Exploring safety systems for dispensing in community pharmacies: Focusing on how staff relate to organizational components

Abstract

BackgroundIdentifying risk is an important facet of a safety practice in an organization. To identify risk, all components within a system of operation should be considered. In clinical safety practice, a team of people, technologies, procedures and protocols, management structure and environment have been identified as key components in a system of operation.ObjectivesTo explore risks in relation to prescription dispensing in community pharmacies by taking into account relationships between key components that relate to the dispensing process.MethodsFifteen community pharmacies in England with varied characteristics were identified, and data were collected using non-participant observations, shadowing and interviews. Approximately 360 hours of observations and 38 interviews were conducted by the team. Observation field notes from each pharmacy were written into case studies. Overall, 52,500 words from 15 case studies and interview transcripts were analyzed using thematic and line-by-line analyses. Validation techniques included multiple data collectors co-authoring each case study for consensus, review of case studies by members of the wider team including academic and practicing community pharmacists, and patient safety experts and two presentations (internally and externally) to review and discuss findings.ResultsRisks identified were related to relationships between people and other key components in dispensing. This included how different levels of staff communicated internally and externally, followed procedures, interacted with technical systems, worked with management, and engaged with the environment. In a dispensing journey, the following categories were identified which show how risks are inextricably linked through relationships between human components and other key components: 1) dispensing with divided attention; 2) dispensing under pressure; 3) dispensing in a restricted space or environment; and, 4) managing external influences.ConclusionsTo identify and evaluate risks effectively, an approach that includes understanding relationships between key components in dispensing is required. Since teams of people in community pharmacies are a key dispensing component, and therefore part of the operational process, it is important to note how they relate to other components in the environment within which they operate. Pharmacies can take the opportunity to reflect on the organization of their systems and review in particular how they can improve on the four key categories identified.

A Sociotechnical Approach to Analyse Pharmaceutical Policy And Services In Primary Health Care

“…Insert Fig. 1 These components were chosen after researching the literature on the analysis of socio-technical systems in the health eld [17,19,20,21,26,27,28] and in other sectors [16,29,30,31,32,33,34]. PPS organization in Brazil was another topic sought [9,10,25,35,36].…”

“…In the experience analysed in this study, the sociotechnical theory was the framework of the methodology of evaluation and design of systems, from the classic studies by Trist (1981) and by several authors who have been developing the theory application in different sectors. In health systems, this theory has been applied to evaluate strategies for incorporating technological innovations [17,18,19,20], and also in pharmaceutical services [20,21]. However, this is the rst approach of the theory of sociotechnical systems to characterize and analyse the PPS of a municipality in Brazil, aiming to prepare the interventions in the system.…”

Innovative Advances in Connectivity and Community Pharmacist Patient Care Services: Implications for Patient Safety

“…Safety in community pharmacy practice traditionally was synonymous with safe medication dispensing . Accordingly, existing literature on patient safety in community pharmacy has focused on the prevention of errors and adverse events within the dispensing process.…”

“…Safety in community pharmacy practice traditionally was synonymous with safe medication dispensing. 1 Accordingly, existing literature on patient safety in community pharmacy has focused on the prevention of errors and adverse events within the dispensing process. Previous studies described the prevalence of drug-related problems and drug-drug interactions, 2-4 electronic prescribing (e-prescribing), [5][6][7][8] clinical decision support systems, [9][10][11][12][13][14] and continuous quality improvement programs.…”

Community Pharmacists’ Perceptions on Ethical Dilemmas, Pharmacy values and Decision-making

“…4 In community pharmacy, prescriptions, medical devices and other over the counter products are dispended by community pharmacists. 13 Ethical issues do exist while dispensing medications based on prescription and over the counter products. 14 Community pharmacists are expected to dispense a medication by providing information of drug use, information on adverse effects, interactions of drug with other drugs or with any food, information on appropriate drug dosage, information on drug administration, precautions and contraindications, storage and stability of drugs.…”