Are More Mistakes Happening at Pharmacies?

A Fox 9 Investigation looks at mistakes at Minnesota pharmacies and how complaints are on the rise.

In one instance a customer was given the wrong prescription, and a blood clot formed and a paralyzing stroked occurred. The damage was permanent. A confidentiality agreement prevents the person from talking about it publicly.

The Executive Director of the Minnesota Board of Pharmacy, Cody Wiberg, said they don’t know with certainty how often errors occur.

Drug stores are filling more prescriptions than ever, at some locations as many as 800 a day, and it's not uncommon for some pharmacists to work 14 hours straight. Volume often makes up for lower reimbursements from insurance.

CHAOS IN THE PHARMACY

Pharmacist Lyla Aaland is able to speak freely because she is now retired. The Fox 9 Investigators contacted her after reviewing a file obtained from the pharmacy board. She was among dozens of pharmacists who wrote the group to share concerns about working conditions. "Chaos in the pharmacy, busy, phone calls, drive thru, too many interruptions, that's what it is," she said.

The records checked by Fox 9 offer rare insight into what's going on behind the drug store counter. "14 hour days with no breaks are extremely exhausting and lead to errors," wrote one pharmacist in the reports. Another wrote "there is no question that fatigue becomes a problem." Insiders said that as it all adds up, it becomes more likely that mistakes will happen.

MORE COMPLAINTS

"We're getting more complaints than we've ever received,” Wiberg said. When he joined the pharmacy board more than a decade ago, consumers filed maybe 100 complaints a year. Now he said the number has nearly tripled. "We also know that for every complaint that we get, there are many more errors that are never reported to us," he said.

On occasion, the state has fined a drug store for giving a medication to the wrong patient. But regulators really have no idea when errors happen, unless someone registers a formal complaint with the pharmacy board. That's because drug stores are not required to report that data. They are, however, supposed to keep an internal log of mistakes. An industry trade group said that approach "emphasizes correcting and preventing future errors." Aaland said while she always reported any mistakes, some of her colleagues did not, primarily because they were so busy.

SILENCE AFTER A SETTLEMENT

When mistakes cause serious injury or even death, the cases are often settled out of court with a clause that no one can talk about it. Personal Injury Attorney Jeff Sieben had a client who was mistakenly given pain killers instead of diabetes medicine.  It impaired his driving, causing a crash and injury. "They don't want the general public to know of a problem," he said. He added the case involved a well-known drug chain, but couldn’t disclose the name due to the settlement terms.   

CONSULTS ARE KEY

Druggists are supposed to discuss every new prescription with the customer. It’s a way to prevent errors by confirming the medication in the bag is appropriate. “[Consults] supposed to [happen] and people will say they are doing it. But it’s the one thing that I think gets put by the wayside," said Aaland.

According to state regulators, lack of consults is one of the main reasons why pharmacists might be disciplined; it's considered such a crucial step in the safety process.

Fox 9 asked the National Association of Chain Drug Stores for an interview. They declined but in a statement said "Patient safety is a pharmacy's top priority. Pharmacies constantly pursue opportunities to improve safety."

PHARMACISTS' HOURS TO BE LIMITED

Under a new rule by the Pharmacy Board starting July 1, Minnesota will no longer allow pharmacists to work more than 12 hours in a row, and they'll be required to get mandatory breaks. "This is an attempt to relieve that stress that we acknowledge is out there so pharmacists are less likely to make errors," said Wiberg.

Customers have a safety role in all of this too. When the pharmacist asks questions, they should take the time to answer. Studies show that it’s during those discussions that mistakes come to light.

Full statement from the National Association of Chain Drug Stores:

Patient safety is a pharmacy’s top priority. Recognizing that human error is a possibility in any profession, pharmacies constantly pursue opportunities to improve safety. One example is updating and enhancing quality assurance and training programs for pharmacy personnel. Another example is using work flow and technology innovations to help reduce the chances of human error. Scanning technology is used in some instances to verify that the medication that has been prescribed matches the medication actually being dispensed. Also, the use of electronic prescribing is on the rise. E-prescribing can reduce the risk of errors from prescribers’ handwriting and from incorrectly entering prescription information.

In addition to patient-safety-focused processes and technology, community pharmacies have provided feedback to the Minnesota Board of Pharmacy on the pharmacist work rule surrounding breaks. As responsible and highly educated professionals, pharmacists’ judgments are more effective than rigid rules when it comes to decisions about breaks. The work rule taking effect July 1 reflects input provided by community pharmacies to the Minnesota Board of Pharmacy. The Board arrived at a reasonable approach in its final work rule, and we appreciated the opportunity to provide context throughout their process. In the end, everyone agrees that the best policies should be consistent with a pharmacist’s ability to meet the needs of patients and put safety first.

Also, the pharmacy community supports legislation that fosters quality assurance programs and patient safety for all healthcare providers, including pharmacies. Further, we support voluntary reporting of medical and prescription errors in a non-punitive forum, with a focus on strategies and education to help identify an error’s root cause. This approach, common among healthcare professions, emphasizes correcting and preventing future errors.