Patient Safety Alert-Debate continues: Is pharmacist shortage creating risks?
More pharmacy schools opening, but that's not a short-term fix
Some industry experts fear the pharmacist shortage eventually will threaten patient safety as the demand for prescriptions increases from 3 billion to 4 billion by 2004. And while there is a growing need for pharmacists, the number of students entering pharmacy schools essentially remains the same year after year.
Carmen Catizone, executive director of the Park Ridge, IL-based National Association of Boards of Pharmacy, says the nature of the job creates a potential for danger. "Any time you dispense a prescription as a pharmacist and you make an error, patient safety is at risk. The volume [of prescriptions] certainly adds to the risk."
To reduce the chances of compromising safety, Catizone says there is a need for more pharmacists and better-trained technicians. But that isn't likely to happen within the next few years.
Pat Minard, PharmD, pharmacy manager at Shawnee Mission (KS) Medical Center, says there's no doubt that the shortage creates a risk for patients, particularly in the retail setting.
Minard says there are cases where retail pharma-cists are under a lot of pressure to meet a bottom line. "Sometimes they end up working to the point where they are ignoring information screens where there could have been an interaction or they are asking technicians to do things that the pharmacist should be doing," he says.
Retail pharmacists also face a time crunch, Minard says. "Patients are more tolerant in a hospital," he says. "If it takes 30 minutes to fill a prescription, usually the patient doesn't know because he's upstairs in a bed. The nurse might get a little irritated. But standing around waiting in a drug store for 30 minutes is completely different."
He fills about 150 prescriptions during an eight-hour shift.
Lisa Abrams, MD, an internist at Lake Forest Hospital in Deerfield, IL, began working as a pharmacist in the early 1980s. Back then she would easily fill 600 prescriptions a day.
"This problem is not new," she says. "There's been a shortage for years even when I was starting out. I don't think patient safety is at risk because, by nature, pharma-cists have compulsive and obsessive personalities. "I would check and re-check a prescription, and I think other pharmacists do the same thing."
Patients suffer when pharmacists too busy
When pharmacists are under pressure to "lick, stick, count, and pour," the patient is the one who suffers, Minard says. "We are trained in pharmacy college to spend a lot of time counseling patients," he says. "You don't have time to do that in the retail setting."
Taking an extra few minutes to talk to a patient can dramatically reduce the likelihood of an error, most pharmacists agree. And indeed, a growing number of retail pharmacies are focusing more on patient care, says Dan Kidder, spokesman for Alexandria, VA-based National Association of Chain Drug Stores. "Chain stores are getting away from having pharmacists [getting stuck] behind the counter."
Kidder says no one doubts pharmacists need to spend more time with patients. "Approximately 50% of prescriptions are taken improperly by the patient. The time spent with the patient is crucial."
But even Richard Penna, executive vice presi-dent of Alexandria, VA-based American Associa-tion of Colleges of Pharmacy, concedes that a pharmacist with the best intentions can inadvertently put a patient at risk. "I have no information to say the lack of pharmacists puts lives in danger. But you could make a case, similar with a physi-cian in his residency who spends 36 hours on call. The last five or six hours are crucial time when errors occur.
"The same thing would hold true of pharmacy situations," he says. "They may not have time to double-check the order. One issue that does need to be dealt with is the amount of time pharmacists are spending with insurance companies," he says.
The solution to the pharmacist shortage seems obvious — recruit more pharmacy students. But that's easier said than done.
"In pharmacy, just like medicine, dentistry, and nursing, fewer and fewer people are entering the fields, and I don't know why," says Penna.
Some experts say careers in the medical field are taking a backseat to technology-based careers. "That has been mentioned by a variety of people and it sounds logical, but I don't know if it is the real reason." Pharmacy may not be as popular as technology because the hours are not regular and the salaries are not as high as in some computer-related positions.
New technology, however, can help support pharmacists in the delivery of better and safer care. One example is Excalibur Patient Safety Net, a software package and information system from Safety-Centered Solutions Inc. (SCS) in Tampa, FL. Excalibur includes reporting, analysis, and trending capabilities, as well as medical error and adverse drug reaction taxonomies to assure reliable data. Pharmacists using Excalibur have been able to significantly reduce the incidence of errors," says David Spencer, founder and CEO of SCS.
Pharmacy schools are doing their best to keep up with the demand. The 82 pharmacy schools across the country graduated 8,000 students in spring 2000.
New pharmacy schools are opening every year, but most graduate less than 100 students at a time. Meanwhile, there are 7,000 openings in drugstore chain pharmacies alone, and 94,000 pharmacists are employed nationwide. That doesn't count hospitals, community pharmacies, HMOs, and drug companies.
"Pharmacists are in demand by a lot of com-panies because of their knowledge of drugs," Penna says. "And that's all a part of it."
For more information, contact:
Carmen Catizone, executive director, National Association of Boards of Pharmacy, Park Ridge, IL Telephone: (847) 698-6227.
Pat Minard, PharmD, pharmacy manager, Shawnee Mission (KS) Medical Center. Telephone: (913) 676-2110.
Lisa Abrams, MD, internist, Lake Forest Hospital, Deerfield, IL. Telephone: (847) 535-8333.
Dan Kidder, spokesman, National Association of Chain Drug Stores, Alexandria, VA. Telephone: (703) 549-3001.
Richard Penna, executive vice president, American Association of Colleges of Pharmacy, Alexandria, VA. Telephone: (703) 739-2330.
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