It's taking so long to fill my prescription (Pt 1)

Why does it take so long to fill a prescription? It is a question I hear from clients every day in the retail community pharmacy where I work, and as a pharmacist, when I have the rare occasion of getting my own prescription filled, I become impatient and ask myself the very same thing.

In an 'ideal' situation, with an 'ideal' prescription, when the pharmacist has one prescription to fill and just one client waiting, prescriptions can take a short time. In 1989, I filled a prescription in 90 seconds. I haven't done that since. Throw into that 'ideal' situation various interruptions and not-so-ideal prescriptions, and a backlog will develop (please see my next article).

The 'ideal' prescription

This prescription is legible and bears the client's name, age, address, gender, telephone number and allergies. Name, strength, dosage of drug(s), intended treatment duration are included and all these are suitable for the client. The items on the script are ready-made, do not require any extensive calculation or reconstitution, and do not require the pharmacist to make them from raw materials.

'Ideal' health insurance and payment arrangements

In the 'perfect' world, the client's health-insurance card(s) is presented at the same time as the prescription, it belongs to the client and is not borrowed or rented, and will subsidise the cost of all drugs on the prescription. Continuing with this perfect world, regardless of health-insurance subsidy, the client has sufficient cash (or credit/debit) to pay for the prescription, whatever the cost.

The ideal staff cadre and process

In the 'ideal' pharmacy where there is at least one pharmacist and two pharmacy technicians (personnel who directly assist pharmacists), there is a sort of production line. One technician (or in some cases, a pharmacist) greets the client, receives the prescription, assesses the client's needs, analyses the prescription for correctness, and for first-time clients to that pharmacy, enters all the client's information, including known allergies, into a computer to create a patient profile.

The same person enters drug information from the script, the doctor's name, and details. Any insurance claim is then submitted via computer. The other technician gets item(s) from the shelf, counts tablets, packages medication and sticks labels to medication, writes any prescription copy, places everything in an individual prescription tray and hands the tray to the pharmacist.

In the most important step, a pharmacist reviews the original prescription, checks that all of the above (prescription, tray contents, and labels) are correct and safe for that client. To do this, the pharmacist needs to know what medical condition is being treated, age, weight, other medical conditions the patient has, allergies, etc.

Potentially harmful interactions between one drug and another, drug and food, drug and disease have to be ruled out by the pharmacist. This may seem simple and straightforward, and in many cases it really is. But the world and its prescriptions are not 'ideal'.

(Next time, we will look at the real deal regarding prescriptions and why they take so long.)

Dr Dahlia McDaniel is a pharmacist with a doctorate in public health. She is the chief executive officer of two pharmacies and a medical practice in Kingston; email: yourhealth@gleanerjm.com.