When the pharmacy is hazardous to your health

Ontario pharmacist Elena Salgado never imagined that just five years after graduating, she’d be unable to practise the profession she loved. But an injury she developed in the workplace has permanently limited her ability to do certain dispensing tasks in a retail pharmacy setting. Salgado developed a repetitive strain injury at the start of the pandemic in 2020, when 30-day medication supply came into effect to combat drug shortages; her pharmacy was doing three times the normal dispensing volume as a result. “I have a high tolerance for pain but given the stressful environment during COVID and always putting patients first, I kept pushing through,” she says. “My height is a huge factor too as pharmacies aren’t set up ergonomically to accommodate someone four foot eleven.” (The counter was five inches too tall for Salgado to work comfortably.) While the pharmacy owner allowed her to take breaks from dispensing, there were no other accommodations made so the injury progressed until Salgado had to go on temporary disability leave. Eventually the pharmacy put in a motorized standing desk, but her injury was so far gone, she wasn’t able to work full-time anymore. Even doing injections during flu season became a problem as her arm would twitch every so often. “It definitely caused a rift with my former employer as I was the main pharmacist working 40-50 hours a week and suddenly I couldn’t anymore.” According to a 2018 ergonomics pharmacy evaluation by the National Institute for Occupational Health and Safety, the top three ergonomic risk factors in a pharmacy setting include high task repetition, forceful exertions and sustained awkward postures. A recent poll on Canadian Healthcare Network conducted in October 2022 showed that almost a quarter of respondents said they’d had repetitive strain injury from injecting vaccines on numerous patients. Another 27% were worried they would get an injury or health issue from these duties. Creating a safe space “The issue is that a lot of pharmacies are not designed by pharmacy designers,” says Wayne Caverly, President of Caverly Pharmacy Solutions which has been designing pharmacies for the last 38 years to be more efficient. “If it’s a new build, the guy doing the drawings may not know anything about pharmacies and will have [elements] in them that will make the space more prone to injuries.” He recalls having a meeting with a pharmacy board of directors where he advised cutting down the filling station from 20 feet to eight feet to reduce repetitive strain injuries risk for staff. “It might be getting worse as chains are consolidating and they’re less likely to spend additional money on redoing stores,” he says, noting that independents with fewer stores have the advantage here. With every station in pharmacy being a computer station, good ergonomic design is paramount and Caverly says standard design practices—like proper spacing so people don’t have to walk more than needed or constantly turn around to reach items—go a long way. He says what some pharmacy owners don’t realize is that small fixes in the workplace can make a big difference. For example, putting the top 50 drugs in front at the prescription filling station means staff aren’t continually turning around to reach for medications. “You don’t see a lot of headsets either which prevent cradling of phones—even having an electric stapler means you’re not constantly picking it up throughout the day,” he says. Another important fix, albeit more costly, is changing pharmacy shelving in the dispensary. “You don’t want to be reaching below two feet or above 6,” says Caverly. “People feel that extra space is wasted without product but you are improving efficiencies and preventing the risk of injury.” Other ways to ‘safer-guard’ the pharmacy space include using computer touch screens instead of keyboards, or changing from a computer mouse to trackball, and installing adjustable ergonomic chairs and counters. “It’s important to make sure people are switching tasks throughout the day and taking frequent breaks every 1.5 to two hours,” he adds. The pharmacy as an inclusive environment The reality is that about one in five Canadians aged 15 or over have one or more disabilities that limit their daily activities, according to the most recent Canadian Survey on Disability from Statistics Canada. As labour shortages become an increasing problem, pharmacy stakeholders in Canada can take a page from other sectors who are not only finding ways to accommodate people with disabilities in the workplace but encouraging them to step forward with their concerns. Take Brendan Gramer who was born deaf. He joined Amazon in 2015 and is now senior manager UX/Design & Payment on the company’s Consumer Payments team. A passionate advocate in raising the bar for people with disabilities, he helped launch the AmazonPWD (People with Disabilities) affinity group. Gramer says there are people in every workplace with disabilities who are afraid to disclose for fear of losing their jobs. “It’s important to acknowledge that we are all working with people with disabilities because they are everywhere,” he says. “In building a community that supports people with disabilities, we’ve also given them a voice so they can speak out about what they need to be successful.” Beyond physical workplace accommodation and the use of technological assistance, Gramer says education is a key part. “On my team, for example, we talk about what it means to be deaf and what is the best way to work with me,” he says. “We also create opportunities [for coworkers] to learn about the deaf community and culture so that they can make sure I feel equal and part of the team.” Scotland’s Royal Pharmaceutical Society (RPS) is running a disability in pharmacy awareness campaign this year, to highlight some of the barriers and challenges raised by RPS members and to work with stakeholders across the profession to overcome these. A workforce wellbeing survey conducted by the RPS among its members in 2021 showed that working in pharmacy with a disability is a major barrier to entering or staying in the profession. On October 3, 2022, the group brought together a wide range of pharmacists, pharmacy technicians and pharmacy organizations from across Scotland at the Scottish Parliament to support people living with disabilities. Every organization attending made a commitment to go back and stimulate discussions with their own organizations to ensure pharmacy team members living with disabilities would be better supported. Salgado says her ordeal—while physically and mentally taxing—has made her unafraid to ask for what she needs right off the bat when going into a job. A Certified Diabetes Educator, she is now working in an endocrinologist clinic where she is providing clinical services. “We’re conditioned to hide our pain, but now I’m very transparent about the fact that I’m dealing with a workplace injury,” she says. “The day I came in for a site visit [at my current job], I brought a measuring tape and said this is what has to change."

When the pharmacy is hazardous to your health

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