Who is to blame for pharmacy mistakes?
The issue of pharmacy mistakes is possibly the most serious issue facing our profession. Why have we been unable to solve this problem? I blame the following:
1. State boards of pharmacy—In my opinion, the state boards need to have the authority to levy hefty fines against those employers who don’t provide adequate staffing for the safe filling of prescriptions. The fines need to be more than a slap on the wrist. As it is now, the big employers find it less expensive to pay customers harmed by pharmacy mistakes, rather than hire adequate staffing. The state boards need the muscle and willpower to aggressively go after the big employers, rather than slap them with a fine that means nothing to these multi-billion-dollar corporations. The fines need to be big enough so that the big employers conclude that understaffing and the inevitable pharmacy mistakes are simply not a profitable business model.
2. National Association of Boards of Pharmacy (NABP)—According to its website, NABP is “the impartial professional organization that supports the state boards of pharmacy in protecting public health.” In my opinion, this places NABP in a unique position to make a difference with the issue of pharmacy mistakes. I would like to see NABP take its role seriously in protecting public health by making a forceful presentation to Congress that safe staffing in pharmacies must be assured. Surely NABP could do more in this regard than it is now, i.e., nothing.
3. American Pharmacists Association—Many pharmacists harbor a tremendous amount of contempt for APhA for not focusing on those working conditions (primarily staffing levels) that make errors inevitable. The American Medical Association seems to be far more effective in addressing working conditions for doctors than APhA is for pharmacists. Many pharmacists are incredulous that APhA appears to be too timid to fight for pharmacists’ working conditions. Many pharmacists feel that APhA’s timidity in addressing this issue is more than enough reason to refuse to join that organization.
4. State legislatures—The anti-regulatory ideology that predominates in America today (even after the near-collapse of our financial system) holds that the market should be left to its own devices to fix every problem, and that no governmental agency should intervene in the private sector. Accordingly, workplace issues such as understaffing are conveniently viewed by state legislatures as employer-employee issues rather than public safety issues. But state legislatures have a duty (like state boards) to protect the public safety. Fear of being labeled by state legislatures as anti-business causes leaders of pharmacy boards, NABP, and APhA to avoid focusing on understaffing. Unfortunately, state legislatures have tremendous power to overturn helpful workplace regulations that any pro-employee state board dares to pass. I would like to see some head of a state pharmacy board put his job on the line by standing up to the big chains even at the risk of being labeled by that state legislature as anti-business. We need courageous leaders who put this issue above their own job security. It seems that our leaders prefer to bask in the prestige that accompanies their positions, rather than use their visibility to make a real difference for pharmacists in the trenches.
5. Employers—I know many pharmacists who privately welcome the huge multi-million dollar jury awards against the big employers as a result of serious and/or fatal mistakes. Many pharmacists hope that these huge jury awards will embarrass and shame the big employers into providing adequate staffing so that pharmacy mistakes are a rarity. As it is, pharmacy mistakes are a predictable consequence of this business model based on slinging out prescriptions as fast as McDonald’s slings out burgers. Many pharmacists are disgusted that McDonald’s seems to be far more capable of providing adequate staffing for the preparation of hamburgers, whereas the huge drugstore chains seem to be incapable or unwilling to provide adequate staffing for the preparation of a far more critical product: prescription drugs.
6. Pharmacists—Every pharmacist knows that many of our colleagues are an accident waiting to happen. These pharmacists would make errors regardless of prescription volume and regardless of staffing levels. Some pharmacists seem to have no clue about how high the stakes are with each prescription we fill. They seem to be completely oblivious to the fact that lawyers are salivating over the possibility of taking a huge bite out of our posterior.
7. Pharmacy customers—Our customers deserve a big chunk of the blame for pharmacy errors because they—like our employers—seem to judge pharmacists solely by how fast we fill prescriptions. Unfortunately, drive-thru windows send an unmistakable message to customers that prescriptions are no different from burgers.
8. Cultural factors—Our quick-fix, pill for every ill culture has commodified health. When health is seen simply as the result of the consumption of commodities, it is not surprising that the rapid distribution of those commodities is seen as paramount. Mistakes are inevitable when pharmacy is seen primarily as a distributive activity rather than a cognitive activity.