Sarah Sundin continues her four-part series on contemporary pharmacy. Today she focuses on the community pharmacist. This series is providing a lot of great background information for these health care professionals and potential fictional characters.
Back to Sarah….
Fiction writers do mean things to their characters. If those mean things require pharmaceutical care, you may need to introduce a pharmacist character or understand how pharmacies work. As a pharmacist myself, I want to help you get those details straight.
Today’s article discusses community pharmacy practice. Previous articles gave an overview of the profession, and discussed pharmacy education and training, and the following article will discuss practice in the hospital setting.
About 65% of America’s pharmacists work in retail pharmacies inside drug stores, supermarkets, or mass merchandisers such as Walmart, Costco, or Target. There are approximately 23,000 independently owned pharmacies in the U.S., and 39,000 chain stores.
In the typical American drugstore, the pharmacy is toward the rear of the store, with over-the-counter (OTC) medications stocked close to the pharmacy. A counter divides the pharmacy from the rest of the store, usually with prescription drop-off and pick-up in separate areas. The secure pharmacy area is set further back, usually behind bulletproof glass. Access is restricted to pharmacists and pharmacy technicians. Other persons are allowed inside briefly to make deliveries or for housekeeping, and only with a pharmacist present.
The pharmacy area includes a main counter with computer workstations. Shelves hold bulk medications divided by type—oral tablets and capsules, oral liquids, suppositories, topicals (creams and ointments), eye and ear medications, inhalers, and injectables, plus bulk storage. Each pharmacy has a refrigerator for temperature-sensitive drugs and a locked cabinet or safe for the most heavily controlled substances (C-IIs).
Traditionally, the owner pharmacist ran the complete store as well as the pharmacy, and this configuration still occurs in smaller independent stores. However, in most situations, a store manager runs the main store, while the pharmacy manager runs the pharmacy. The pharmacy manager must be a pharmacist and performs administrative as well as dispensing duties.
Most community pharmacies employ one or two full-time pharmacists, plus on-call or floating pharmacists to cover absences. Several pharmacy technicians work each shift as well. Most pharmacies are open from morning to early evening to cover the after-work rush, as well as shorter hours on weekends. Therefore, most pharmacists and techs work odd hours—morning shifts, afternoon to evening shifts, and alternating weekends. Larger pharmacies may be open twenty-four hours.
Pharmacists and technicians work on their feet. Pharmacists are required to dress professionally—a dress shirt and tie for men, a nice blouse and dress pants or skirt for women. Technicians tend to dress “business casual.” The traditional pharmacist’s short-sleeved lab coat that buttoned up the side to a high neck is rarely worn nowadays. Most pharmacists and techs wear a white hip-length lab coat with short or long sleeves.
Pharmacy technicians are allowed to do many duties, but those requiring professional judgment are restricted to the pharmacist. The precise division of labor varies between stores.
The prescription is taken in by a technician, who checks to see if the prescription is complete and that the patient’s information in the computer is current. The prescription is then entered in the computer. A pharmacist checks if the drug and dose are appropriate for the patient’s condition, age, and weight, and checks for potential problems due to allergies, drug-drug interactions, or drug-disease interactions. Sometimes the pharmacist needs to call the physician due to illegibility, errors, clinical interactions, or to verify a controlled substance prescription. The correct medication is pulled from the shelf, and tablets or capsules are counted on special counting trays. Larger stores often use automated systems to count and fill. The pharmacist performs a final check, and the medication is dispensed to the patient.
As accessible and visible health-care professionals, pharmacists often advise patients on proper treatment of ailments needing over-the-counter medications, including when to see the physician. Also pharmacists consult with patients when medications are dispensed to make sure the patient understands the proper use of the medication and side effects to watch for.
Offering immunizations is a growing role for pharmacists, with 147,000 certified to give vaccinations. Pharmacists enjoy this chance to serve the community and improve public health.
Many of the medications used for legitimate medical purposes are also drugs of abuse with high street value. Therefore, pharmacists must balance two conflicting community needs—to provide health care to those who need it, and to prevent diversion, fraud, and theft. High security, locked cabinets, background checks, and multiple counts are used to prevent outright theft and in-house diversion.
However, fraudulent prescriptions are often phoned in or written on stolen prescription pads. The pharmacist must use professional judgment to determine if each prescription is authentic. Does the prescription use improper medical jargon? Unusual and large quantities? Is the patient paying cash for a high bill? Do they come in after the physician’s office is closed? A pharmacist can legally refuse to fill any prescription for any reason. However, recently patient advocates threaten lawsuits if they believe access to medications is blocked.
The Community Pharmacy Experience
Overall, working in a community pharmacy is fast-paced and often stressful, especially when dealing with insurance companies or when disgruntled patients or irritated physicians vent their frustrations. However, most pharmacists can overlook these issues, knowing they’re providing excellent health care and helping patients get better.
Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2010-11 Edition, Pharmacists, on the Internet at http://www.bls.gov/oco/ocos079.htm (visited October 17, 2011).
American Pharmacists Association http://www.pharmacist.com/
National Community Pharmacists Association http://www.ncpanet.org/
National Association of Chain Drug Stores http://www.nacds.org/index.cfm
Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.