Tag Archives: #pharmacy

Understanding how Community Pharmacists complete tasks in practice

30 Jan

community pharmacists sorting meds_banner

by Ahmed Ashour, PhD Fellow in the NIHR Greater Manchester PSTRC

The World Health Organization set its 3rd Global Patient Safety Challenge in 2017 to reduce severe avoidable medication-related harm by 50%, globally in five years (1). This led researchers to publish a new report investigating how often medication errors happen and the cost to the NHS in England (2). This renewed the focus on reducing errors and particularly errors occurring within primary care. Internationally, and specifically within the UK, the majority of healthcare interactions will occur with a primary care healthcare professional. One of the ways medication errors can be reduced is by using the scientific discipline of Human Factors and Ergonomics, which uses a number of tools to help reduce human error.

Human Factors and Ergonomics (HFE) aims to understand how individuals are affected by and affect factors around them, and the consequences of their actions. One of the tools used by Human Factors experts is Hierarchical Task Analysis (HTA). HTAs presents the sub-tasks involved in completing a task in a step-by-step form, accompanied by plans that describe the order and context in which the sub-tasks take place (3).

Within community pharmacy practice, pharmacies are required to have in place procedures describing how they should deal with the sale and supply of medicines and for specific services related to patients (4). However, it has been reported that under certain circumstances these Standard Operating Procedures (SOPs) are not always followed (5).

Ahmed Ashour’s PhD will aim to identify and develop the non-technical skills that community pharmacists require in practice. He will use the HTA tool to describe the tasks community pharmacists complete in practice. As part of the work of the Community Pharmacy Patient Safety Collaborative, which was set up by the NIHR Greater Manchester Patient Safety Translational Research Centre (GM PSTRC), participants were trained by a process expert in how to conduct an HTA before being asked to prepare an HTA for a specific task. These HTAs were then discussed in a focus group consisting of between 5 and 7 community pharmacists. Participants were encouraged to share the differences in how they completed the sub-tasks. The HTAs will be used as a basis for observations in community pharmacies. Differences will be documented and an analysis between the HTAs produced by the focus groups and those observed in practice, will be conducted.

There are a number of error-predicting tools that can be applied to HTAs to identify potential errors ahead of time and suggest solutions. One such tool is the Systematic Human Error Reduction and Prediction Approach (SHERPA), which is a method used to identify potential failures. The SHERPA tool can be used to design tasks in a way that minimises the possibility of potentially serious errors. By applying such methods to tasks that community pharmacists do, more specific training can be developed which will help to reduce the number of errors that occur.

Error prediction is not the only use for HTAs. HTAs provide an accurate description of how tasks are completed in practice, which can help to better understand the skills required to complete the tasks. It can also be used as a basis for discussing best practice and sharing information on the barriers to effectiveness. By producing this collection of HTAs, an important resource will be available to HFE researchers and others, to improve how tasks are carried out within community pharmacy.

The validated HTAs will also be published online for use by researchers. If you would like to get involved or for more information, you can contact Ahmed Ashour.

1.       https://www.who.int/patientsafety/medication-safety/medication-without-harm-brochure/en/

2.       Elliot R, Camacho E, Campbell F, Jankovic D, Martyn M, Kaltenthaler E, Wong R, Sculpher M, Faria R. Prevalence and economic burden of medication errors in the NHS in England. Rapid evidence synthesis and economic analysis of the prevalence and burden of medication error in the UK. 2018.

3.       Stanton N. Hierarchical task analysis: Developments, applications, and extensions. Applied Ergonomics. 2006;37(1): 55-79, ISSN 0003-6870, https://doi.org/10.1016/j.apergo.2005.06.003.

4.       Royal Pharmaceutical Society. Developing and implementing standard operating procedures for dispensing, 2007:1–13.

5.       Thomas C, Phipps D, Ashcroft D. When procedures meet practice in community pharmacies: qualitative insights from pharmacists and pharmacy support staff. BMJ Open. 2016.

REVISiTing GPs in training prescribing to improve medication safety

16 Nov

Pharmacist_small

by Ndeshi Salema

In 2012, the PRACtICe study, funded by the General Medical Council, set out to determine the prevalence and nature of prescribing and monitoring errors in general practices in England. The PRACtICe study found that prescribing errors occur in around one in twenty, or about 5% of the prescriptions. This is important because:

The PRACtICe study also highlighted that, as a group, GPs in training may benefit from further support in prescribing. Further exploratory work took place to identify possible ways to support GPs in training with their prescribing, which resulted in the development of an educational intervention, called REVISiT.

The REVISiT intervention involves:

  • a retrospective review of GPs in training prescribing, which is completed by a pharmacist, followed by
  • individualised feedback on the results of this review in the form of a report, which is discussed in a face-to-face meeting setting.

A small feasibility study of the REVISiT intervention (a retrospective review of approximately 100 prescriptions prescribed by 10 GPs in training) found that 9% of the prescriptions by GPs in training contained an error. The percentage of errors made by GPs in training was much higher than the percentage that was found in the PRACTiCE study, which may be due to the relative inexperience of GPs in training. It also indicated some benefits of the REVISiT intervention in improving the knowledge, skills and attitudes of GPs in training towards prescribing.

Interviews with a variety of stakeholders (healthcare professionals, policymakers, and members of the public) have shown that there is support for REVISiT as an educational intervention that can help improve prescribing, not only for GPs in training but for all types of prescribers. This will enhance the safety of healthcare received by patients.

With funding from the NIHR Greater Manchester PSTRC, the REVISiT intervention is being further developed and tested, in preparation for a trial in the future.

Safer medicines after hospital discharge

29 Oct

Involvement opportunity_small

by Mark Jeffries

Salford Royal NHS Foundation Trust (SRFT) is introducing an electronic system which will enable hospital pharmacists to refer patients to community pharmacists when they leave hospital, in order to receive advice about their medicine taking.  It is hoped these patients (or their carers) will be able to discuss their medicines with their community pharmacist and that this might resolve potential medication related issues, as well as improving patient knowledge and understanding about their medicines. This may help with the avoidance of errors and may help patients better understand any changes in their medicines. A positive outcome of this initiative is hoped to be patients taking their medicines more safely after spending time in hospital.

As part of our planned evaluation of the service we hope to talk to patients (and carers) about their experiences of using the electronic system and their interactions with the community pharmacists.

We are looking for a patient representative who could be involved in the project and might provide the research team with help and guidance at the different stages of project design, recruitment, data collection and data analysis. If you are interested, or would like more information, please contact Mark Jeffries at mark.jefferies@manchester.ac.uk.

What can we learn from North America about the role of community pharmacy teams in suicide awareness and prevention?

10 Sep
Hayley Gorton_Pharmacy trip photo

Hayley Gorton (r) with Bloom pharmacist Melissa at Haliburton Pharmacy, Antigonish

by Hayley Gorton

It is the NIHR Greater Manchester PSTRC I have to thank for starting the metaphorical journey that is my study of community pharmacy teams in suicide prevention. I joined the original Greater Manchester PSTRC in 2014 to undertake, and later complete, a PhD in the epidemiology of suicide and self-harm (epidemiology looks at how often and where diseases or healthcare events happen). Throughout my time, I was acutely aware of my profession and practice as a community pharmacist: “how would I help someone with thoughts or actions of suicide or self-harm in my pharmacy practice?” I didn’t know, but made it my mission to find out.

This summer, I spent a month in the USA and Canada exploring this question, thanks to a fellowship from the Winston Churchill Memorial Trust (WCMT) and support from the Greater Manchester PSTRC. There is too much to cover in one short blog, but you can find out about each leg of my trip by reading my own blog series. I’ve been back for a month and only now getting some clarity on which (of my many) research questions to pursue, fostering collaborations with those people I met en route and looking at how I can inform UK policy and practice with my WCMT findings. It was a brilliant experience in chronological order from grassroots research to mandatory training.

Refer-to-Pharmacy: improving medicines safety and reducing medicines wastage

2 Aug
Jane Ferguson

Jane Ferguson, lead author on the Refer-to-Pharmacy paper

by Jane Ferguson

Transition between care settings is a time of high risk for preventable medication errors. Poor communication about medication changes on discharge from hospital can result in adverse drug events and medicines-related readmissions. Refer-to-Pharmacy is an electronic referral system which allows hospital pharmacy staff to refer patients to their community pharmacist for post-discharge medicines support, or to update a patient’s pharmacy record with medication changes.

Better communication between settings has the potential to improve medicines safety and adherence and reduce cost and wastage. Despite input from hospital pharmacy staff, many patients, once they leave hospital, are unsure about how and why they should take medicines introduced or changed during their hospital stay, meaning that they may end up taking wrong or old medicines. Refer-to-Pharmacy means that community pharmacists can contact patients soon after they leave hospital and provide them with advice and support on their medicines. Through Refer-to-Pharmacy, hospital pharmacists can send an electronic copy of the discharge information to the community pharmacist – enabling them to identify and highlight medication discrepancies and avoid potential adverse drug events. Furthermore, when patients are admitted to hospital, community pharmacists are usually unaware and can continue to dispense their patients’ regular medicines, which are likely to change during their hospital stay, meaning that these medicines are then wasted. Refer-to-Pharmacy notifies community pharmacies of hospital admission for particular patient groups so they can stop dispensing and reduce wasted medicines.

Refer-to-Pharmacy is now routine in East Lancashire Hospitals NHS Trust where it was first established, with high acceptance rates from local community pharmacies. There is much interest in spreading the development into other health economies. The aim of this study was to examine factors that promoted or inhibited the implementation of Refer-to-Pharmacy in hospital and community settings. This information will be useful to other health economies wishing to adopt this service.

We carried out twenty six interviews with hospital pharmacists, hospital technicians, and community pharmacists to understand the implementation of the technology, as part of their normal routine.[1] This study is the first to examine perspectives from community and hospital pharmacists about the Refer-to-Pharmacy scheme at an important time in the development of transfer of care initiatives.[2] Previous research has highlighted that use of new technologies is dependent on the successful integration into existing practices combined with the collective effort of those involved.[1, 3] This study has extended this understanding by detailing the early stages of the implementation of Refer-to-Pharmacy in a hospital trust and community pharmacies.

Shared views on the perceived benefits of Refer-to-Pharmacy and ease of integration into existing work practices were key factors that promoted the implementation of the scheme in both the community and hospital pharmacy settings. Barriers to implementation were more evident in the community setting where it was more challenging to promote and legitimise the scheme due to the different types of community pharmacy.  An important message for health economies interested in adopting this service is to prepare community and hospital pharmacists and organisational leaders at the earliest opportunity – who will then need to work individually and collectively if Refer-to-Pharmacy is to become more widely embedded across healthcare settings.

The full paper can be read in BMC Health Services Research.

  1. May, C. and T. Finch, Implementing, Embedding, and Integrating Practices: An Outline of Normalization Process Theory. Sociology 2009. 43 p. 535-554.
  2. Royal Pharmaceutical Society, Keeping patients safe when they transfer between care providers – getting the medicines right. 2012: London.
  3. Black, A.D., et al., The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview. PLOS Medicine, 2011. 8(1): p. e1000387.

Risk Management: developing a learning resource to support pharmacy teams across England

3 May

Risk man guide supported by NIHR GM PSTRC

Good risk management is well recognised as the cornerstone of safe practice in the workplace and risk assessment has long been part of legal requirements for health and safety in UK workplaces.

In 2017, the World Health Organisation highlighted the importance of medication error by choosing the issue of medication-related harm as the focus of its Global Challenge. In response to this, the Medication Safety theme of the Greater Manchester PSTRC worked with CPPE (The Centre for Pharmacy Postgraduate Education) to develop their learning resources on Risk Management.

This was an ideal opportunity for the PSTRC, allowing the team to apply their broad expertise in theoretical risk management concepts to the challenges of the pharmacy context but also enabling them to incorporate the expertise and insights from the PSTRC’s Community Pharmacy Patient Safety Collaborative – a group of current in-practice community pharmacists working in the Greater Manchester region (see blog post for more information).

This ensured that the guide would be both theoretically sound in terms of risk management but also enriched with examples that pharmacists saw as pertinent to their day to day work.

Through the co-development of this guide, it was recognised that this could be part of something with much greater impact and, as a result, CPPE dedicated their 2018 learning campaign to be focussed on the topic of Patient Safety, using the guide as a focal point to provide the theoretical background for the campaign.

The guide was distributed to over 67 500 pharmacy professionals as part of CPPE Patient Safety campaign. The PSTRC continued to support CPPE designing appropriate learning activities that would be delivered by CPPE – including face to face “focal point” sessions with over 100 events due to run nationally throughout England and online weekly activities in Feb/Mar 2018 – including an e-challenge quiz and encouraging involvement via Twitter, Instagram and Facebook. This resulted in over 1500 individuals signing up to the campaign activities over the six week period and continuing beyond this with pharmacists still adding their intentions to improve patient safety on CPPE’s ‘Pledge Wall’.

Matthew Shaw, interim director of CPPE, was delighted at the opportunity to collaborate with PSTRC recognising the huge value of building an evidence base into this core learning programme. He commented “It has been a great opportunity to work with PSTRC to link theory with practice and through this to support pharmacy professionals across the country to make their practice safer, and to reduce the risks to people using our services.”

PhD Fellow Focus: Ahmed Ashour

3 May

Ahmed Ashour_cropped

Ahmed Ashour is the latest PhD student to join the NIHR Greater Manchester Patient Safety Translational Research Centre at The University of Manchester. Ahmed began his PhD in January 2018, having graduated with a distinction MPharm degree in the summer of 2017. He has worked in community pharmacy since 2014 in a variety of roles including as a dispenser, pre-registration pharmacist and ultimately a community pharmacist. Ahmed’s main passion derives from personal development and he has taken an active interest in ways of developing communication skills, especially in young people.

Ahmed’s research will revolve around identifying the skills that are essential to patient safety in community pharmacy. These skills are complementary to the technical knowledge acquired by pharmacists at university and while on their pre-registration placement. Since the 1970s, other sectors have extensively researched the impact non-technical skills have on outcomes, with many areas in healthcare now using specific classifications to identify these skills, in addition to the elements and behaviours attributed to safe practice.

Ahmed aims to present these skills to be able to ensure pharmacists in the future are well equipped with the skills that are necessary for the central role they now play in the health of communities all around the country. Ahmed will aim to identify these skills by first looking at the role community pharmacists currently play within the healthcare team, and then extracting the skills that are required to complete the tasks involved within this role.