Archive | March, 2014

Quality and safety in community pharmacies: a complex business

17 Mar

by Denham Phipps, Research Fellow for Medication Safety theme Image “Hero pharmacist saved my life” was the headline that caught my eye in our local newspaper recently.  In the story, a customer recounted what happened when she went to her pharmacist with leg cramps.  “Going to him as the first port of call was the obvious thing to do.”  However, the pharmacist realised something was amiss when he heard her symptoms.  “He was very calm and told me to go to A&E immediately, which I did, but I had no idea I’d be diagnosed with deep vein thrombosis.  He saved my life.”1 In a previous blog (https://gmpstrc.wordpress.com/2014/02/11/the-earlier-the-better-why-visiting-your-local-pharmacy-sooner-rather-than-later-could-make-all-the-difference/), we saw that community pharmacies play a role in the vanguard of primary healthcare.  According to NHS England’s “Call to Action”, this role could become even more prominent as primary care faces increasing, and increasingly complex, demands.  How can pharmacies contribute to the management of long term conditions, to out-of-hospital care, and to the operation of other services such as general practices and hospitals?  Big questions, which we are invited to consider for NHS England’s consultation.  (If you wish to contribute your own views, then you have until March 18th to do so: http://www.england.nhs.uk/ourwork/qual-clin-lead/calltoaction/pharm-cta/). Meanwhile we in GM PSTRC, and our colleagues in Manchester Pharmacy School, have been studying the work of pharmacies.  In a recent study,2 we examined a sample of reports made by community pharmacies following a patient safety problem.  We found that most of the problems reported (about 92 percent) resulted in no harm to the patient, while the remainder resulted in varying degrees of harm; often minor or moderate.  Why did so few of the problems that occurred lead to any actual harm, and yet fewer to serious harm?  While luck may have a role to play, so too do the actions of pharmacy staff and service users to detect and correct problems.  It is important that these actions are not left to chance – pharmacies should be designed and managed in such a way to allow them to occur. What do the suggested changes to primary care have to do with this?  To answer that question, our study also looked at what pharmacies currently have to achieve.  We identified four main purposes for a pharmacy: supplying medication; supporting the use of medication; functioning as a business; and (as the opening story shows) promoting health.  For pharmacy staff, these purposes lead to a balancing act between cost-effectiveness, adherence to professional and legal standards, quality and safety.  Their day-to-day work involves keeping this balance, through whatever means they can, in the face of the demands on the pharmacy.  As demands change, or increase, pharmacies may have to work differently in order to maintain the balance. The challenge for quality and safety is to ensure that, as they adapt to changes in demand, pharmacies are still able to deal with the risks that arise in their work.  This is one of the topics for our ongoing research.  Our aim is to help ensure that the pharmacies of today, and of tomorrow, are ones that are fit for heroes. References: 1. “Hero pharmacist saved my life”, Manchester Evening News, 6th December 2013. 2. “Integrating data from the UK National and Learning System with work domain analysis to understand patient safety incidents in community pharmacy”, Journal of Patient Safety.  http://dx.doi.org/10.1097/PTS.0000000000000090

2MMs

6 Mar

by Brian Minor and Wendy Barlow, Research User Group members affiliated with Multimorbidity theme

MM RUG members blog photo

It’s nearly 12 months since we applied, were interviewed and subsequently invited to become members of the Research User Group (RUG).  Our first meeting was in April 2013 and since then there have been six meetings one of which was a full day at which we had a presentation on ‘Research? What’s it all about?’ Sometimes as RUG members we feel as if we haven’t moved forward or done very much, but when we look back over the past few months we realise just how much has been achieved i.e. developing/agreeing terms of reference for the group, developing/agreeing role descriptions for the Chair and Vice Chair, electing and appointing to these roles, reviewing theme documentation, developing reporting forms etc. As RUG members we are getting to know one another and starting to gel as a team, especially within our themes.  After the January RUG meeting the members went for a meal, which for those of us able to attend was a great opportunity to have a chat and find out more about each other in a social setting whilst enjoying a good meal. At the September 2013 meeting of the RUG we were asked to choose which of the five themes we would like to be assigned to and we were both fortunate in that we were aligned to the Multimorbidity theme which was our first choice. The multimorbidity research is aimed at patients with two or more long-term conditions i.e. an illness that at present can’t be cured but can be managed via medication and therapy.  These patients might need several sorts of medication and with a growing ageing population, there are a number of older people living with long term conditions who may be experiencing some form of memory loss.  This means that the patient is liable to make mistakes with his/her medicines by either taking too many or missing doses completely.  These patients are often under the supervision of several different clinicians, one of whom might prescribe medication that has an adverse effect on the prescriptions of another. The Research Team have welcomed us and provided us with a list of involvement opportunities.  We have reviewed some of the theme documentation and our input, particularly with feedback of the language used in documents resulted in changes being made.  This is not taking the ‘professionals’ to task, but as lay people we want to be able to read without being distracted by jargon or language that is not widely known outside the field of research. We are currently involved (after receiving training from Gavin Daker-White Research Fellow) in the thematic analysis and identifying themes from the results sections of published studies, and whilst this is a challenging task for us, as we don’t have research experience, we are relishing the opportunity to ‘have a go’ and hopefully our contribution will prove useful.  Brian is also looking forward to getting involved with interviewing participants as part of the research. Brian –  is retired and has a background is Sales and Marketing.  He has voluntary experience as Chairman of the PPI (Patient and Public Involvement) Forum set up at Salford Royal a few years ago and he also volunteers with the Local Community radio station and produces and presents four hours of radio each week. Wendy – up until a few months ago worked full-time at the University of Salford and is currently working part-time for the Big Life Centre as a Community Researcher looking at the development of a health and wellbeing website. She is also a registered volunteer with Salford Royal NHS Trust working with the Macmillan Cancer Support Services.