title: Pharmacists' Perceptions of the Barriers and Facilitators to the Implementation of Clinical Pharmacy Key Performance Indicators.
abstract: BACKGROUND
  In hospitals around the world, there has been no consensus regarding which clinical activities a pharmacist should focus on until recently. In 2011, a Canadian clinical pharmacy key performance indicator (cpKPI) collaborative was formed. The goal of the collaborative was to advance pharmacy practice in order to improve patient outcomes and enhance the quality of care provided to patients by hospital pharmacists. Following a literature review, which indicated that pharmacists can improve patient outcomes by carrying out specific activities, and an evidence-informed consensus process, a final set of eight cpKPIs were established. Canadian hospitals leading the cpKPI initiative are currently in the early stages of implementing these indicators.
  
  
  OBJECTIVE
  To explore pharmacists' perceptions of the barriers and facilitators to the implementation of cpKPIs.
  
  
  METHODS
  Clinical pharmacists employed by the Nova Scotia Health Authority were invited to participate in focus groups. Focus group discussions were audio-recorded and transcribed, and data was analyzed using thematic analysis.
  
  
  RESULTS
  Three focus groups, including 26 pharmacists, were conducted in February 2015. Three major themes were identified. Resisting the change was comprised of documentation challenges, increased workload, practice environment constraints, and competing priorities. Embracing cpKPIs was composed of seeing the benefit, demonstrating value, and existing supports. Navigating the unknown was made up of quality versus quantity battle, and insights into the future.
  
  
  CONCLUSIONS
  Although pharmacists were challenged by documentation and other changes associated with the implementation of cpKPIs, they demonstrated significant support for cpKPIs and were able to see benefits of the implementation. Pharmacists came up with suggestions for overcoming resistance associated with the implementation of cpKPIs and provided insights into the future of pharmacy practice. The identification of barriers and facilitators to cpKPI implementation will be used to inform the implementation process on a local and national level.
authors.affiliation: Department of Pharmacy, Nova Scotia Health Authority, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
authors.forename: Laura V
authors.initials: LV
authors.lastname: Minard
authors.affiliation: College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Heidi
authors.initials: H
authors.lastname: Deal
authors.affiliation: College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Harrison
authors.affiliation: Department of Pharmacy, Nova Scotia Health Authority, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
authors.forename: Kent
authors.initials: K
authors.lastname: Toombs
authors.affiliation: Department of Pharmacy, Nova Scotia Health Authority, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Neville
authors.affiliation: Department of Pharmacy, Nova Scotia Health Authority, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Meade
mesh_terms: D001291:Attitude of Health Personnel; D004282:Documentation; D017144:Focus Groups; D006801:Humans; D009674:Nova Scotia; D010465:Perception; D010594:Pharmacies / Q000592:standards; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000592:standards*; D036301:Qualitative Research; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires; D016526:Workload