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Violence Against Pharmacists

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Pharmacist examining a perscriptionSince the early 1990s, the National Institute for Occupational Safety and Health has conducted research on and provided recommendations for preventing workplace violence. Efforts had focused on the highest risk occupations, including taxicab drivers and convenience-store workers. In 2002, NIOSH released the document Violence: Occupational Hazards in Hospitals. The document found that the circumstances surrounding violence in hospitals differed from those of workplace violence in general. In other workplaces such as convenience stores and taxicabs, violence most often relates to robbery. Violence in hospitals usually results from patients and occasionally from their family members who feel frustrated, vulnerable, and out of control.

We are finding that violence against pharmacists differs from violence experienced by other healthcare workers. Increasingly, pharmacists face violence from robberies at their workplace. Across the United States, reports of pharmacy robberies specifically related to the theft of Oxycontin and Vicodin have been reported. These prescription pain killers may be used for the robber’s own addiction or sold on the street for a significant amount of money.

Currently, a comprehensive nationwide database of pharmacy robberies does not exist. It is difficult to grasp the magnitude of the problem using the data that is readily available to researchers. NIOSH is partnering with the Statistical Analysis Center (SAC) to collect information from police departments to provide NIOSH with the data necessary for a study of homicides, robberies, and assaults (simple, aggravated, and sexual) of healthcare workers, especially pharmacists. NIOSH successfully partnered with several Statistical Analysis Centers in the late 1990s for a data collection effort related to workplace violence and robberies in convenience stores.

The goal of the current effort is to determine the frequencies and rates of homicides and injuries associated with robberies and assaults occurring in healthcare and pharmaceutical work environments and to assess the risk factors and circumstances surrounding these violent events. This information will assist NIOSH in developing prevention recommendations to protect pharmacists and other healthcare workers.

Until NIOSH has recommendations specifically addressing prevention of violence against pharmacists, some of the existing recommendations for violence prevention may apply to pharmacists located in retail establishments. See OSHA guidelines for violence prevention in Recommendations for Workplace Violence Prevention Programs in Late-Night Retail Establishments and Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers.

As we continue our research, we are interested in learning what prevention strategies pharmacists have found useful in dealing with violence in the workplace.

—Dan Hartley, Ed.D.

Dr. Hartley is an Epidemiologist in the NIOSH Division of Safety Research and is the NIOSH Coordinator for Workplace Violence Prevention Research.

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20 comments on “Violence Against Pharmacists”

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    Dear Dr. Hartley,
    I was wondering whether there were materials we as educators in pre-professional programs would share with our students regarding this issue.

    A brief literature search on this topic yielded very few scientific studies of violence against pharmacists. Internet searches of local newspapers in the United States yielded hundreds of results over the past year and thousands when the search period was extended. These results indicated that pharmacy robberies are not limited to any particular states or any particular geographic locations (e.g., rural vs. urban). This is a situation that can occur in any pharmacy and we hope that our research will lead to additional effective interventions for prevention. In short, we do not have any specific materials ready for distribution at this time, but the intent is to use the data from our current study to produce either a peer-reviewed article or a NIOSH publication that addresses the workplace violence risk factors and prevention strategies related to pharmaceutical occupations. In the meantime, you can reference the materials mentioned in the blog or consult the NIOSH topic page for other workplace violence resources.

    Thank you for your interest in this topic.

    As a student of occupational safety and health, I share Dr Hartley’s interest in educational materials and perhaps the possibility of including workplace violence in our public health/OSH curricula. Those of us preparing to enter the professional field need to know more about violence in the workplace so that we in turn can protect workers through education and prevention.

    Our prevention strategy is that we do not stock any controlled drugs in the clinic pharmacy….a fairytale world…….and one that I am very happy to be involved in!

    As a University of Miami graduate student taking an environmental health course, I was wondering if the architectural design, functionality, and appearance of the work played factors in providing a safer environment for pharmacists without reducing their accessibility to consumers. For examples, teller windows at bank buildings built more recently employ building designs that thwart bank robberies. Although pharmacists may not need bulletproof glass panels to thwart potential violence by consumers or robbers, a building’s design and functionality may help pharmacists avoid violent confrontations.

    Several scientific studies that examined the relationship between environmental design elements and robberies determined that interior and exterior design features combine to reduce or eliminate crime in retail establishments. The Crime Prevention Through Environmental Design (CPTED) theory was developed in the 1970s and has been refined through the years. The recommendations for late-night retail establishments that the Occupational Safety and Health Administration (OSHA) issued in 1998 were based on CPTED principles and can be located at http://www.osha.gov/Publications/osha3153.html. In addition to good environmental design of the exterior structure, CPTED principles promote keeping small amounts of cash on hand, having unobstructed views of the counters, and having adequate interior lighting.

    Our research will show if these same factors are effective in preventing violence in pharmacies where the criminals are after the medications as well as the money. We hope to determine what additional interventions may need to be in place to reduce violence in pharmacies.

    Hi Dan,
    I am a graduate student from the University of Miami as well. According to your comment, a good environmental design of the structure, both interior and exterior design features, have been determined to be successful tools to reduce or eliminate crime in retail establishments. On the other hand, the highest rates of past year depression among full-time workers aged 18 to 64 were found in the personal care and service occupations 10.8 % (Mental Health Services Administration (SAMHSA) 2007). A new piece of research shows that a good method for people to improve both their memory and mood is to talk to someone for at least ten minutes. Socializing is an important feature of preventing or reducing depression (SCHWARTZ, 2007).

    When considering the fact that vendors’ isolation could play a significant role in robberies prevention, but at the same time, preventing them from social interaction becomes a major feature of depression, especially if taking into account that vendors fall into the population at higher risk for depression, it makes sense to consider interior and exterior design features as tools to reduce or eliminate crime in retail establishments and their impact on workers’ mental health.

    Are there any studies on the impact of reduction of accessibility to consumers and restriction of vendors’ social interaction as a tool to prevent crime and their influence on depression rates?

    At this time, I am not aware of any studies that address this issue. NIOSH has not conducted any research regarding use of physical barriers, such as bullet-proof shields, and possible links to depression. The nature of the pharmacists’ job requires them to talk with customers even if from behind some kind of barrier. The shields that I have seen in use always provide a method for verbal and visual communication with the customers.

    Hello Dan,
    Thank you for getting back to me. At this point I am really interested on this depression-isolation issue among workers. Although pharmacists would be able to establish verbal and visual contact with their clients, I wonder about what could be the isolation impact on depression.

    While NIOSH has not conducted research on this area some points to consider while you continue to explore this issue are offered below.

    Physical barriers may also be seen as protective in situations where other risks are felt to be more important such as preventing the transmission of infectious disease (i.e., the current swine flu situation) or, in addition to the discussed protection from robbery/assault, when encountering an unusual demand for a particular medicine that is in short supply (as could happen with the antivirals in this flu outbreak).

    The barrier may lead to greater isolation felt by the customer, and this may lead to fewer attempts to ask questions or to interact with the vendor. In many establishments there is often more than one person behind the counter/barrier—so the worker does have some social interaction, and does have a break schedule that entitles them to leave the enclosed space. Workplace policies may need to attend to the tasks of such workers to ensure that they have the opportunity to get out from behind the barrier (i.e., stock the floor, take breaks, or assist customers on the floor).

    Although pharmacists may not need bulletproof glass panels to thwart potential violence by consumers or robbers, a building’s design and functionality may help avoid violent confrontations.

    The reason that pharmacies are being robbed is that it is easier to get OxyContin, legal heroin, from unarmed pharmacists than to steal street heroin from people with guns. This is a vast epidemic where we are addicting our children to legal heroin but telling them it is safe. As the director of a drug detox, I daily see the ravages caused by this legal heroin epidemic.

    I’m a regular customer at local pharmacy store. So far, I never heard such issues in my country. It is good to take a precaution before its too late.

    Pharmacy and hospitals are in the field of “saving life”. It’s sad and ironic to heard such violence threat. Wearing a bullet proof vest or stand behind a barrier might be good to protect the pharmacists, but wouldn’t it looks a little bit funny? Customers may felt uncomfortable and might walk away. Good writings though.

    In relating to John Constantinide question about the influence of Architectural design in providing a safer environment and from my experience as a lighting designer for many years (Louie Lighting) I believe that lighting has a major impact as part of the overall space design. When relating to the lighting, strong consideration should be taken to exterior spaces starting from the parking areas around the pharmacies, to the entry area and then the interior spaces. Well illuminated exterior and interior spaces will usually cause people to feel more “exposed” and therefore reduce their tendency for crime or violence. Also the quality of light would have a psychological and physiological effect. Good color renditions and “warmer” more natural looking environments will usually “Calm” people down while harsh cold style lighting causes the reverse effect.
    Respectfully
    Arie Louie

    Interesting article as for me. At this point I am really interested on this depression-isolation issue among workers. It is really actual and important. I support it.

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