KIRK SQUIRES
The Packet
It’s affecting the lives of hospital pharmacists and it could have serious implications for hospital patients in this province.
There is a shortage of pharmacists across Canada but it’s particularly bad here.
It’s a situation the Pharmacists’ Association of Newfoundland and Labrador (PANL) says is not being addressed by government.
In fact PANL, in a recent release, says, "Government is being penny wise and pound foolish in its decision not to address the pharmacist shortage in the public sector."
The shortage is about to cause a potentially dangerous situation at the G.B. Cross Memorial Hospital in Clarenville.
That facility has one full-time pharmacist on staff, Bernadine Barrett. Another is scheduled to return to work today. But the facility should have three.
This summer one of the three pharmacists left the area, leaving just two to carry the workload and fill the on-call responsibilities.
Barrett says the situation caused a great deal of stress and concern.
In an effort to raise public awareness of the situation, and the implications this shortage could have on patent safety and care, Barrett forwarded a letter to VOCM’s Open Line.
At that time the two pharmacists had been working with a shortage for approximately six weeks with no end in sight.
"The extra demands and responsibilities that we now deal with have forced us to work at a much faster pace . . . and, quite frankly, a much faster pace than I am comfortable with."
With an increase in workload Barrett says the chances of a medication error also increase.
Due to the increase in workload the pharmacy had to be closed on weekends. Instead of a pharmacist working in the pharmacy from 8:30 a.m. to 4:30 p.m. on Saturday and Sunday, the two shared 24-hour on call duties.
Being on 24-hour call created stress for Barrett. When her husband was working it was impossible to find a sitter, for their young child, at a moment’s notice..
Aside from family concerns she was greatly concerned for patient safety.
"Prescriptions that are written between 4:30 p.m. on Friday to 8:30 a.m. Monday morning are not checked by a pharmacist. If an error should occur on Friday evening it could continue for the entire weekend and might not be picked up. Because we are so busy it is hard to pick up on mistakes at this point," she says.
"Ensuring safe medication use is a primary function of every pharmacist. Unfortunately, the safeguard that we provide against medication error is no longer available throughout the weekend at our hospital," Barrett writes in her Sept. 22 letter.
With the heavier reliance of the health care system on medications, and more types of medications being used, the danger of serious interaction between certain drugs is increasing. That is one reason why pharmacists are an integral part of the health care team.
"That is why we exist, that’s what we do. We as pharmacists can identify interactions and know the most serious interactions to look for."
Bad to worse
The concerns of PANL, Barrett and other pharmacists haven’t done much to alleviate the situation or get action from government.
In fact, the situation at G.B. Cross went from bad to worse about four weeks ago when another pharmacist at the hospital went off on extended leave.
"That basically left me as the only full-time pharmacist at G.B. Cross. I have been lucky up to now to have a relief pharmacist to fill in," explains Barrett.
In an Oct. 17 letter to Liberal Health Critic, MHA Yvonne Jones, Barrett outlined the extent of the increased workload she is expected to deal with on a regular basis.
For example on an average workday a single pharmacist would normally be responsible for 100-150 prescriptions. On Thanksgiving Monday Barrett filled 331 prescriptions.
That does not include other responsibilities such as meeting with patients to go over their medication before they are released or if special cases come into the hospital that need attention.
In her letter to Jones, Barrett also notes the best hope for another pharmacist for G.B. Cross is July, 2007, when a new crop graduates from Memorial University’s School of Pharmacy.
However, those that do decide to stay in this province will likely be lured by the more attractive pay scale in the retail sector.
PANL executive director George Skinner says it has created a lot of stress among pharmacists working in the public sector.
"It is very stressful. I have talked to members across the province and they are basically at their wits end as to what to do. They have high demands and there doesn’t seem to be any resolution forthcoming. What concerns the association so much is we thought for a while government had heard the problem and was going to take some creative approach to solve it."
Facts and figures
Earlier this year, PANL established an ad hoc Hospital Steering Committee on Labour Market to review the situation.
The result was the 2006 Report on Critical Hospital Pharmacists Shortage in Newfoundland and Labrador.
The report outlines the important role pharmacists play in the health care system "Providing comprehensive drug management to hospitalized patients, physicians and other members of the multi-disciplinary health care team."
The report also notes as of March, 2006, the Regional Integrated Health Authorities in Newfoundland and Labrador had 19 vacancies. According to a Nov. 17 release from PANL, that number now stands at 25 vacancies.
Two of those positions, in St. Anthony, have been vacant for two years. As a result the Newfoundland and Labrador Pharmacy Board has not renewed that hospital’s pharmacy license.
The report goes on to state, "The loss of highly qualified, experienced pharmacists has been crippling the health care system and associated pharmacy services."
All the regional health authorities have advertised for pharmacists in local and national newspapers and recruitment fairs. At the time the report was released there was zero success in recruiting.
What’s worse the situation is not likely to change any time soon.
"In the last two years, only one new graduate has taken a position with the public health care system in this province," the report notes.
Government responsibility
What’s the solution?
Skinner says it’s not rocket science. All government has to do, he says, is carry out a Labour Market adjustment like the other three Atlantic provinces have already done. That adjustment was also noted in the Department of Health and Community Services human resources report in 2003.
"You can’t debate the facts and the fact is the other three Atlantic provinces . . . their governments have had to take action to remedy it and, for some reason, our government has chosen not to.
"You have some of our youngest, brightest Newfoundlanders being forced to leave the province for all kinds of very legitimate reasons when we could be doing something to keep them here," adds Skinner.
Even those pharmacists who do decide to stay in the province are not looking to the public sector.
"They don’t have to go across the Gulf, they can go across the street (to retail). That’s why PANL has asked for a Labour Market adjustment."
Money not the issue
But money is not the issue for pharmacists like Barrett.
In her letter of resignation she says, "Five years ago, I decided to accept this position for two reason; the opportunity to do clinical work and because I thought it would be the best place for me to continue my professional career and start a family. The events of the past three months have made participation in any type of clinical practice all but impossible."
It was a tough decision for Barrett.
In an emotional interview with the Packet Barrett says she feels she was forced to make this decision. She says the main reason for her decision to resign was her family.
"Due to the increase in on-call responsibilities and workload that have been imposed on me, as well as the high probability that circumstances within the pharmacy will worsen in the very near future, I feel I have been forced to make a choice between my family and my job," writes Barrett in her letter.
"I have chosen my family."
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