.
The first concern is patient access. If a single-pharmacist store is open for 12 hours, will dispensing for 120 patients per day cover the needs of the community? What about in cough and cold season? Keep in mind that this legislation is for Chicago, the third-largest city in the United States, not a small town out in the country.
One thing that is certain is that the number of prescriptions being written is only going up. While the rate of dispensing will be restricted, the data entry and filling queue will become backlogged, and it is naive to think pharmacies will not choose to cherry-pick the most profitable prescriptions just to survive.
Additionally, the chains will likely move chronic medication prescriptions to their nearest mail-order facility outside of Chicago's jurisdiction before the ink on the ordinance dries. This can lead to fragmentation of the patient's pharmacy record. And ironically, if patients choose not to wait at Pharmacy A and instead go to Pharmacy B for a shorter wait time, they may expose themselves to interactions no pharmacist will catch.
As alluded to above, pharmacy profitability is being jeopardized by these rules. To reiterate, patient care and safety is the primary goal of our profession, however, pharmacies must be in business to achieve this. With third-party reimbursements going down and no relief from DIR fees yet, maintaining positive income is easier said than done.
For many pharmacies, filling as many prescriptions as possible is the business model. Processing high volumes of prescriptions in and of itself is not a bad thing, but missing or ignoring interaction alerts is.
Until cognitive services provided by pharmacists are reimbursed — which is on the horizon with community pharmacy enhanced services networks and MTM platforms — we will be tied to selling a commodity. Most pharmacists would love nothing more than to be able to have a detailed counseling session with each patient who needed one, but retail pharmacy is just not able to sustain that yet.
The pharmacy industry will certainly be monitoring how this ordinance is implemented and the downstream effects. Can pharmacies withstand the throttling of prescription dispensing? Will medication errors decrease?
This is a significant government intervention, so it will be interesting to see what impact it has on Chicago. Hopefully, it will strike a perfect balance between patient safety and pharmacy sustainability that can provide a model for the rest of the nation.
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