Poll: Legislated workload limits


Would you support legislated limits on your hours or the number of scripts you could fill?

In the United States, Illinois General Assembly representative Mary Flowers has sponsored a bill which would require a pharmacist to have a pharmacy technician working with them at all times; to limit prescription fills to 10 per hour; to mandate non-working breaks; and to limit pharmacist working hours to eight hours a day.

The legislation, introduced in February, is still undergoing the state’s regulatory process.

Illinois Governor Bruce Rauner also made some proposals, moving that all pharmacists should be required to counsel patients on first-time prescriptions and changes to patient medicine.

The proposals follow a Chicago Tribune investigation which discovered 52% of 255 pharmacies targeted did not warn patients about dangerous drug interactions. The speed at which pharmacists needed to fill the scripts could have been a contributing factor in failing to counsel on the medicines, the report suggested.

A few other US states cap a pharmacist’s workday at 12 hours.

Medscape this week shone a light on the issue of workplace pressure on pharmacists, citing the Tribune investigation as well as another study, by Malone and colleagues, which found that the risk of dispensing medication with a potential drug/drug interaction rose by 3% with each extra script filled each hour.

Claims of overwork have been cited as contributing facts in dispensing error cases, such as that of Northern Irish pharmacist Martin White, who mistakenly gave a patient propranolol instead of prednisolone.

His legal representative said Mr White was “an ordinary man who struggled because he worked too hard… regularly working up to 60 hours a week… always on call.”

Last year PDL noted a rise in medication errors, and when we asked how many of you work through lunch breaks, 44% of respondents stated that they were an employee that worked through breaks and were not compensated for it.

What do you think? Would you support legislated limits to the hours you could work and the number of scripts you could fill, similar to the Illinois proposal?

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8 Comments

  1. JimT
    19/05/2017

    it’s not that simple….from having 10 new patients with 1st time using medication to 10 repeat scripts for a chronic stable condition and all the combinations in between, as well as OTC counselling etc etc etc. Just thinking outside the square doctors have a different item number and hence payment schedule for a short consult vs a long consult etc etc….maybe a model like this for dispensing fees on top of a more realistic mark up component for the “handling costs” with an appropriate increase in the award/contract rates for employee pharmacists !!

  2. Philip Smith
    19/05/2017

    The only way to do this logically is that all dispensing and counseling would require an appointment.
    No more walk in.

  3. I really think we need to stop and take a deep breath on this one!
    To me, It is interesting that some jurisdictions in the United States have decided to move towards a legally
    prescriptive method, to effectively achieve what we already have, both from a legal and professional viewpoint, in Australia, in a much more practical and workable framework, under the Health Practitioner National Law, overseen by the Pharmacy Board of Australia.

    Therefore, in my view, with the existing Pharmacy Board codes and Guidelines, specifically,in this context, the Guidelines for Dispensing of Medicines, we don’t need to have a layer of further separate, highly-structured legislation in Australia for this purpose.

    A brief reminder of the current situation in Australia. Under the Pharmacy Board of Australia’s
    “Guidelines for Dispensing of Medicines” it states:

    : ”These guidelines have been developed by the Pharmacy Board of Australia (the Board) under section 39 of the Health Practitioner Regulation National Law, as in force in each State and Territory (the National Law). They provide guidance to pharmacists in relation to the dispensing of medicines, not set out in the
    legislation or a registration standard”. The Guidelines also state that” pharmacists are expected to be aware of and comply with the profession’s standards and guidelines (including any other standards or guidelines referred to in those documents”.

    Furthermore, in the Introduction to Guidelines for Dispensing of Medicines Under the heading:

    What happens if I do not comply with these guidelines?
    It states: ”
    Non-compliance with these guidelines and the practice standards and guidelines relevant to dispensing may be notified to the Board for appropriate action under the National Law. Under section 41 of the National Law, these guidelines can be used in disciplinary proceedings under the National Law or law of a co-regulatory jurisdiction as evidence of what constitutes appropriate professional conduct or practice for pharmacists.” (My bolding).

    With regard to workload, under Section 11 of the Guidelines for Dispensing of Medicines:”- Pharmacists’ workloads”, it states:

    1.”Workload should be at a reasonable and manageable level to ensure the safety of the patient, provide an appropriate pharmacy service in an accurate, professional and timely manner and cope with fluctuations in workflow, and support a safe working environment”.

    And:

    2. The Board recommends that if dispensing levels for a pharmacist are in the range of 150–200 items per day, consideration needs to be given to the use of trained dispensary assistants/technicians and/or intern pharmacists to assist the pharmacist. If the dispensing workload exceeds 200 items per day,
    additional pharmacists or dispensary assistants/technicians may be required to ensure adequate time is allowed to dispense properly every prescription in accordance with the practice standards and guidelines, and Board guidelines”.

    However, importantly, it should be noted that, under our system, the Pharmacy Board Guidelines, with the link to the requirement of adhering to agreed professional and legal standards, does take account of times of excessive dispensing workloads in “unforseen circumstances”, which would be difficult to achieve if we were to go down the track of creating a system of structured inflexible legal definitions, as is proposed under the various U.S.A proposals.

    Thus, the Pharmacy Board Guidelines take account of times of excessive dispensing workloads in “unforseen circumstances”, the Guidelines for Dispensing Medicines state that “The Board acknowledges that pharmacists may be required to dispense above this rate in unforeseen circumstances, such as staff shortage due to sudden illness or unpredicted demand. The Board recognises that in such circumstances pharmacists can take effective short-term measures to deal with the workload while continuing to
    meet their professional obligations”.

    Yes, of course, as a separate issue, we can have a debate as to what is the current demonstrable degree of pharmacist compliance with these professional and, indeed, legal obligations within pharmacy practice in Australia, and how that can be monitored. Indeed, we are all aware of the ever-increasing dispensing workload in the face of diminishing income structures in every area of dispensing practice. However, I’m certain that adding a layer of specifically defined inflexible legal prescriptiveness in the manner that pharmacists fulfil their professional and legal dispensing practice obligations is not the answer, and would not be either appropriate or, indeed, would add to the overall compliance rate with those professional and legal standards.

    • JimT
      27/05/2017

      …..and how is this allllll paid for……at a business level as well as an employee pharmacist level

      • Ron Batagol
        27/05/2017

        Not sure what you’re referring to. Certainly I would see as wasteful and counter-productive ,any move to overlay an external US syle of structured legal system, to our existing system, that already adequately spells out the professional and legal obligations of pharmacists.
        As I wrote, we can debate as to whether or not we enforce these standards , but adding a further external legal layer wouln’t solve those problems!

        • JimT
          27/05/2017

          1. Pharmacist award rates are a joke and must increase. Yes I know a lot of employers pay above award but it needs to be formalised and hence recognised.
          2. If pharmacists were to “work to rule” then lets say businesses will need another half full time equivalent per employee already there.

          like I asked in previous post””…..and how is this allllll paid for……at a business level as well as an employee pharmacist level””

  4. Kate Deambrogio
    27/05/2017

    Having more than one pharmacist on duty would greatly assist in counselling customers at every opportunity and fulfil the extra professional services we are tasked to do. How this will be financed is an important question, especially for pharmacies with smaller t/o.

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