Investigation finds pharmacies failed to ask questions critical to patient safety

A CBC Marketplace hidden-camera investigation found several pharmacies in Edmonton failed to screen for potentially dangerous drug interactions.

A CBC reporter bought behind-the-counter drugs at six randomly chosen Edmonton pharmacies. Staff at none of the pharmacies asked any questions necessary to determine if the drugs might lessen the efficacy of other drugs or even cause harm.

Alberta College of Pharmacists registrar Greg Eberhart acknowledged there is a problem with those pharmacies, but he doesn’t believe the results are necessarily indicative of a widespread failure to catch potentially dangerous drug interactions.

“It clearly identifies a need,” Eberhart said. “It clearly identifies that the appropriate questions were not asked. And certainly as a regulator that is of such interest that we will look into it.”

The Edmonton test was part of a Canada-wide investigation, the largest of its kind, to determine whether pharmacy staff at various types of drugstores — independents, big-box chains, and grocery stores — are following provincial guidelines around the sale of Schedule 2 drugs.

Schedule 2 drugs are medications stored behind the counter which require a conversation with a pharmacy employee before purchase, according to the Standards of Practice for Pharmacists in the province. If a patient has not taken the drug before, a pharmacist should inform the patient about the drug and its possible side effects.

The pharmacist should also ask if the patient is taking any other drugs to ensure medications don’t interact in negative ways.

Hidden camera

In Edmonton, a reporter, equipped with a hidden camera, visited five pharmacies and asked to purchase the iron supplement Palafer. Staff at four of the five locations properly counselled the reporter about the drug and its potential side effects.

But no one asked the reporter if she was taking any other medications. Had they asked, the reporter was to say she was taking the antibiotic Cipro. Palafer reduces the effectiveness of Cipro, so the drugs should not be taken together.

In the second part of the test, the reporter visited other pharmacies and attempted to purchase Tylenol No. I, which contains the narcotic codeine. Like other Schedule 2 drugs, its purchase should not be allowed without a conversation between the patient and a pharmacy employee.

Alberta is one of three provinces which more strictly regulates the sale of Tylenol No. I. In order to purchase it, a customer must present his or her health card to a pharmacy employee, who then logs the sale of the drug. Customers can only purchase one bottle of the drug each month.

If a patient has not taken Tylenol No. 1 before, the customer must speak with the pharmacist directly.

An employee at the first pharmacy did not properly counsel the reporter about the drug, and sold it without getting the store’s pharmacist to speak with the reporter.

The employee did, however, ask for the reporter’s health card and recorded the sale.

Because only one bottle of Tylenol No. 1 can be purchased each month, the test ended at the second pharmacy when a staff member again asked for the reporter’s health card.

Pharmacist Basel Alsaadi said many factors could have led to the pharmacies’ failure to ask those crucial questions. But he said pharmacy resources are a key issue.

“We have had some huge cutbacks, governmental cutbacks on pharmacy profit that have affected our work flow, our staffing, and our ability to provide care to patients,” he said.

Alsaadi said patients should take at least some of the responsibility for their own safety, and he said they can do that by developing a professional relationship with a pharmacist.

“The pharmacist and the patient need to know each other,” he said. “The pharmacist needs to understand what medical conditions you have, what medications you take, and know you on that level.”

Proper Counselling

Of the nine cities tested, Edmonton was the most thorough in counselling customers about the potential effects of the behind-the-counter drugs.

Less than half of the 50 pharmacies visited across Canada gave advice about the drugs being purchased. In Edmonton, four of five pharmacies did.

But Edmonton pharmacies were among the 50 across Canada which failed to properly screen for potential negative drug interactions.

Alberta College of Pharmacists registrar Greg Eberhart said many factors may have contributed to this problem.

But he said more education is clearly needed so that both pharmacists and the public understand the importance of identifying any potential risks.

“I think what is really important here is that it creates an opportunity for awareness, an awareness for patients, an awareness for consumers, an awareness for pharmacists, an awareness for us as regulators that there is work to be done.”