Managing External Pressures in the Pharmacy to Reduce Incidents and Harm

A pharmacist serves a patient while under pressure from a growing line of patients queuing up to the counter.

As a pharmacy professional, it is important to be aware of the potential risks that can arise when there is a deviation from the standard workflow and functioning of the pharmacy. In some cases, external pressures can contribute to medication incidents and harm. According to an ISMP Canada report on incidents that caused harm in Manitoba, complicated medication regimens, interruptions, and multi-tasking under time pressure are common factors that contributed to medication incidents. 

Staffing pressures have also increased in community pharmacies during the COVID-19 pandemic. Inadequate staffing increases the pressure to work quicker and multi-task. It’s important to not only acknowledge these pressures, but also to recognize the essential services that pharmacy professionals continue to provide during a very challenging time and under conditions that are sometimes beyond their control. 

Incident Example from the National Incident Repository for Community Pharmacies 

One Manitoba-based incident reported to the National Incident Data Repository for Community Pharmacies involved compliance packs for patients: 

“A patient’s compliance pack required an immediate replacement within a short period of time. Another patient’s compliance pack had been started but could not be completed before the replacement pack was needed, therefore both compliance packs (and their associated medication stock bottles) were open on the same workspace. While filling the replacement pack, phone calls interrupted the process, and an incorrect medication (from the other patient’s compliance pack) was included. The patient took a few doses of the incorrect medication, experienced side effects, and required assessment at the hospital.” 

Use the key recommendations below to help you prepare and dispense medication safely during times of high stress in the pharmacy. 

Four Key Safety Recommendations to Address External Pressure in the Pharmacy 

  1. Enhance the use of technology. To ensure patient safety, pharmacies can leverage technology, such as a medication synchronization program to align refill dates for a patient’s medications. This can improve workflow and reduce interruptions. 
  2. Restart a task after being interrupted. If you have been interrupted mid-task, starting from the beginning can ensure a clear, continuous thought process. This can make it less likely that you will miss a step or make a mistake.  
  3. Schedule appropriate shift overlaps. Additionally, scheduling staff with an appropriate shift overlap during the busiest time(s) of the day and week can help to manage workload and reduce the likelihood of errors. When this is not feasible, communicating potential delays to staff and patients can help to set reasonable expectations. 
  4. Implement a system of independent double checks. If you limit independent double checks to the most impactful and risky processes, they are an effective tool even under times of high workload or staffing constraints.

You may also want to review ISMP Canada’s additional recommendations to balance efficiency and patient safety in community pharmacy and our recommendations on reducing distractions and interruptions 

As a pharmacy professional, it is important to prioritize patient safety and be aware of the potential risks that can arise when there is a deviation from the standard workflow and functioning of the pharmacy. By implementing these key recommendations, you can help to reduce the likelihood of incidents occurring and ensure that your patients receive the best possible care. 

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