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Pharmacist Considerations

We found that lack of adequate pharmacist coverage may have contributed to errors. It is of concern to see that a sole pharmacist was responsible for filling between 251 and 300 prescriptions per day without additional pharmacist coverage or overlap. It was even more alarming that pharmacists reported that this was a typical work schedule and not a result of a pharmacist shortage or reduced staffing due to illness. Pharmacies that had 2 pharmacists on duty had fewer errors, supporting the premise that additional pharmacist coverage may help reduce error rates. These findings lead us to believe that increasing pharmacist overlap hours during periods of high activity may subsequently reduce error rates significantly. A majority of the errors occurred during the pharmacist final check stage of the prescription filling process. Additional pharmacist coverage dedicated to this work area may minimize errors due to distractions and other responsibilities, such as immunizations, that interrupt work flow. Further investigation may be necessary to evaluate the process and identify causes and areas of improvement, particularly at this later stage. As pharmacist workload (long hours, limited pharmacy staffing, and lack of lunch/dinner breaks) may contribute to errors, the NHBOP is addressing some of these concerns. Legislation has been introduced to grant rule-making authority to the Board. This would allow the Board to implement changes to address workload issues, especially with regard to adequate pharmacist coverage in higher volume pharmacies and mandatory pharmacist breaks to reduce fatigue and pro-mote safer medication practices.

Pharmacy Technician Considerations

Many of the medication errors occurred while processing a new prescription. While it is the responsibility of the pharmacist to perform the final verification, regardless of who performed the data entry, it is important to note that pharmacy technicians performed the data entry for many of the prescriptions for which errors were reported. The cause of these data entry errors may be due to inconsistencies in pharmacy technician training in pharmacies. When this research occurred, there were no formal laws in New Hampshire requiring technicians to be trained or certified to perform tasks in the pharmacy. The previous New Hampshire law stated that “a registered pharmacy technician is not required to obtain any formal training but shall have training or experience as deter-mined by the pharmacist-in-charge.”7 This could have led to inconsistencies among pharmacy technicians across the state based on the requirements imposed by the pharmacist-in-charge at the pharmacy where they are employed. As a result of this research, the NHBOP updated the rules to standardize the requirements, duties, and training of pharmacy technicians. These rules were adopted in November 2014.

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