Pharmacy Unions Push for Improvements

High workloads for pharmacists increase the potential for medication errors, and during the current coronavirus disease 2019 (COVID- 19) pandemic, the pressures are greater than ever. Unions are taking unprecedented steps to protect pharmacists and their patients. Their focus over the next year will be on making significant and lasting changes to prevent the growing number of obstacles that distract pharmacists from safely dispensing drugs.

In Chicago, permanent changes are occurring. Several years ago, a Chicago Tribune investigation revealed that 52% of 255 Chicago-area pharmacies had failed to warn patients about drug combinations that could cause harm or death.¹ Since then, Teamsters Local 727 has worked with the Illinois legislature to update the state’s pharmacy act to better reflect the issues of working in a retail pharmacy. The union is pushing for mandatory, uninterrupted breaks for pharmacists.

In 2020, Teamsters Local 727 aims to raise standards, improve working conditions, and lift the collective voice of pharmacists and members of Teamsters Local 727. In an email, Teamsters Local 727 told Drug Topics® that the union is advocating for further reforms to the Illinois Pharmacy Practice Act, and, through its 2 seats on the Illinois Pharmaceutical Task Force, this fall it will give recommendations to the state legislature regarding further reforms.

The union supports additional policy reforms, including limiting retail pharmacists’ workdays to 8 hours, requiring that at least 1 pharmacy technician be on duty at all times when a pharmacist is scheduled, and requiring a separate break room to guarantee uninterrupted breaks. In addition, Teamsters Local 727 is asking for a triple-pay penalty for days when a retail employer fails to give a pharmacist the opportunity for an uninterrupted break.

“Retail chains should be held responsible for any failure to allow pharmacists to take uninterrupted breaks. When pharmacists are unable to take breaks, it’s usually due to understaffing in the pharmacy while the duties for pharmacists continue to grow,” Teamsters Local 727 said in the email.

Protecting Pharmacists and Their Patients

Ilisa Bernstein, PharmD, JD, senior vice president for pharmacy practice and government affairs at the American Pharmacists Association in Washington, DC, said several states have rules governing pharmacist breaks, including the minimum number, based on hours worked, and where they can be taken. “In addition, some employers have begun providing breaks for pharmacists,” Bernstein told Drug Topics® in an email. “Whether by law or policy, employers should provide pharmacists with mandatory, scheduled, uninterrupted meal breaks away from the pharmacy workflow to promote pharmacist well-being and improve patient safety.”

The COVID-19 pandemic has created significant disruptions in pharmacy operations and raised pharmacist safety concerns, according to Bernstein. “Access to appropriate [personal protective equipment (PPE)] and barriers in accordance with CDC guidance, distancing issues, personnel shortages, drug supply disruptions, and more have left pharmacists in a constant state of uncertainty, and they are taking extraordinary measures to ensure consistent delivery of quality patient care,” she said.

States, federal agencies, and employers have taken steps to improve conditions, she said, but as the pandemic evolves, so do pharmacist issues and concerns. For example, she said, although pharmacists welcome the ability to provide COVID-19 testing and a potential vaccine, employers and employees need to collaborate in the workplace to mitigate pharmacy operation and safety concerns.

Veronica Bandy, PharmD, MS, past president of the California Pharmacists Association in Sacramento, said that state laws regarding staff breaks vary. “Breaks for pharmacy personnel are needed to prevent fatigue and allow for time to use the facilities. Adequate staffing, breaks, and safety would be beneficial to be addressed to ensure the ability for pharmacists to provide health care at its highest level,” Bandy told Drug Topics® in an email.

The pandemic has changed the practice of pharmacy. Some pharmacies have placed protective partitions between patients and personnel. Individuals are encouraged to use drive-through or other social distancing methods for prescription pickup. In addition, masks need to be worn, and PPE use and social distancing between staff members must increase.“The California Pharmacists Association has been instrumental in advocating that pharmacists as health care providers have access to face masks and other [PPE]. As with many areas of health care, the practice of pharmacy is adapting on a daily basis as more scientific information becomes available,” Bandy said.

James Broughel, a senior research fellow at the Mercatus Center at George Mason University in Arlington, Virginia, said that in response to the pandemic, many governors expanded pharmacists’ prescribing authority or made it easier for medical professionals licensed in another state to practice. Many states have drive-through COVID-19 testing sites at pharmacy locations; although the extent of these operations varies significantly across states, pharmacists already play a significant role, which is likely to grow over time. "Unions should anticipate that pharmacists are going to be doing a lot of COVID-19 testing and ensure that adequate precautions are taken to ensure the safety of pharmacy staff, as well as customers,” Broughel told Drug Topics®.

Workload Matters

Study results published in 2007 in the journal Medical Care found that high workloads for pharmacists increase the potential for medication errors.

In a retrospective study, investigators reviewed data submitted to insurance companies by 672 pharmacies in 18 metropolitan regions. The pharmacies filled an average of 17,948 prescriptions from January to March 2003. The investigators found that factors significantly related to an increased risk of dispensing prescriptions with potential drug-drug interactions included pharmacist workload (odds ratio [OR], 1.03), pharmacy staffing (OR, 1.10), and various technologies, such as sophisticated telephone systems, internet receipt of orders, and refill requests.²

The pharmacies employed an average of 1.2 pharmacists for each hour the store was open, and each pharmacist filled an average of 14.1 prescriptions per hour. The risk of dispensing potentially harmful drug combinations increased by 3% for each additional prescription filled per hour. There has been little improvement since the research was done, said study investigator Dan Malone, PhD, RPh, a professor at the University of Utah College of Pharmacy in Salt Lake City. “Working conditions are worse,” Malone told Drug Topics® in an email. “I would suggest that not much has changed.”

Mike DeAngelis, senior director of corporate communications for CVS Health in Woonsocket, Rhode Island, said the company has policies and protocols to help ensure that stores are safe for both employees and patients during the current pandemic. All employees have received protective masks, gloves, hand sanitizer, and cleaning supplies and are required to wear a company-issued mask, their own mask, or a cloth face covering. “We have installed protective panels at our pharmacy counters and front-store checkout stations in all stores. We have hourly protocols in place for cleaning hard surfaces and more frequent cleaning of commonly handled items,” DeAngelis said in an email.

B. Douglas Hoey, MBA, RPh, CEO of the National Community Pharmacists Association in Alexandria, Virginia, said community pharmacies are the safety nets helping their communities during both times of crisis and normal times. In addition, pharmacists now are on the front line in America’s fight against COVID-19, ordering and administering tests. “With testing now and immunizations once a vaccine becomes available, community pharmacists could be the centerpiece for helping the country get back to normalcy,” Hoey told Drug Topics® in an email. How smoothly that goes will depend on the rights and protections afforded pharmacists in retail stores across the nation.

References:

1. Roe S, Long R, King K. Pharmacies miss half of dangerous drug combinations. Chicago Tribune. December 16, 2016. Accessed July 1, 2020. https://www.chicagotribune.com/investigations/ct-drug-interactions-pharmacy-met-20161214-story.html
2. Malone DC, Abarca J, Skrepnek GH, et al. Pharmacist workload and pharmacy characteristics associated with the dispensing of potentially clinically important drug-drug interactions. Med Care. 2007;45(5):456-462. doi:10.1097/01.mlr.0000257839.83765.07