The Investigative Report

CBC Marketplace released a segment entitled "Pharmacy Errors: Dispensing Danger" last night (Jan 23, 2015) that I noticed popping up on my Twitter feed with #pharmacists. Centered in Canada, the episode (available Here) covers some weighty issues at the current time in the community setting (e.g. retail pharmacies). Interviewing 2 undisclosed community pharmacists, several patients and family members that have experienced medication errors, and pharmacy organizations, the episode covers several key points (which I will summarize):

• Pharmacists are being overworked. This is emphasized by the 2 interviewed pharmacists from "Large Retail Stores" that identify that they are victims of metrics, most businesses are not pharmacy friendly and run by others who have little idea about the professional duties of pharmacists, and may be exchanging patient safety for profit. This is addressed by the pharmacists stating how much they stress on errors they possibly made through the day, fear of hurting someone, and lack of time to perform  patient counseling.
• Patients are losing trust. Several individuals were interviewed that experienced what happens when a medication error is made to themselves or a loved one, and the long-term effects. Overall, the patients want justice for the errors, but some shed light that they feel the pharmacists were responsible, but also placed in an unfavorable position due to work stress.
• Pharmacies are not counseling or catching issues. The investigative reporting really comes into role when the news team goes 'undercover' to purchase several medications (e.g. Iron, Codeine) behind the counter to determine if the pharmacist would provide counseling. Overall, the damning part came when only 27 out of 50 pharmacies offered counseling, and none of the 50 caught a potential drug interaction. One caveat that I noticed that I think needs to be addressed (and why I emphasize pharmacy and not just pharmacists) is that some of these medications were picked off the shelf and sold by the technicians and did not seem to involve the pharmacist. Thats no excuse (But I can understand as a busy pharmacy will try to get things done quick, and if the pharmacist is busy, a technician may not bother them, especially if busy and forgets), but does demonstrate that some effort needs to be made to make the pharmacy a cohesive team. 
• Pharmacy Corporation did not offer any comments on current practice or errors. 
• Pharmacy Organizations offer very little to comment upon. Personally, I felt bad for the pharmacy representative speaking for the Canadian Pharmacist Association (CPA), as you can tell they are on the spot and while being very positive in the beginning, breaks down at the end after seeing the undercover data conducted by the investigative team. They just do not have much to add to the conversation, and while proclaiming that there are standards and guidelines, cannot go into detail. Lastly, CPA cannot give any metrics on the effectiveness of pharmacists, which leads into the final segment of the episode...
• We need more Metrics to track pharmacy related errors. At least thats what the investigative team posits. Tracking errors will help identify where issues are taking place and demonstrate where the system is breaking down and improve patient safety.

Overall Thoughts on Report

I feel that Pharmacy goes through waves where they have investigative reports conducted, and often its the same thing. Interview those that have been harmed, go 'undercover' and show the pharmacy messing up, and then report that the public should be scared of the pharmacy - and the pharmacist in particular. 

That being the case, I feel that this has been a fairer portrayal, interviewing pharmacists and their comments an concerns. While the CBC Marketplace called for patients to comment, they didn't do a good job of giving pharmacy a good opportunity to talk about their own concerns and thoughts. I particularly like the comment sections of the articles though on the CBC website that is demonstrating the fact that while pharmacists make errors, they also prevent alot, and that is never reported (and that is something I want to come back to later). They really put CPA on the spot, and that may be a good thing, as sometimes professional organizations and academics (such as myself) live in the 'Ivory Tower' of pharmacy and forget that the majority of pharmacists are practicing in community and are under alot of pressure.

One thing future journalist should concentrate on is just the chaos of most pharmacies. Watch it for a few hours, and document all the crazy stuff that goes on. Maybe the can count the phone calls, the patients attitudes, pharmacists activities (e.g. counseling, going into the isles); but also the bitterness that is present such as the verbal lashings the pharmacy takes on a daily basis. That I feel would give the audience a better understanding. It's one thing to be overworked, it's another to be verbally assaulted on a daily basis as well. 

So what can pharmacy take away from this report?

Part of me wonders if this report comes in the wake of the news of a patient dying from a significant drug interaction back in October, 2014. The reason I state this is that really, when someone dies and pharmacy was last to see that patient, pharmacy really needs to step up and talk about it and work with the media. My biggest example would be the debacle with the New England Compounding Center meningitis outbreak that many patients in the US are still reeling from. I do not think pharmacy did a good job addressing this problem with the public.

And really, the public and our patients is where pharmacy relations suffer. Honestly, pharmacy has no good representation in media as I have said again and again. Look at television, we are selling drugs for sex, a bumbling idiot, or the butt of a many joke. We really have no 'star' pharmacist to put on show for the public to demonstrate our ability or roles and characterize the profession. I would posit our biggest media presence really comes when we hit the news, and often its after something like this report or we mess up! How disappointing is that?

So why does that matter? How can we attempt to pursue more professional duties when we have a lack of trust from society? How can we seek provider status to do more clinical duties when we are still haven't mastered our longstanding role as being in charge of the distributors and gatekeepers to the drugs the vast population takes? 

Pharmacy organizations  and the overall profession needs to tackle this issue (which I feel impacts >75% of pharmacists nationwide) before trying to expand clinical roles (that even when rolled out will probably impact just a small segment of pharmacists prior to buy-in by the population and then expand services). 

Lastly, these reports, while putting the pharmacist in some negative light, may be the only way to thrust some key issues into the public light, and see any meaningful impact if patients clamor for changes in their care. This may turn into a demand for greater transparency on the number of errors made by pharmacists, but I would also thing we would want to talk about all the great things we do as well. Otherwise, we would be trading for a balance of metrics for mistakes vs metrics for money.