In a collaborative report with Chicago physician Dr. Steven Fox and two pharmacy professors who specialize in drug interactions, the Chicago Tribune has pulled back the curtain on a frighteningly common occurrence. Pharmacists at both major chains and independent pharmacies are dispensing medications with well-known interactions with no warning to the patient. The study, conducted over 9 months at 255 Chicagoland, Indiana, Michigan, and Wisconsin pharmacies, found that 52% of the time, pharmacists entirely missed the opportunity to notify the patient of interactions or to call Dr. Fox to confirm that the two conflicting drugs prescribed were intentional, which is considered a best practice.
Prescription drug interactions cause thousands of hospitalizations a year. The FDA, citing data obtained from a JAMA study, estimates that 2 million people a year experience a serious drug interaction (from both prescription and over the counter meds) and that 100,000 a year die from these combinations. The pharmacy failure rate demonstrated in our region alone should be enough of a cause for concern to major pharmacies and small pharmacies alike. If some of the 5 combinations chosen by the pharmacists that led the study were actually taken by patients, the end results could’ve been kidney failure, stroke, birth defects, multi organ failure, extremely low blood pressure, gangrene and even death. According to one of the pharmacists leading the study, the possible interactions of the drug combinations they had Dr. Fox write were ‘no-brainers’ for pharmacists.
CVS Has Highest Failure Rate of Any Chain Pharmacy
Although independent pharmacies had the highest failure rate of all stores tested (72%), chain pharmacy CVS topped the list, with a failure rate of 63%. CVS fills an estimated 1 billion prescriptions a year, the most of any chain in the country. Each of the chains tested were given 30 opportunities at several of their locations. The study also concluded that failure was systemwide, meaning pharmacies in neighborhoods with higher incomes did no better than lower income neighborhoods.
For comparison, here are the failure rates for the other chains tested by the Tribune:
- Kmart – 60%
- Costco – 60%
- WalMart – 43%
- Jewel – 43%
- Mariano’s – 37%
- Walgreens – 30%
Why Is This Happening?
According to many pharmacists, including one from an independent pharmacy that passed the Tribune’s test (Mexicare Pharmacies in Chicago), the major problem is time and the desire to meet customer’s need for speed. In most pharmacies, one or two pharmacists are working per shift and filling hundreds of prescriptions. Although many pharmacies utilize a computer system that warns the pharmacist of potential interactions, pharmacists are in a hurry and are used to seeing many pop up boxes on their screen, a healthcare phenomenon known as alarm fatigue. There is a tendency to skip over warnings and assume that if a doctor prescribed a medication, they would also know the patient’s history and the potential drug interactions or complications that could arise. However, that’s not always the case. It’s estimated that 1 in every 10 Americans has 5 or more prescriptions. The odds are that these prescriptions have come from multiple providers who only know what their patients tell them. If a patient leaves a drug off a patient questionnaire, how would the physician know of a potential interaction? This leaves the pharmacist to shoulder the burden of catching potential problems and notify the physician and the patient. According to many pharmacists, this responsibility is embedded in their training and is considered the professional standard.
This desire for speed has been criticized by pharmacists themselves, several of whom were willing to speak to the Tribune. One former CVS pharmacy head said that the pressure is constantly in your face, with CVS tracking the prescription fill speed and showing different colored computer warnings based on the time it’s taking to fill a prescription. While CVS corporate argues that warnings are just to notify the pharmacist of the promised time of prescriptions, pharmacists themselves say they receive store-based monthly scorecards notifying them of how long it took them to fill prescriptions. They are then ranked by city, region, and across the country.
Speed vs. Accuracy
It appears that this dedication to customer service is coming at the detriment of the customer themselves. If speed is destroying accuracy and lack of accuracy can lead to organ failure, stroke, and death, pharmacies should understand that taking slightly longer to fill prescriptions is preferable to customers than the alternative. CVS, WalMart and Walgreens all said they would implement measures such as increased training and reviewing policies in order to help solve this alarming problem. It can only be hoped that major corporations and independent pharmacies realize the severity of favoring speed over all else. In a world of choices, customer satisfaction is vital, but patient safety should always be priority number one.
The advice from pharmacists and physicians to patients such as ourselves? Tell your pharmacist all of the medications you are taking and ask if there are any known interactions between the drugs you’re there to pick up and the drugs you’re currently taking. By taking charge of your own health, you could save a hurried pharmacist from making a huge mistake and maybe even your own life.