NYT: How Chaos at Chain Pharmacies Is Putting Patients at Risk

[Mike 03]

Pharmacists across the U.S. warn that the push to do more with less has made medication errors more likely. “I am a danger to the public,” one wrote to a regulator.

For Alyssa Watrous, the medication mix-up meant a pounding headache, nausea and dizziness. In September, Ms. Watrous, a 17-year-old from Connecticut, was about to take another asthma pill when she realized CVS had mistakenly given her blood pressure medication intended for someone else.

Edward Walker, 38, landed in an emergency room, his eyes swollen and burning after he put drops in them for five days in November 2018 to treat a mild irritation. A Walgreens in Illinois had accidentally supplied him with ear drops — not eye drops.

For Mary Scheuerman, 85, the error was discovered only when she was dying in a Florida hospital in December 2018. A Publix pharmacy had dispensed a powerful chemotherapy drug instead of the antidepressant her doctor had prescribed. She died about two weeks later.

The people least surprised by such mistakes are pharmacists working in some of the nation’s biggest retail chains.

In letters to state regulatory boards and in interviews with The New York Times, many pharmacists at companies like CVS, Rite Aid and Walgreens described understaffed and chaotic workplaces where they said it had become difficult to perform their jobs safely, putting the public at risk of medication errors.

They struggle to fill prescriptions, give flu shots, tend the drive-through, answer phones, work the register, counsel patients and call doctors and insurance companies, they said — all the while racing to meet corporate performance metrics that they characterized as unreasonable and unsafe in an industry squeezed to do more with less.

“I am a danger to the public working for CVS,” one pharmacist wrote in an anonymous letter to the Texas State Board of Pharmacy in April.

“The amount of busywork we must do while verifying prescriptions is absolutely dangerous,” another wrote to the Pennsylvania board in February. “Mistakes are going to be made and the patients are going to be the ones suffering.”

snip

The American Psychiatric Association is particularly concerned about CVS, America’s eighth-largest company, which it says routinely ignores doctors’ explicit instructions to dispense limited amounts of medication to mental health patients. The pharmacy’s practice of providing three-month supplies may inadvertently lead more patients to attempt suicide by overdosing, the association said.

“Clearly it is financially in their best interest to dispense as many pills as they can get paid for,” said Dr. Bruce Schwartz, a psychiatrist in New York and the group’s president.

A spokesman for CVS said it had created a system to address the issue, but Dr. Schwartz said complaints persisted.

Regulating the chains — five rank among the nation’s 100 largest companies — has proved difficult for state pharmacy boards, which oversee the industry but sometimes allow company representatives to hold seats. Florida’s nine-member board, for instance, includes a lawyer for CVS and a director of pharmacy affairs at Walgreens.

Aside from creating potential conflicts of interest, the industry presence can stifle complaints. “We are afraid to speak up and lose our jobs,” one pharmacist wrote anonymously last year in response to a survey by the Missouri Board of Pharmacy. “PLEASE HELP."

Fairly long article: https://www.nytimes.com/2020/01/31/health/pharmacists-medication-errors.html?action=click&module=Top%20Stories&pgtype=Homepage

[murielm99]

1. I filled my prescriptions at Shopko,

and had no complaints. They knew me and were great. My Medicare D plan worked well there. Then they closed.

Then I had to transfer to Walgreens. They have one pharmacist on duty and about half a dozen pharmacist's assistants. The lines are long. Their tempers are often frayed. They made a mistake with one of my medications once.

When I could change my plan, I switched to the small pharmacy in my community of 2,500. It was the best plan. I am saving about $150.00 a year. The pharmacist's assistant there is someone I knew as she was growing up. I never have to wait in long lines, like Walgreens.

I don't know if I can get my flu shot there, and I am due for another pneumonia shot. I may have to go back to Walgreens for those.

People can go to their local senior centers and get help comparing Medicare D plans. Please do this if you can. Often, the small pharmacies offer better service for everyone. They know their customers.

[Warpy]

2. Given the hectic pace at most chain pharmacies

I'm surprised that there are so few screwups.

Still, the best thing to do is go to one of the online pill identifiers when you bring a prescription home to make sure it's the right drug in the right dosage. It only takes a few seconds and makes you your best advocate. It's especially important when you're taking generic drugs and pharmacies swap manufacturers.