The Associated Press recently
reported on the horror of the month — pharmacy technicians.
Pharmacy technicians are the
folks who do most of he work in modern pharmacies. Although they usually
lack any sort of formal training, they typically do the data entry for
drugs, count the actual tablets and slap the label on the pill bottle.
The pharmacist then checks everything to make sure the drug type and amount
is correct before the prescription is handed to the consumer.
According to some consumers
and regulatory bodies, this is an unacceptable state of affairs — they
want additional training required for pharmacy technicians and stiff licensing
requirements. The Associated Press gives a typical horror story. A woman
noticed the drug her 5-year old was taking contained a special warning
about giving it to children. The pharmacy technician told her this was
no problem. Unfortunately that was very bad advice, and as a result the
child suffered severe side effects including ongoing learning disabilities.
The Associated Press cites
a 1998 study by the Virginia Board of Pharmacy that found pharmacists
catching an average of 6.5 mistakes by technicians each week. Unfortunately
there are serious problems with that study. Only half of the 1,590 drugstores
surveyed bothered to respond and asking pharmacists to estimate how many
errors they spot in a given week is a very poor way of measuring the problem.
The real problem with the criticism
of pharmacy technicians, however, is that while technicians do indeed
make mistakes, the limited evidence available indicates they don’t make
mistakes any more often than regular pharmacists do. Last year, for example,
U.S. Pharmacopeia’s Medication Errors Reporting Program reported receiving
314 reports of pharmacy errors, half of which were made by technicians.
But what of the half that weren’t made by technicians? Logically, they
were almost certainly made by pharmacists.
Having spent a couple years
working as a pharmacy technician at a small pharmacy and a big chain the
basic problem in filling prescription is accurately processing data, not
having any special pharmaceutical skills or knowledge.
The main source of error is
still doctors who tend to right out almost unreadable prescriptions. It
is amazing in this day of hand-held computers, fax machines and cell phones
that doctors introduce a large risk into drug prescriptions by scrawling
out their drug orders. To really lower the risk of getting the wrong drug,
always have a doctor’s office phone in a prescription.
The second source of error
was the dizzying array of different compounds, many with similar names,
not to mention the occasional drugs that look very much alike (there are,
after all, only so many names and shapes available for the pills we take).
Such errors, in my experience, were uncommon but they did happen. However,
if a pharmacist and technician are doing their jobs, these never get out
the door. Not once did I ever see the process break down so a person go
the wrong drug.
On the other hand, such errors
are inevitable regardless of what sort of system is in place. States could
require that only licensed pharmacists have anything to do with dispensing
drugs, and such errors are still going to occur. There’s no way to get
around that.
But the presence of pharmacy
technicians probably increases the reliability of the system, since with
the pharmacy technician system the technician and the pharmacist both
check the prescription before it goes out the door. That is far superior
to having a single individual pharmacist doing the entire process from
beginning to end. To the extent that there is a problem with this system
it is that pharmacists don’t adhere to it. The Virginia Board of Pharmacy
interviewed dozens of pharmacists, with half of them saying they never
checked the results of their technicians.
Licensing of technicians or
limiting what technicians can do — both popular solutions among the regulate-it-to-death
crowd — will simply raise the cost of running a pharmacy while doing
very little to reduce the risk of a serious tragedy (largely because that
risk is probably already as low as it can get given the current economic
and time pressures).
Reference:
Proliferation
of pharmacy technicians raises questions of quality. The Associated
Press, February 14, 2000.