Portrait of female pharmacist standing at counter in pharmacy, slap a label on it

“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.

Interruption:

The phone rings. “Are you open?”

Interruption:

“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.

Interruption:

“EXCUSE ME!” Cries a voice from the other side of the counter. “Where is the windshield wiper fluid? Can someone walk me to it?”

Interruption:

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.

Interruption:

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.

Interruption:

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?

Interruption:

“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.”

Interruption:

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.

Interruption:

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!

Interruption:

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.

Interruption:

“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 karenmichelleberger@gmail.com

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  1. JAM
    New York
    Reply

    I sent this article to my pharmacist daughter. She laughed & said, “So true!”

    • Terry Graedon
      Reply

      Apparently, the issues that plague pharmacists have not changed that much since 2011.

  2. Stacy
    Florida
    Reply

    Several studies have been conducted regarding error rate due to interruptions. Each interruption increases the chance of error by approximately 3%. Just by looking at the number of interruptions, in the filling of this one script, it is a miracle that pharmacists multi-task well enough to maintain an extremely low error rate. An experienced pharmacy technician can make all the difference in the world, but you don’t always get that.

    You wouldn’t interrupt a bus driver, on duty, to find out what aisle shampoo is on. You wouldn’t interrupt a cashier counting out your change. Consumers should offer the same respect to the pharmacist because a simple error could be a life or death situation. Pharmacies should be walled off from the general public to minimize random distractions, purely for the safety of the patient. The pharmacist will gladly speak to you or answer your questions, but the task at hand should be completed first.

    Also, this drive-thru nonsense needs to stop. Rarely is it a simple drop off or pick up transaction and pharmacists are not personal shoppers. Patient safety is our main concern. The reasons for the majority of these errors is pretty clear, you would think the large chains would get on board with safety instead of numbers. That one serious med error is just not worth it.

  3. Bryan
    Indy
    Reply

    Ha! If anything, this leaves some things out? There should be another pharmacy on the phone needing copies immediately for scripts you already have ready because it is a dollar cheaper with goodrx there; a doctors office on hold who refuses to leave a voicemail or escribe a new rx, a useless computer alert needing an override so it can be sold at drive thru (yes, I’m aware birth control shouldn’t be taken if she is pregnant…) and a patient who wants us to special order a certain genetic manufacturer because the new ones make her feel bloated… rinse and repeat 450 times a day. It just never ends

  4. Mindy
    Burlington,VT
    Reply

    This is spot on. Anyway, this was only one script; imagine 100 or more each day with the same interruptions. As if all this is not enough, the District Manager WILL call to give the pharmacists the GOOD news: tech hours will get cut starting next week!!!

  5. Jim
    San Antonio
    Reply

    And the M.D. who calls upset because there are two prescriptions, one for Warfarin and one for Ibuprofen and wants to know why am I calling him at 8PM.

  6. Mariah
    CO
    Reply

    I would only say that, for how we run our store, the technicians do a lot of the stuff “Anna” did. I’m glad we don’t have a drive thru or walk-up, so that takes away one problem. And us techs call on insurance issues, call doctors on minor verification issues (after we sometimes double check with the pharmacist), do returns, filing, pre-full vaccine baskets (so we can grab vaccines out of the fridge & go), write the schedule, go over predicted metrics, and all inventory work (and just make sure the reports the pharmacist needs are kept up to date and accurate). We have seen the workload the pharmacists have and do whatever we can to lighten that load, even if it’s just a little thing.

  7. Cx
    Toronto
    Reply

    It’s just brought tear to my eye. So true.

  8. Peggy
    CA
    Reply

    I can imagine and guess at the chaos that a pharmacist and staff live with every day! And I appreciate and understand the education and training necessary to fulfill the role of being a licensed pharmacist.

    But, because our vitamins and medicines are manufactured in China, I believe we the public can only be protected so far by our pharmacist.
    They are not responsible for what these pills contain, nor do they have any way of screening them. We are at the mercy of the almighty dollar, more now than at any other time. We are ingesting crap from China! Shame on us for settling.

    For new mothers and fathers: are you okay with feeding your newborn vitamins from China? check the regulations surrounding the manufacturing of vitamins and medicine. follow how often mistakes occur, pills are pulled, people get sick or die. And then tell me you’re okay with China made meds.

  9. bettye d
    Texas
    Reply

    Such great information. Worth every minute for gaining this insight.

    • Lucy
      Canada
      Reply

      But the FDA (American food and drug administration) spent years and years to approve these “made in China” drugs. It’s not like the pharmacy just goes on Amazon and selects the cheapest option. There are standards to meet even if the drug is made outside of America. Besides, I doubt you’d be complacent once you realize that no insurance company in America would be willing to pay anything more than the lowest cost alternative on the market for generic drugs.

  10. Chuckie D
    San Antonio, TX
    Reply

    So true, we tend to get wound up in our own wants and needs and don’t even consider what frustrations others may also be experiencing . Being made aware of just what happens “behind the scenes” can often resolve much of this misunderstanding and anger that results. More informative articles such, as this one, should be made available to ally frustration “on both sides of the counter”.

  11. Betsy
    Pennsylvania
    Reply

    Hit the nail on the head! Understaffed and underpaid!

  12. Luis
    New York
    Reply

    Love it. I would start the challenge by asking: how do we fix it? I am an advocate for expanding the CPhT role to offer more involved patient care. I would also model pharmacies to work like banks where one patient per tech with a top down workflow from start to end. If a tech gets caught up with an issue the RPh or Senior Tech can come over to assist.

  13. ray
    ga
    Reply

    i use a local drug store.they have more staff than the big chains. they eat lunch around 1 so i dont call at that time.most my meds same with refills. i call a day or two ahead so they can fill at slower time of day,then when i make dr appointment i have only 3 to fill instead of 11 at once. usually i dont have a question so its hand them scripts,dont carry on conversation,till they filled. some had worked at rite aide in past and more friendly then they was at rite aide. very friendly to pick best and cheapest OTC,BTC,

  14. Val
    Denver
    Reply

    As a pharmacist, so much of this happens repeatedly during the day, albeit not to one prescription. The insurance card put me in mind of working alone one Sunday when a patient had me go through FOUR insurance cards before we got the right one (entering numbers and trying to bill). She just shrugged and said “I just never throw anything away.” My response was that this had now created a line of people waiting for THEIR prescriptions, and I hoped in the future that she’d be respectful of people’s time when they had other patients’ needs to tend.

  15. Sue
    Vermont
    Reply

    Having worked for years as a telephone triage nurse, I have great sympathy & Understanding for the pharmacist’s plight. This article is spot on. Sadly, the people who need to read this to get a clue, won’t.

  16. O.G.
    Spartanburg, SC
    Reply

    Very interesting! Thank you for enlightening us!

    Although I THINK I’m one of the “”patient” patients — I usually drop any prescription off with a sympathetic look and a “just have the mechanical lady give me a call when it’s ready” — I HAVE been guilty of interrupting. 🙀

    I had no idea what really goes on behind the pharmacy counter: in the future, though, I will, and promise to be a better person… and patient. 😸

  17. Jim
    Reply

    Tom, it WAS invented by the government. Just like the rest of medicine, it was invented by government and, like the Post Office, is hopelessly archaic. All those rules are supposed to protect the patient but they really protect the government-sponsored monopoly; the: patent-medicines are magical, mysterious potions paradigme, so powerful that “the little people” can’t be trusted with them. As if cough syrup and diuretics are more dangerous than ammunition (sporting goods), motor oil (automotive section) or sulphuric acid (plumbing section, aisle 8).

  18. Alma
    Enterprise,Alabama
    Reply

    That sounds like a scene that could possibly be in any one of a Healthcare professions scenario. In this day and time it seems that’s just the way it is. Certainly a very stressful and dangerous time to work in this field.

  19. Yana
    Chicago Illinois
    Reply

    This chaos was exactly the reason I moved all my family’s scripts to an independent pharmacy. They know me by name there, and service is neighborly

  20. Berge
    Banner Elk, NC
    Reply

    I check my Rx bottle before I pay for it always.
    Here at a Walmart Rx, my refill medication given to me in a bottle, was 125 mcg Tikosyn # 60 , instead of 250 mcg# 60 with the wrong doctor’s name . But the price for lower dose was still $159.oo
    which would have lasted me 15 days instead of 30 days. Meaning I would have paid twice as much due to pharmacist’s negligence
    BTW there was no apology from the pharmacist

  21. John
    Rock Hill SC
    Reply

    The story is so typical. I retired in 2011 but my PTSD kicked in just reading this accounting of a day in a busy pharmacy.

  22. LeeLa
    Oregon
    Reply

    Excellent article. Pharmacists are the most underappreciated members of the healthcare team. I have observed much of what is described in this article while waiting, and yet I still get a very compassionate “hope you feel better soon” when I check out.

    • Karen
      Nj
      Reply

      Exactly Leela! That’s why I added the part at the end that we do the best we can. Despite all the craziness we really want to help people! :)

  23. Joe
    WI
    Reply

    Having worked as a CVS pharmacist for 14 years, I can say that this story is both humorous and true. It is unfortunate that corporate America doesn’t value its employees and puts our patients at risk.

  24. Larry
    Ferndale, WA
    Reply

    Excellent article. I wish it were available for everyone to read.

  25. Tom M
    Reply

    Sounds like the government invented this process. Filled with confusion, non-productivity and internal structure flaws. You really can’t blame the pharmacist who is working under a distressed system filled with nonsense.

  26. Big Box RPh
    Mansfield, OH
    Reply

    Anna and I must work at the same pharmacy!!! This article hits the nail right on the head.

  27. Jay
    Toronto
    Reply

    Never knew filling a Rx was this complicated. Very educational article. Congratulations to Ms. Berger for the explanation!

  28. Alex
    84041
    Reply

    The older pts don’t understand data entry and how it works. Example, at the register, pt is already swiping card, “what’s your date of birth?” “How much?” “I don’t know unless I can find your priscriptions. Also you should pull your card out because it’s doing nothing to the situation” “but it says for me to.”

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