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

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