----- Original Message -----
From: janet marie paterson <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, February 14, 2000 11:58 AM
Subject: NEWS: Pace of job proves too brutal for some pharmacists


> Pace of job proves too brutal for some pharmacists
>
> Second of three parts
>
> By JOHN HENDREN
>
> DAYTONA BEACH, Fla. (February 14, 2000 12:06 a.m. EST) - Pharmacist Randy
Kautz asked Walgreens for help at least four times. He warned that the busy
pace of his drug counter in Daytona Beach might lead to errors. On June 15,
1994, he no longer had to make the point. That day one of his regular
customers, Nathan Johnson, sank into a coma from which he never emerged.
>
> "Oh my God," Ruth Johnson remembers Kautz saying as he re-examined the
prescription bottle that she brought back to the store. "I've given the
wrong medication."
>
> A pharmacist's task is now filled with more speed and more stress than
ever before - and, studies suggest, less satisfaction. Pharmacists blame
their workload, growing along with their worries. When that workload affects
accuracy, the pharmacist's worries become the patient's.
>
> The National Pharmacists Association, a trade group based in Darien, Ill.,
recommends that, for safety's sake, a pharmacist fill no more than 15
prescriptions an hour. Elizabeth Allan Flynn, a researcher at Auburn
University School of Pharmacy in Alabama, says studies by her and others
suggest that the rate of pharmacists' errors increases after they fill more
than 24 prescriptions an hour.
>
> Whatever the number, pharmacists complain they routinely have to exceed
it.
>
> Druggist J.F. Burnham warned Walgreens managers in 1991 that the frantic
pace at his store in Arlington Heights, Ill., "enhances the chances for
error." Two pharmacists working separate shifts were filling up to 400
prescriptions a day - or nearly 29 an hour.
>
> "It's not unusual for me to talk to pharmacists who are filling 300
prescriptions a day," says Thomas J. Moore, a health policy analyst at the
George Washington University Medical Center in Washington, D.C. "The job of
the pharmacist is becoming nearly untenable. Management is putting on
pressure to increase output and reduce waiting time. And it's going to get
worse."
>
> That stress has driven druggists like John Magaudda from their jobs.
>
> "I'd see a bottle of thyroid medication on the counter and I'd say, `Why
is this out here? I didn't fill a thyroid prescription today,"' said
Magaudda, who quit his job at a Rite Aid in Santee, Calif., in 1997 after 36
years. "If things went on, it was going to get worse, and I was going to
make a mistake. A bad mistake."
>
> In a letter of warning to the California State Board of Pharmacy, Magaudda
wrote that more pressure on pharmacists would inevitably lead to more
errors.
>
> Several of the 50 state boards of pharmacy that oversee the industry have
begun to take complaints like Magaudda's seriously. Some have linked
understaffing to patterns of mistakes by the high-volume chains that now
dominate the industry.
>
> In Oklahoma, Eckerd reached a settlement with regulators in 1998 after the
state board of pharmacy found 23 prescription errors over one year at the
chain's Oklahoma stores.
>
> In one of those instances, pharmacist Shirley Frame worked 67 hours over
seven days before making a mistake that she attributed to "understaffed,
overworked employees." The state board said Eckerd didn't employ enough
pharmacists "to safely fill prescriptions," and concluded, "The harm to the
public is tremendous."
>
> Eckerd admitted no fault. "No inappropriate staffing was found," the
company said in a recent statement, and the settlement with regulators "did
not include any changes in staffing."
>
> In Washington state, the state pharmacy board reached an agreement with
Rite Aid last year after regulators fielded 134 complaints of dispensing
errors over three years at various locations. The chain agreed to pay
$50,000 in fines. It also agreed to review its staffing policies, but made
no promises to change them.
>
> Rite Aid made a similar deal with Oregon regulators in March, agreeing to
pay $60,000 to resolve a pharmacy board investigation. The state alleged
that the chain had shown poor supervision and violated state laws requiring
pharmacists to counsel patients on how to take their drugs.
>
> Rite Aid spokeswoman Jody Cook said the company has since taken action. In
Washington state, Rite Aid put every company pharmacist through a revamped
training program, installed automated dispensing machines at its busiest
stores, and reduced the number of complaints last year from 95 in February
to six in December.
>
> In Oregon, the company appointed a new regional vice president to
coordinate with regulators. It also increased staffing, automated some
dispensing and reduced complaints from 22 in January to one in December.
>
> Pharmacy owners say there are no easy answers.
>
> An expanding array of innovative drugs and insurance plans that cover them
has driven aging Baby Boomers - and Americans with conditions ranging from
baldness to cancer - to the drugstore in record numbers. Consumers now buy
an estimated 3 billion prescriptions each year - two pills for every one
they bought in 1989.
>
> Yet pharmacy schools turn out about the same number of druggists as they
did in 1989, creating what drugstore owners call a national pharmacist
shortage.
>
> President Clinton signed legislation in December to study the extent of
the shortage. The National Association of Chain Drug Stores, a retail trade
group, estimated that 4,000 of the 120,000 jobs at the nation's major chains
were open as of December.
>
> The American Society of Health-System Pharmacists estimates a moderate to
severe shortage of druggists at 90 percent of its hospital pharmacies, based
on a survey of 350 of its directors earlier this year. Nearly half of the
directors reported openings, with an average vacancy rate of 17 percent.
>
> The group's chief executive officer, Henri Manassi Jr., wrote to hospital
pharmacy managers Jan. 26 that the shortage is leading to overworked
pharmacists and "error hazards" that threaten patient safety.
>
> Many safety-related professions set limits on the hours worked. Air
traffic controllers, for instance, take breaks every two hours. But
pharmacists, like physicians, have no limit. Many complain that they rarely
take lunch breaks, or even bathroom breaks.
>
> In some cases, that has changed. Walgreens generally schedules pharmacists
for no more than 42 hours of work a week, spokesman Michael Polzin said. Yet
the shortage often translates to extra hours at Walgreens and other chains.
>
> Following a 1997 incident in which an Eckerd pharmacist in Wilmington,
N.C., dispensed the wrong drug during a 16-hour shift, Eckerd started
guaranteeing lunch breaks for druggists in selected regions.
>
> As they grow busier, pharmacists are coping with more paperwork than ever.
The chain drug association cites an industry-funded study done last year by
the Arthur Andersen accounting firm, which found that pharmacists spend 20
percent of their time dealing with insurance.
>
> The workload crunch has left druggists struggling to keep up.
>
> At the Daytona Beach Walgreens where Ruth Johnson picked up her husband's
fateful dose, the pace was picking up. In June 1991, the pharmacy averaged
162 prescriptions a day. When she picked up her husband's prescription in
June 1994, it was open 24 hours and averaging 247 prescriptions.
>
> Kautz was scrambling to supply customers with their drugs within 15
minutes. He meant to give her Coumadin, a blood thinner to prevent blood
from clotting. Instead he gave her Cycrin, a female hormone that can have
the opposite effect.
>
> Two weeks later, Nathan Johnson suffered a stroke that left him comatose.
He died last year, never regaining consciousness. His widow won a verdict of
$6 million.
>
> Between October 1991 and June 1994, when Ruth Johnson arrived, the Daytona
Beach pharmacy reported 27 other errors to Walgreens headquarters, according
to store records revealed in Ruth Johnson's lawsuit.
>
> In a deposition, Kautz recalled three or four occasions before the June 15
error when the same mistake happened - Cycrin placed in a bottle labeled
"Coumadin." But he caught those mistakes before they left the store.
>
> Along with reports of errors came store reports of chronic understaffing.
In February 1994, store managers warned of "current staff being stretched to
the limit." Kautz had asked for more help at least four times, according to
testimony from Kathryn Correia, the pharmacy's manager.
>
> Kautz said he asked for another pharmacist to work with him but was told
one "wasn't in the budget." He said he never took lunch or other breaks
because the store was too busy and he had no one to relieve him. And,
between 1993 and 1994, the store added six hours of pharmacist time per
week, but not a second pharmacist, according to court records.
>
> The now-relocated store has added pharmacist and technician hours since
then, but a spokesman declined "for competitive reasons" to say how many.
>
> Walgreens director of pharmacy operations, Phil Burgess, testified that
he'd heard pharmacists at various Walgreens stores complain "forever" about
inadequate staffing and excessive workload.
>
> Walgreens officials would not say how many errors the company's
pharmacists make, but spokesman Polzin said mistakes make up a "minute
percentage" of the prescriptions the chain's pharmacists fill. The chain
recently paid $150 million to revamp its computer system, replacing
computers handling 250 prescriptions a day with those that can manage more
than 400.
>
> "There is more business coming into the pharmacy, no doubt about that,"
Polzin said in a recent interview. "But we've made a very concentrated
effort to deal with that workload efficiently and allow our pharmacy staff
to handle that business without it becoming overwhelming."
>
> The expanding workload has left many pharmacists frazzled - and unhappy.
In 1998, Drug Topics magazine asked 870 pharmacists whether they would still
choose their profession. Only 45 percent responded yes, a drop of 10
percentage points over six years. For many, high stress is a daily part of
the job.
>
> Pharmacist Jim Ellison manned the Daytona Beach Walgreens counter a few
years before Randy Kautz took over. He also had tried to cope. He asked for
more help but, he told his brother David, "It doesn't do any good." He
rejected a promotion that meant more work and eventually transferred to a
slower store. He even gave up bathroom breaks.
>
> To calm down after work, his brother said, Ellison jogged, lifted weights
and started drinking four or five beers a night.
>
> Anxiety was Ellison's unshakable companion, even in his final moments. In
March 1995, he had chewed the nail on his middle finger to the nub. Bite
marks cut into the plastic tube that he hooked to the tailpipe of his Honda
Civic inside his garage.
>
> No one will ever know for certain why Ellison killed himself. But his
brother and his widow think they know.
>
> It was "his job."
>
> http://www.nandotimes.com/
>
> Copyright 2000 Nando Media
> Copyright 2000 Associated Press
>
>
> janet paterson
> 52 now / 41 dx / 37 onset
> a new voice: http://www.geocities.com/janet313/
> 613 256 8340 PO Box 171 Almonte Ontario Canada K0A 1A0
>