Pharmacists believe drive-through windows contribute to delays, errors

Jan 23 2008

Consumers who pick up their prescription medications at a pharmacy drive-through window might be jeopardizing their own safety in the name of convenience.

A new study indicates that pharmacists who work at locations with drive-through windows believe the extra distractions associated with window service contribute to processing delays, reduced efficiency and even dispensing errors.

The surveyed pharmacists reported that the design and layout of their workplace has an impact on dispensing accuracy, especially the presence of drive-through window pick-up services. Results also indicate that automated dispensing systems in pharmacies are likely to reduce the potential for errors and enhance efficiency.

The study suggests pharmacy design should emphasize minimal workflow interruptions but it also offers a caution to consumers to check their prescription medications, especially those obtained from a pharmacy's drive-through window, said Sheryl Szeinbach, the study's lead author and a professor of pharmacy practice and administration at Ohio State University.

“Maybe we ought to stop and consider: ‘Am I likely to get the same level of service from the drive-through as I am actually interacting face-to-face with a health-care professional?'” Szeinbach said.

With the number of prescriptions dispensed annually in the United States nearing the 4 billion mark, Szeinbach said the public is best served by pharmacists with the fewest possible distractions. Even with stringent internal quality controls, pharmacists nationally make an estimated 5.7 errors per 10,000 prescriptions processed, according to the study, which translates to more than 2.2 million dispensing errors each year.

Responding pharmacists attributed about 80 percent of dispensing errors to cognitive problems that Szeinbach said could be associated with various disruptions that interfere with their work.

The survey results were published in a recent issue of the International Journal for Quality in Health Care.

Szeinbach and colleagues surveyed 429 U.S. pharmacists working at pharmacies located within mass merchant retailers, traditional chain drugstores or independently owned shops. The questionnaire sought pharmacists' perceptions of how their practice was affected by the pharmacy layout and design, the presence of a drive-through window and the availability of an automated dispensing system. Specifically, they were asked whether those factors had a positive or negative influence on errors in dispensing, communication between staff and pharmacists, prescription processing time, efficiency and physical mobility in the practice setting.

Participating pharmacists were asked to respond to questions using a scale from 1 to 5, with 1 indicating pharmacists strongly disagreed with suggestions that their practice was affected by these factors and 5 meaning they strongly agree.

While the responding pharmacists agreed that the layout and design of their workplace could contribute to errors and reduce efficiency, the presence of a drive-through window elicited a much more definitive response, Szeinbach said.

“The drive-through window, overall, poses a huge problem with respect to causing dispensing errors, contributing to communication errors, delaying processing and forcing staff to take more steps,” Szeinbach said. “Think about it – that window has to be in an area that's convenient for the patient driving up to the window, yet may not – and obviously is not – convenient to the pharmacist and the staff. The link between drive-through and dispensing errors alone should be a concern to the public.”

She said the findings suggest that consumers should always check the prescription medications they pick up at a pharmacy to confirm they received the right medicine.

According to the survey, pharmacists perceive that the drive-through window has the biggest impact on causing pharmacists and their staff to take extra steps (average agreement response of 3.7 on a 5-point scale); reducing efficiency (average response of 3.8); and causing delays in prescription processing (average response of 3.7). The respondents also attributed dispensing errors (average response of 3.2) and communication errors (average response of 3.3) to the presence of a drive-through window.

Szeinbach suggested the addition of a drive-through to a pharmacy has the potential to place unreasonable multitasking demands on professionals whose job includes counseling patients about medication use, not simply dispensing the drugs.

“A pharmacist or staff member could be responsible for four or five tasks, and serving people at the drive-through window is just one of them,” she said. “Some people seeking the convenience of the drive-through window don't care about getting information. They just want the medication, and they want it as fast as possible. They should probably think about that and at least look at the medication and make sure it's OK. And if they have questions, it may behoove them to come into the pharmacy.”

The study also identified a potential remedy to this problem – automated dispensing systems that count tablets or, in some high-volume practices, are linked to the pharmacy computer system so they can complete the entire dispensing process. Automated dispensing systems are typically used for medications that are in particularly high demand, such as antibiotics, blood pressure medications and painkillers.

“We found that this type of automated dispensing definitely contributes to the positive side – it's less likely to cause dispensing errors or errors in communication, and can speed up the processing.

Pharmacists view the automation as efficient and foolproof,” Szeinbach said.

She noted that an additional study comparing actual error rates at pharmacies with and without drive-through windows is needed to verify her results.

“There's a potential bias that could exist against drive-through windows,” she said. “But since the responding pharmacists pointed out the drawbacks of both drive-through windows and the entire layout and design, and their responses are fairly consistent, it leads me to believe their perceptions are probably accurate.”

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