Charles W. Morecroft

Safety culture assessment in community pharmacy: development, face validity, and feasibility of the Manchester Patient Safety Assessment Framework

Objective: To develop a framework that could be used by community pharmacies to self-assess their current level of safety culture maturity, which has high face validity and is both acceptable and feasible for use in this setting. Design: An iterative review process in which the framework was developed and evaluated through a series of 10 focus groups with a purposive sample of 67 community pharmacists and support staff in the UK. Main outcome measures: Development of the framework and qualitative process feedback on its acceptability, face validity, and feasibility for use in community pharmacies. Results: Using this process, a version of the Manchester Patient Safety Assessment Framework (MaPSAF) was developed that is suitable for application to community pharmacies. The participants were able to understand the concepts, recognised differences between the five stages of safety culture maturity, and concurred with the descriptions from personal experience. They also indicated that they would be willing to use the framework but recognised that staff would require protected time in order to complete the assessment. Conclusions: In practice the MaPSAF is likely to have a number of uses including raising awareness about patient safety and illustrating any differences in perception between staff, stimulating discussion about the strengths and weaknesses of patient safety culture within the pharmacy, identifying areas for improvement, and evaluating patient safety interventions and tracking changes over time. This will support the development of a mature safety culture in community pharmacies.

Views of the general public on the role of pharmacy in public health

Objectives To determine the views of healthy adults on the importance of activities aimed at improving public health, on the role of community pharmacies in contributing to these and on a range of potential pharmacy‐based public health services.

Likelihood of reporting adverse events in community pharmacy: an experimental study

Background: In the UK the National Reporting and Learning System (NRLS) is designed to coordinate the reporting of patient safety incidents nationally and to improve the ability of the health service to learn from the analysis of these events. Little is known about levels of engagement with the NRLS. Objective: To examine the likelihood of community pharmacists and support staff reporting patient safety incidents which occur in community pharmacies. Methods: Questionnaire survey containing nine incident scenarios. In the scenarios two factors were orthogonally manipulated: the outcome for the patient was reported as good, bad or poor, and the behaviour of the pharmacist was described as either complying with a protocol, not being aware of a protocol (error), or violating a protocol. Respondents were asked to rate whether they would report the incident (1) locally within the pharmacy and (2) nationally to the National Patient Safety Agency (NPSA). Results: 275 questionnaires were returned (79% response rate) from 223 community pharmacists and 52 members of support staff. There were significant main effects for both patient outcome (F(2,520) = 18.19, p<0.001) and behaviour type (F(2,520) = 93.98, p<0.001), indicating that pharmacists and support staff would take into account both the outcome of the behaviour and whether or not it follows a protocol when considering to report an incident within the pharmacy. Likewise, both pharmacists and support staff considered patient outcome (F(2,524) = 12.59, p<0.001) and behaviour type (F(2,524) = 34.82, p<0.001) when considering to report to the NPSA. Both locally and nationally, the likelihood of reporting any incident was low, and judgements on whether to report were more affected by the behaviour of the pharmacist in relation to protocols than the resulting outcome for the patient. Conclusions: Community pharmacists and their support staff would be unlikely to report adverse incidents if they witnessed them occurring in a community pharmacy. They remain to be convinced that the advantages to them and their patients outweigh the consequences of blame.

Narratives about illness and medication: a neglected theme/new methodology within pharmacy practice research. Part I: Conceptual Framework

This paper sets out a conceptual and theoretical framework relevant to developing research in the area of narratives about medication. Drawing on an understanding and critique of the psychological, sociological and anthropological literature in the area of patients’ narratives about health and illness, we argue that pharmacy practice researchers need to acknowledge and appreciate the insights that can come from engaging with narrative. We provide a critique of the current limitations of pharmacy practice research as applied to patient’s use of medication and suggest that an appreciation of narrative might provide another window on the world of patients’ experiences.

Can in‐depth research interviews have a ‘therapeutic’ effect for participants?

Objective The studys objective was to explore whether there was any discernible ‘therapeutic’ effect upon participants after an in‐depth research interview, which focused upon their experiences of hypertension and its management.

Narratives about illness and medication: a neglected theme/new methodology within pharmacy practice research. Part II: medication narratives in practice.

AimPart 2 of this paper aims to provide a methodological framework for the study of medication narratives, including a semi-structured interview guide and suggested method of analysis, in an attempt to aid the development of narrative scholarship within pharmacy practice research. Examples of medication narratives are provided to illustrate their diversity and usefulness.MethodsThe framework is derived from the work of other researchers and adapted for our specific purpose. It comes from social psychology, narrative psychology, narrative anthropology, sociology and critical theory and fits within the social constructionist paradigm. The suggested methods of analysis could broadly be described as narrative analysis and discourse analysis. Examples of medication narratives are chosen from a variety of sources and brief interpretations are presented by way of illustration.ConclusionNarrative analysis, a neglected area of research in pharmacy practice, has the potential to provide new understanding about how people relate to their medicines, how pharmacists are engaged in producing narratives and the importance of narrative in the education of students.Impact of the articleThis article aims to have the following impact on pharmacy practice research:Innovative approach to researching and conceptualising the use of medicinesIntroduction of a new theoretical perspective and methodologyIncorporation of social science research methods into pharmacy practice researchDevelopment of narrative scholarship within pharmacy

Measuring the impact of long-term medicines use from the patient perspective.

Polypharmacy is increasing, seemingly inexorably, and inevitably the associated difficulties for individual patients of coping with multiple medicines rise with it. Using medicines is one aspect of the burden associated with living with a chronic condition. It is becoming increasingly important to measure this burden particularly that relating to multiple long-term medicines. Pharmacists and other health professionals provide a myriad of services designed to optimise medicines use, ostensibly aiming to help and support patients, but in reality many such services focus on the medicines, and seek to improve adherence rather than reducing the burden for the patient. We believe that the patient perspective and experience of medicines use is fundamental to medicines optimisation and have developed an instrument which begins to quantify these experiences. The instrument, the Living with Medicines Questionnaire, was generated using qualitative findings with patients, to reflect their perspective. Further development is ongoing, involving researchers in multiple countries.

Involving community pharmacists in pharmacy practice research: experiences of peer interviewing.

Background Translation of interest in research into active engagement of community pharmacists as research partners/co-researchers remains a challenge. Involving pharmacists in specific research techniques such as peer interviewing, however, may enhance validity of the results. Objective To enhance community pharmacists’ involvement in pharmacy practice research through peer interview training. Method A subgroup of participants in a multi-phase pharmacy practice research project trained to do peer interviews. These pharmacist interviewers attended a workshop and were mentored. Comments from their feedback forms and ongoing engagement with the Research Associate were thematically analysed. Results Positive themes from five interviewers included the importance of the topic and their wish to learn skills beyond their everyday role. The small group format of the training day helped to build confidence. Interviewers felt their shared professional background helped them to capture relevant comments and probe effectively. There were challenges, however, for interviewers to balance research activities with their daily work. Interviewers experienced difficulty in securing uninterrupted time with interviewees which sometimes affected data quality by ‘rushing’. Conclusion Community pharmacists can be engaged as peer interviewers to the benefit of the volunteers and research team, but must be well resourced and supported.

Informing patients about medicines—A hospital in-patient survey in England

OBJECTIVE To determine the frequency with which hospital in-patients receive information about medicines and whether this varies dependent on patient characteristics or hospitals. METHODS Cross-sectional survey of medical in-patients in six hospitals in North West England. RESULTS 1218 questionnaires were completed sufficiently for analysis by medical in-patients. 534 (43.9%) respondents were informed fully about their medicines by a hospital doctor, nurse or pharmacist and 411 (33.9%) partly informed, but 272 (22.49%) had received no information or could not recall any. Fewer than 20% had received written medicines information. The majority of respondents (763; 62.6%) were not asked if they had any concerns or could not recall this. Patient factors including age, educational level and number of medicines taken did not influence whether or not medicines information was provided, but there were differences between hospitals. CONCLUSION There is considerable variation between hospitals in the frequency with which patients are given verbal and written information about medicines and are asked about any medicine-related concerns. PRACTICE IMPLICATIONS Informing patients about medicines while in hospital needs to be improved. Doctors, nurses and pharmacists all need to accept and co-ordinate responsibility for informing patients about medicines and asking if they have any concerns or questions.

Prescribing liquid medication: can the dose be accurately given?

Dosing errors and children are uncomfortable bedfellows but will they ever be separated? Published research indicates that dosing errors are the most common type of errors.1 ,2 An audit was undertaken of liquid medications prescribed to paediatric and neonatal inpatients at two hospitals in North West England over a 5-week period in January–February 2011. The aim of the audit was to explore the measurable proportion of prescribed doses of liquid medication for children and neonates. Anonymised patient and drug details including name, strength, prescribed dose of drug, volume to be administered and whether the dose was measurable in a single syringe using the graduations marked on …