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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 generic viagra with echeck 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.