Last fall the Oregon State Board of Pharmacy enacted new rules and regulations that held corporations and non-pharmacist owners accountable to the Board for working conditions and business practices that adversely affect patient safety in the pharmacy. These rules and regulations allow the BOP to suspend, restrict or revoke the pharmacy license and/or impose monetary penalties on offending businesses.
This is a huge step in improving the miserable working conditions many pharmacists and their support staff must endure on a daily basis. It also holds corporations accountable for medication errors that result from unsafe working conditions.
Every state Board of Pharmacy should adopt regulations that will protect the public from unsafe business practices and working conditions. If you are reading this and haven’t done so already you should make the BOP in your state aware of the new Oregon BOP rules and urge them to enact similar changes in your states’ rules and regulations.
Remember, as a member of The Pharmacy Alliance you can be reimbursed for up to $100 for reasonable expenses incurred when meeting with a state legislator or attending a Board of Pharmacy meeting.
What follows are the Grounds for Discipline of a pharmacy (not pharmacists) in the state of Oregon
Grounds for Discipline
The State Board of Pharmacy may impose one or more of the following penalties which includes: suspend, revoke, or restrict the license of an outlet or may impose a civil penalty upon the outlet upon the following grounds:
(1) Unprofessional conduct as defined in OAR 855-006-0005;
(2) Advertising or soliciting that may jeopardize the health, safety, or welfare of the patient including, but not be limited to, advertising or soliciting that:
(a) Is false, fraudulent, deceptive, or misleading; or
(b) Makes any claim regarding a professional service or product or the cost or price thereof which cannot be substantiated by the licensee.
(3) Failure to provide a working environment that protects the health, safety and welfare of a patient which includes but is not limited to:
(a) Sufficient personnel to prevent fatigue, distraction or other conditions that interfere with a pharmacist’s ability to practice with reasonable competency and safety.
(b) Appropriate opportunities for uninterrupted rest periods and meal breaks.
(c) Adequate time for a pharmacist to complete professional duties and responsibilities including, but not limited to:
(A) Drug Utilization Review;
(D) Verification of the accuracy of a prescription; and
(E) All other duties and responsibilities of a pharmacist as specified in Division 19 of this chapter of rules.
(4) Introducing external factors such as productivity or production quotas or other programs to the extent that they interfere with the ability to provide appropriate professional services to the public.
(5) Incenting or inducing the transfer of a prescription absent professional rationale.
The Pharmacy Alliance is the only organization advocating for pharmacists, pharmacy students and pharmacy technicians that has as its core mission the goal of restoring dignity, self respect and integrity to the profession of pharmacy.
We are doing this by being an organization that prioritizes patient safety above all else. The TPA believes that any action that increases the safe delivery of medications to patients benefits the profession. The TPA strongly believes that common practices such as long work shifts without breaks, inadequate staffing, production quotas, metric measurements and wait time guarantees puts the health and safety of patients at risk. As practitioners and guardians of the profession, it is the duty of every pharmacist to protect the patient. This can be accomplished only if pharmacists regain control of the wheel that is steering the direction of pharmacy.
With your help, TPA will be rolling out a series of initiatives this year that will begin the process of informing the public, lawmakers and other health professionals as well as those that practice in the profession of the issues and solutions to the obstacles that prevent pharmacists from keeping our patients safe.
This is an opportunity for each and every pharmacist, pharmacy student and pharmacy technician to become part of the solution. New membership is just $100 for pharmacists, $40 for pharmacy students and $20 for pharmacy technicians.
Unlike other pharmacy organizations, we will not accept funds from drug chains, drug manufacturers or other companies that may profit from unsafe working conditions in the pharmacy. We will not be influenced or swayed in our drive to restore the integrity of the profession as so many other organizations “representing” pharmacy have been.
We can’t do it without your help and the help of others in the profession. Our goal is 500 new memberships in March. That’s 500 more voices speaking up for the safety of patients. That’s 500 more voices working toward restoring a safe workplace.
We will be adding new features and information to this website in the coming months designed to keep pharmacists, pharmacy students and technicians informed on the latest issues and solutions that affect the practice of pharmacy and patient safety.
Please consider joining The Pharmacy Alliance today by visiting the JOIN TPA page on this website. Together we can keep patients safe and determine the future course of the profession!
The temporary glitch in the new member “join” button has been fixed. By joining TPA today you will be hitting the professional “START” button that will add to our voice to “STOP” the decline in our profession. Your membership will add strength to our mission of restoring dignity, self respect and integrity to our profession.
“The Journey of a Thousand Miles Begins With a Single Step”
-Lao-tzu 600 BC
One thing all pharmacists can agree upon is that our profession is in disarray and chaos. The reasons for this are numerous and varied. They can be debated ad nauseum, and if you look at the blogosphere you will see some lively and interesting discussions regarding patient care issues, work place issues, regulatory issues, third party issues and the job market. We are now at a point where discussions without action have caused irreparable harm to the safety of the patients we serve. We are now at a point where pharmacists and their support staff have been relegated to assembly line workers by employers and must regularly endure working conditions that are unsafe and unhealthy to both themselves and the public.
The paramount issue facing the profession of pharmacy today is that pharmacists have no voice. We are college educated professionals who have received a very specialized education and are engaged in a profession in which the public, by necessity, has placed great trust in. But we have lost our ability to effectively influence the standards by which we practice. Can the same be said for physicians, nurses or dentists? I think not. Other existing pharmacy organizations that profess to represent the interests of pharmacists do not. If they did I have no doubt their membership numbers would be growing exponentially. They are not. These organizations don’t represent the views or the needs of the practicing pharmacist. Instead most of these so-called “pharmacist organizations” look to drug chains, pharmaceutical companies and institutions to fund their activities. They represent those interests, not the interests of pharmacists or the patients we serve.
I have been fortunate enough to have practiced in a variety of settings in my thirty-five years in pharmacy. I have worked for independent, compounding, small local chains and large national chains. I have worked in LTC, specialty packaging and home infusion pharmacy. I have worked for one of the largest drug companies in the world as well as a corner store independent owned by a husband and his wife. I have been an affiliate faculty member of one of the most recognized schools of pharmacy in the country and have mentored dozens of students. I have been the only pharmacist at an inpatient mental health hospital. In short, when it comes to pharmacy I’ve just about done it all. I’m still working full time behind the counter in a busy neighborhood pharmacy.
I joined The Pharmacy Alliance because I want my voice and those of my fellow pharmacists, pharmacy students and technicians to be heard. It’s why I agreed to manage this website.
I want our voices to be heard in state legislatures, at Board of Pharmacy meetings and in the media. I want to be part of an alliance that will get things done for those of us that practice the profession, not just have the title behind our name. I want patients to know that despite all the adversity that pharmacists face today we are still focused on providing them with the best possible professional services and outcomes. I want those outside the profession to understand and help us change the barriers that stand in the way of providing a high standard of professional care. I want pharmacists to feel they have an organization that has their back and will advocate for them.
I am challenging all who read this to take that first step in the journey that will restore our profession by becoming a member of TPA. We need boots on the ground. We need to know what is going on in the state legislatures, Boards of Pharmacy and chain and institutional pharmacies around the country. Information is knowledge. Knowledge is power. Power is influence.
We must be prepared to fight not just gripe.
Your membership will add strength of our voice. Your active participation will help to reverse the disastrous course that pharmacy is currently navigating.
There is strength in numbers. Whether you are a pharmacist, pharmacy student or technician you can make a difference. Your voice will be heard. Let others in the profession know about this site. Help bring some light to the darkness that hangs over our patients safety by joining an alliance of pharmacy professionals dedicated to restoring safe working conditions to the pharmacy.
For less than a few hours pay you can take your first step in the journey to restore sanity in the pharmacy and protect our patients by joining The Pharmacy Alliance today.
Our goal for March is 500 new members. With your help we can reach that goal. With your help we will improve working conditions in the pharmacy. With your help we will improve the health and safety of our patients.
Together we can do this.
Cameron Stuart, Editor
Gary Schnabel, RPh Executive Director of the Oregon State Board of Pharmacy
“A Pharmacy is a professional environment. It is not the deli counter”.
Oregon pharmacists say: We’re not burger flippers
Published: Sunday, May 27, 2012, 6:51 AM Updated: Sunday, May 27, 2012, 8:51 AM
Oregon pharmacists are fed up.
They say they’re overwhelmed with the crush of prescriptions totaling hundreds per day. They’re tired of long days with rare bathroom or meal breaks. Mostly, they’re worn down by the stress that comes with dispensing life-or-death medicines in a burger-flipping environment.
So they’re fighting back through the board that licenses their employers. Last week, the Oregon State Board of Pharmacy approved new rules governing working conditions in pharmacies. These rules may compel some of the big chain stores, which are coming to dominate the pharmacy world, to adopt more patient-centered business practices.
This is good news for people in Oregon who regularly get prescriptions for themselves, their children or elderly parents: The status quo simply isn’t safe enough.
“Patients aren’t being treated well,” says Oregon pharmacist Blake Rice, a former pharmacy board member. “The board is finally bringing into immediate relief the staffing issue at outlets.”
In 2011, the board invited the state’s 5,000-plus licensed pharmacists to answer an online survey about working conditions. The 1,400 respondents highlighted a troubling gap between chain outlets and independent pharmacies in Oregon. Only one quarter of chain store pharmacists said their working conditions promoted safe and effective patient care, compared with more than three quarters of pharmacists at independent stores.
Chain pharmacists also warned about their workload and patient safety. They further railed against the endless incentives that chains often use to encourage people to transfer and fill prescriptions: the gift cards, the bonus coupons, the fuel points. The incentives may be good for luring people to buy groceries, but they also create billing headaches and dangerous prescription mix-ups as patients swap pharmacies to save $10 or rack up fuel points.
“I feel like I’m sort of a glorified gas station attendant now,” says Portland chain pharmacist Belinda Misterek, who works for one of the major grocery-store chains and who testified last week to the state board. “People who don’t need prescriptions, they’re just filling them to get their fuel points. … These working conditions are awful.”
The survey and testimony spurred the board into action. Under the new rules, the state board can fine pharmacies — and even suspend or revoke their licenses — for creating a work environment that puts patient safety at risk. The rules require employers to provide rest periods and meal breaks and to allow pharmacists enough time to do their jobs, including patient counseling and prescription verification.
The board wisely backed down from a few heavy-handed proposals that would have restricted what businesses can say when they advertise. However, the board bucked the chain-store lobby and prohibited pharmacies from “incenting or inducing the transfer of a prescription absent professional rationale,” which is intended to curtail some of the frenetic pharmacy-swapping.
“I think soon you will start to see changes,” says Lis Houchen, a regional lobbyist for the National Association of Chain Drug Stores. ”Each company will have to look at the rules and see what they need to do. There’s probably going to be a trial period.”
Gary Schnabel, the executive director of the pharmacy board, agrees. He says the board’s intent isn’t to dictate business operations, but rather to discourage any activity that becomes detrimental to patients, from inadequate staffing to crazy-making promotions.
“It’s about the environment,” he says. “A pharmacy is a professional environment. It’s not the deli counter. I think some of the stores had forgotten that.”
It’s impossible to know for certain if pharmacy error rates are going up, or if chain stores in Oregon have more problems than independent ones. The system relies largely on self-reporting and the data aren’t reliable enough to confirm suspected trends. But the feedback from pharmacists is telling, and it mirrors what customers see from their side of the counter.
I’ve seen it many times, waiting in line for medicine at the local Safeway and watching the staff scurry around like fast-food workers. In fairness, I’ll confess to adding to their stress by being irritated when my prescription is not ready instantly, as if it were a pound of turkey or a Tillamook cheeseburger rather than actual medicine.
So these new rules represent progress. Ideally, they will push chains to step up their staffing and allow pharmacies to treat customers more humanely, as patients.
But there’s more to the story here. Real change may require pharmacy customers — with their prescriptions in hand and internal clocks ticking wildly — to be a little bit more patient, too.
– Associate editor Susan Nielsen, The Oregonian
Thousands of hours in many separate organizations have contributed to this. Small groups, individuals. Take some credit. A compromised pharmacist due to bad working conditions makes mistakes. The Pharmacy Alliance has stated “A tired pharmacist is a dangerous pharmacist” for the last three years. Members of The Pharmacy Alliance can pat themselves on the back. You helped get this done.
The game is on. We just made a first down. The next step is to publicize the result in Oregon everywhere. Ask this question of the media, “If this is necessary in Oregon, to protect the public, don’t you think it is necessary everywhere?”
Ask this question of your board, “Isn’t it time to do your job, protect the public? You know that pharmacists are compromised by long hours, no adequate meal or rest periods and a work place that is frenetic and very dangerous. You must act before the media jumps on this and embarrasses the board and the profession.”
Ask this of your colleagues, “Are you ready now, to do something other than complain”?
Join The Pharmacy Alliance today.
Our Boy Hubert Humphrey, the turncoat. The lackey of the doctors’ lobby and Pharma.
You may not be familiar with the term counter-prescribing. Some pharmacists still believe that this is as important in 2011 as it was in 1965. It is unfortunate that younger pharmacists do not think that it is part of the job.
I remind them as often as I can that OTC medicines are real drugs and that OTC counseling is real pharmacy.
The Golden Days of Counter-Prescribing
Well Before Durham-Humphrey
Counter-prescribing is the prescribing of Over The Counter medicines by the pharmacist. I do not use the word prescribing flippantly. People did not consistently get their medical care for minor illnesses like colds, coughs or gastric hyperacidity at the doctor’s office. They came to the druggist, the man they called “Doc”. Pharmacists made a substantial part of their livings from counter-prescribing.
Counter-prescribing is a carry-over from before the Durham-Humphrey Amendment. There weren’t that many drugs in those days. We relied heavily on the official formulas of drugs that were found in the USP and the NF. Pharmacists were still compounders and we were medical practitioners separate from doctors. That is probably hard for you to get. We are so accustomed to following the doctor’s lead even when it is not in the best interest of the patient that the idea of a pharmacist being independent is unbelievable.
Why would anyone go to the doctor for a headache when his best shot was surgery? The pharmacist could give you cocaine or heroin. No prescription needed, Amazing.
The original, with cocaine
The Durham-Humphrey Amendment of 1951 changed the game. It formally distinguished between prescription and over-the-counter drugs. Until that time, all drugs could be legally dispensed by pharmacists. No prescription necessary. Hence: Counter-Prescribing. It took more than a decade, but by 1965, my first year as a Registered Pharmacist, we had relinquished our independent role and had securely landed below the nurse in the medical hierarchy. It would take us decades to get back to where we are recognized as an important contributor to the patient’s health and we have not gotten back to our rightful spot yet.
The preceding was lifted from “The Comfort Demands. Occupy Pharmacy” by Jim Plagakis, RPh, available January 2012.
Here is an email from one of our members to his state board.
The nature of the RRRRRRR program’, one of XXXXXXXs business practices that is an automatic refill service, created numerous instances of unintended polypharmacy. I do not have records of these instances, because when I noticed them, I corrected them. The ones I didn’t notice were not corrected, because the system has no set way to make a pharmacist aware of them. We simply must catch them as they appear, and use our best judgment at the time. This can be very difficult due to the horrendous pressure the pharmacist is under to do things quickly. Every action is timed, how quickly you get prescriptions done, how fast you answer the phone, how quickly you get drive through customers handled and move to the next one. Failing to meet these targets results in discipline or even termination. This pressure puts the pharmacist in an untenable position: Do I satisfy company demands even if I feel in my professional judgment this may do harm, or do I take the legal and ethical path and possibly lose my job? Can a pharmacist comply with the mandates of counseling as defined by 21NCAC 46.2504, if they only have 2 minutes 30 seconds to do it in at the drive through? Why is there a ‘target’ number of automatic refills we must achieve every week, if the pharmacist honestly feels that a patient would not benefit, or possibly be harmed by this service, do we not have the ethical and professional obligation to act in the way that defends the patients interests, and not the company bottom line, no matter how that ‘shakes out’ on our weekly RRRRRRR report?
This constant pressure creates an unnecessary distraction that is a breeding ground for errors. I do not have records of actual patient harm, but the assumption that a harried pharmacist is more prone to make errors is a logical one. I do know that XXXXXX has a policy that any misfills are to be reported online via the company channels. I obviously cannot acquire these now, but I would imagine that should the Board inquire these records would be turned over. Then one could backtrack to see if XXXXXX policies led to these errors. Several pharmacists and store managers in the district may have other information as well.
I am curious, however, how this relates to my original complaint? I had initially stated that XXXXXXX’s involvement of a non-pharmacist manager – who is not even registered as a tech on the NCBOP website – in countermanding my authority in the filling and dispensing of prescription orders constituted an unlawful violation of 21 NCAC 46.1804 ( a ):
“The pharmacist-manager of the pharmacy shall be ultimately responsible for the safe, lawful and secure receipt of prescription orders and delivery of prescription drugs.” – to be responsible for something, yet unable to exert authority, cannot be the intent of the law. Such would be ludicrous. and ( b ):
“In filling or refilling prescription orders, the pharmacist shall not be required to deal with parties, including managed care companies and insurance providers, outside the practitioner-pharmacist-patient relationship.” – I can’t imagine that the store manager or district manager, both non-pharmacists, as agents of the permit holder, are included in the practitioner-pharmacist-patient relationship.
I would also point out that this behavior was incongruent with the “Practice of Pharmacy” as defined by 90-85.3-( r ):
“the responsibility for: interpreting and evaluating drug orders, including prescription orders; compounding, dispensing and labeling prescription drugs and devices; properly and safely storing drugs and devices; maintaining proper records; and controlling pharmacy goods and services.”
These are clear violations of the law. The fact that I left the pharmacy in protest of being forced to work in an environment I had repeatedly announced to management and staff was unsafe is irrelevant. Whether I stayed or left, a non-pharmacist usurped my authority as provided by the law. This action created a magnified potential for patient harm as the pharmacist in charge was no longer able to control the delivery of pharmacy goods and services to best benefit the public. To say otherwise, would be to admit that the public the Board is charged to protect is at the mercy of non-medical management who do not have the training to practice pharmacy, and whose loyalties will be to the good of corporate profits and not the patient.
To my mind, this is a cut and dried situation. Either a pharmacist manager is in charge, as the law would seem to imply, or they are not, in which case the law needs clearer language. I must admit that as a pharmacist of 12 years, over half of which has been as managing pharmacies, I find the notion of a non-pharmacist manager walking into a pharmacy and telling the pharmacist manager what she/he will or will not do in regards to any aspect of the pharmacy appalling. The fact that the legality of it seems to be up for debate is unconscionable.
The Royal Pharmaceutical Society
The Pharmaceutical Journal
Law and Ethics Bulletin
This organization, I believe, is the United Kingdom’s equivalent of the APhA.
Since the powers at our APhA would never dirty their hands or soil their reputations
with such a mundane, and non-important issue, where do we look for an organization that will?
This may be like a national board. Who wants to find out? Regardless, we need statements
like this from official organizations that carry weight. Is that APhA? Yeah Sure!
Making adequate provisions for pharmacists to have appropriate rest breaks
Pharmacists’ prime concern must be for the safety and well being of patients and the public. Working for extended hours without taking appropriate rest breaks can adversely affect a pharmacist’s ability to practice safely and may compromise patient care. Pharmacists, pharmacy owners and pharmacy managers should therefore ensure that provisions are in place to allow pharmacists to have appropriate rest breaks.
The Code of Ethics supports this requirement by stating that pharmacists should ensure that they do not work in conditions that they do not work in conditions that do not enable them to comply with the key responsibilities of a pharmacist. Similarly, there is a professional requirement for pharmacy owners, pharmacists and pharmacy managers to ensure that they do not seek to impose conditions on pharmacists that may adversely affect their ability to comply with their professional and legal duties. It is essential to encourage pharmacists to take appropriate breaks, and requiring an employee pharmacist to work for extended periods without adequate provision for rest breaks could constitute a breach of the Code of Ethics.
A pharmacist’s capacity to undertake his or her professional duties safely for specified periods, without a break, will differ between individuals. It will also depend on various factors such as the tasks being undertaken, the complexity of patients’ needs, the level of trained support staff on duty, prescription volume and the level of over-the-counter business. Pharmacists and their employers should give particular consideration to the provision of appropriate rest breaks for pharmacist who work extended hours pharmacies, provide on call services or travel long distances to their place of work.
When agreeing working hours and breaks be taken during the working day, employers and employees should take note of the Working Time Regulations 1998. These state that if an employee is required to work for more than six hours at a time, he or she is entitled to a rest break of 20 minutes. The break should be taken during the six-hour period rather than at the beginning or the end, but the exact time at which breaks are taken is left to the discretion of the employer. Employees are entitled to have a minimum 11 hours rest between working days and cannot be forced to work more than 48 hours a week on average.
While the Working Time Regulations can provide a useful benchmark, more frequent breaks may be required, for example, where high volumes of prescriptions are being dispensed. Employers are responsible for making sure that their employees can take a rest break, but they are not required to make sure that the break is taken.
The right to rest breaks does not apply where a job requires round-the-clock staffing, such as in hospitals, and exceptions can be made for emergencies or busy periods.
The above principles and guidelines also apply to Registered Pharmacy Technicians.
While a pharmacist is taking a break, robust standard operating procedures should be in place to ensure that no activities take place that require the pharmacist’s personal involvement or oversight. All pharmacy support staff should be aware of these procedures and patients should be advised of when a pharmacist is not available and when he or she is due to return.