Pharmacists reveal how business pressures are putting public safety at risk in BC survey

Public safety “appears to be at risk” from pharmacy business practices that push targets, business metrics and use metrics that reduce labour costs, says a new report from the College of Pharmacists of British Columbia. These pressures were present in every type of pharmacy, the report found, but were much more common in corporate and franchise pharmacies than in independent ones.The survey was done in April and answered by 2,199 registrants. More than 85% of those were pharmacists, and of those, 59% worked at corporate pharmacies or franchises. Nearly a quarter of all respondents worked at Shoppers Drug Mart. Pharmacists expressed frustration with a system that left them feeling overwhelmed and led to mistakes that could harm patients. “One pharmacist cannot simultaneously check prescriptions, give injections, complete medication reviews, handle adaptations, complete minor ailments, answer phones, speak to physicians, answer customer questions, provide over-the-counter and prescription counselling, assist pharmacy technicians, send faxes and more,” while ensuring patient safety, one respondent said. Read: Quotas in pharmacy: Initial survey findings in Saskatchewan are 'aligned' with Ontario's resultsQuotas and understaffing push pharmacists to do more with lessOne in two respondents who worked at corporate or franchise pharmacies said they felt pressure to meet targets. Those metrics measured a wide variety of things, including procedures, assessments, immunizations, injections, prescription adaptations, professional services and dispensed prescriptions. Those pressures were felt much less in independent pharmacies, with 24% of respondents who worked there reporting feeling those work-related pressures. The results are similar to those from a recent survey in Ontario that found seven out of 10 respondents had been pressured to hit quotas or speed targets for their services. They also mirror a survey of pharmacists in Saskatchewan that found 70% of respondents had experienced direction or pressure to complete activities in a set time or meet quotas for pharmacy services. The B.C. respondents also said they were under pressure to do unnecessary medication reviews, with 66% saying they were pressured to hit targets for medication reviews.“We’re constantly under pressure to meet service quotas,” one respondent said. “If we don’t meet these quotas, we won’t be allocated enough labour hours for the next quarter.” Another said that in their pharmacy, pharmacist hours were evaluated by labour cost per prescription, and if labour costs exceeded the target, pharmacists would be labelled ‘at risk.’ “[This was] creating a threatening work environment where job security was constantly in question,” they said. Read: Major OCP report reveals what corporate pressures pharmacists say they’re facing really look likeCorporate pressures leading to patient harmUnderstaffing was also a big problem, with respondents reporting pressure to reduce the number of labour hours. Twenty-three percent of respondents working in corporate pharmacies reported that patient safety was compromised due to understaffing caused by labour metrics. Independent pharmacies reported nearly the same, at 20%; hospital pharmacies, 17%; and long-term care, 15%. Nearly one-third of respondents said that pressures to meet targets or labour metrics had resulted in direct harm to members of the public. The most common harms were dosing mistakes or dispensing the wrong medication. One respondent said that their pharmacy had given a narcotic dose that was 10 times too high and resulted in a hospital visit and dispensed a potentially fatal insulin concentration that was only not given because the patient’s guardian noticed. They also said management told them not to report those errors. “The pressure to meet increasing services quotas has resulted in numerous errors that directly endangered patients,” another said, saying they had personally seen errors dispensing incorrect medication, missing critical drug interactions and giving incorrect injections, and one where a pharmacist gave a patient the wrong dosage after working 14 hours straight. Another said decreased staffing levels forced them to eliminate a safety check where pharmacists review medication batches. The situation was worst in corporate pharmacies, with 37% percent of respondents who worked in them saying these pressures have made them unable to meet practice standards. Thirty percent of those working in long-term care reported the same, while 24% of those working in independent pharmacies and 16% of those working in hospital pharmacies said so.Read: Proposed class-action suit against Shoppers and Loblaw claims terminated owners were berated and ‘perp walked’ out of their storesThe five-minute rule: Time pressures mount Respondents also said they were under intense time constraints, with 65% saying they were pressured to adapt prescriptions in five minutes or less. Fifty-eight percent said they were pushed to provide injections or immunizations in five minutes or less. And almost 30% said they were under pressure to do minor ailment assessments in under five minutes as well. Those time pressures were more common in corporate pharmacies, with 20% of those in corporate pharmacies saying they were under pressure to do minor ailments in a specific timeframe, and 12% of those independent pharmacies saying so. One pharmacist said they were also pressured to offer those services in the first place. They were told (incorrectly) by management that if they didn’t fill walk-in requests for flu shots or COVID-19 vaccines, they would be refusing to provide care and breaking the CPBC’s code of ethics. Potential solutions to harmful pharmacy business practices The CPBC said it “is considering every policy and legislative tool available to address these very serious concerns.” That includes finding ways to hold pharmacy owners—including corporations and franchises—accountable when these pressures lead to non-compliance, creating a whistleblower program, developing a staffing standard, making fees rise after repeated or frequent non-compliance with practice standards, and working with government agencies and similar organizations. Read: OCP kicks off town hall series on corporate pressure concerns

Pharmacists reveal how business pressures are putting public safety at risk in BC survey

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