Give Me a Break! Lack of Meal Break Jeopardizes Patient Safety

By: Anonymous on 4:34:00 PM

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I moved to Virginia eighteen months ago to take my current position with the Bernard J. Dunn School of Pharmacy.  Being new to the state, my students occasionally point out or expose me to state-related issues that I didn't realize were occurring in practice.  Such is the case with this post, co-researched, written and approved for posting by TeeAl D. Barksdale, PharmD Candidate, one of my PHAR 640 Leadership By Design students.

Over the past seven years at the Virginia community pharmacy where I work, I have seen the on-duty pharmacist continuously dispense medications, educate patients, administer vaccinations, and intervene on behalf of patients to prevent drug interactions and medication errors.   However, my mind goes blank when trying to recall a time in which the pharmacist actually sat down and took a break to eat. I’m not saying the pharmacist doesn’t eat. I’ve seen food scarfed down quickly in between physician calls and patient counseling. But, to see the pharmacist actually sit-down uninterrupted, in order to refuel and reenergize, without fear of prescription queues backing up or being asked to answer the phone or check prescriptions, well that I have not witnessed.   The lack of a break had me thinking about community pharmacy work environments, pharmacist fatigue and patient safety.  I was curious about whether other pharmacies provided a meal break for their pharmacist(s), which led me to conduct an informal poll among my classmates.

Like my experience, the vast majority of my peers’ community pharmacies did not provide a meal break for the pharmacist.  Interestingly, one of my classmates, who worked for Target, indicated the pharmacy closes for thirty minutes, so the pharmacist can take an uninterrupted break without falling behind in the daily workflow. Given the potential patient safety ramifications, I wondered why this wasn’t a mandatory law here in the state of Virginia for all pharmacies. After all, in the community setting, pharmacists are the last line of defense against potential medication errors and interactions.   One would think a patient would prefer their pharmacist be alert and energized with proper nutrition, in order to provide that safety check and ensure quality care. Yet, when I checked out Target’s pharmacy reviews, many customers were irate and displayed numerous comments regarding how the meal break policy was unacceptable and infringes upon customer convenience.  

This raised the question as to why in the state of Virginia do we not have legislation or regulation in place to protect patients by ensuring that pharmacists are “really” allowed the same thirty-minute uninterrupted break that most workers are granted by employers and in some states are entitled to under labor laws. When people work for hours on end without a break, the risk for errors increases.  When pharmacists make mistakes, lives are at risk!  It is common for physician offices to close for up to an hour mid-day so that all employees, including the physicians, can take a break, grab some lunch and catch up on paperwork. Pharmacies, however, seem to be held to a different accessibility and convenience standard than other types of healthcare providers.  Remarkably, even the restaurant across from my pharmacy closes for a couple hours between their hectic lunch crowd and reopening for dinner to refuel and regroup.   

Some states have recognized the patient safety implications for mandating a meal break for pharmacists.  In North Carolina in 2006, that state’s supreme court upheld the North Carolina Board of Pharmacy’s authority to regulate the pharmacist’s work environment including entitlement of a meal break.  In the case Judge Sanford Steelman denoted that “pharmacist fatigue and hunger can clearly contribute to dispensing errors”.

 I spoke with over fifty of my classmates and only one out of the fifty actually had a pharmacist that clocked out for a 30-minute meal break, because the company they worked for endorses a corporate policy to close the pharmacy to enable the break.  In the interest of patient safety, shouldn’t this example be the norm instead of the exception?  Why can’t the Virginia Board of Pharmacy (VBOP) similar to North Carolina promulgate a mandatory meal break to help protect patients?  In 2013, there was proposed regulatory language put forth by VBOP to address pharmacist fatigue and meal breaks.  The proposed rule change appears to have stalled out in review by the Secretary of Health & Human Resources following the economic impact analysis conducted by the Department of Planning and Budget. How do we as a profession advocate to regain traction on this important patient safety issue?