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Ergonomic Evaluation of Pharmacy Tasks
Ergonomic Evaluation of Pharmacy Tasks
HHE 2016-0042-3306
March 2018
Abbreviations...................................... iii
Introduction.......................................... 1
Methods................................................ 1
Conclusions........................................... 7
Recommendations............................... 7
Appendix A......................................... 10
References........................................... 11
Acknowledgements............................ 13
The employer is required to post a copy of this report for 30 days at or near the
workplace(s) of affected employees. The employer must take steps to ensure
that the posted report is not altered, defaced, or covered by other material.
The cover photo is a close-up image of sorbent tubes, which are used by the HHE
Program to measure airborne exposures. This photo is an artistic representation that may
not be related to this Health Hazard Evaluation. Photo by NIOSH.
What We Did
●● We observed employees while they opened and closed child-resistant medication
bottles and performed other pharmacy tasks.
●● We measured workstation heights and took
pictures and videos of pharmacy tasks. We evaluated the potential
●● We asked employees about their work history, for musculoskeletal disorders
training, tool use, health information related to among pharmacy employees at
exposures, and health and safety concerns. a health service clinic. We found
●● We reviewed logs of work-related injuries and that employees used repetition,
illnesses for the years 2011‒2015. forceful movements, and
awkward postures during their
●● We reviewed medical records concerning two
work. Many employees reported
employees’ exposure to repetitive and forceful
symptoms consistent with
movements and awkward postures.
work-related musculoskeletal
What We Found disorders. We recommended
evaluating a way to reduce
●● Pharmacy staff did not use the adjustability the number of return-to-stock
features that were available for some equipment.
bottles that need to be opened,
●● Capping and uncapping medicine bottles removing child-resistant caps
required repetitive and forceful movements and from larger quantity medication
awkward wrist postures. bottles, and educating
●● We observed repetition, force, awkward wrist employees on musculoskeletal
and shoulder postures, and reaching above disorders and ergonomics.
shoulders while employees did some pharmacy
tasks. These factors increased employees’ risk
for musculoskeletal disorders of the shoulders, arms,
and hands.
●● Employees reported hand and neck symptoms and conditions that were consistent with
work-related musculoskeletal disorders.
●● Repetitive motion injuries were the most common recordable injury among pharmacy
department employees.
Methods
Our objectives included the following:
●● Evaluating the ergonomic characteristics of the current work practices
●● Determining if current work practices may increase the risk of musculoskeletal injuries
●● Determining whether employees had workplace health and safety concerns
Figure 1. Different types of medication bottles in stock at the pharmacy. Photo by NIOSH.
Bottles of stock medication were either used to fill the robotic prescription dispensing
system, labeled directly for the patient, or opened to remove the appropriate amount for
the prescription and placed back on the stock shelf. The employees opened stock bottles
multiple times when a medication was not dispensed from the robotic prescription dispensing
system. In those instances, when possible, the employees removed the child-resistant cap and
replaced it with a regular screw top cap to eliminate the repetitive and awkward postures.
The pharmacy employees had tried two commercially available tools to help with cap
removal. However, the tools seemed to be designed with the patient in mind, not for
pharmacy employees to use multiple times per day. The cap-shaped tool in Figure 2 was
meant to help remove caps that required a push and turn motion. However, the pharmacy
employees felt that this tool made cap removal harder in some instances because the bottle
cap slipped during use, leading to greater hand forces. The tool shown in the bottom of
Figure 3 was a long slender hand tool with a hook, meant to aid in the removal of the outer
plastic child-resistant portion of the cap. The motion required to use the tool resulted in
awkward wrist postures, and the pharmacy employees described a high hand force. Neither
tool was used regularly by the employees at this pharmacy.
Figure 3. Hand tool used to remove plastic child-resistant portion of the cap on the medication bottle.
The bottle on the right has an intact child-resistant cap. The child-resistant cap on the bottle on the
left has been removed. Photo by NIOSH.
Stock bottles and boxes of medications were stored 5"–76" above the floor surface. Reaching
for items stored too high can cause awkward shoulder postures. Bending for items stored too
low can cause awkward back and shoulder postures.
The pharmacy had three seated and three standing workstations. Although the employees
reported a previous ergonomic evaluation of the workstations in 2013, few were set correctly
for the employee using them. For example, the adjustable standing monitor heights were
within the recommended range of 61"–65"; however, they were not adjusted so that the top of
the monitor was at the line of sight for the employee at the workstation. Additionally, some of
the standing fixed-height monitors with touch screen capability were above the recommended
fixed height of 59". Only the monitors were adjustable at some of the standing workstations.
Therefore, the height of the keyboards, mice, and scanners were limited by the counter or
tray height. The standing workstation counters were 35"–41" above the floor,
Conclusions
Pharmacists and the pharmacy technician were exposed to work-related factors such as
repetitive and forceful movements, awkward wrist and shoulder postures and contact stress
such as opening or closing bottle caps that put them at risk for musculoskeletal disorders
including de Quervain tenosynovitis, carpal or radial tunnel syndrome, and/or upper extremity
tendinitis [OSHA 2009]. To reduce musculoskeletal injury risk we recommended providing
and using adjustable workstations, educating employees on injury prevention during pharmacy
tasks, and communicating and reporting work-related health and safety concerns.
Recommendations
On the basis of our findings, we recommend the actions listed below. We encourage the
pharmacy to use a labor-management health and safety committee or working group to
discuss our recommendations and develop an action plan. Those involved in the work can
best set priorities and assess the feasibility of our recommendations for the specific situation
at the pharmacy.
Our recommendations are based on an approach known as the hierarchy of controls. This
approach groups actions by their likely effectiveness in reducing or removing hazards. In
most cases, the preferred approach is to eliminate hazardous materials or processes and
install engineering controls to reduce exposure or shield employees. Until such controls
are in place, or if they are not effective or feasible, administrative measures and personal
protective equipment may be needed.
Engineering Controls
Engineering controls reduce employees’ exposures by removing the hazard from the process
or by placing a barrier between the hazard and the employee. Engineering controls protect
employees effectively without placing primary responsibility of implementation on the
employee. Many of the recommendations listed below were obtained from The Handbook of
Ergonomic Design Guidelines [Humantech 2009].
1. Consult with a university that has a human factors, ergonomics, or engineering design
program and can assist with the evaluation and design of medication bottles and caps
or of devices to assist with removal of bottle caps.
2. Provide adjustable workstations to accommodate all employees.
3. Position adjustable touchscreens with the top of the screen adjustable 47"–71" above
the standing surface. If a fixed height is used, the top of the touch screen should be
placed at 59" above standing surfaces. Maintain a touch distance of less than 22" for
touch screens.
4. Position adjustable visual displays that are not touchscreen with the top of the display
adjustable 58"–71" above the standing surface. If a fixed height is used, the top of the
visual display should be placed at 66" above the standing surface. The top of the
display should be in the employee’s line of vision. Maintain the viewing distance for
adjustable displays at 18"–30" or 23" for fixed displays.
5. Provide adjustability for hand working height. The optimal adjustable height is
38"–47" above the standing surface. The acceptable zone is 30"–57" with a fixed
height of 42" above the standing surface.
6. Store items 24"–70" above the standing surface. The most frequently used items
(e.g., medication bottles) should be located in the middle of this range to reduce
bending at the back and reaching above the shoulder.
Administrative Controls
The term administrative controls refers to employer-dictated work practices and policies
to reduce or prevent hazardous exposures. Their effectiveness depends on employer
Disclaimer
The recommendations in this report are made on the basis of the findings at the workplace
evaluated and may not be applicable to other workplaces.
Mention of any company or product in this report does not constitute endorsement by NIOSH.
Citations to Web sites external to NIOSH do not constitute NIOSH endorsement of the
sponsoring organizations or their programs or products. NIOSH is not responsible for the
content of these Web sites. All Web addresses referenced in this document were accessible as of
the publication date.
Acknowledgments
Desktop Publisher: Shawna Watts
Editor: Ellen Galloway
Logistics: Donnie Booher, Kevin Moore
Availability of Report
Copies of this report have been sent to the employer and employees at the facility. The state and
local health department and the Occupational Safety and Health Administration Regional Office
have also received a copy. This report is not copyrighted and may be freely reproduced.