“Don’t you just have to slap a label on it?”
Pharmacists around the country hear the same thing, all day, every day. I know this because I am in several pharmacist groups on Facebook, each with over ten thousand members, and follow several pharmacy pages, each with over 100,000 “followers.”
Patients come up to us, eagerly waving a wrinkled prescription and saying, “I’ll wait! How long?” After hearing the answer, the next thing they say is, “15 minutes? Don’t you just have to slap a label on it?” I have even heard stories of patients telling the pharmacy staff they see the box and can grab it themselves.
Why We Can’t “Just Slap a Label on It”:
Since it is hard to know what goes on behind the pharmacy counter, I would like to explain why prescriptions cannot be processed instantaneously.
Drawing from my fifteen years of experience working as a pharmacist in a chain, this is a typical scenario in a chain environment. (Note: independent pharmacies are also busy with many of these tasks, but tend to have much better staffing, no pressure from corporate, no metrics to meet, etc.) Of course, I tried to add in a little humor for entertainment; we truly treasure our patients!
Filling Mrs. Smith’s Prescription:
Let’s say the patient’s name is Mrs. Smith- she is holding a prescription for a Z-Pak. Tick tock, the clock starts ticking!
If Mrs. Smith is lucky, one of the few technicians (most chain stores run on very limited staffing budgets and are constantly understaffed) will immediately greet her at the drop-off window, verifying the correct spelling of her name, date of birth, and allergies. If Mrs. Smith is a new patient, all of this information, along with her address, contact telephone numbers, and insurance information, must be entered as well.
The phone rings. “Are you open?”
“EXCUSE ME!” shouts a voice from the other side of the counter. “The bathroom is locked. Can you open it for me?”
Back to typing:
BUT WAIT! A drug interaction pops up! Mrs. Smith could suffer from a dangerous cardiac arrhythmia if she takes the Z-Pak with one of her other medications, fluconazole. The prescription is handed off to the pharmacist, Anna, who is on the phone with an insurance company. After ten minutes on hold, Anna finally resolves the issue and starts to dial Mrs. Smith’s doctor to discuss the drug interaction.
“EXCUSE ME!” Cries a voice from the other side of the counter. “Where is the windshield wiper fluid? Can someone walk me to it?”
The phone rings. “Do you have the number to the dry cleaners down the street?”
Anna finally gets a moment to call Mrs. Smith’s doctor. She explains the situation to the nurse, who replies, “Well, that’s what the doctor wrote so that is what he wants to give her.” Anna insists that the doctor must be made aware of this drug interaction, but he is with a patient, so the office must call back. Forty-five minutes later, while Mrs. Smith’s ice cream is slowly melting in the trunk of her car, the doctor calls back, appreciative of Anna’s call, because Mrs. Smith forgot to mention a few of her medications while at the urgent care center. (Note – this is why it is important to get all of your prescriptions in one place, if possible). The doctor changes the medication to a safer alternative, and Anna hands the revised prescription back to her technician, Marta, to type.
REJECTED! Mrs. Smith brought in her insurance card that expired 5 years ago! She digs through her purse, finally finding the correct card. The information is again updated, and the prescription is processed successfully.
The phone rings. “Can my photos be ready in an hour?”
The technician at the production station, Laura, must print out the label from the production queue, where hundreds of prescriptions are waiting to be filled, and prepare the prescription for the pharmacist to verify. Easy, right? Now we just slap a label on it? Nope. The production technician is stuck at the drive-through with a line of three cars, each of which has a patient asking to “just grab” something from the store in addition to the prescription.
The phone rings. “My husband is on the way to get my prescription – can you tell him to pick up vanilla ice cream?”
Anna wants to label the prescription, so Mrs. Smith can go home and rest, but she is now tied up on the phone, because her regional pharmacy supervisor has chosen this time to call and go over metrics. Metrics, you say! Yes, pharmacies must meet metrics, and Anna did not give enough flu shots last week, and the number of prescriptions done this week was less than last year, so guess who is getting her already minimal technician hours cut even further?
“EXCUSE ME!” shouts out another voice. “Is this the stuff that Dr. Oz recommends? I’ll just buy it down the street, it’s cheaper over there.”
The phone rings. “I don’t have any refills on this prescription, I’m all out of pills, and I’m leaving for the airport in 5 minutes.”
Finally, Laura has a moment to print the waiting prescription, and after entering her initials to print, BEEP BEEP! The printer is jammed again. Time out to fix the printer, for the fourth time that week.
The phone rings. “Why is my copay $2? It should be $1.99.”
The label prints out, but before Laura can attach the label (note, most prescriptions require counting by hand and do not just have a label that can be attached to the box), she realizes they just used the last of the medication that is needed. Since the weekly warehouse medication order is in the corner, waiting to be put away, Laura starts going through the 16 totes one by one, until she finds the medication she needs – in the very last tote, of course!
The phone rings. “You need to call my doctor right now for a new prescription. He’s leaving the office in 2 minutes, so you have to call right now.”
Laura places the labeled medication and paperwork in a “waiter”’ basket and hands it off to the pharmacist for final verification. But Anna is now over in aisle 13, counseling a patient on allergy medications. When Anna returns to the pharmacy five minutes later, she is finally ready to verify the prescription and send Mrs. Smith on her way.
“EXCUSE ME I JUST HAVE A QUICK QUESTION SINCE YOU’RE NOT BUSY WHAT CAN I TAKE FOR AN EAR INFECTION?” comes another voice from the other side of the counter. Anna is interrupted three times while verifying Mrs. Smith’s prescription, and each time, she starts from the beginning to ensure no mistakes are made due to those interruptions.
Anna sighs, glancing over at the pile of other things to be done – medication therapy management consults, writing the staff schedule, return to stocks (prescriptions that were not picked up that must be reversed from insurance and returned to shelf), inventory activities, and more. She knows she just can’t get everything done every day, so she does her best to take care of her patients.
Total time, including waiting for the doctor to call back: 75 minutes!
Now, many busy chain stores fill 300+ prescriptions per day! Imagine all of this chaos and distraction happening over and over, all day, every day, in a chronically understaffed store, where any mistake can kill someone. Although most prescriptions can be processed without calling the doctor, many prescriptions require clarification of some sort. Even a prescription with zero issues whatsoever must still be “queued” among all the other activity going on in the pharmacy.
Done Fast or Done Right?
As most of my fellow pharmacists tell their patients, “Do you want it done fast, or do you want it done right?” We very much appreciate our “patient patients” and I hope this brings a little understanding of just SOME of the many things that go on in the pharmacy. This is why we can’t just slap a label on it.
About Karen Berger:
Karen Berger, PharmD, RPh, graduated from the University of Pittsburgh School of Pharmacy in 2001. She has worked in community pharmacies for 17 years, first, as a pharmacist/pharmacy manager for a large chain, and currently, as a pharmacist at an independent pharmacy in Northern New Jersey. She can be reached at firstname.lastname@example.org