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Are Performance Metrics Contributing to Pharmacy Error?

When pharmaceutical errors happen, the results can be deadly. This type of medical malpractice hurts patients in two ways. First it results in their taking a medication that may be dangerous for them and second it results in their not getting the medication that their doctors have determined they need. Despite the danger of both of these consequences and despite the years of training required for pharmacists, these errors still happen at a shockingly high rate. It is important to figure out why. A report from the Boston area indicates one potential contributing factor: performance metrics.

Do Performance Metrics Contribute to Pharmacy Error?

CBS Boston recently reported on the possibility that performance metrics contribute to pharmacy errors. So what are performance metrics? They are a system used by CVS to measure how many prescriptions a pharmacist fills and how fact he or she does it. The system also includes information about other pharmacist duties like flu shots and calling patients to get them to fill their prescriptions. These numbers are then used by CVS to judge the pharmacists performance. CVS is of course adamant that their system does not contribute to pharmacy errors, but it is hard to imagine how it could not. Pressuring professionals to work faster and faster is ultimately going to result in more errors, regardless of the profession.

It is important to note that while CVS uses this system, it is not the only pharmacy chain that does so. Susan Holden, the president of the Massachusetts Association of Pharmacists, was subjected to a similar system at a different drug store chain. She called the system she worked under “very nerve-wracking, very stressful, sometimes tearful.” If the system truly is that high stress, then its no wonder patients are winding up with the wrong pills.

The Institute for Safe Medication Practices conducted a survey of nearly 700 pharmacists in which it asked them whether they believe performance metrics contribute to dispensing errors. A full eighty-three percent of the pharmacists responded that they believed it does. The National Association of Boards of Pharmacy is now working to convince states to restrict the use of these metrics.

What are the Consequences?

It is hard to say what the full extent of the consequences of these systems are. After all, even without these high pressure systems some number of errors would still happen. But there are basic numbers available about the number and types of errors happening. In Massachusetts pharmacies have reported 194 serious drug errors since 2010. These errors include a high blood pressure patient being given an allergy drug instead of the blood pressure drug, a patient being given an acid reflux drug instead of the prescribed antidepressant, and an arthritis drug being given in place of a seizure medication. Nationwide the FDA tracks voluntary reports of medication errors, and since 1992 there have been around 30,000 reports. Since these reports are voluntary the actual number of errors is likely much higher.

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