Search

Objectives We aimed to explore the experiences and opinions of researchers who have involved pharmacy professionals in research studies. Pharmacy teams are valued healthcare professionals, with a wide knowledge base and skill set. They have regular contact with service users who may be interested in research, placing them in a good position for collaboration with researchers. Methods Cross-sectional survey circulated to researchers in the UK; analysed using descriptive, quantitative methods. Key findings A total of 238 responses were received from researchers, mainly within hospitals and universities. Most had more than 10 years of experience (45%) and had worked on 2–10 studies involving pharmacies (54%), frequently requiring hospital services (74%). Two-thirds of researchers had worked on clinical trials of investigational medicinal products. Most researchers worked with pharmacy teams that all had previous research experience (78%) yet did not involve them in participant recruitment (85%). Pharmacy staff frequently managed or dispensed medication (43%), however also engaged with other research-related tasks. Their previous experience and keenness were desirable qualities for researchers. Many respondents had a positive experience of collaboration and acknowledged various advantages (e.g. developing training/knowledge) and disadvantages (e.g. staffing issues). Conclusions Researchers’ positive impression of working with the pharmacy sector bodes well for future collaborations. Many had experience with pharmacy, however, those more unfamiliar should consider the roles staff could perform; and pharmacy teams and professional bodies should advocate their involvement. For collaboration to prosper, we should promote the benefits of research engagement and consider how to overcome known challenges.

Aims To understand service users' views and experiences of alcohol relapse prevention medication, views of a telephone behavioural modification intervention delivered by pharmacists and the use of Contingency Management (CM) to support acamprosate adherence following assisted alcohol withdrawal. Methods Four focus groups were conducted within four alcohol treatment and recovery groups across England (UK), with service users with lived experience of alcohol dependence (26 participants). Semi-structured topic guide was used to explore participants' views and experiences of alcohol relapse prevention medication, a telephone behavioural modification medication intervention delivered by pharmacists, and the use of CM to support acamprosate adherence. These were audio-recorded, transcribed verbatim and thematically analysed inductively and deductively. Results Four themes were identified: concerns about support and availability of alcohol relapse prevention medication; lack of knowledge and understanding about acamprosate treatment; positive perceptions of acamprosate adherence telephone support from pharmacists; and negative perceptions of CM to support acamprosate adherence. There were misunderstandings about acamprosate's mode of action and strong negative beliefs about CM. However, most were positive about pharmacists' new role to support acamprosate adherence. Conclusion This study highlighted challenges service users face to commence alcohol relapse prevention medication. It appears service users could benefit from a pharmacist-led telephone intervention to improve understanding about acamprosate medication, particularly, if delivered in an engaging and motivating way.

Objectives To investigate the rounding of prescribed drug doses for paediatric administration. Methods A cross-sectional medication chart review was conducted at a UK paediatric hospital. Proposed administration dose volumes were calculated for prescribed doses using available manufactured liquids measured with oral and intravenous syringes. Resulting percentage deviations in doses administered were calculated. Results Of 2031 doses observed, 524 (25.8%) required rounding. The majority of which were for children aged 1–12 months. Twenty-seven rounded doses deviated from the prescribed dose by more than 10%. Conclusion This study highlights the impact of dose-rounding in paediatrics and the need for standardisation.

Objectives Although pharmacist-led medicines use reviews (MURs) are effective for medicines management, little is understood about patients’ experiences of alcohol-related advice delivered therein. Sampling a population at high risk for misuse (within an area of socio-economic deprivation), we explored patient experiences of alcohol-related MURs. Methods Two focus groups were conducted with patients who had discussed alcohol in an MUR in the preceding 3 months (n = 9). Data were analysed thematically. Key findings and conclusion Patients were open to discussing alcohol in the MUR context. The absence of practitioner-patient power asymmetry and pharmacists’ sensitivity to cultural contexts were critical to patient engagement.

ObjectivesTo determine the common stages and strategies involved in the dispensing accuracy-checking process used by pharmacy staff and to determine the training activities used by these staff to gain the knowledge and skills for accuracy checking.MethodFace-to-face tape-recorded ethnographic interviews (n = 28) were undertaken in 2009–2010 at two large teaching hospitals with a purposive sample of pharmacists and accredited checking technicians qualified to undertake the final accuracy check on dispensed medicines. Participants described their accuracy-checking process, strategies used to aid checking using anonymised prescriptions and accurate dispensing of medicines to aid discussion. The range of training activities undertaken to develop this skill were discussed. Qualitative data were analysed in accordance with the principles of grounded theory to identify themes.Key findingsThe accuracy-checking process was described as a cognitive and systematic process. The order in which accuracy checking was executed was found to follow two pathways, with all participants checking the prescription first before verifying either the label or dispensed product. Various physical and sensory aids were used to assist in this verification process. There were inconsistencies in the level of accuracy-checking training received by pharmacists and accredited checking technicians, with many pharmacists reporting no training.ConclusionAlthough an important medication-error prevention strategy, until this study little was known about the process used by pharmacy staff when verifying the accuracy of dispensed medicines. Accuracy checking is a complex cognitive task involving verification of the product and label with the prescription. Strategies obtained during past experience and in training were used to aid checking. The study highlighted that pharmacy staff training to undertake this task was variable. Application of strategies identified in this study may allow individuals to adopt further safeguards to improve patient safety.

Objectives To determine the effect of installing an original-pack automated dispensing system (ADS) on dispensary workload and prevented dispensing incidents in a hospital pharmacy. Methods Data on dispensary workload and prevented dispensing incidents, defined as dispensing errors detected and reported before medication had left the pharmacy, were collected over 6 weeks at a National Health Service hospital in Wales before and after the installation of an ADS. Workload was measured by non-participant observation using the event recording technique. Prevented dispensing incidents were self-reported by pharmacy staff on standardised forms. Median workloads (measured as items dispensed/person/hour) were compared using Mann–Whitney U tests and rate of prevented dispensing incidents were compared using Chi-square test. Spearman's rank correlation was used to examine the association between workload and prevented dispensing incidents. A P value of ≤0.05 was considered statistically significant. Key findings Median dispensary workload was significantly lower pre-automation (9.20 items/person/h) compared to post-automation (13.17 items/person/h, P < 0.001). Rate of prevented dispensing incidents was significantly lower post-automation (0.28%) than pre-automation (0.64%, P < 0.0001) but there was no difference (P = 0.277) between the types of dispensing incidents. A positive association existed between workload and prevented dispensing incidents both pre- (ρ = 0.13, P = 0.015) and post-automation (ρ = 0.23, P < 0.001). Dispensing incidents were found to occur during prolonged periods of moderate workload or after a busy period. Conclusion Study findings suggest that automation improves dispensing efficiency and reduces the rate of prevented dispensing incidents. It is proposed that prevented dispensing incidents frequently occurred during periods of high workload due to involuntary automaticity. Prevented dispensing incidents occurring after a busy period were attributed to staff experiencing fatigue after-effects.

Objective Determine the effect of installing an original pack automated dispensing system (ADS) on staff experience of occupational stressors. Methods Pharmacy staff in a National Health Service hospital in Wales, UK, were administered an anonymous occupational stressor questionnaire pre- (n = 45) and post-automation (n = 32). Survey responses pre- and post-automation were compared using Mann–Whitney U test. Statistical significance was P ≤ 0.05. Four focus groups were conducted (two groups of accredited checking technicians (ACTs) (group 1: n = 4; group 2: n = 6), one group of pharmacists (n = 17), and one group of technicians (n = 4) post-automation to explore staff experiences of occupational stressors. Focus group transcripts were analysed according to framework analysis. Key findings Survey response rate pre-automation was 78% (n = 35) and 49% (n = 16) post-automation. Automation had a positive impact on staff experience of stress (P = 0.023), illogical workload allocation (P = 0.004) and work–life balance (P = 0.05). All focus-group participants reported that automation had created a spacious working environment. Pharmacists and ACTs reported that automation had enabled the expansion of their roles. Technicians felt like ‘production-line workers.’ Robot malfunction was a source of stress. Conclusion The findings suggest that automation had a positive impact on staff experience of stressors, improving working conditions and workload. Technicians reported that ADS devalued their skills. When installing ADS, pharmacy managers must consider the impact of automation on staff. Strategies to reduce stressors associated with automation include rotating staff activities and role expansions.

Objectives To compare dispensary workload, determined using the Welsh benchmarking event recording technique and the direct time technique, at two district general UK National Health Service hospitals within different university local health Boards (hospital A – manual dispensing system; hospital B – automated dispensing system). Methods Data on dispensary workload were collected, over a period of 6 weeks (hospital A: 8 May–18 June 2007; hospital B: 1 October–11 November 2007), by a non-participant observer using two simultaneous methods of workload measurement: direct time and event recording. Direct time technique involved timing each task involved in dispensing a sample of prescriptions from receipt to issue of dispensed medicines to patients. Welsh benchmarking event recording involved continuously logging staff activities that deviated from the dispensary rota on a data collection form to enable calculation of total staff time involved in dispensing activities. Data on number of items dispensed were obtained from the pharmacy computer system and also by manual counting of prescription items. The mean dispensary workloads were calculated as the number of items dispensed per person per hour. Two-sample t-tests were used to compare dispensary workload measurements determined using direct time and event recording technique reported by each individual hospital. Mean workloads for hospitals A and B were compared using a two-sample t-test. Statistical significance was taken as P ≤ 0.05. Key findings Hospital A was associated with a lower workload (direct time: 7.27 ± 7.16 items per person per hour; event recording: 9.57 ± 10.6 items per person per hour). In contrast, hospital B gave a higher workload (direct time: 11.93 ± 8.3 items per person per hour; event recording: 12.6 ± 8.80 items per person per hour). There was a significant difference between workload (direct time: P < 0.01; event recording: P < 0.01) reported for both hospitals. The direct time and event recording techniques produced consistent results at each hospital (hospital A: t = 0.02, P = 0.99; hospital B: t = 0.004, P = 0.1). Conclusion The direct time and Welsh benchmarking event recording techniques produced consistent results at both hospitals. Thus the Welsh benchmarking event recording technique is a valid and reproducible method of measuring dispensary workload. Hospital B (automated) had a higher workload than hospital A (manual). Further work is required to investigate the impact of automation on dispensary workload.

Objective To determine potential predisposing factors to medication errors involving confusion between drug names, strengths and dosage forms. Methods The study analysed medication errors reported over the period January 2005 to December 2008 from the two main dispensaries of a 1200-bed NHS Foundation Hospital Trust in London. Dispensing incidents considered for analysis included all incidents involving drug name, strength and dosage label and content errors. Statistical analyses were performed using Statistica. Dispensing frequencies of the prescribed and wrongly dispensed drugs were compared by means of Wilcoxon signed-rank test, and the extent of correlation between dispensing frequency and error frequency was assessed using Spearman's rank correlation coefficient. Key findings The Trust recorded a total of 911 dispensing errors between 2005 and 2008. The most significant category, which accounted for 211 (23.2%) of the reported errors, involved errors in drug selection. Drug-selection errors were not random events because the plot of error frequency against the average yearly dispensing frequency for the 1000 most issued drugs showed little evidence of association (r = 0.19, P(α) = 0.03). There was, however, an increased likelihood of drug-selection errors occurring when the prescribed drug was dispensed with relatively low frequency and shows a significant orthographic similarity to another drug which has a higher dispensing frequency. Conclusion The majority of drug-selection errors would seem to be caused by insufficient attention paid to the specified drug strength. Dispensing frequency is an important factor influencing the likelihood of a drug-selection errors occurring, but it is also shown here that a large proportion of the drug-selection errors involved specifications exhibiting high orthographic similarity.

Objectives To compare the rate, error type, causes and clinical significance of unprevented and prevented dispensing incidents reported by Welsh National Health Service (NHS) hospital pharmacies. Methods Details of all unprevented and prevented dispensing incidents occurring over 3 months (September–December 2005) at five district general hospitals across Wales were reported and analysed using a validated method. Rates of unprevented and prevented dispensing incidents were compared using Mann–Whitney U test. Reported error types, contributory factors and clinical significance of unprevented and prevented incidents were compared using Fisher's exact test. Key findings Thirty-five unprevented and 291 prevented dispensing incidents were reported amongst 221 670 items. The rate of unprevented (16/100 000 items) and prevented dispensing incidents (131/100 000 items; P = 0.04) was significantly different. There was a significant difference in the proportions of prevented and unprevented dispensing incidents involving the wrong directions/warnings on the label (prevented, n = 100, 29%; unprevented, n = 4, 10%; P = 0.02) and the wrong drug details on the label (prevented, n = 15, 4%; unprevented, n = 6, 14%; P = 0.01). There was a significant difference in the proportions of prevented and unprevented dispensing incidents involving supply of the wrong strength (prevented, n = 46, 14%; unprevented, n = 2, 5%; P = 0.02) and issue of expired medicines (prevented, n = 3, 1%; unprevented, n = 5, 12%; P = 0.002). Conclusion The use of prevented dispensing incidents as a surrogate marker for unprevented incidents is questionable. There were significant differences between unprevented and prevented dispensing incidents in terms of rate and error types. This is consistent with the medication error iceberg. Care must be exercised when extrapolating prevented dispensing incident data on error types to unprevented dispensing incidents.

Aims and objectives The study aimed to evaluate the causes of prevented dispensing incidents reported by hospitals using the critical incident technique developed by key-informant interviews, focus group and observation. Setting All Welsh NHS hospitals (n = 20) were invited to participate in the study. Sixteen hospitals agreed to take part; 10 hospitals reported incidents, four hospitals did not report any incidents and two hospitals withdrew from the study. Method In June 2005 three key-informant interviews and a focus group were conducted to determine dispensary workflow, which was then validated by a piloted non-participant observational study at three Welsh hospitals. Self-reported critical incident forms were then developed to collect dispensing-incident data involving drugs at high risk of dispensing incidents. Sixteen Welsh hospitals participated in the 4-month study (January-August 2006). Key findings Dispensary workflow encompassed the following events: prescription receipt, validating patient information, log of prescription, technical check, clinical check, label generation, stock selection, medicines assembly, product labelling, completion of registers, self-checking/endorsing and final accuracy check. Twenty-four incidents were reported by 10 hospitals involving paediatrics (n = 9, 38%), morphine sulphate (n = 5, 21%), insulin (n = 5, 21%), angiotensin-converting enzyme inhibitors (n = 3, 13%) and nifedipine (n = 2, 8%). Incidents commonly occurred at label generation (n = 9, 43%) and stock selection (n = 9, 43%), caused by error-producing conditions, active and latent failures. Active failures involved dispensing the wrong quantity of medication, interchanging different formulations, and computer and stock-selection errors. Error-producing conditions were reported as high workload, complex prescriptions and interruptions. Latent conditions were inadequate staffing/ skill mix, unclear drug computer selection lists and the storage of drugs on dispensary shelves. Conclusion The critical incident technique provided an in-depth understanding of the causes of dispensing incidents. Dispensing incidents arose because of organisational pathologies, error producing conditions and active failures such as inadequate staffing, high workload, interruptions, and computer and drug-selection errors.

Objective To monitor unprevented dispensing incidents in NHS hospitals by identifying incident types, drugs involved and factors that may have contributed to the occurrence of incidents. Setting All 20 Welsh NHS hospitals (15 district general; 2 teaching; 2 psychiatric and 1 other specialist hospital). Method Unprevented dispensing incidents that occurred between January 2003 and December 2004 were reported and analysed using a validated method. Incident rate was calculated for those hospitals that provided both incident and issue data. Incident rate was compared with previous research using a two-sample t-test. Reported incident types and contributory factors were compared with previous research using chi-square analysis. Key findings A total of 1005 unprevented dispensing incidents were reported by 20 hospitals. The overall incident rate, based on data from 17 hospitals, was 16 incidents per 100000 items dispensed (range 0.2–46 incidents per 100000 items dispensed). The overall dispensing incident rate was less than previously reported (18 incidents per 100000 items dispensed).This finding was not statistically significant (t = 0.421, P = 0.676). The most common incidents reported were dispensing the wrong strength of drug (n = 241, 24%), wrong drug (n = 168, 17%), wrong form (n = 134, 13%) and printing the wrong warnings/directions on the label (n = 112, 11%). A statistically significant finding was that fewer incidents involving dispensing the wrong drug were reported by Welsh hospitals (17%) compared to previous research in the UK (23%; P = 0.01). Drugs most commonly involved in incidents were insulin (n = 34; 6 incidents per 10000 issues of insulin), nifedipine (n = 16; 10 incidents per 10000 issues of nifedipine) and carbamazepine (n = 10; 5 incidents per 10000 issues of carbamazepine). Conclusion The overall unprevented dispensing incident rate was less than previously reported. Dispensing the wrong strength of the correct drug is a problem. Staff should be aware of the risk of dispensing incidents involving insulin, nifedipine and carbamazepine. Strategies for minimising dispensing incidents include using shelf labels to highlight different strengths or formulations of the same drug, and educating staff about easily confused drugs.

Objective The aim was to evaluate the potential causes of dispensing-label errors at a hospital. Methods The study took place at a 1200-bed NHS Foundation Trust with two main pharmacy dispensaries (one manual and one automated). Face-to-face interviews were conducted with staff involved in label-generation errors to obtain in-depth understanding of dispensing-label errors. Interviews were tape-recorded, transcribed and analysed with the aid of Nvivo into themes. Key findings Factors suggested as causing label-generation errors were illegible handwriting, lack of knowledge, hurrying through tasks, distractions, interruptions and the use of past medical records in generating labels. Self-checking every stage of the labelling process was suggested as the key to detecting and preventing errors. Conclusions The study highlights the vulnerability of the label-generation process to errors, with potential causes linked to organisational, environmental, task, team and individual factors.

During a 17-month study to determine if community pharmacists have access to sufficient appropriate and relevant information to complete adverse drug reaction reports, 21 out of 98 pharmacies submitted 49 ADR reports. Each report required 31 fields of information. Between 15 and 30 fields were completed on each report. Twelve reports covered “new” medicines (identified in the British National Formulary by a black triangle), 19 “established” medicines, nine generic medicines and nine pharmacy only (P) medicines. Evaluation of the reports by a panel of six pharmacists revealed total agreement that 16 of the reports (33 per cent) were ADRs but one was not. A further 16 (33 per cent) reports were considered by all but one panel member to be ADRs. There was a varying level of agreement over the remaining 17 (35 per cent) reports. Eight months into the study, the participating pharmacists evaluated the scheme by postal questionnaire. The replies indicated that submitting reports to both the Committee on Safety of Medicines (CSM) and the patient's general medical practitioner were the preferred route of 87 per cent and 75 per cent of respondents, respectively, for reporting ADRs to new and established prescription only medicines, while 59 per cent favoured direct submission to the CSM alone for ADRs to medicines purchased over the counter. The results demonstrate that the pharmacist has appropriate knowledge and access to sufficient information to identify and submit ADR reports.