Is OREGON STATE Board Setting The Stage For More States To Get Real?

Jp Enlarged

 Here we go again.  250,000 pharmacists wishing they were in Oregon.

2/19/14

 To: jpgakis@hotmail.com

 Jim,

 Please withhold my name (I’m on probation with my board and I don’t want issues right now from employer)

 

Below is from the new Oregon Board of Pharmacy Newsletter, page 4.  I can see this new blog post now… Oregon Board of Pharmacy says what Jim’s already been Saying: “Be professional and Document” … It’s an article on what changes have occurred since Oregon put in place their workplace conduct rules, which said no incentivizing transferring prescriptions, uninterrupted break and meal times, among other things.  From Tony pacific NW

Original URL:  (CLICKING HERE WILL DOWNLOAD THE FEBRUARY, 2014 OREGON BOARD OF PHARMACY NEWSLETTER.  LOADED WITH GOOD STUFF. LIKE DEEP FRIED PORK CHOPS FOR A HUNGRY COLLEGE FOOTBALL LINEMAN IN LOUISIANA.

http://www.nabp.net/system/rich/rich_files/rich_files/000/000/196/original/or022014.pdf  

 

 No. 534 Workplace Environment Update

By Angie 2014 PharmD Candidate

The primary function of the Board of Pharmacy is to preserve

and protect the public health, safety, and welfare by ensuring

high standards in the practice of pharmacy and by regulating

the quality, manufacture, sale, and distribution of drugs. The

Board is not the entity for professionals to look to or rely upon

to “promote,” “enhance,” or “propel” the profession of pharmacy

– that is the responsibility of the local, state, and national

professional associations.

 

Licensees should realize and understand this distinction and

be involved with a professional organization to advance the profession.

Additionally, licensees should comprehend and practice

with the mindset that the rules are written as

minimum standards 

to exceed and not as a best practice to achieve.

 

In June 2012, the Board adopted regulations regarding “Unprofessional

Conduct for the Outlet.” The Board adopted these

rules in response to safety concerns expressed by pharmacists

in a 2011 Working Conditions Survey conducted by the Board.

Please refer to the November 2012 Newsletter.

Some folks have inquired as to whether and how this rule

has impacted current practice. In the time since the rule’s inception,

pharmacy practice has seen some immediate changes. For

example, the prohibition of the use of coupons and gift cards to

incentivize patients to repeatedly transfer prescriptions resulted

in a swift discontinuation of this practice and the recognition of

patient safety at the forefront. The Board believes that such

prohibition, at a minimum, has resulted in fewer incomplete profiles.

Other impacts of this rule are more subtle and require invocation

of the investigatory process. Allegations regarding an 

outlet’s use of productivity or production quotas and failure (Read Metrics/JP)

to provide sufficient personnel and appropriate opportunities

for uninterrupted meal and rest periods have been reported to

the Board. However, many outlets have changed procedures in

order to provide for uninterrupted meal and rest periods and, in

some situations, outlets have procedures for these breaks that

pharmacists may not be aware of or are not following.

The Board reviews all complaints on a case-by-case basis and

determines if a violation has occurred and whether to propose

disciplinary action. Licensees must understand a few critical tenets

of administrative law and perhaps the investigatory process

itself. In order to have a solid case that exhibits the violation of

a law or rule, one must have concrete evidence. Evidence in a

case alleging drug outlet misconduct may include such things

as documentation of communication between a pharmacist and

his or her supervisor. For example, if a pharmacist determines

that staff is working at an unsafe rate, he or she must request

additional personnel in the pharmacy department and document

the response and what steps were taken to maintain patient safety.

 

Documentation is crucial and may be reviewed by an administrative

law judge (ALJ) at a hearing. It may compel the ALJ to

determine that the outlet failed to provide a working environment

that protects the health, safety, and welfare of a patient due to

failure to provide sufficient personnel and/or adequate time for

a pharmacist to complete professional duties.

 

This type of investigation takes time and the long-term outcomes

of this regulation may not occur as immediately as the

changes described above. The Board is keenly aware of the reality

of the environment in which many community pharmacists

currently work as exhibited by the data collected in the initial

and 2013 follow-up Working Conditions Survey. Remember, the

Board has a mission to keep patients safe, not to protect pharmacists,

but there may be instances where keeping patients safe

means “protecting” pharmacists from unsafe working conditions.

 

Pharmacists must maintain standards of professionalism and

not take shortcuts in their practice or attempt to practice at a rate

that is not safe. Pharmacists want to remind themselves that they

have a license that permits them to practice. It is the pharmacist’s

responsibility to take the steps necessary to practice safely and

not act in a manner that jeopardizes patient safety and may result

in discipline.

 

Speak with your supervisor if you have a concern of an outlet

conduct violation and find out if there is a current procedure in

place to address your concern (eg, lunch break procedure) that

is not being followed. Document the interaction and specifics of

date, time, and who was involved. Remember that pharmacists,

interns, and technicians have a duty to report and the Board may

not be able to take action if a suspected violation is not reported.

Pharmacist Steve keeps better track of this than anyone.  That includes the ‘WATCHERS’ at CVS, RAD, Target, WAG, Safeway and the rest.  AND… you can give odds that they pay people to ‘WATCH’ us.  The following is Steve’s follow-up on Oregon and related issues.  There are those among you who get hot when we shine light on the dark places.  But you do NOTHING. We don’t expect you to drive your big ass SUV crashing through the front doors of your state board offices to get attention.  If you want to make a difference, you can target just one member of the board and go after him/her.  If you can get a statement (written) acknowledging that there is a problem, that is a huge start.  If you can get this board member to actually suggest that they have to do something because current conditions place the public in danger you will have completed a significant revolutionary act.  Come on, you cannot fairly expect Peon, Goose, me, Steve and Pharmacy Gal among others to carry the load. Where are the newbies in this picture?  They can reasonably expect 40 more years behind the counter, if they want it.  Get going, kids.   What you have to lose is huge.  Get into the conversation.

The following was passed on by Pharmacist Steve.

 

June 12, 2014 — The Oregon State Board of Pharmacy is the 2013 recipient of the National Association of Boards of Pharmacy (NABP) Fred T. Mahaffey Award which was presented during NABP’s 109th Annual Meeting and Conference in St. Louis on May 21. This is the second time Oregon has received the award.

The award was given to the Oregon Board of Pharmacy in recognition of its adoption of administrative rules defining grounds for discipline of drug outlets (pharmacies) that fail to provide a working environment that protects the health, safety and welfare of patients. The new Oregon rules for patient safety resulted from a survey of pharmacists’ opinions conducted by the Board. These rules have become a model for other state boards of pharmacy and will bring national attention to this important issue.
http://www.thelundreport.org/resource/oregon_board_of_pharmacy_receives_nabp_award
not seeing rush to the various legislatures to emulate Oregon – are we ?


Goose, you are up.  Can you handle the curve? 

As some of you know, I live in Indiana and I have a friend on the board, I will offer to do this.
I will approach my friend on the board and see if we can get on the agenda as a concerned group of pharmacists about workflow issues.
I need folks from Indiana that work for the chains to come in and tesify about staffing concerns with times, dates etc.
Keep in mind that Wags and CVS both are represented on the board and that Ron Snow, head of college relations for CVS in Indiana goes to every meeting.
Maybe we could offer up the Oregon Board’s work as an example for what we could hope for.
If we get a model from this meeting or a response, maybe we could get a grassroots effort going with other state boards.
The soonest I could do this is June 2014, the board meeting is around the firss of the month.
SRA, can you help get the word out?
Let’s do this.  Goose

 

12 Comments

12 Comments

  1. pharmaciststeve  •  Feb 21, 2014 @7:17 pm

    June 12, 2014 — The Oregon State Board of Pharmacy is the 2013 recipient of the National Association of Boards of Pharmacy (NABP) Fred T. Mahaffey Award which was presented during NABP’s 109th Annual Meeting and Conference in St. Louis on May 21. This is the second time Oregon has received the award.

    The award was given to the Oregon Board of Pharmacy in recognition of its adoption of administrative rules defining grounds for discipline of drug outlets (pharmacies) that fail to provide a working environment that protects the health, safety and welfare of patients. The new Oregon rules for patient safety resulted from a survey of pharmacists’ opinions conducted by the Board. These rules have become a model for other state boards of pharmacy and will bring national attention to this important issue.
    http://www.thelundreport.org/resource/oregon_board_of_pharmacy_receives_nabp_award
    not seeing rush to the various legislatures to emulate Oregon – are we ?

  2. pharmaciststeve  •  Feb 21, 2014 @7:35 pm

    In the same vein.. there is going to be a major expose by investigative reporter starting Monday on NBC 4 in DC and Wednesday on NBC5 in Chicago
    “Starting Joe Zorek and his previous employer ”
    http://www.pharmaciststeve.com/?p=5046

  3. Pharmacy Gal  •  Feb 23, 2014 @3:06 pm

    I’m in. This is not just a chain issue anymore. What about writing a state legislator? My BOP is well represented by all three chains. I don’t think they will be too responsive. As far as the newbies–they are too busy showing management what big numbers they can achieve filling orders quickly so they can push me out of a job.

  4. Peon  •  Feb 23, 2014 @9:44 pm

    The action by the Oregon State Board of Pharmacy is to be applauded! Great job! And, the expose on CVS is another bit of good news. The idea of targeting certain members of one’s state board sounds like a great idea. While all these things are positives, there remains some entrenched problems in pharmacy that I have always felt needed changing: working conditions. And, I am not just talking about the metrics, the quotas and etc, but the entire pharmacy ‘environment’. To put it bluntly, at my place of work, January was ‘hell’. I am not blaming my employer. I am blaming the whole way that pharmacy is practiced, the way we do our work, and the design of pharmacies. The dominant problem was insurance! Everyone has a new card, but 75% never think to present their card until they get to the cash register. Not to be bashing my employer, Wal-Mart, because they really do try to do the right thing, but their new bagging system is the last ‘straw’. It has become so cumbersome and complicated to fill a rx that it has reached the point of absurdity. The things that were suppose to make our lives better and increase patient care has resulted in one big ‘mess’. E-scripts have become a nightmare. We are filling so many rx’s that people never pick up which results in a lot of wasted work. Computers have increased the complexity and the time it takes to fill rx’s. Something is wrong….very wrong with the way we do things. If this is not enough, here comes the customer. Instead of seeing the customer as a patient needing our care, we have gravitated to the idea that here comes another idiot to bash us. We had one woman, standing at the cash register, start yelling at at the cashier. My cashier came running back to me crying. I had to threaten the woman with calling the police before she calmed down. A few days later another woman threatened to slap the cashier. To be honest, things are so bad, with long lines at the cash register that I don’t see how my cashier can handle her job. One day at the cash register and I would be looking for another job. The patient is no longer a patient but a hostile, bitching, complaining moron. Whether my area of working is typical of the rest of my state or of the country, I have no idea. If everyone is trying to work in the same type environment as me, then I feel sorry for all pharmacists. Beyond all the things that the Oregon Board of pharmacy is doing, and all the lawsuits aimed at the chains, there is still a major problem in pharmacy. It is the work environment. As I have been saying for so many years, it is no place for a professional to work. The chains love to have pharmacists open to the customers, but this creates major distractions. No one is dealing with the problem of distractions and noise in the pharmacy! How many of you pharmacists have problems communicating with customers because they have those damned cellphones glued to their ears? Talk about something obnoxious! You would think that these chains would allow us to put signs in the windows saying, “No Cellphones”. But, no way! Just this small, very small thing has become an impossibility and it shows just how little importance with which we are regarded and just how little the powers that rule us care about us. I have sent 30 emails to my employer trying to get them to allow us to put a sign in the window about these cellphones. The response I got was that I ‘better shut up’. The basic design of the pharmacy has not changed in 100 years! Is it necessary that a pharmacist trying to check that techs are inputting and filling rx’s properly, checking for drug interactions, trying to contact physicians to determine what the hell they are trying to write, and to counsel patients, is exposed to so much noise and so many distractions and the constant interruption of every person coming to the pharmacy window. This is the equivalent of an airliner letting passengers into the cockpit to complain to the pilots, to talk on their cellphones, to yell, to curse and just about anything else. Not only do pilots have peoples lives in their hands, but so do we. Yet, we are treated worse than auto mechanics, and as bad as the worker at McDonalds. What I am saying has been a very long running complaint of mine. Things have gotten worse, not better. I would hate to think that I had a 40 year career in retail chain pharmacy in front of me. It is bad…it is that bad.

  5. goose  •  Feb 25, 2014 @10:30 am

    As some of you know, I live in Indiana and I have a friend on the board, I will offer to do this.
    I will approach my friend on the board and see if we can get on the agenda as a concerned group of pharmacists about workflow issues.
    I need folks from Indiana that work for the chains to come in and tesify about staffing concerns with times, dates etc.
    Keep in mind that Wags and CVS both are represented on the board and that Ron Snow, head of college relations for CVS in Indiana goes to every meeting.
    Maybe we could offer up the Oregon Board’s work as an example for what we could hope for.
    If we get a model from this meeting or a response, maybe we could get a grassroots effort going with other state boards.
    The soonest I could do this is June 2014, the board meeting is around the firts of the month.
    SRA, can you help get the word out?
    Let’s do this.

  6. goose  •  Feb 25, 2014 @10:57 am

    Hey,
    I forgot this. It’s not just retail, I have some staffing concerns at my hospital also.
    I would be glad to testify about the challenges the pharmacists at my hospital are experiencing.

  7. RalPh  •  Feb 25, 2014 @2:54 pm

    Peon, great post.

    As for other issues with chains…

    We pharmacists will need documentation of discipline based on the numbers, not just evidence that chains use metrics. Any business will make a case for steps to ensure efficiency. It’s when the managers threaten based on those numbers that we need to document. Email it to yourself via Gmail to timestamp it.

    Also document concerns with pharmacy manager, and document when pic is directing staff to behave differently based on statements about the metrics. Etc.

    If there’s no proof they’re more than interesting goals, Boards will do nothing.

  8. pharmaciststeve  •  Feb 26, 2014 @4:34 pm

    @Goose.. I can help with my blog.. Ron Snow is also Pres elect of the IPA.. I am sure that Lary Sage would decline sending anything out with their emailing list… afraid of pissing someone off that contributes to the IPA. They have < 200 members on their LinkedIN and 700+ on their facebook page.

    I will relate a phone I had last night from a Legend RPH in the NE.. the RPH complained to the BOP about practice act violation that his employer was allowing to happen.. apparently this state's BOP is stacked with employees of this chain.. it came back down from the BOP that they "were taking care of it" and this RPH started getting retaliation from this chain's management.. This same chain did the same thing in a SE state.. and the BOP suspended a handful of stores from performing this service for two years. My understanding is that there are no chain employees on this BOP.

    IMO.. going thru Ron Grooms and Steve Davidsson is probably a better path. I am attending a small luncheon with Ron this Friday.. I will try to see his opinion.
    -
    Generally speaking.. the BOP have taken the stance that staffing and work environment has no relationship with patient safety.

    That being said.. in the last few weeks there has been investigative reporters in five different states doing reports on med errors in pharmacies.. the last of 5 will air tonight on NBC 5 Chicago tonight at 11 EST.. here is the link to watch it live http://www.nbcchicago.com/on-air/as-seen-on/live-video-129648223.html.. the link to the three segment expose from NBC 4 Washington is on my blog. The other areas was Raleigh/Durham, Fort Worth, Tampa.

    I got a call yesterday from a investigative reporter in Louisville that wants to talk about med errors in community pharmacy..

    IMO.. the BOP can blow us off.. getting the media to pay attention.. is a whole different animal. The bureaucrats don't like microphones stuck in their face being asked uncomfortable questions.

  9. goose  •  Feb 27, 2014 @5:08 pm

    Guys,
    Have a new wrinkle that just came up, watch for communications coming from my home email.

  10. Pharmacy Gal  •  Feb 27, 2014 @10:26 pm

    Goose- thank you for mentioning hospitals.

  11. broncofan7  •  Feb 28, 2014 @10:55 pm
  12. pharmaciststeve  •  Mar 1, 2014 @9:52 am

    Here is a link to all the “bad press” on pharmacy from around the country in the last month or so
    http://www.pharmaciststeve.com/?p=5083
    CBS 11 in Dallas/Fort Worth.. this is their second expose on pharmacy errors in the last month..

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