Statement
The National Coordinating Council for Medication Error Reporting and Prevention advocates the elimination of prescription time guarantees and a strengthened focus on the clinical and safety activities of pharmacists within the community pharmacy setting.
Background
Community pharmacists provide important clinical and safety services to their patients, including checking the patient’s profile; looking for possible drug-drug interactions, therapeutic duplications, and other drug use evaluation concerns; calling prescribers for clarification; and educating patients about the proper use of medications.
Pharmacist intervention is effective in the improvement of patient adherence. 1,2 Likewise, pharmacist direct involvement, including in collaboration with prescribers and other healthcare providers, in disease state management also has contributed to improved control of risk factors in outpatients. 3,4,5
The Council acknowledges that many issues, including patient satisfaction and the current reimbursement model under which a pharmacist is only paid for a dispensed drug product or device, encourage a focus on prescription volume and the speed at which a community pharmacy dispenses prescriptions. However, this can have detrimental effects on patient education and patient safety.6 Pharmacists may feel compelled to bypass critical safety checks or offer insufficient counseling in order to meet prescription volume quotas or time promises.
A number of community pharmacies have offered prescription time guarantees to entice patients to their stores. 7, 8 In the Community Pharmacy Time Guarantee Survey,9 conducted by the Institute for Safe Medication Practices and the American Pharmacists Association, 62% of responding pharmacists reported that their pharmacies have policies and procedures related to the time it takes to fill a prescription. More than a quarter (27%) responded that their pharmacies advertise a time guarantee to patients. The time guarantees were as ambitious as 10 prescriptions in 10 minutes with the most often reported guarantee of 15 minutes to fill up to one to three prescriptions. In 21% of the pharmacies with time guarantees, the patient received some sort of reward or compensation (e.g., a pharmacy coupon) if the time guarantee was not met.
The Council believes prescription time guarantees and inducements for such (e.g., discount coupons) can be detrimental to patient safety. Forcing pharmacists to work quickly has the potential to lead to the development of at-risk behaviors that can rapidly become unsafe practice habits. For example, the added time pressures may discourage pharmacists from conducting critical clinical and safety checks which can result in medication errors. Eighty-three percent of pharmacists working at pharmacies with advertised time guarantees reported that the time guarantee was a contributing factor to medication errors with 49% feeling it was a significant factor.9 Forty-four percent of pharmacists working in pharmacies with time guarantees reported being personally involved with a dispensing error directly attributed to attempting to comply with the time guarantee.9
The Council believes that pharmacists should not be held to specific timeframes for preparing and dispensing medications. The Community Pharmacy Time Guarantee Survey found that forty-nine percent of the responding pharmacists indicated that they were penalized if they do not meet the time guarantee.9 Twenty-three percent reported they were incentivized via bonuses for meeting time guarantees. Evaluating pharmacists’ productivity based on the number of prescriptions they dispense and whether or not they meet time promises can incentivize pharmacists to work faster, not safer.
The Council believes prescription time guarantees and inducements jeopardize the practice of pharmacy. While efficiency and prompt service are important considerations, patient safety must not be jeopardized in order to meet time guarantees. Time guarantees suggest that the pharmacist merely needs to fulfill what the prescriber ordered, count tablets and capsules, and do it quickly. They also send a message to patients that speed should be the primary factor in determining where to have their prescriptions dispensed.
Recommendations
The Council recommends community pharmacy leadership, state boards of pharmacy, payers, and other stakeholders work together to eliminate the use of prescription time guarantees and inducements for such in community pharmacy.
The Council recommends community pharmacies promote the clinical and safety activities they perform. Pharmacies also should promote the availability and value of patient education services.
The Council recommends local and corporate pharmacy leadership take all the steps necessary to make it safe for pharmacists to perform their job, address barriers to safe practice, and provide opportunities for practitioners to openly discuss concerns and patient safety issues.
The Council recommends local and corporate pharmacy leadership foster the provision of patient education, including what a pharmacist does to ensure the appropriateness and safety of prescription medications, the importance of allowing pharmacy staff ample time to review prescriptions, and the value of confidential patient education in maintaining their safety.
1 Rubio-Valera M, Serrano-Blanco A, Magdalena-Belío J, et al. Effectiveness of pharmacist care in the improvement of adherence to antidepressants: A systematic review and meta-analysis. Ann Pharmacother. 2011 Jan;4(1)5:39-48.
2 Eussen SR, van der Elst ME, Klungel OH, et al. Effectiveness of pharmacist care in the improvement of adherence to antidepressants: A systematic review and meta-analysis. Ann Pharmacother. 2010 Dec;44(12):1905-13.
3 Santschi V, Chiolero A, Burnand B, et al. Impact of pharmacist care in the management of cardiovascular disease risk factors. Arch Intern Med. 2011;171(16):1441-53.
4 Anaya JP, Rivera JO, Lawson K, et al. Evaluation of pharmacist-managed diabetes mellitus under a collaborative drug therapy agreement. Am J Health Syst Pharm. 2008 Oct 1;65(19):1841-5.
5 Blenkinsopp A, Anderson C, Armstrong M. Systematic review of the effectiveness of community pharmacy-based interventions to reduce risk behaviours and risk factors for coronary heart disease. J Public Health Med. 2003 Jun;25(2):144-53.
6 Resnik DB, Ranelli PL, Resnik SP. The conflict between ethics and business in community pharmacy: What about patient counseling? J Bus Ethics. 2000 Nov;28(2):179-86.
7 Institute for Safe Medication Practices. Speed trap. ISMP Medication Safety Alert! Community/Ambulatory Care Edition 2008 Oct;7(10):2-3.
8 Institute for Safe Medication Practices. Return of the speed trap. ISMP Medication Safety Alert! Community/Ambulatory Care Edition 2011 Mar;10(3):1.
9 Institute for Safe Medication Practices. Prescription drug time guarantees and their impact on patient safety in community pharmacies. ISMP Medication Safety Alert! 2012 Sep;18(17):1-4. http://www.ismp.org/Newsletters/acutecare/showarticle.asp?id=30.
Actions/Decisions are those of the Council as a whole and may not reflect the views/positions of individual member organizations.