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Results of the ABC News '20/20' Undercover Pharmacy Investigation
March 30, 2007 10:17 PM
For the last two months, a team of "20/20" producers fanned out across four states to conduct an undercover field test of prescription dispensing at the country's best known chain drug stores.
They found that in more than one in five cases, chain pharmacies made some type of error in filling their prescriptions.
"The results confirm our worst fears," said Dr. Ken Barker of Auburn University School of Pharmacy, one of the country's leading experts in studying pharmacy error rates. "There really is a problem out there."
The ABC test was designed and supervised by Auburn's Dr. Betsy Flynn, a specialist in studying errors in neighborhood pharmacies who designed a similar undercover test for ABC News over a decade ago.
"The 22 percent error rate found in the study was unacceptable," said Flynn, who expressed her "surprise and disappointment" that "despite all of the implementation of technology over the past 12 years, the error rate was similar to the previous study."
While in no case were ABC's producers given the wrong medication, there were a variety of dispensing errors found -- too many or too few pills, faulty and missing instructions on the labeling, even a failure to put a child proof cap on a powerful medicine for bi-polar disorder.
But perhaps the most important finding of the undercover test was a dramatic reduction in time spent on patient counseling by pharmacists.
Despite federal and state laws that require pharmacists to provide counseling to customers picking up new medications, patient counseling was only offered in 27 out of 100 purchases of new prescriptions, less than a third, in the ABC-Auburn Study.
Particularly alarming to the Auburn experts was the chain pharmacies' failure to warn patients of potentially harmful interactions when they purchased certain over-the-counter medications, such as adult strength aspirin with Coumadin, a blood thinner. In only eight cases out of 25 were the customers given a verbal warning.
Finally, the study revealed that some pharmacies appear to be misleading customers into signing away their right to patient counseling.
Although the ABC producers paid with cash and no insurance was involved, in most cases they were still asked to sign at the pharmacy counter to pick up their prescriptions. But with only a few exceptions, our producers were never told they were signing forms that also included language to waive the legal right to counseling with a pharmacist.
"They're deceiving the patient about what they're really signing," said Bruce Berger, a department head at Auburn's pharmacy school who says the pharmacy personnel at the counter may not know it, but they are in effect, undercutting the law.
March 30, 2007 in Pharmacy Investigation | Permalink | User Comments (166)
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For those that think trained pharmacy technicians should NEVER fill a prescription you need to look at the facts: There is a pharmacist shortage in America. With billions of prescriptions being filled in the U.S. each year, there are simply not enough pharmacists to handle filling ALL of these prescriptions without trained assistance. The wait time to get your medication would be in hours or DAYS instead of 15-30 minutes. When you are ill, do you really want to wait a day or two to get your medication? The answer is to enhance the training and compliance of all pharmacy employees, NOT to quadruple the workload of already over-burdened pharmacists.
Posted by: Rick | Mar 31, 2007 2:04:20 AM
Once again I am disappointed in 20/20. This expose demonstrates the ability of the uneducated media to present a story that misleads the public. The main "hook" of this story appears to be the fact that you as the comsumer are "signing away" your right to counseling at your local pharmacy when you pick up your prescription. The real fact is that when picking up your rx the main, and most important question asked is "do you have any questions about your presciption". When most consumers put down their cell phone long enough to actually listen to this important question asked at the point of sale they say "no just get me my rx as fast as you can". In our fast paced 24 hour society the unfortunate reality is that people are too busy to get to their next appointment to slow down enough to listen to this important question. The job of a pharmicist is that of a gate keeper. The pharmacist performs the final check of safety for each rx filled and I find it hard to believe a pharmacist would knowingly dispense something that would harm anybody. Furthermore I am sure that far more people have been helped than harmed by our nation's dedicated pharmacists and pharmacy technicians. What about all the mistakes made by the Dr, physician's assistant or nurse that the pharmacist spots and prevents from going out to the patient. This attack on retail pharmacy is an unbalanced presentation of what really happens at your local pharmacy and should be discounted as such. Our nation's pharmacists provide a valuable and in most cases free service to our population, and I challenge ABC to find a more dedicated group of profesionals with the fortitude and ability to provide such a service.
Posted by: Sheri | Mar 31, 2007 2:06:51 AM
in response to john...a pharmacist is always on duty when a pharmacy is open as required by law. a pharmacy can not open without a pharmacist present. in addition, an 6 year degree is frankly not required to "fill" a prescription. trained technicians are more than capable in typing up a script and counting out the medication. it is the duty of a pharmacist to make sure that the information is typed in correctly, that the right drug dispensed, to check for drug interactions, correct dosing, qty, etc. how can you expect one person to do it all? unless the public wanted to wait a week to receive their prescriptions, it would be impossible given the number of scripts the average pharmacy fills in a day. but i agree, something needs to give. i found that popping the lid at the check out counter has reduced a lot of errors. it gives the patient and the pharmacist an opportunity to do one final visual check together and opens up diaglogue. also, get rid of the drive thru. they are errors just waiting to happen.
Posted by: Gwen | Mar 31, 2007 2:10:39 AM
I am a pharmacy tech at one of these large chains and have been a tech for 13 years. Our store fills over 650 rxs per day. Our longest wait time is 30 minutes when we are busy,If I tell a customer 15min.sometimes the response is, that long,this not not a fast food rest.People today want there meds asap. The pharmacy i work at makes sure all employees get certified before being able to handle important tasks in the pharmacy. Another problem is that technicians are so underpaid that sometimes hiring quality employees is a difficult task. As I have been doing this 13 years and only make 14$ per hour.As computers do a lot of error checks people are human and will make mistakes just like the doctors writing the rxs do also.We do not want to cause harm to anybody abd this show makes it seem as thats what pharmacies are trying to do.Not all pharmacies are run this way!!
Posted by: Sammy | Mar 31, 2007 2:13:26 AM
Pharmacists are placed under an extreme amount of stress. I have been yelled at, threatened, have items thrown at me. In several cases I have had to call the police to have unruly customers removed.
In addition, most pharmacists are forced to work 8 to 10 hour shifts without meal breaks. Due to heavy workloads, many pharmacists do not even take restroom breaks.
And the public expects perfection under these conditions?
Posted by: Liza | Mar 31, 2007 2:42:47 AM
As a pharmacist, I found your report to be short-sighted not investigative. With 12 years of retail pharmacy experience, many times Doctor's sloppily written prescriptions are a source of errors. I found it very interesting that Mr. Ross did not question why there are laws that require prescriptions to be typewritten rather than handwritten. Yes, pharmacists make mistakes, so do physicians. Sometimes a physician will have an unqualified staff member (no licensing involved) write a prescription and the physician will simply sign it, without reading what was written. It is the pharmacist who catches these errors and help to save the patient unnecessary harm. Mr. Ross if you are going to report on the subject, do not report half a story, but a whole one. I thought that this is what an objective journalist does.
Posted by: Jim S | Mar 31, 2007 3:08:00 AM
The entire reason pharmacies employ pharmacy technicians is to free up the pharmacists so that they can adequately perform tasks that require in-depth knowledge or training. A pharmacist is required to be present at all times and must check every prescription before it can be given to a patient -- these laws are intended to prevent medication errors such as those described in the article. That the technician incorrectly transposed a prescription is unfortunate, and certainly more training could have helped prevent this from occurring, but I believe the real issue is that the pharmacist didn't catch the mistake. I can't speculate as to why s/he didn't, but this highlights the problem that arises when prescriptions are treated as goods rather than the entire process being seen as a service. Whether a pharmacist spends 20 minutes discussing a medication with a patient or 5 seconds "checking" a prescription, the pharmacy makes the same amount of money. Consider how many 5-second checks could be performed in 20 minutes and it's easy to see why some chains push quantity at the expense of quality. I would bet that if pharmacies could get reimbursed for patient services such as consultations, question research, etc, chains would again focus on patient care and not so heavily on volume.
Posted by: Jessica | Mar 31, 2007 4:06:46 AM
I am a nationally certified, educated, well trained tech with many years experience. Unfortunately, 20/20 didn't bother to mention our side of the story. I don't know of ANYONE who wants high school kids filling Rx's. A lot of us have been pushing for mandatory certification and education in all fifty states.
There are requirements in some states and with some employers, but there is nothing on a national level. I would like to see that happen sooner rather than later.
This program, in my opinion, was designed to frighten the general public. National Boards of Pharmacy and legislators-are you paying attention now??
Posted by: RG, CPhT | Mar 31, 2007 6:19:25 AM
I am a small pharmacy chain owner who supports pharmacists with high quality technicians so they have the time to counsel patients. We are being forced out of business due to low reimbursement by the government and insurance companies. This situation demands that large numbers of prescriptions be filled to survive. The answer is to increase reimbursement and enforce laws already in place that require patient counseling. If the current low reimbursement is not changed I don't think there will be any independent or small chain pharmacies left within two years. Patients will have no choice except the large pharmacy mills.
Posted by: Larry | Mar 31, 2007 6:29:45 AM
I am a PTCB certified tech that has worked in both a hospital and retail pharmacy. I am now in retail and work in a small family owned pharmacy that has one pharmacist. After reading the comments posted here I had to tell you about her! Our pharmacist always takes the time to counsel patients and will even stop what she's doing to offer to counsel. It's not always the technician or the cashier that offers it. We also double check behind each other to make sure that dosage, directions, count and even the correct doctor is on the prescription. We know and love all our patients and treat them like family even though some are not always so friendly to us. This story should just prove to the world why you should use a smaller drug store instead of the big chains. Some of the big chains (I've been told) will ask the pharmacies to take longer to fill a prescription so that the customer will have to spend time waiting and will possibly spend more money because they've shopped while they waited. Use the smaller, local stores and see if it doesn't make a difference........I know ours does!
Posted by: proud tech | Mar 31, 2007 8:21:23 AM
I just want to say first that I have a lot of respect for pharmacists. My issues have never been them, but their assistants are mostly incompetent, in my opinion. I've heard many complaints from friends and co-workers, and I've had some of my own as well. I can't understand how a pharmacist has to go to school for years to be qualified to dispense medication, but these high school kids and other unqualified people can do their job as an assistant. I've wondered for years when something would be done about it. I have an idea: How about the pharmacies hire more than one pharmacist for each store? They make a ridiculous amount of money. I think maybe they can afford it. Because that's what it really boils down to, isn't it? It's always about the money. Money is always more important to these companies than people's lives. Shame on them!
Posted by: Kerry | Mar 31, 2007 9:38:29 AM
Four years ago, the night before leaving on vacation, I picked up a prescription at a local Rite Aid. I opened it early the next morning to check it and pack it in my bag. Yes, it was the drug the doctor had prescribed BUT it was the wrong dosage and it belonged to someone else - an elderly woman living in the same community. Her name was not even remotely similar to mine. I can't imagine what might have happened if I had just thrown the medication in my suitcase without paying attention to it. When I called the pharmacy that morning to complain, I received a very lukewarm response. "Yeah, these things happen. Sorry about that." I even spoke to the store manager, who while apologetic, was not surprised or outraged that this had happened. He promised me that he would refer this to the district pharmacy manager. I never heard from either one of them again. Needless to say, Rite Aid has lost my business and I tell everyone that story and my other endless complaints about Rite Aid.
Sadly, Rite Aid is not the only error prone pharmacy - Eckerd is a very close second. I picked up a prescription for my elderly mother there only to find it was filled with a much larger dose than was required. The bottom line is, when dealing with ANYONE - doctor, nurse, pharmacist, pharmacist assistant, pharmacy clerk - ultimately, it is up to the patient to be responsible for their own medication.Sad but true.Doesn't anyone assume responsiblity for their own mistakes anymore??
Posted by: Judy | Mar 31, 2007 9:41:43 AM
I think this is a very informative story that adds substance to the position that everyone needs to be an advocate in their own health care. As an RN who works with pharmacies and patients on a daily basis, I have seen the good and the not so good on both sides. Pharmacies catch errors that are made on the clinic side at times and clinics also catch errors that the pharmacies have made. To me, the bottom line is that everyone in health care needs to be doing the right job at the right time for the right person so that expensive "re-work" (fixing mistakes) and any possible harm to our patients is avoided.
Posted by: Heidi | Mar 31, 2007 10:05:54 AM
I am a PTCB Certified Pharmacy Technician CPhT and have been for the last 6 years. I work for one of the large chains. And yes a pharmacist is required to be in the pharmacy at all times. A pharmacy cannot open without one. I am a college graduate who has decided to make this my career. I have taken numerous courses and taken a 3 hour long test to become certified. Just like pharmacists we are required to complete at least 20 hours of continuing education every 2 years to keep our certification. The continuing education we take is often times the same that the pharmacists take. Well trained and educated techs are extremely competent and a vital member of a pharmacy team.
And yet as several people have mentioned before, techs are paid extremely poorly. During a typical day my pharmacy fills 300 prescriptions all the while answering constantly ringing phones, having to answer the drive-up (which should be removed), ring purchases out for customers with no prescription, and being screamed at because someone thinks their medication is too expensive. Oh I forgot. when people come to pick up their prescriptions, there is often an issue with their insurance which needs to be resolved (resolving an insurance issue can take anywhere from 5 minutes to an hour depending on the issue), all the while a line is forming and the phone is still ringing.
My pharmacy wants us to have all prescriptions ready in 15 minutes or less. You tell me what the chance is of an error in the situation I described. The chance is there, however we send out all prescriptions most days without one error. And the errors that do get made are caught by the Pharmacist before it's even filled. By the way, we report every single error as required by our state law.
Posted by: Kathleen | Mar 31, 2007 10:30:09 AM
I am a PTCB certified tech that has worked in one of the named chains for almost 7 years. Pharmacy errors due occur it is a fact. If there is anyone to blame it is at the corporate level. At the corporate level it seems to all be about money and wanting more. More stores, less paid staff equals higher profits for the big boys. At my store we must promise customers unreasonable time frames. It does not matter how busy we are, or that we are already one hour behind schedule. Some of the time when a customer drops off a prescription the tech is unable to get all the proper information from the patient usually because they have a phone to their ear and are in a hurry.
Many Pharmacists and techs must work long hours and with out lunches, breaks, or even bathroom breaks making them standing on their feet for 8 to 12 hours. The McDonaldisation has now spread to retail pharmacy, and is choking the life out of it. I believe that 20/20 should do an investigation regarding what goes on behind the counter to offer an explanation of pharmacy error. Then maybe we can then point the fingers and work together to fix the problem!!!
Posted by: A CVS Tech | Mar 31, 2007 11:30:39 AM
It is always wonderful to see how the media takes a negative and turns it into an epidemic. Pharmacist are under high pressure to fill medications at a fast pace because society is always in a rush to do something. What we do is life threating but people seem to think that our job is a joke. We are there to just put pills in a bottle and that is it. You forget to see that when a patient is rung up at the register the technicians also ask if you have any questions for the pharmacist. Your show happily skipped that part and only showed your under cover person signing a paper to waive that right. If it wasn't for us, people would not be living as long as they are. We catch many critical drug errors and try our best to prevent any harm to occur to a patient. You made it see like it is a joke when an error is made. You should feel horrible for portraying this.
I am sure that the pharmacist involved felt horrible and that their life is ruined because of such a mistake. Just like when you guys make a mistake reporting a story you apologize to the world. You should really apologize to us because we do care about our patients and we do try to do our best to help them. We are not God and neither are you.
Posted by: Lou | Mar 31, 2007 11:33:19 AM
I have told our company that we have a pharmacist who makes 2 miss fills per month and they have not looked into this matter yet.I think the company is waiting until one of our patients dies before they will look into this problem we have.
sign great tech
Posted by: suzzie | Mar 31, 2007 11:34:13 AM
News or Entertainment?
I have been watching the coverage of this story and have to conlcude this has nothing to do with news. If it was news, why not address the issues raised by those in the industry that posted on this site? I am not a pharmacist or technician but they seem to raise valid concerns. Why didn't we get to see the prescription with the doctor's handwriting from that lady's case? Why did we not see the written warnings given to the fake customers or the people suing the pharmacy? This "report" gave most of the time to the lawyers and union representative, not people who actually work in the industry. With that many lawyers helping them write the story/set the agenda you would think Brian Ross could correctly state the law!! Oops was that a mistake? I noted other inconsistencies in the various stories posted on this site (which have either been removed or edited since the story aired--nice touch). Guess Mr. Ross and his team are no better than 16 year olds, they just have better opportunity to cover their tracks. Could it just be a reality that everyone can make mistakes?
Posted by: Matt | Mar 31, 2007 11:38:00 AM
I have been a pharmacy tech for 12 years, and I have been certified for almost 8 years. I have worked in several areas of pharmacy including hospital, long-term care, and retail. The pharmacists depend a lot on techs and if a store hires someone that has no experience in pharmacy then it is the stores responsibility to properly train the tech. They can even send them to take the classes to become certified. I know a lot of stores will pay for this, but it may not be broadcasted. There are things an untrained tech can do in the pharmacy and learn about medication. Job experience is also education! (for the comment about Pharmacists having 6-8 yrs of schooling and have the "experience" needed for the job.)
I never took a pharmacy class. I learned everything I know through experience. I was trained properly then offered a chance from the company I was employed with to take the certification test. I have the confidence of every pharmacist I have ever worked with that I am very capable of filling prescriptions and much more. I always have them check behind me and am not shy about asking questions.
Posted by: proud tech 2 | Mar 31, 2007 11:47:53 AM
Thank you for doing the research on how pharmacy drugs are dispensed. I would like to see the same regarding hospitals dispensing prescriptions to sick patients, many of them unconscious and unable to ask the right questions or know what they are being given. When I was in the hospital after giving birth to my daughter the lady in my room (who also just gave birth) was given an injection. A few minutes later her husband came to visit (he happened to have been a pharmacist) saw the vial on the table and ran to get help. His wife had been given the medication that was meant for a man across the hall that had a terminal illness. Over the years, when I have repeated this incident, many people have come up with their own horror stories. I do believe that hospitals need to be held accountable, and perhaps a survey should be done there.
Posted by: Sharon | Mar 31, 2007 12:47:49 PM
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