Introduction: Community pharmacies are high-performance workplaces; if the environment is not conducive to safe practice, mistakes can occur. There has been increasing demand for pharmacists during the COVID-19 pandemic as they have become integral to the response. Suboptimal practices in the work environment and with pharmacists and their teams can impact the safe delivery of services. New Zealand pharmacists’ perceptions of the current work environment and beliefs around whether suboptimal practice have increased within the last five years and the effect of the COVID-19 pandemic on their practices are unknown. Aim/Objectives: To assess what New Zealand pharmacists associate with suboptimal practice in their workplace and investigate the effect of the COVID-19 pandemic on pharmacists and their workplaces. Methods: We employed an anonymous online questionnaire derived from a human factors framework utilised in the aviation industry to explore the potential environment, team and organisational factors as the determinants of suboptimal work practices. The software, hardware, environment and liveware (S.H.E.L.L) model was adapted to create questions classifying the risk factors to potentially identify aspects of work systems that are vulnerable and may provide risks to optimal practice. Additional perceptions around the effect of COVID-19 on their workplace and roles as pharmacists were explored. Participants were community pharmacists working in New Zealand contacted via a mailing list of the responsible authority for the profession. Findings: We received responses from 260 participants. Most participants indicated that suboptimal practice had increased in the last 5 years (79.8%). The majority of participants indicated that COVID-19 had impacted their workplaces (96%) and their roles as pharmacists (92.1%). Participants perceived that suboptimal practice was associated with a lack of leadership and appropriate management; poor access to resourcing, such as adequate staff and narrow time constraints for work tasks; a lack of procedures; competition; and stress. A lack of experience, professionalism and poor communication between staff, patients and external agencies were also issues. COVID-19 has affected pharmacists personally and their work environments. Further study in this area is required. Conclusions: We have identified that pharmacists across all sectors of New Zealand agreed that suboptimal practices had increased in the last 5 years. A human factors S.H.E.L.L framework can be used to classify themes to understand the increases in suboptimal practice and the role of COVID-19 on pharmacist practice. Many of these themes build on the growing body of the international literature around the effect of the pandemic on pharmacist practice. Areas for which there are less historical data to compare longitudinally include pharmacist wellbeing and the impact of COVID-19.
(1) Background: The safe performance of pharmacists is an important issue for patients and regulators. It is recognized that pharmacists interact with a variety of healthcare professionals and act as a bridge between other healthcare providers and systems and patients in the health setting. There has been growing activity in exploring factors that impact optimal performance and determinants that are linked with medication errors and practice incidents. The aviation and military industries have used S.H.E.L.L modeling to identify how personnel interact with factors that affect outcomes. A human factors approach is a useful angle to take when trying to improve optimal practice. Little is known about the experiences of New Zealand pharmacists and S.H.E.L.L factors that affect day-to-day practices in their work environment. (2) Methods: We investigated environment, team, and organizational considerations as the determining factors of optimal work practices using an anonymous online questionnaire. The questionnaire was built from a modified version of the software, hardware, environment, and liveware (S.H.E.L.L) model. This identified components of a work system that were vulnerable and that provided risks to optimal practice. Participants were New Zealand pharmacists approached through a subscriber list provided by the regulatory authority of the profession. (3) Results: We received responses from 260 participants (8.56%). The majority of participants indicated that optimal practice was occurring. More than 95% of respondents agreed that knowledge, fatigue interruptions, complacency, and stress affected optimal practice. Equipment and tools, medication arrangement on the shelf, lighting, physical layout, and communication with staff and patients were important factors for optimal practice. A smaller cohort of participants, 13 percent (n = 21), stated that dispensing processes, dissemination, and enforcement of standard operating procedures and procedural guidance did not affect pharmacy practice, 21.3% responded that professional and ethical requirements did not affect optimal practice, 20% stated that having a staffroom affected optimal practice, 20% did not think substance use affected optimal practice, and 30% did not state that cultural differences affected optimal practice. Optimal practice is constrained when there is a lack of experience, professionalism, and communication among staff, patients, and external agencies. COVID-19 also has had an impact on pharmacists both personally and in their work environments. Exploring how the pandemic has affected pharmacists and their work environment warrants further research. (4) Conclusions: Pharmacists across New Zealand agreed that optimal practices were occurring and considered other factors that were perceived to not affect optimal practice. A human factor S.H.E.L.L framework has been used to analyze themes to understand the optimal practice. The rising body of international literature on the effect of the pandemic on pharmacy practice serves as a foundation for many of these themes. Longitudinal data would be useful in exploring some factors, such as pharmacist well-being over time.
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