Pharmacy Safety Research Articles

Pharmacy Safety and Occupational Health: Quality Perspective

Pharmacy Safety and Occupational Health: Quality Perspective

Pharmacy Safety and Occupational Health: Crisis and Disaster Management

Pharmacy Safety and Occupational Health: Crisis and Disaster Management

Pharmacy Safety and Occupational Health: Education and Training

Pharmacy Safety and Occupational Health: Education and Training

Pharmacy Safety and Occupational Health: Fire Safety Perspectives

Pharmacy Safety and Occupational Health: Fire Safety Perspectives

Pharmacy Safety and Occupational Health Program in Saudi Arabia

Pharmacy Safety and Occupational Health Program in Saudi Arabia

KSA-Self Assessments of Pharmacy Safety and Occupational Health

KSA-Self Assessments of Pharmacy Safety and Occupational Health

Ant colony optimisation of a community pharmacy dispensing process using Coloured Petri-Net simulation and UK pharmacy in-field data

There are 11,619 community pharmacies in England which dispense over 1 billion prescriptions each year, providing essential primary care to NHS (National Health Service) patients. These pharmacies are facing pressure from a number of sources including funding cuts and high demands on services, while trying to deliver the highest standards of care. This paper presents an optimisation of a Coloured Petri Net (CPN) community pharmacy simulation model using an Ant Colony Optimisation (ACO) method. The CPN method was proposed by Naybour et al . Quantitative data from UK community pharmacies was collected by the authors and incorporated into the CPN simulation model. The optimisation is made up of a choice of how many staff to employ, which prescription checking strategy to use, and which staff work pattern to implement. This method aims to provide decision makers with a set of optimal pharmacy configurations at different cost levels. This can help to support pharmacy safety, efficiency, and improve decision making processes. It has been demonstrated how reliability modelling techniques traditionally used in safety-critical industries, can be used to carry out safety and efficiency analyses of healthcare systems, such as dispensing processes in community pharmacies, illustrated in this contribution.

Impact of early release of oral investigational prescriptions on safety and efficiency at a comprehensive cancer center.

257 Background: At Dana-Farber Cancer Institute (DFCI), timing of order release to the pharmacy is a contributing factor to safety and processing concerns for oral investigational medications. Day-of release can lead to delayed delivery to the patient, creating a risk of missing timed specific protocol data collection, and rushed critical pharmacy safety checks, an issue raised in a comprehensive proactive systems safety risk assessment. We conducted a pilot project aimed at improving the safety and efficiency of oral investigational medication processing within the pharmacy by releasing prescription orders at least 24 hours in advance of a patient’s appointment. Methods: A team of pharmacists, nurses, process improvement professionals, and a physician designed a pilot project where the prescriber released oral investigational prescriptions, from 9 selected research protocols, at least 24 hours before a patient’s appointment. From 11/2/2018-3/1/2019, we used manual timestamp data to compare prescription processing times for prescriptions released at least 24 hours in advance (“released early”) to prescriptions released less than 24-hours in advance (“not released early”). Qualitative feedback was obtained to assess pilot impact on prescription processing safety. Results: As shown in the table below, prescription processing time on day of patient appointment for prescriptions released early was shorter, on average, compared to those not released early (p < 0.05). Due to orders being released early, pharmacy staff noted feeling less pressure during prescription checks and a better ability to proactively assess inventory and prescription issues. Conclusions: Releasing oral investigational prescriptions early reduced the prescription processing time and increased time available for safety checks. Expanding this workflow change to all investigational medication orders can increase the safety and efficiency of prescription processing at DFCI. [Table: see text]

Implementation of an internal check of oral oncolytics: a single-center, specialty pharmacy safety initiative

Background: Oral oncolytic therapies (OOT) for patients with cancer continue to pose unique safety challenges. Unlike infusion therapies, there are few best practice recommendations for checking OOT. A multicenter review of four oncology clinics in the United States, estimated 8.1 errors in medications per 100 clinic visit identified. 1 The American Society of Health-System Pharmacists identify administration and ordering were the most common phases of the medication-use process where errors occur. 2 Despite the high-risk nature of OOT and high error-rate in these particular phases, with pharmacist surveillance, there continues to be little consensus for oral oncolytic safety to guide specialty pharmacists (SPs). Aims: The objectives of this single-center, quality improvement study was to review the quality metrics of the implementation of an oral oncolytic check process, in the specialty and ambulatory setting as a method to enhance medication safety and improve vigilance. Methods: The study was approved by the Institutional Review Board at the Hospital of the University of Pennsylvania. A standardized check process and documentation of capecitabine and temozolomide was implemented beginning in December 2016 for an adult oncology population. SPs have direct communication to pharmacy specialists and provider teams through the electronic medical record via Epic. Upon receipt of a new prescription, the SP reviews the prescription for: prescriber, chemotherapy regimen, indication, body surface area, dose verification, appropriate day supply/refills, laboratory values, allergy evaluation, drug interactions, and pre-medications. The SP documents this review as an intervention in Epic for every capecitabine and temozolomide prescriptions before processing. Intervention data between December 2016 and September 2018 was queried and quantified. Results: Over 22 months, a total of 1,619 intervention documents were reviewed with 551 intervention documents requiring intervention (34%). A total of 639 actionable interventions were identified. The top three categories were missing pre-medications (54.1%), missing/abnormal laboratory results (19.6%), and drug-drug interactions (13.6%). Rare interventions included dose clarification requests (3.6%), dose change requests (1.4%), and quantity supply requests (2.7%). A SP referred to a pharmacy specialist or provider outside of Epic communication in 21.2% of cases and 3.7% of cases respectively. The average time by the SP per intervention was 12.1 minutes (Range: 10-45 minutes). Conclusions: OOT is exponentially growing with unique risks associated when prescribing, with the SP being the last line of defense. Implementing an internal checking tool of oral oncolytics creates a standardized safety check and promotes active communication with oncology care teams. Addition of all OOT to incorporate mandatory documentation is ongoing.

Medication Error Factors, Safety Guideline System, Flow of Drug Usage, and Code of Conduct to Prevent Medication Error

Medication error is any preventable event that may lead inappropriate drug service or patient harm while the drug administration is in control of the healthcare professional or patient. This study aimed to analyze the factor that may lead the medication error and identify the medication error solution to pharmaceutical installation in research hospital, Indonesia. This study used an action research method. The research subject included doctor, pharmacist, pharmaceutical engineering personnel and nurses. Action research involves six process: diagnosis, reconnaissance, action plan, action, evaluation and monitoring the subject. Diagnosis were obtained from primary and secondary data. Primary data were obtained by interview, observation, and Focus Group Discussion (FGD). Secondary data were obtained from adverse event and near-miss events in medication error data in pharmacy installation. The results indicated that there were four major factor of medication error. First, prescribing error is an unclear written prescription, incomplete administration and unavailable prescription. Second, transcribe error is a misread of prescription drug that lead to mistreatment. Third, dispensing error is involved the misreading of prescription drug by pharmacist, wrong dose, wrong quantity of drugs, and incompetent pharmacist personnel. Fourth, administration error is an incorrect administration by hospital personnel. In conclusion, the establishment of safety guideline is important to medication error in pharmaceutical installation. The safety guidelines consist of the policy and standard operational procedure, flowchart of outpatient service, code of conduct of pharmacy safety and monitoring to ensure the quality of medical service.

Patient safety culture in Palestinian hospital pharmacies: a cross-sectional survey

BackgroundAssessment of safety culture—safety-related norms and behaviours—in health care settings is receiving increasing attention. Assessment of pharmacy safety culture in the occupied Palestinian territory is scarce. We aimed to investigate patient safety culture in Palestinian hospital pharmacies and its association with hospital characteristics (ie, ownership and number of beds) and pharmacy staff characteristics (including sex, age, education, job title, working hours, and years in profession and working in a hospital). MethodsThe self-administered safety attitudes questionnaire (SAQ) was translated into Arabic and was then undertaken in February 2012 to April 2012. All pharmacy staff (n=115) working for more than 3 months before taking the survey in 28 public, private, and non-governmental hospitals in the West Bank were targeted. We used IBM-SPSS (version 19) for data analysis. Findings73 staff completed surveys (response rate 69%). Mean age of participants was 35·3 (SD 6·5) years and 48 (67%) respondents were women. The mean scores for overall safety varied significantly between hospital pharmacies, ranging from 43 (poor safety) to 85 (good safety) on a 0–100 scale (p=0·004). For SAQ domains (including teamwork atmosphere, job satisfaction, safety climate, positive perception of management, stress recognition of respondents, and favourable working conditions), mean scores ranged from 76 (SD 21) for favourable working conditions, to 62 (SD 25) for stress recognition. Only two SAQ domains received 75% or more positive responses from participants, which were for job satisfaction (56 respondents, 77%) and favourable working conditions (56 respondents, 77%). Overall safety score was significantly associated with hospital ownership, with higher scores in private and non-governmental hospitals than in public hospitals (p=0·002). Additionally, participants working in hospitals with less than 50 beds reported higher positive perceptions of management than did their counterparts in hospitals with a greater number of beds (p=0·031). No participant characteristic was significantly related to SAQ domain scores. 45 (62%) respondents did not report any drug-related adverse event recorded by patients in the past year. 64 (87%) participants rated patient safety at their hospital units as excellent or very good, and 9 (13%) rated patient safety as acceptable. InterpretationOur results showed that patient safety could be improved in Palestinian hospital pharmacies. Additionally, results showed the interventions that are needed might vary across hospitals. FundingNone.

Comparative Evaluation of Pharmacy Patient Safety Culture in all Levels of Health Care Delivery in Delta State, Nigeria

In health care, there is a move towards a patient safety culture as a means of ensuring sustainable positive patient care outcomes. This study evaluated the safety cultures in the health institutions in Delta State, Nigeria. An adapted form of the Agency for Healthcare Research and Quality Questionnaire on Pharmacy Safety was administered to 118 pharmacy personnel in 10 hospitals spread across the 3 senatorial districts. Data was analyzed with SPSS.20. The number of pharmacists was inadequate; pharmacy organization at the secondary and tertiary levels was better than the primary level; At all three levels, the safety cultures of Staff Training and Skills, Teamwork, Communication Openness, and Patient Counseling were generally positively rated. Highly significant differences existed in the safety culture of documenting mistakes in the pharmacy. There were significant differences in most culture composites between the three levels of care. The general trend was Tertiary>Secondary>Primary in positivity. On the overall Rating of Patient Safety, all levels were rated Very Good / Excellent. However, there were isolated lapses in safety culture composites requiring attention; pharmacy managers, in particular, are therefore enjoined to re-evaluate the safety cultures in their domain to identify areas of systemic failure.

Regulatory Authority Approaches to Deploying Quality Improvement Standards to Community Pharmacies

Background: Continuous quality improvement (CQI) programs provide an effective means to improve the safety and quality of community pharmacy practice. The role of formal support processes in ensuring the success of these CQI programs is explored in this research using the SafetyNET-Rx project. Objective: The primary objectives of this research were to determine how knowledge of, and confidence in, mandated CQI standards differs among pharmacies with access to formal support mechanisms and those without and the challenges faced by both. Methods: A survey questionnaire was mailed to 179 community pharmacies in Nova Scotia, Canada, in spring 2011. Quantitative results were analyzed using the Mann-Whitney U test for nonparametric data. Qualitative open-ended responses were analyzed using content analysis. Results: Performing the Mann-Whitney U test indicated that a number of differences exist between the 2 groups with respect to: (1) staff knowledge of reporting quality-related events (QREs) to an anonymous database; (2) conducting annual pharmacy safety self-assessments; (3) confidence in meeting these 2 elements; and (4) documenting changes to address QREs. A number of challenges were identified by respondents through the open-ended questions. Conclusions: This research highlights the value of the active provision of formal support when developing standards related to quality improvement.

Illegal online drug sellers: How to stop them?

Illegal online drug sellers: How to stop them?

Evaluation of the Pharmacy Safety Climate Questionnaire in European community pharmacies

To evaluate the internal reliability, factor structure and construct validity of the Pharmacy Safety Climate Questionnaire (PSCQ) when applied to a pan-European sample of community pharmacies. A cross-sectional survey design was used. Community pharmacies in Denmark, Germany, the Netherlands, Portugal and Great Britain. A total of 4105 members of the community pharmacy workforce, all drawn from one of the five participating countries. Each participant completed a copy of the Pharmacy Safety Climate Questionnaire in his or her respective language and rated the perceived safety of the pharmacy in which he or she worked. Exploratory and confirmatory factor analyses of the data identified four factors that accounted for item responses, with 24 of the original 34 items loading onto them. They were labelled organizational learning, blame culture, working conditions and safety focus. These factors were found to have an acceptable level of reliability (with Cronbach's alpha values ranging from 0.70 to 0.92) and to predict the rating of pharmacy safety. This study provided information on the PSCQ's psychometric properties when used in community pharmacies in different European countries. A modified version of the original PSCQ (known as PSCQ-4) is presented, and further work is proposed to demonstrate its application to safety improvements in pharmacies.

Development of the Pharmacy Safety Climate Questionnaire: a principal components analysis

Objective:To develop, and examine the component structure and internal consistency, of a questionnaire designed to assess safety climate in the community pharmacy setting.Methods:998 pharmacists working in community pharmacies in England...

Introduction

<h3>Objective</h3> To examine the relationship between psychosocial job characteristics and safety climate. <h3>Design</h3> Cross-sectional survey. <h3>Setting</h3> Community pharmacies in Great Britain. <h3>Participants</h3> A random sample of community pharmacists registered in Great Britain (n=860). <h3>Survey instruments</h3> Effort–reward imbalance (ERI) indicator and Job Content Questionnaire (JCQ). <h3>Main outcome measures</h3> Pharmacy Safety Climate Questionnaire (PSCQ). <h3>Results</h3> The profile of scores from the ERI indicated a relatively high risk of adverse psychological effects. The profile of scores from the JCQ indicated both high demand on pharmacists and a high level of psychological and social resources to meet these demands. Path analysis confirmed a model in which the ERI and JCQ measures, as well as the type of pharmacy and pharmacist role, predicted responses to the PSCQ (χ²(36)=111.38, p&lt;0.001; Tucker–Lewis index=0.96; comparative fit index=0.98; root mean square error of approximation=0.05). Two general factors (effort vs reward and control vs demand) accounted for the effect of job characteristics on safety climate ratings; each had differential effects on the PSCQ scales. <h3>Conclusions</h3> The safety climate in community pharmacies is influenced by perceptions of job characteristics, such as the level of job demands and the resources available to meet these demands. Hence, any efforts to improve safety should take into consideration the effect of the psychosocial work environment on safety climate. In addition, there is a need to address the presence of work-related stressors, which have the potential to cause direct or indirect harm to staff and service users. The findings of the current study provide a basis for future research to improve the safety climate and well-being, both in the pharmacy profession and in other healthcare settings.

Medication Safety: Patients’ Experiences, Beliefs, and Behaviors

To measure patients' experiences with medication errors and examine how these experiences relate to their beliefs about pharmacy safety and their engagement in medication-safety behaviors. Cross-sectional study. Primarily Michigan. 920 employees and retirees from the University of Michigan. Mail survey. Patients' experiences, beliefs, and behaviors related to medication safety. Of the respondents, 168 (18.3%) reported that they had experienced a medication error at some time in their lives and 193 (21.0%) knew a family member or friend who experienced an error; 63 (6.8%) had experienced an error within the past year and 5 (0.5%) had required additional medical attention because of an error. The majority of respondents did not worry about pharmacy safety and generally believed that the drug dispensing process at their pharmacy was safe. Approximately 80%-90% of respondents engaged in basic safety-related behaviors when receiving a prescription medication (e.g., checked for their name on the label or checked the directions on the label). While 72.3% of respondents reported that they read the medication pamphlet provided by the pharmacy, only 27.3% talked to the pharmacist about their medications. Respondents who had personal experiences with medication errors--or knew someone who had encountered such errors--had lower perceptions of pharmacy safety and were more likely to engage in several safety-related behaviors. Patients who have experienced medication errors have lower perceptions of pharmacy safety and are more likely to engage in behaviors to protect themselves from future errors, as compared with those who have not had an error experience.