Tired employees at Walgreens and CVS are making mistakes that may threaten patient safety.
For some time, pharmacists have argued that understaffed and high-pace work environments are contributing to medication errors and compromising public safety. Management has challenged these allegations but is planning to review the standards used to evaluate pharmacists’ performance.
Video Spotlight: Medication Errors at 24-Hour Pharmacies
This post is based on The New York Times article, At Walgreens, Complaints of Medication Errors Go Missing, by E. Gabler, February 21, 2020, and the YouTube video, Prescription Drug Dispensing Errors Kill 100,000 People Per Year in US, by CBSDFW, May 14, 2018. Image source: fstop123/Getty Images.
1. How do Walgreens and CVS try to ensure high levels of productivity from their pharmacists?
Guidance: The productivity index is measured by the ratio of output to input. In this article, the efforts mentioned to boost productivity involve a reduction of inputs through increased quantitative workload and multi-tasking. The high pace of work, lower staffing levels (e.g. elimination of overlapping pharmacists, reduced work hours for technicians), and longer hours contribute to quantitative overload. Answering the phone, filling drive-through and in-store orders, and giving flu shots are some of the multiple activities pharmacists must perform with little or no downtime.
2. High customer service levels (“promise time”) are used to evaluate pharmacists’ performance. Assess this practice.
Guidance: In principle, it is good to tie performance to customer service. In this instance, customer service is measured by timeliness. The problem is that overload, multi-tasking, and a lack of control over staffing contribute to stress which, in turn, jeopardizes patient safety. In other words, performance emphasizes timeliness at the expense of reliability. The compensation system is therefore similar to manufacturing’s basic piece-rate system which prioritizes quantity over quality.
3. At the Owasso CVS pharmacy, a 9.5% error rate was found in a sample of 200. Is the process capable of meeting the Oklahoma board’s and patients’ specifications?
Guidance: Process capability is not assessed with a single sample. However, the process must be in control for capability to be determined. If this sample percentage is within the upper and lower control limits, the pharmacy’s activities should be suspended until major process improvements are implemented. The process would not be capable. For this type of product, the allowable error rate should be very small for minor errors and zero for type of drug and dosage.