MEDICATION SAFETY ACTIVITIES OF HOSPITAL PHARMACISTS IN GHANA; EXPERIENCES AND EXPECTATIONS OF DOCTORS AND NURSES
Keywords:Doctors, Nurses, Perceptions, Medication safety, Pharmacists, Teamwork
Objective: This study explored the experiences and expectations of doctors and nurses with pharmacists' medication safety activities in the hospital to determine the barriers to effective collaboration and potential clinical roles that pharmacists need to undertake to promote patient safety
Methods: This was a cross sectional descriptive survey. Questionnaires were administered to a conveniently selected 200 doctors and 120 nurses working in a 2000 bed teaching hospital in Ghana.
Results: A total of 269 questionnaires were completed representing a response rate of 84.1%. The response rates for doctors and nurses were 86% and 80.8% respectively. Sixty percent of doctors and 59% of nurses were satisfied with the interactions they had with pharmacists. Only 39.9% and 31.4% of respondents agreed that pharmacists write refill prescriptions and treat common ailments respectively. Moreover just over half (53.8%) agreed that pharmacists reconstitute I. V preparations for administration. However 80% and 85.3% agreed that pharmacists provide drug information and report on medication errors respectively. Doctors were twice as much less likely to agree that pharmacists monitor effectiveness and side effects of medication (P=0.006). More than 90% of respondents expect pharmacists to provide medication education to patients whiles only 66.3% agreed that pharmacists use their knowledge and skills to alter drug regimes in the best interest of patients.
Conclusion: The experiences of doctors and nurses with pharmacists were considered positive though they were more likely to accept and recognize traditional pharmacy services. Increasing awareness of these new pharmacists' clinical skills will be important for enhancing medication safety activities in the hospital.
NPSA. Safety in doses: Medication safety incidents in the NHS. In. London: National Patient Safety Agency; 2009.
Le Grognec C, Lazzarotti A, Durnet-Archeray MJ, Lorcerie B. Medication errors resulting from drug preparation and administration. [French]. Ther 2005;60(4):391-9.
Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T, et al. Systems analysis of adverse drug events. JAMA 1995;274(1):35-43.
McDonough PR, Doucette WR. Developing colloborative working relationship between pharmacists and physicians. J Am Pharm Assoc 2001;41(5):682-92.
Lawton R, Carruthers S, Gardner P, Wright J, McEachan RRC. Identifying the latent failures underpinning medication administration errors: an exploratory study. HSR Health Serv Res 2012;47(4):1437-59.
Dean B, Schachter M, Vincent C, Barber N. Causes of prescribing errors in hospital inpatients: a prospective study. Lancet 2002;359(9315):1373-78.
Nuckols TK, Bell DS, Paddock SM, Hilborne LH. contributing factors identified by hospital incident report narratives. Qual Saf Health Care 2008;17(5):368-72.
Reason J. Safety in the operating theatre-Part 2:human error and organisational failure. Qual Saf Health Care 2005;14(1):56-60.
Reason J. Beyond the organisational accident: the need for "error wisdom" on the frontline. Qual Saf Health Care 2004;13 Suppl 2:ii28-33.
Franklin BD, Reynolds M, Shebl NA, Burnett S, Jacklin A. Prescribing errors in hospital inpatients: a three-centre study of their prevalence, types and causes. Postgrad Med J 2011;87(1033):739-45.
Bond CA, Raehl CL. Clinical and economic outcomes of pharmacist-managed antimicrobial prophylaxis in surgical patients. Am J Health Syst Pharm 2007;64(18):1935-42.
Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care units. JAMA 1999;282(3):267-70.
Carter BL, Malone DC, Billups SJ. Interpreting the findings of the improve study. Am J Health Syst Pharm 2001;58:1330-7.
Klopotowska JE, Wierenga PC, de Rooij SE, Stuijt CC, Arisz L, Kuks PF, et al. The effect of an active on-ward participation of hospital pharmacists in internal medicine teams on preventable adverse drug events in elderly inpatients: protocol of the wings study (Ward-oriented pharmacy in newly admitted geriatric seniors). BMC Health Serv Res 2011;11:124.
Murray MD, Ritchey ME, Wu J, Tu W. Effect of a pharmacist on adverse drug events and medication errors in outpatients with cardiovascular disease. Arch Int Med 2009;169(8):757-63.
Tonna AP, Stewart D, West B, Gould I, McCaig D. Antimicrobial optimisation in secondary care: the pharmacist as part of a multidisciplinary antimicrobial programmeâ€”a literature review. Int J Antimicrob Agents 2008;31:511-7.
Langebrake C, Hilgarth H. Clinical pharmacistsâ€™ interventions in a german university hospital. Pharm World Sci 2010;32:194-9.
Bailie GR, Romeo B. New York State primary care physiciansâ€™ attitudes to community pharmacistsâ€™ clinical services. Arch Int Med 1996;156(13):1437-41.
Bluml BM, McKenney JM, Cziraky MJ. Pharmaceutical care services and results in project impact: hyperlipidemia. J Am Pharm Assoc 2000;40:157-65.
Boudreau DM, Capoccia KL, Sullivan SD. Collaborative care model to improve outcomes in major depression. Ann Pharmacother 2002;36:585-91.
Ritchey FJ, Raney MR. Effect of exposure on physiciansâ€™ attitudes toward clinical pharmacists. Am J Hosp Pharm 1981;38(10):1459â€“63.
Liu Y, Doucette WR, Farris KB. Examining the development of pharmacist-physician collaboration over 3 months. Res Soc Admin Pharm 2010;6:324-33.
Zwarenstein M. Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes (Review). In.: The Cochrane Library; 2009.
Tahaineh LM, Wazaify M, Albsoul-Younes A, Khader Y, Zaidan M. Perceptions, experiences, and expectations of physicians in hospital settings in Jordan regarding the role of the pharmacist. Res Soc Admin Pharm 2009;5:63-70.
Muijrers PE, Knottnerus JA, Sijbrandij J, Janknegt R, Grol RP. Changing relationships: attitudes and opinions of general practitioners and pharmacists regarding the role of the community pharmacist. Pharm World Sci 2003;23(5):235-41.
Gillespie U, MoÂ¨rlin C, Hammarlund-Udenaes M, HedstroÂ¨m M. Perceived value of ward-based pharmacists from the perspective of physicians and nurses. Int J Clin Pharm 2012;34:127â€“35.
Kucukarslan S, Lai S, Dong Y, Al-Bassam N, Kim K. Physician beliefs and attitudes toward collaboration with community pharmacists. Res Soc Admin Pharm 2011;7:224-32.
Wilkinson R. Nursesâ€™ concern about IV therapy and devices. Nurs Stand 1996;10:35-7.
Westbrook JI, Rob MI, Woods A, Parry D. Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience. BMJ Qual Saf 2011;20:1027-34.
Taxis K, Barber N. Incidence and severity of intravenous drug errors in a German hospital. Eur J Clin Pharmacol 2004;59(81):15-7.
Chedoe I, Molendijk HA, Dittrich ST, Jansman FG, Harting JW, Brouwers JR, Taxis K. Incidence and nature of medication errors in neonatal intensive care with strategies to improve safety: a review of the current literature. Drug Saf 2007;30(6):503-13.
Franklin BD, Taxis K, Barber N. Parenteral drug errors. Reported error rates are likely to be underestimation. BMJ 2009;338:b1814.