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Pharmacists Severely Under-Staffed, Threatening Patient Safety

Regina (November 28, 2014) – “I have said many times that it will take an error where someone dies before anything will change”. These are the chilling words of a Saskatchewan hospital pharmacist, one of many who shared their concerns with the Health Sciences Association of Saskatchewan in recent membership surveys.

“Our surveys heard from hospital pharmacists across the province, who identified threats to patient safety from: chronic under-staffing, managers who refuse to put ‘patients first’, and health regions that knowingly refuse to follow professional best practices for pharmacist services,” Health Sciences President, Karen Wasylenko, told a Regina news conference.

“Even more alarming, hospital pharmacists told us over and over they have raised their concerns with health region managers, who dismiss them out of hand, showing disrespect not only for specialized health care professionals, but also for the patients they are trying to serve,” Wasylenko noted.

“This is why Health Sciences is determined to see all health regions made more accountable to the public, with management decisions related to staffing, job vacancies and service levels reported to patients and their families. For those who ask: “why are the health regions so afraid of public accountability; what are they trying to hide?” They need only review a few of the troubling comments from hospital pharmacists,” Wasylenko added.

The comments from hospital pharmacists confirm:

  • Chronic under-staffing of hospital pharmacists means patients in Children’s Wards, Emergency Rooms, Cardiac Care Units and Post-Operative areas in our major cities are receiving minimal assistance with critical drug therapy
  • To save on their budgets, health regions refuse to replace hospital pharmacists who are on maternity leave, educational leave or temporary work assignments, which worsens the staffing shortage and means a further reduction in services
  • Pharmacists are instructed to enter medication orders for patients, without being able to monitor how that patient is reacting to the drug therapy or being able to provide the patient with information and counselling about their medications
  • Many pharmacists are required to work overtime to meet critical patient needs, but are expected to work this extra time for free, which is illegal

The comments were collected by Health Sciences in two recent internal online surveys of members from across the province. A sample of their comments is attached to this News Release

The following comments are from Saskatchewan Hospital Pharmacists, who responded to online surveys conducted by the Health Sciences Association of Saskatchewan:

Chronic Under-Staffing

“We are often running short a pharmacist and therefore we are apt to miss some important clinical issues – as well, you are so pressured to get work done quickly to avoid overtime hours that you don’t take the time to check things properly before proceeding…. I fear that mistakes will be made.”

“Inadequate staffing – many lines vacant on schedule leading to big increases in how often we have to be on call and being moved around the health region constantly. Numerous vacant lines have been left unfilled for long stretches of time.”

“Inadequate staffing and poor management result in pharmacists stretching themselves to the limit, often when very tired, to perform activities, which require extremely high attention to detail and can result in significant patient harm when mistakes are made.”

“Inadequate staffing is the most important issue. Most days of the week, each pharmacist is responsible for ~100 inpatients. On weekends, each pharmacist has 200-350 patients (usually only one clinical pharmacist on weekends).”

“Pure volume of work allows for only the most basic of functions in our region. This is especially evident on weekends, when we are expected to work with a single pharmacist. No doubt that our region is not utilizing pharmacists to their fullest.”

“We are chronically short staffed; a large percentage of new pharmacists quit within one year, so there is a huge problem with retention. Our role is often more technical than clinical and on many floors we are not staffed for clinical services, only ‘core’ services, which often means refusing consult requests.”

“Other sites across North America have a 1:20 pharmacist: patient ratio in most clinical areas – ours is ~1:70-100 most days – practicing to our full scope is thus not possible, nor can we assist with meaningful practices like discharge medication reconciliation.”

Patient Safety Compromised

“We are expected to do more work with the same or less staff than normal. I have said many times that it will take an error where someone dies before anything will change.”

“I have seen pharmacists sent to work in the Intensive Care Unit (ICU) after four days training. How is that safe?”

“It has been widely shown there are usually at least three drug therapy problems per patient, and more in those who are hospitalized, with around 50% of emergency room visits being related to medications; however pharmacists may have approximately 100 patients per pharmacist per day.”

“We don’t have a pharmacist in ER at the General Hospital in Regina.”

“Inadequate staffing leads to delays in providing medications to patients and frequently medications are administered prior to a pharmacist reviewing the prescription.”

“I do strongly believe that if we had more pharmacists in my practice site, adverse drug reactions could be reduced, as we only have the capacity to follow up with a small portion of admitted patients. Increasing staffing would also allow us to be more involved in discharge, which could likely reduce the chance that patients will bounce back to hospital, due to poor discharge prescriptions being written.”

“Medications might be delayed, complex drug therapy regimens may not be reviewed, and patients may not be reviewed on discharge. We see many errors of patients coming in from a LTC home, multiple meds are stopped (or changed or started), but discharge medication reconciliation does not get done and the patient returns to the LTC home and continues to receive the same meds, then is readmitted.”

“In paediatrics, there are very high acuity neonates who receive minimal pharmacist attention. We provide next to no service to surgical patients, who often are complicated patients with many medication related issues.”

“We haven’t been able provide clinical services to emergency. We have some pharmacists looking after ~ 50 patients, which is well above the national average.”

Illegal Overtime Requirements

“It is very common to stay an extra 30-60 minutes to deal with problems that come up at the end of the day. It is not normal practice to ask for overtime.”

“Overtime hours are required to provide a basic level of service, however, the employer refuses to pay for the extra hours or provide additional or replacement staff. Not working the overtime hours would require me to be negligent in my professional responsibilities.”

“Pharmacists in our facility “volunteer” countless hours of overtime for which we are not paid. There is such an emphasis on justifying OT and applying for it that most times it is not worth the bother. We have pride in our jobs and our profession and in our work ethic. Right or wrong we work far more unpaid overtime hours than paid overtime hours.”

Definition of terms referred to in comments by Saskatchewan Hospital Pharmacists:

Clinical Services – The overall goal of clinical pharmacy activities is to promote the correct and appropriate use of medicinal products and devices. These activities aim at using the most effective treatment for each type of patient, minimising the risk of adverse drug therapy events, and helping the patient comply with their therapy requirements by providing counselling and consulting services to patients and other health care professionals.

Discharge Medication Reconciliation – The goal of medication reconciliation at discharge is to reconcile the medications the patient was taking prior to admission and those initiated in hospital, with the medications they should be taking post-discharge, to ensure all changes are intentional and that discrepancies are resolved prior to discharge. Medication reconciliation should result in avoidance of therapeutic duplications, omissions, unnecessary medications and adverse drug therapy events.

For Further Information Contact:

Dawn Brown
Communications, Health Sciences Association of Saskatchewan
306-527-1977

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