Most chain pharmacies want you to feel safe ordering from them, and so their ads tout the skill, expertise, and personal touch of their tools and personnel. They promise available pharmacists who have computers who alert them to danger, and who can then tell you things like, “Hey, you shouldn’t take these together; it will kill you” if there’s a problem.
But as the Chicago Tribune discovered during an in-depth investigation of area pharmacies, that doesn’t happen as often as you’d think. In fact, on average, pharmacists only warned about the hazardous interaction just over half the time — 114 in 223 tests, or 51% of the time.
How’d the Tribune get those 223 tests? Reporters for the paper took two contraindicated prescriptions with them, for simultaneous filling, at 223 Chicago-area pharmacies including local independent stores, regional chains, and national chains. They graded each interaction as pass/fail: if the pharmacist noted the interaction and/or tried to contact the prescribing physician about it, that was a pass. If the pharmacist didn’t try either, and just handed over the drugs, that was a fail.
Independent pharmacies had the highest fail rate of any the Tribune tried, at 72%, or 23 out of 32 attempts. Next highest was CVS, at a 63% fail rate. Target, Kmart, and Costco also all hovered around a 60% fail rate. Walmart and Jewel-Osco reported in with a 43% failure rate, with regional chain Mariano’s right behind them at 37%. The least likely to kill you? Walgreens, which only (“only”) missed the conflict 30% of the time.
Failures were widespread, the paper adds: they happened routinely in low-income neighborhoods as well as in extremely wealthy ones. Even one pharmacy location in a hospital failed.
The pharmacists who got it right got it very right, the Tribune reports. “You’ll be on the floor. You can’t have the two together,” one Walgreens pharmacist told a reporter.
But a huge number weren’t getting it right at all.
After the Tribune released its story, pharmacy regulators and corporations alike sprang into taking-it-seriously action.
The executive director of the National Association of Boards of Pharmacy — the group that pulls together and represents all the state-level pharmacy regulatory boards — told the Tribune that patient counseling needs to happen more often, and more thoroughly.
“Anytime there’s a serious interaction, there’s no excuse for the pharmacist not warning the patient about that interaction,” he said.
Laws about patient counseling, however, vary wildly from state to state. Even in states (like Illinois) where pharmacists have to offer, that usually takes the form of the check-out question, “Any questions about this prescription?”
However, pharmacists speaking with the Tribune by and large told the paper that there’s just simply not enough time to provide highly personalized service to every customer. Pharmacists are understaffed and overworked, they said.
One told the paper that she typically fills 200 prescriptions in a nine-hour shift — that’s less than three minutes per prescription. And that’s an improvement from a previous job, where she said she and one other pharmacists were covering 600 a day in ten-hour shifts.
Those time pressures aren’t just about consumers’ perception about how long they wait; at CVS, for example, pharmacists are actually measured, very specifically, on how quickly they are able to get drugs into patients’ hands. A 2012 survey of pharmacists found that nearly two-thirds worked for pharmacies that tracked how much time it takes to fill each prescription, and 25% worked for companies that guaranteed short wait times to shoppers.
Haste makes waste… and error.
CVS and Walmart both “vowed to take significant steps” to improve their procedures after the Tribune told them its findings, the paper reports. Those steps include pharmacist training, as well as updates to computer alert systems that are supposed to throw a flag when something bad is impending.
Costco declined to comment, and Kmart told the Tribune that the results were “an opportunity to look in the mirror” and figure out what they need to do better. The regional chains, Jewel-Osco and Mariano’s, both said that their pharmacists prioritize patient safety.
Pharmacies miss half of dangerous drug combinations [Chicago Tribune]
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