The Hospital Practice Direction (HPD) Project’s January/February electronic questionnaire collected information from professionals in all sectors of pharmacy practice about their experiences and knowledge about safety risks associated with hospital pharmacy practice in Manitoba. Results provide a local Manitoba perspective that, combined with Canadian and international evidence, will focus CPhM’s regulatory guidance on aspects of hospital practice that pose evidence-based public safety risks. Focus groups with pharmacists and pharmacy technicians were held in early March to follow-up on some of the results of the questionnaire.
Thank you to the nine pharmacy professionals who contributed their time and valuable perspectives during the focus groups. And thanks to those of you who completed the questionnaire.
Highlights from the results include:
Response Rate:
- Aggregate response rate was 3.9% (77/1968 CPhM pharmacy professionals)
- This selection rate was driven by the hospital sector’s response rate of 11.4% (54/472 hospital professionals). Of these individuals, rural professionals (practicing in hospitals with less than 100 beds) accounted for 27.7% (15/54).
- Only 1.4% (18/1293) of community professionals completed the survey.
- Pharmacist respondents comprised 79.2% (61/77) and pharmacy technicians made up 19.5% (15/77) of the total respondents.
- Pharmacy managers comprised 27.9% (17/61) of pharmacist respondents.
Hospital-Based Pharmacy Professionals (n=54):
- Hospital-based pharmacy professionals practicing in rural communities (n=15) were more likely to be aware of the existence of the current CPhM Hospital Standards of Practice and Guidelines on Practice
- There was a grouping of three safety concerns at the team and individual professional level (aggregate pharmacist and pharmacy technician participants) that were selected by 60-70% of respondents:
- Responsibility and accountability for the team achieving essential minimum requirements for hospital pharmacy (37/54 = 68.5% selected). This selection frequency was largely driven by manager respondents (15/17 = 88.2% selected)
- Communication of patient care information at hospital-to-hospital transfer (37/54 = 68.5% selected)
- Communication of patient care information at hospital to community transitions (33/54 = 61.1% selected)
- Pharmacy technician responses (n=11) were teased out to understand their perspective on team and individual level safety concerns since the aggregate findings were dominated by pharmacist responses. Pharmacy technicians’ top three safety concerns were:
- Intraprofessional team dynamics (9/11 = 81.8%)
- Responsibility and accountability for the team achieving essential minimum requirements for hospital pharmacy (7/11 = 63.6%) which is consistent with pharmacists’ selection
- Process for dealing with patient’s own medications and substances while in hospital (5/11 = 45.5%)
- Aggregated least frequently selected safety concerns at this level consisted of:
- Supervision and appropriate delegation for pharmacy assistants and pharmacy technicians in training (10/54 = 18.5%)
- Labeling, packaging and dispensing pharmacy-supplied medication for self-medication while in hospital (11/54 = 20.4%)
- Supervision and appropriate delegation for pharmacy assistants and pharmacy technicians (16/54 = 29.6%)
- Safety concerns at the organisation and systems level that were most often selected by hospital respondents (aggregate pharmacist and pharmacy technician) also formed a grouping of three in the 60-70% range:
- Human processes for accurate provision of patient medications (36/54 = 66.7% selected)
- Maintaining essential services (35/54 = 64.8% selected)
- Patient safety culture (32/54 = 59.2% selected)
- Aggregated least frequently selected safety concerns at this level consisted of:
- Processes that identify diversion of loss of controlled substances transported between pharmacies (4/54 selected = 7.4%) Note: The sibling item, Processes that prevent diversion…was much more often selected (21/54 selected = 38.9%)
- Medication storage area conditions or monitoring of conditions potentially resulting in medication degradation (14/54 = 25.9%)
- Classification criteria, infrastructure and operational standards for secondary hospitals without a pharmacy or pharmacists (13/54 = 24.1%) and most of the respondents selecting this were rurally located (see next bullet point)
- Rural pharmacy professionals’ responses were teased out to understand their perspectives since the aggregate findings were dominated by urban professionals. Rural professionals’ top safety concerns included maintaining essential services (11/15 = 73.3% selected) but also classification criteria, infrastructure and operational standards for secondary hospitals without a pharmacy or pharmacists was frequently selected (7/15 = 46.7%)
- Free text responses were provided by 27 of 54 (50%) participants. Dominant themes included:
- Best possible medication history and medication reconciliations: processes and accuracy of pharmacy and other professionals
- Workload and staffing creating patient safety concerns
- Labeling issues for patient self-administration/discharge use
Non-Hospital Pharmacy Professionals (n=23):
This group was predominantly community-based pharmacy professionals (n=18) with one primary health team pharmacist and four pharmacists working in non-direct patient care roles. Because of the low numbers, they have been combined in this set of results. These participants responded to a set of questions that focused on their experiences and observations of risks or issues to patient care stemming from hospital practice that occur when patients transition between inpatient and community care:
- 21/23 respondents (91.3%) strongly agreed or agreed that patients experienced safety risks stemming from information exchange at transfer of care to community-based professionals during hospital discharge
- In contrast, only 15/23 (65%) of participants strongly agreed or agreed that patients experienced safety risks stemming from information exchange at transfer of care to hospital-based professionals during hospital admission however, this rate increased to 9/10 (90%) when only community pharmacists (not pharmacy technicians nor managers nor those practicing in other sectors) responses were considered.
- Free text responses were provided by 17/18 (94%) community sector respondents. Respondents provided narratives describing specifics (e.g. root causes, frustration and patient impact) of these information exchange issues at transfer. No other hospital-related safety concerns were expressed.
Many of these results align with evidence existing in the peer reviewed literature, grey literature and CPhM’s anecdotal evidence. Achieving this ‘triangulation’ of safety issues allows confidence in generating a short list for possible regulatory guidance development. Issues that have mixed signals will require further investigation into their actual impact on safety in the Manitoba context.
Next Steps in the HPD Project: HPD Phase 1: Needs Assessment is transitioning into analysis and report writing. This phase of the project will conclude in May/June with a set of recommendations and plan for development of regulatory solutions addressing priority safety issues within Manitoba hospital pharmacy.
Questions or comments related to the HPD project can be shared using the feedback form at the bottom of the webpage.