Exploring attitudes and opinions of pharmacists toward delivering prescribing error feedback: A qualitative case study using focus group interviews.
BACKGROUND
Prescribing error (PE) rates have been extensively reported in the literature. Various interventions at reducing PEs have been studied with some success, yet PEs continue to be a challenge for the health care system. Prescriber feedback has been proposed as one mechanism to reduce PEs in seminal studies. Pharmacists are viewed as an integral safety net in intercepting PEs and have been suggested as best placed to deliver feedback. However, there is very limited literature considering pharmacists; attitudes, views and opinions on facilitating PE feedback.


OBJECTIVE
To explore the attitudes and views of hospital pharmacists in delivering feedback on PEs to prescribers.


METHODS
Twenty-four pharmacists were recruited for one of four focus groups in a large district general hospital in the Northwest of England to explore the views of pharmacists to delivering feedback on PEs. Focus groups were transcribed verbatim and analyzed using a thematic framework approach to identify current practices, beliefs and attitudes of pharmacists toward delivering PE feedback. Transcripts were independently analyzed by the research team.


RESULTS
Pharmacists' views on providing feedback on PEs were organized into eight major themes; Delivery of feedback, impact of feedback, prescription error, work environment, feedback facilitator, working relationships, education and training, and system improvements. Pharmacists recognized that timely feedback on PEs was essential for prescribers to learn from their mistakes and to reduce PEs. However, delivery of feedback appeared to be inconsistent, influenced by time pressures, workload, rapport and PE severity and prescriber availability. Pharmacists reported that ward-based pharmacists in particular, were suitable to facilitate PE feedback, but expressed concern that the process may adversely affect prescriber-pharmacist rapport. Pharmacists reported limited training on delivery of feedback with formalized training required for improved consistency, and quality, of constructive feedback.


CONCLUSIONS
PE feedback should be delivered to prescribers with ward-based pharmacists best suited to the role. Both direct and indirect benefits of PE feedback were reported, although potential barriers to delivering PE feedback were also identified. Pharmacists reported additional anxieties that feedback could create tensions and compromise working relationships with prescribers. PE feedback could be considered an extension of a pharmacist's role and pharmacists welcomed formalization of feedback, but were cognizant of the potential impact on their workload and expressed the need for training in the delivery of feedback.
St. Helens and Knowsley Hospitals NHS Trust, Whiston, Merseyside L35 5DR, UK. Electronic address: Michael.lloyd@sthk.nhs.uk.
M
M
Lloyd
Health Care Education, Institute of Learning and Teaching, University of Liverpool, L69 3GE, UK.
S D
SD
Watmough
St. Helens CCG, St. Helens Chambers, St. Helens, Merseyside WA10 1YF, UK.
S V
SV
O'Brien
St. Helens and Knowsley Hospitals NHS Trust, Whiston, Merseyside L35 5DR, UK.
N
N
Furlong
St. Helens and Knowsley Hospitals NHS Trust, Whiston, Merseyside L35 5DR, UK.
K
K
Hardy
D001291:Attitude of Health Personnel; D004739:England; D005260:Female; D017144:Focus Groups; D000068156:Formative Feedback; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008508:Medication Errors; D010595:Pharmacists; D010607:Pharmacy Service, Hospital
Error reduction; Feedback; Hospital pharmacist; Medication error; Patient safety; Prescribing error