administrative barriers in pharmacy

Meeting minutes of weekly implementation team meetings from Jan to August 2004 were also reviewed to confirm the themes and to clarify relationships between themes. Pharmacists’ journey to clinical pharmacy practice in Ethiopia: key informants’ perspective. Successful pharmacy bar code scanning system implementation must address not only these considerations, but also the high dispensing volume in a hospital pharmacy and the role of pharmacists as consultants to other clinicians. Major changes in the curricula have been made after a 5-year Bachelor of Pharmacy (BPharm) with a 1-year clerkship program has been launched in 2009. For example, as a consequence of human resource deficits, managers reinforced hospital pharmacists to take over the dispensing role (‘Motivation and goals’), and because of the absence of duty and weekend programs, hospital pharmacists perceived this as a lack of government funding and support, which in turn, was a result of the lack of recognition and acceptance of these extended roles (‘Social/professional role’). Because these were not usually supported with further training, most participants held a strong firm in that pharmacists who lacked the know-how about clinical services had greatly impacted the service delivery and believed they should be targets for future interventions. It comes from my own doing. For example, inadequate training, process flow issues, and technology shortcomings contributed to resistance as pharmacy staff felt overwhelmed and developed negative perceptions about the technology. The current study sheds light on hospital pharmacists’ perceptions of their clinical services, including medication reconciliation, in settings where resources are limited. Despite these promising results, few hospital pharmacies have implemented bar code scanning technology. In general, problems that occur during implementation have led to complete halt of the project,14 staff revolt,15 or even poor patient outcome.16–19 The literature documents success factors for the implementation of hospital information systems2,20–34 such as organizational leadership, the availability of capital, and product/vendor maturity. Increased time and resources would have been required to ensure that the training was appropriate for a range of skill sets and tailored to individual differences in learning curves. Harmonic divergence. . Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. Conventional content analysis across all focus groups did not reveal different themes, and thus, we present our findings according to our primary data analysis plan. Privacy Our informants reported that in situations where the staff had increased collaboration and teamwork in a new role, the response to change was a favorable one. II. PN For example, the pharmacy information system was originally set up to dispense medications at standardized times each day. . Whatever it is, however, the major facilitating factor for this was, role recognition by other staff members. Google ScholarÂ. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis. 2015;10:110. Research priority setting working group of the WHO world alliance for patient safety. W 20 examples: This type of barrier is termed an administrative barrier. LL This is especially important with the implementation of a relatively new technology like a bar code scanning system. First, the vendor should provide long-term on-site formal training and support that covers all shifts. Alemayehu B. Mekonnen. . Am J Health Syst Pharm. However, there were also pharmacists commenting seniors had the best connections with them than others and their input was better entertained although most seniors were not that much aware of cognitive services delivered by hospital pharmacists. Forty-four hospital pharmacists took part in eight focus groups, comprising four to nine participants per group (Table 1). A theory based identification of such factors provides a theoretically robust evidence base to inform implementation of an intervention [30]. In contrast to dispensing role, hospital pharmacists perceived clinical services add substantial time commitments and associated with many hardships. Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI, et al. She stated that “if a mistake is not caught [by the automated check], the patient might be at risk.” A pharmacy technician outlined her concerns about performance monitoring, saying that “some people think that this system was put into place as a way to track them and [their] performance.” These negative perceptions about technology were mitigated by its useful functionality. 2009;31(6):696–700. The present study has also identified that, in the eyes of health managers, dispensing was thought to be a core business and thus, hospital pharmacists were reinforced for other competing priorities. We encouraged these people to become champions and placed them up on pedestals so that they could set an example for the others.”. What are the barriers to entry into the pharmaceutical industry? Clinical pharmacy services, pharmacy staffing, and hospital mortality rates. 2015;10:e0136545. Oxford University Press is a department of the University of Oxford. We contacted pharmacy personnel who were either using the bar code scanning system or involved in its implementation. This is the first study to investigate the potential barriers and facilitators to implementing evidence-based medication safety activities delivered by hospital pharmacists using the TDF and is an initial step necessary for informing theory-based interventions to target these barriers. Stavri LeMaistre Overall, environmental constraints were highly referred by hospital pharmacists as being a major barrier to the delivery of medication safety activities. Hospital pharmacists play a central role in medication safety activities. Franz Callen There is no body who support us in this regard” [Referral hospital, Focus group#3]. Arch Intern Med. What are the barriers to entry into the pharmaceutical industry. N Initially, pharmacists were selected using a purposive sampling strategy, and this was further facilitated with snowball sampling. We conducted a qualitative analysis of the barriers to, and facilitators of, the pharmacy bar code scanning system implementation, taking a close look at sources of resistance and how to overcome them. Impact on medical education. Br J Clin Pharmacol. . 2013;69:995–1008. Featherstone Unlike teaching and referral hospitals, district hospitals also faced a severe shortage of other resources, such as reference books, guidelines, and computers with internet access. Pharmacy Students’ Attitudes towards Learning Communication Skills - a Study among Nordic Pharmacy Students. Also, the scanning system eliminated the pharmacists' need to spend a significant portion of time double-checking drugs that were manually dispensed or manually cross-checking the patient and medication. Duncan EM, Francis JJ, Johnston M, Davey P, Maxwell S, McKay GA, et al. ABM carried out data collection and analysis. Clinical stakeholders’ opinions on the use of selective decontamination of the digestive tract in critically ill patients in intensive care units: an international Delphi study. Content analysis revealed six domains that influence hospital pharmacists’ engagement in medication safety activities. All participants gave written informed consent, and each group was assigned a unique identifier, and anonymity was maintained at all times during the research process. LL While the prospect of changing roles led to significant resistance in some cases, the change also presented an opportunity to identify new champions to help with the implementation process. Participants also raised issues such as the lack of an evidence and guidelines that showed how much their input affects the clinical practice, and this was further supported by the lack of consistent service although hospital pharmacists were confident enough in their skills in identifying medication-related problems. is a platform for academics to share research papers. Implementation Sci. BMJ. ABM carried out the initial analysis and drafted the first manuscript. Description of 12 theoretical domains from TDF. SAGE Open Med. To what extent do you think these entries barriers protect established pharmaceutical companies from new competitors? Overwhelmingly, hospital pharmacists identified more barriers than facilitators in delivering clinical services. “Even other health care professionals are accepting our roles except those who don’t have the know-how. On the other hand, environmental constraints identified in the current study were prominent, and there was none which was mentioned as facilitator in the context of resource issues. CA Our results are consistent with barriers to CPOE system implementations that are reported in the literature.18,24,25Ash repor… Patient safety research: an overview of the global evidence. Because their level is almost equal” [Teaching hospital, Focus group#5]. Journal of Pharmaceutical Policy and Practice “Pharmacists don’t want to face hardships” [District hospital, Focus group#1]. PLoS One. As with any system implementation, training must be initiated early on. Institutional review board approval was obtained at the study site. Introducing focus groups. JS Hsieh HF, Shannon SE. Journal of Pharmaceutical Policy and Practice,, carefinancingethiopia.pdf,,, Increasing the uptake of evidence into clinical practice and improving patient outcomes needs behaviour change. The discussions approximately lasted between 60 to 90 min, and data were collected until a point of saturation was reached. Shabot Although there existed some level of recognition from various sides, yet there had been a lack of awareness regarding the role of hospital pharmacists in medication safety activities at the level of health bureau, regional or federal level. Minard LV, Deal H, Harrison ME, Toombs K, Neville H, Meade A. There are many challenges with us. PLoS Med. Rayes IK(1), Hassali MA(2), Abduelkarem AR(3). The authors would also like to thank the hospital pharmacists involved in this project for their valuable time and responses. Because of the lack of job description best suited for clinical activities, participants felt that there seemed an overlap of activities and also, other HCPs perceived as if their role was taken. Most importantly, although all participants frequently and consistently reported the ‘Environmental context and resources’ domain without variation in their views, it was found that there existed some important interlinks with the domains judged to be relevant. Patient safety has become a hot-button topic in research and media during recent years. To understand the barriers to and facilitators of this implementation, we conducted interviews of pharmacy staff, supplemented by a review of project documentation. Using the directed content analysis, barriers and facilitators perceived by hospital pharmacists as being more relevant to the delivery of medication safety activities were categorized within six of the TDF domains. Generally these obstacles are unavoidable on “…there are staffs who are not aware of the role of clinical pharmacists. Applying the TDF approach, we have for the first time identified a range of barriers, as well as facilitators in relation to hospital pharmacists’ engagement in medication safety activities. There existed considerable interrelationships between domains that were perceived to influence hospital pharmacists’ behaviours, and this may assist in designing behaviour change interventions that target common behavioural domains. A core sets of eight clinical pharmacy performance indicators have been established [38], including admission and discharge medication reconciliation. We understand that facilities have staff turnover. I. It seeks to ensure that the correct medications are dispensed to patient care units and that they carry a bar code for nurses to scan before administering the dose to a patient. Google ScholarÂ. Maybe [the leadership] did not get as much buy-in up front as we could have.” Clear communication around workload expectations during the implementation process may mitigate much of these misunderstandings and the resulting staff resistance. Lee AJ, Boro MS, Knapp KK, Meier JL, Korman NE. Article  The present study was part of a larger project aimed at implementing pharmacist-led medication safety programs (i.e., medication reconciliation) [26], and the implementation of this service was guided by a theoretical framework to help identify the barriers and facilitators to hospital pharmacists’ engagement in medication safety activities in selected public hospitals in the Amhara region, in Ethiopia. Designing an EMR planning process based on staff attitudes toward and opinions about computers in healthcare. Westbrook J, Reckmann M, Li L, Runciman W, Burke R, Lo C, et al. First, in institutions where the numbers of specialists were fewer, the input from pharmacists was taken as crucial and thus, the rate of pharmacist’s acceptance was better. In developing countries such as Africa, patient harm from adverse events is thought to be higher than elsewhere the world [5, 6]. . Although participants strongly believed that there should have been a complete provision of clinical services, these were not done because hospital pharmacists would like to prefer a less challenging job or else, as a result of human resource shortages, they had been placed for other hospital services such as dispensing roles. Mekonnen AB, Yesuf EA, Odegard PS, Wega SS. 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Although it may initially take longer with the bar code scanning system, the entire process becomes more efficient. This is the video I made as an example for my presentation about the communication in pharmacy. Fortunately, in the current study, the domains that have been found with some interrelationships were included in the priority list of behaviours for possible intervention. In addition, those HCPs who believed in team and collaborative works were the most likely candidates for promoting clinical pharmacy services. People need to practice to get used to the technique.” Consequently, as the technicians gained more experience with scanning, their comfort level with the new system increased. Duncan et al. As there were usually expert system users available, and the volume of medications requiring scanning during the NICU-pilot was low, training was on-the-job, without formal classes. “We know that pharmacists working in Debre Markos and Felege Hiwot are doing better, and have better acceptance. We presented our findings to the pharmacy leaders to verify our results. 2013;1:2050312113502959. J There were also a number of resource constraints, such as staffing, infrastructure and government funding, and acceptance rate of pharmacist’s recommendation that were likely to influence the clinical practice of pharmacists. In an effort to get the pharmacy technicians familiar with scanning, the pharmacy implemented bar code-assisted dispensing for medications destined for the neonatal intensive care unit (NICU) 1 year before full deployment of the bar code scanning system. JA On the other hand, HCPs who were supportive and ready to accept pharmacists’ input did have some know-how about clinical pharmacy or had been exposed to some form of sensitization workshops. Doorewaard Unlike the developed countries, pharmacists’ involvement in direct patient care is a recent journey in Ethiopia [24]. 2012;344:e832. volume 11, Article number: 2 (2018) GJ Cadogan CA, Ryan C, Francis JJ, Gormley GJ, Passmore P, Kerse N, et al. Role of computerized physician order entry systems in facilitating medication errors. CAS  Specifically, the role of the hospital pharmacist has been rapidly evolving beyond the traditional roles of medication dispensing and distribution to expanded clinical services [20], and their role in improving medication safety is well acknowledged. BMC Res Notes. RI Article  The mean clinical experience and age of the participants were 2.4 and 25.8 years, respectively (Table 1). To the best of our knowledge, this was the first study to apply the TDF to categorize the barriers and facilitators to hospital pharmacists’ engagement in medication safety activities. Implementation Sci. During ward visit, hospital pharmacists took medication history and used it for pharmaceutical care decisions; however, this was done inconsistently and the evidence-base was not clear to many. These domains included ‘Knowledge’, ‘Skills’, ‘Environmental context and resources’, ‘Motivations and goals’, ‘Social influences’ and ‘Social/professional role’. Communication Barriers Between Pharmacist and Patient: Literature review Liis Märss, Alar Sepp, Estonia INTRODUCTION There may be situations where the communication between client and pharmacist proves to be difficult in the pharmacy. J Multidiscip Healthc. Impact of barcode medication administration technology on how nurses spend their time on clinical care. 2012;9:e1001164. J Pharm Policy Pract. Pharmacy Daily for Wed 18 Sep 2013 - Guild claim \'exaggerated\', TWC welcomes Sclavos, Di-Gesic ruling blasted, Health . IT-adoption and the interaction of task, technology and individuals: A fit framework and a case study. Google ScholarÂ. Additionally, clinical services were rarely and irregularly documented though there were institutional variations. Unlike the environmental constraints, the barriers and facilitators that were reported by hospital pharmacists showed inter-institutional and -individual variations in the remainder of domains. Using a qualitative approach, we identified three major barriers to implementing pharmacy bar code scanning technology at our center: Processes, technology issues, and staff resistance. “…we do believe there is a severe problem of clinical pharmacy documentation. Apart from the challenges encountered with regard to knowledge and skill deficits (e.g. Staff resistance to bar code scanning system implementation was a prominent barrier identified in our interviews. . Reddy DJ Another recent study [42] has also shown a high acceptance rate of pharmacist-provided services associated with medication reconciliation as compared with other clinical services, such as those related to medication indication, efficacy, and therapeutic drug monitoring. The initial implementation of the pharmacy bar code scanning technology required a dedicated pharmacy-based medication repackaging center, which affixed two-dimensional bar codes onto the lowest unit dose of every medication that did not already have a bar code from the manufacturer.7 As the medications were picked from inventory, pharmacy technicians scanned each bar code to match the medication, strength, and dose with the pharmacist-approved physician order. Lawton R, Heyhoe J, Louch G, Ingleson E, Glidewell L, Willis TA, et al. The majority of participants also stressed that the lack of human resource was the challenge for delivering clinical services. Cohen Cina E Alsulami Z, Conroy S, Choonara I. Shawahna R, Rahman NU, Ahmad M, Debray M, Yliperttula M, Decleves X. Ongoing vendor involvement, acknowledgment of technology limitations, and attempts to address them were crucial in overcoming technology barriers. The successful implementation of this technology has been shown to reduce medication dispensing errors alone by 85%.7,9,10 In addition, emerging evidence indicates minimal impact on nursing workflow,11,12 and a positive financial return on bar code scanning technology13 from the hospital's perspective. However, little is known about the current status of the implementation of these extended services, as well as the barriers and facilitators experienced by hospital pharmacists in delivering patient care services in Ethiopian public health facilities. Patient injuries are most commonly due to adverse drug events (ADEs), which occur at a rate of 6.5% or approximately 1,900 ADEs per hospital per year.1–3 Many of these ADEs are caused by medication errors and are by definition preventable. Laird In addition, government recognition and supervision of hospital pharmacists’ clinical services have been cited as a main driving factor, and participants perceived these services should not have been confined to few settings and national endorsement of these services have been found to be necessary. . Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital. Ash Using a qualitative approach, we identified three major barriers to implementing pharmacy bar code scanning technology at our center: Processes, technology issues, and staff resistance. statement and Article  Objective — To establish the perceived barriers to the implementation of pharmaceutical care into community pharmacy practice in different European countries and the relative importance of these barriers.. “As any human, they [hospital pharmacists] might prefer a less challenging job” [Referral hospital, Focus group#4]. Although some pharmacists and technicians expressed preference for a more incremental implementation, pharmacy leaders preferred the big-bang approach because they felt they had the political capital to execute a series of significant workflow changes and that momentum for these changes would be lost if they were introduced individually. Although these barriers were significant, our informants identified strategies to overcome them. E “We are going far from the place where we are, but other HCPs follows patients at their own site” [District hospital, Focus group#6]. Implementing. “So, the changes I have seen at the management is like incentives for us” [Mixed hospitals, Focus group#8]. Introducing physician order entry at a major Academic Medical Center. Pharmacists were recruited from four teaching/referral and four district hospitals, and there were a total of 252 pharmacy staffs (pharmacists, 140; pharmacy technicians, 112) working in the studied hospitals at the time of data collection. Keohane 2016;11:113. Barriers to good communication can be spilt into two main groups: physical and emotional (see Panel 2). One pharmacy leader explained that batteries drained because users were holding down the scan button continuously, causing bar codes to repeatedly scan. Our case suggests that these principles hold true not only for physicians but also for pharmacists and pharmacy technicians with varying backgrounds, responsibilities and levels of education. As with any large project, the pharmacy bar code scanning system implementation had to overcome a few unexpected challenges, which usually involved workflow redesign. They are not clinical based” [Referral hospital, Focus group#3]. Pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis. Most hospital pharmacists believed knowledge gap was an issue, as was the lack of training and supportive skills although some expressed as they were competent enough for their skills in identifying medication related problems. The present study identified a wide range of factors that may influence the uptake of medication safety interventions delivered by hospital pharmacists. Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. The practice of pharmacy has seen major changes in the past decade. Pharmacotherapy. Computerization can create safety hazards: A Bar-coding near miss. et al. Champions were well-respected pharmacists and technicians who took on leadership roles during system implementation by encouraging users to look beyond any immediate frustrations, working through hurdles with them, and reminding them of the system's downstream benefits. Participants mentioned that clinical pharmacy services were included as one of the hospital standards and had been getting the support from government policy side, and thus, no health care staff opposed the existences of these services. Implications for prevention. Lipworth W, Taylor N, Braithwaite J. However, in Ethiopia, this role has been launched recently and little is known regarding the current status of this extended service. Some pharmacists and pharmacy technicians perceived that the pharmacy staff was “led to believe that [the new system] would make the work a lot easier” when it in fact initially involved “a lot more work.” One pharmacy leader explained that “some of the technicians didn't see the big picture. Perceptions of house officers who use physician order entry, Computerized physician order entry and communication: Reciprocal impacts, Basics of Qualitative Research. 2012;68:1339–45. 2005;14:26–33. JAMA. A cross-country comparison of intensive care physicians’ beliefs about their transfusion behaviour: a qualitative study using the theoretical domains framework. The hospital pharmacy employs sixty-one full time equivalent pharmacists and 45 full time equivalent pharmacy technicians. 2015;15:83. R Bates BASIS OF APPROPRIATE ADMINISTRATIVE PROCEDURES 8 Good Governance 8 Commitment to an Environment That Enables Private Sector Development 9 Costs of Administrative … It was mentioned that the hospital standards currently ratified by the government well advocated the integration of pharmacists in care teams. Lorenzi Acceptance of recommendations by inpatient pharmacy case managers: unintended consequences of hospitalist and specialist care. JS Article  This was revised when pharmacists suggested that they would like the ability to schedule the first dose of a medication at a different time than the remaining doses. The pharmacy leaders identified alternate manufacturers with bar codes that were easier to scan. 2014;83:572–80. Carcillo Derived from the TDF, the factors identified in this study were clustered into six domains: ‘Knowledge’, ‘Skills’, ‘Environmental context and resources’, ‘Motivations and goals’, ‘Social influences’ and ‘Social/professional role’. Even though most technicians were familiar with scanning and were given additional informal training, this was a challenging period. 2013;13:530. Cookies policy. JL Many informants reported other cases where continuous improvement principles were successfully incorporated into the system implementation process. The biggest responsibility is to the government for other staffs to consume pharmacist’s input” [Referral hospital, Focus group#2]. Eight focus group discussions, using an interview guide that was drawn upon the TDF, were conducted with 44 hospital pharmacists to explore their beliefs regarding their involvement in clinical services. Research in Social and Administrative Pharmacy (RSAP) publishes monthly/twelve times per year, featuring original scientific reports, comprehensive review articles, proposed models, and provocative commentaries in the social and administrative pharmaceutical sciences.Topics of interest include outcomes evaluation of drug … R Medication dispensing errors and potential adverse drug events before and after implementing Bar code technology in the pharmacy. KM Bouvy JC, De Bruin ML, Koopmanschap MA. Salmasi S, Khan TM, Hong YH, Ming LC, Wong TW. Weiss . WR 2009;67:656–61. Background In some countries, such as Portugal, clinical pharmacy services in the hospital setting may be implemented to a lower extent than desirable. The TDF from health psychology provides the basis for such an approach, ensuring that a wide range of possible theoretical explanations for the behaviours can be considered. Karsh National Assessment on the Implementation Status of Clinical Pharmacy Service at Public Hospitals in Ethiopia. PubMed Central  You can complete the definition of administrative barriers given by the English Definition dictionary with other English dictionaries: Wikipedia, Lexilogos, Oxford, Cambridge, Chambers Harrap, … Notably, government’s commitment to enact on behalf of the hospital pharmacist’s impact in the health care system has been found more influential than ever, and the likelihood of accepting pharmacists extended roles to other staffs is possibly geared by the government’s pressure. Unlike other clinicians, for example, there had not been any room available for practicing pharmacists nearby to the wards they were working. “Even the trainings are more focused on system strengthening like APTS [Auditable Pharmaceutical Transactions and Services] and they are so much science oriented. Several strategies for choosing a vendor were suggested. DW Implement Sci. Doubling the income of an importing country is associated with a 6% decrease in per-shipment costs. Implement Sci. Many opportunities exist for hospital leaders and policy makers to facilitate the adoption of pharmacy bar code scanning systems. 2006;166:955–64. Accessed 11 Jan 2018. Kohn LT, Corrigan JM, Donaldson MS, editors. Selection of participants also considered variations in health service structure (teaching/referral and district) to capture a wide range of beliefs in the clinical practice of pharmacists. Given the positive impact of pharmacist-led medication reconciliation services [22, 23], and the evidence that these services have shown better acceptance [42], it is our opinion that pharmacists’ clinical services in the studied hospitals, mainly those above the district level, might be well utilized if they could able to implement medication reconciliation services. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated. Iller I don't think it was the additional information on the labels [that changed how we work together but it was instead] a result of needing each other to get the system implemented.” This collaboration and teamwork further fostered self-motivation and information sharing. Using a theory-based approach, the present study uncovers additional relevant barriers—for example, the lack of knowledge and skills necessary for the execution of clinical services and poor acceptance of pharmacists’ recommendation. medication safety activities delivered by hospital pharmacists) that we would like to intervene have certain unique features as compared to other studies. “It is not fair to cancel the Saturday and Sunday services. Prevention of medication errors: teaching and training. The literature on pharmacy bar code scanning technology is sparse9,10,35 and focuses on clinicians' use of these systems after they have been implemented36–38 rather than on the implementation process itself. We hope that other health care centers can use these lessons learned to realize the full benefits of bar code scanning technology. Method — Structured interviews with representatives from national pharmacists' organisations or … 2016;41:128–44. 1999;282:267–70. Mirbaha F, Shalviri G, Yazdizadeh B, Gholami K, Majdzadeh R. Perceived barriers to reporting adverse drug events in hospitals: a qualitative study using theoretical domains framework approach. Minard et al. If given the support from the management, participants considered this as their major driving force for their motivation. Cite this article. et al. The bar code scanning technology also facilitated collaboration and teamwork, which served as a catalyst for system adoption. California Privacy Statement, “…those [pharmacists] who have knowledge about the service, and know what the service is about, support the service we are doing. However, creating something out of nothing was challenging, and lacked remuneration, and a concern among the majority of hospital pharmacists. Yoo Communication is critical, notonly in the pharmacy environment but in any environment where there are people ‘present'.The clinical role of the pharmacist means that there are plenty ofopportunities to communicate with the patient and with other healthprofessionals. . In most of the studied hospitals, pharmacy own documents prepared for the purpose of recording clinical activities were not part of the medical record, or if it had been in place, pharmacist’s documentation was done infrequently. Poon Washington: National Academy Press; 2000. The channel structure of the pharmaceutical industry, in part because of the level of regulation applicable to it, has the potential for idiosyncratic strategic behaviour. Hardware problems were largely related to scanning equipment. BMC Pediatr. Vermeulen KM, van Doormaal JE, Zaal RJ, Mol PG, Lenderink AW, Haaijer-Ruskamp FM, et al. Although these barriers were significant, our informants identified strategies to overcome them. [45] have also confirmed that Ethiopian graduate pharmacists are very much enthusiastic to promote clinical pharmacy service but the challenge is the minimal effort made at the level of institutions. H Based on prior work related to the implementation of both CPOE2,24,39,40 and the bar code scanning system, we developed a semi-structured interview instrument to elicit the pharmacy staff's perceptions of barriers to, and facilitators of, the bar code scanning system implementation in the hospital pharmacy. MM The frequency and potential causes of dispensing errors in a Hospital Pharmacy. . Pharmacists' perceptions of the barriers and facilitators to the implementation of clinical pharmacy key performance indicators. E Important safety issues introduced by clinician use of bar code scanning systems, such as degraded coordination between nurses and physicians,37 nurses dropping activities to reduce workload during busy periods37 and changes in communication between nurses38 have been reported in the literature. Computerized physician order entry systems in hospitals: Mandates and incentives. Bilal et al. All authors conceptualized the study. Barcode Medication Administration Understanding patient safety risks. Learning curves, taking instructions, and patient safety: using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors. 2013;17:R266. Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the theoretical domains framework. In a large hospital, these error rates can translate to more than 45,000 undetected dispensing errors annually.6–8. While the analysis of the interview data indicated major differences in individual thoughts related to hospital pharmacists’ knowledge, skills, and social/professional role as well as their motivation and goals, inter-institutional variation mainly appeared in the social influence domain. All participants expressed a desire for further trainings and certifications to target their knowledge and skills gaps; this was also a motivating factor for delivering these services. Beso The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. PLoS One. Before, we did weekend services, and even there was duty program and we did CP service and those things at least moralize us” [Referral hospital, Focus group#1]. Karen C. Nanji, MD, MPH, Jennifer Cina, PharmD, Nirali Patel, PharmD, William Churchill, MS, Tejal K. Gandhi, MD, MPH, Eric G. Poon, MD, MPH, Overcoming Barriers to the Implementation of a Pharmacy Bar Code Scanning System for Medication Dispensing: A Case Study, Journal of the American Medical Informatics Association, Volume 16, Issue 5, September 2009, Pages 645–650, J of Pharm Policy and Pract 11, 2 (2018). Objective To report the frequency of 27 enhanced pharmacy services (EPS) provided in Australia's community pharmacies and to analyse barriers and facilitators for providing priority services. PubMed Central  Pharmacy bar code scanning technology offers a new strategy to address medication errors in the hospital setting. Research in Social & Administrative Pharmacy (in press, online first 28 March 2017: DOI: 10.1016/j.sapharm.2017.03.055), reprinted with permission from Elsevier. Principles for a successful computerized physician order entry implementation. MC Another study’s limitation was that it involved a homogeneous group of participants; that is, only pharmacists who taught in the newly designed patient-oriented curricula were included. “Even we are busy of reading at home, it is not different from an academic life” [Teaching hospital, Focus group#5]. 1995;311(7000):299–302. Martin Bennett, who owns Wicker Pharmacy in Sheffield, has noticed an increase in the number of languages spoken by the patients he has helped over the years. PubMed Google Scholar., DOI: Physicians' use of electronic medical records: Barriers and solutions. JS Venkataraman Another reported, “I now have the ability to see dosing frequencies and understand the principles of drug regimens!” Increased information empowered the technicians and pharmacists to be more involved in the pharmacy processes, leading to an increased sense of involvement in patient care. Gorman medication administration. Braithwaite Medication errors in the Middle East countries: a systematic review of the literature. [38] reported that the challenges surrounding hospital pharmacists’ implementation of these indicators comprised of documentation challenges, work burden, environmental constraints and competing priorities. However, most pharmacists hesitated whether this had been met, given the lack of government funding and support for these services. The use of information technology in improving medical performance. Berg Available from: carefinancingethiopia.pdf. One respondent explained that the pharmacists “rely on the system more and more to be accurate … When it's down, (we) run into a hard time.” Another expressed a safety concern with the shift from manual checks to automated checks. M The principal investigator (ABM) conducted and led the FGDs using the translated version (Amharic) of the topic guide. Ten pharmacy staff were interviewed about their experiences during the implementation. Addis Ababa: PFSA and SIAPS; 2016. Ash Systems: Their occurrences, causes and threats to patient safety. “Nowadays, there is also support from the management and this has been increased from time to time, and this is a motivating factor by itself” [Mixed hospitals, Focus group#8]. For example, during the initial system implementation, three days worth of medication were dispensed at a time, known as a “three-day fill”. PubMed  Also, our previous systematic reviews confirmed the positive impact of pharmacists, particularly when pharmacists are engaged in medication reconciliation at care transitions [22, 23]. . Jaggi A coding guide was prepared based on previously published definitions [31, 36] and utilized for the purpose of consistent reporting (Additional file 2). C Even, you can see that some pharmacists are not attending our morning session” [Referral hospital, Focus group#3]. However, when you come to the department of clinical pharmacy, there is a problem in the way pharmacists are looking at the service. Tonnesen Part of Accessed 7 Mar 2017. Pharmaceuticals Fund and Supply Agency (PFSA) and Systems for Improved Access to Pharmaceuticals and Services (SIAPS). Practical guide to Bar coding for patient medication safety. Barriers and facilitators to hospital pharmacists’ engagement in medication safety activities: a qualitative study using the theoretical domains framework. . This practice was originally intended to limit the number of daily fills by increasing the volume of medications dispensed. In this instance, it might be difficult to determine the origin of barrier and facilitator and prioritize interventions [48]. Rosenthal MM, Breault RR, Austin Z, Tsuyuki RT. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Certain pharmacy technicians thought that they were not adequately trained and identified this as an obstacle to system implementation. We don’t know what will happen and in that sense, we are trying our best” [District hospital, Focus group#6]. ST Gadd Particularly, hospital pharmacists working in district hospitals clearly indicated their interventions were better entertained and accepted by other health care members, and there was an increasing demand for these services—for example, expressed in the number of telephone inquiries and consultations received in these hospitals. We identified three main barriers (Fig 1) to pharmacy bar code scanning technology implementation at our hospital and strategies to overcome them. In contrast to other studies which also judged beliefs about capabilities [49], beliefs about consequences [33, 49], memory/attention and decision processes [32, 35, 49] as relevant domains for a successful medication safety intervention, these domains in our study were described infrequently (‘Memory/attention and decision processes’) and varied little (‘Beliefs about capabilities’), and participants were confident enough in the positive impact of clinical pharmacy services (‘Beliefs about consequences’). JI The questions were initially drafted by one researcher (ABM) and then refined by health service researchers (AJM, JEB) and discussed by the research team to check for clinical relevance. There was a considerable variation in the clinical practice of pharmacists among institutions—for example, there were institutions that praise the role of hospital pharmacists and yet, there were who had seen them as fault finders. Islam R, Tinmouth AT, Francis JJ, Brehaut JC, Born J, Stockton C, et al. Physician-support tools. Ammenwerth Pharm Pract. Three main negative perceptions were identified through the interviews: overdependence on technology, potential for harm, and concerns about increased performance monitoring. This study has several strengths and limitations. A range of conflicting views regarding hospital pharmacists’ motivation and goals were collected. Conventional content analysis was also conducted, and both analyses approaches were employed so as not to miss any themes [35]. “Now, most of us are doing this work because we are interested in this” [District hospital, Focus group#6]. M BMC Health Serv Res. Many participants emphasized why hospital pharmacists lacked the inspiration for delivering clinical services, whereas they mentioned that the curriculum is very much patient oriented unlike the previous courses, yet there were few hospital pharmacists struggled into the duty of dispensing with the mere reason of collecting an additional benefit from the extra hours, but this was not arranged for clinical services. Mekonnen, A.B., McLachlan, A.J., Brien, Ja.E. “With seniors, there is no problem to accept your recommendation. 2015;38:437–53. For instance, medication review was done with a limited scope, and there were no organized ways to perform medication reconciliation. et al. The issue of medication safety has received increased attention since the publication of To Err is Human: Building a Safer Health System [1] in the USA, and is now a concern of many other countries [2,3,4]. Churchill Hospital pharmacists expressed their beliefs from the broader array of these services, and beliefs for each of the afro mentioned domains should have been thus, viewed from that angle. Implementing information systems in health care organizations: Myths and challenges. These included hardware and software problems, and the role of vendors. This, in turn, encouraged users to find creative alternatives to scanning. ADE Prevention Study Group. Ash There are staffs who ask us what we are doing in the ward, on the other hand, there are who eagerly want us, and even among these, there do have various perceptions of the profession” [Referral hospital, Focus group#2]. 2. Using the TDF, this study identified a wide range of barriers and facilitators to hospital pharmacists’ engagement in medication safety activities in resource-limited settings. However, the implementation team promptly identified the improper technique and technicians were appropriately re-educated. Int J Med Inform. JL Koppel The Ethiopian health care system is challenged by poor health care financing, and close to 80% of the health expenditure is dependent on out-of-pocket expense [28], and the population mainly receives health services from public health institutions. We also understand that you are frequently asked to do more … DW Find out why barriers to entry for U.S. drug companies are so high and how the Food and Drug Administration, or FDA, inhibits competition in pharmaceuticals. “…we are working for the benefit of the profession, not for us, we are paying our life, and we are wishing only the best future” [District hospital, Focus group#6].“…we are working expecting the future might be bright” [District hospital, Focus group#6]. Proc of the AMIA Annu Spring Congress, AMIA. The study was conducted between February and August 2016. Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A, et al. Eur J Clin Pharmacol. 2016;11:e0152903. Barriers to pharmacy practice change: Is it our nature or nurture? 2015;10:161. Bane Bussières AE, Patey AM, Francis JJ, Sales AE, Grimshaw JM, Canada PRIme Plus Team, et al. E Epidemiology of adverse drug reactions in Europe: a review of recent observational studies. Quantifying nursing workflow in medication administration. Mekonnen AB, McLachlan AJ, Brien JE. However, few pharmacists believed there were a lack of distinction between technical and clinical services and role duties for pharmacists from the government itself. Trainings were arranged occasionally; however, most were not suitable to the interest of strengthening clinical pharmacy services. All the authors have read and approved the final manuscript. For example, the region allows duty only for dispensing, and for this reason, at least to collect 500 or 600 birr for the duty program we are doing it rather than the clinical service. 2010;19:42e47. Although these differences represent unique organizational and interpersonal challenges that contribute to resistance, they can also be leveraged to overcome the resistance. ‘Social/professional role’, ‘Social influence’), awareness creation campaigns targeting the whole medical community (including the management, other pharmacists, and HCPs) may possibly facilitate the uptake of pharmacist’s cognitive services. Coiera Springer Nature. In comparison with other studies using the TDF framework, the domains ‘Knowledge’, ‘Skills’, ‘Environmental context and resources’, ‘Social influences’ were identified as vital areas which could be targeted in the implementation of medication safety programs [32, 33, 35], although other issues such as, ‘Motivation and goals’ [32, 33] and ‘Social/professional roles’ [32] were also equally important. Brittany Myers-O'Shea, PharmD, is a Pharmacy Manager of a high volume store for a large retail chain in the Northeast. JL Although this is not necessarily an administrative barrier, it may indicate that health professionals should look to raise awareness and provide comprehensive training for INSPECT users. CS – Barriers to entry and entry deterrent strategies are widely discussed elements of the strategic literature and help define the attractiveness of an industry. PubMed  DJ Blumenthal Google ScholarÂ. Dykstra Hospital pharmacists urged concerned bodies in support of these services through a remuneration scheme, and they believed this would likely bring major changes in the clinical practice of pharmacists. Using the 12 domains of the TDF as a coding framework, directed content analysis of texts into the theoretical domains was performed [37]. J Am Pharm Assoc (2003), 2011;51:363–7. Acad Med. Kuperman Implement Sci. Westbrook ABM, AJM, JEB, DM and ZA have all made significant contributions to the scientific content of this manuscript. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. For each of the 12 domains that could act as facilitators or barriers to current medication safety practices, the authors developed several interview questions. Faculty of Pharmacy, University of Sydney, Pharmacy and Bank building (A15), Sydney, NSW, 2006, Australia, Alemayehu B. Mekonnen, Andrew J. McLachlan & Jo-anne E. Brien, School of Pharmacy, University of Gondar, Gondar, Ethiopia, Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia, Department of Internal Medicine, University of Gondar, Gondar, Ethiopia, You can also search for this author in Effect of bar-code technology on the safety of medication administration. A For example, one informant explained, “the system allows me to track things better; if a medication is sent wrong, I can track who, what, when and why it happened.” Informants acknowledged the usefulness of the increased information in preventing medication errors. Staff resistance was addressed through clear communication, identifying champions, emphasizing new information provided by the system, and facilitating collaboration. Additionally, an important point worth discussing is regarding the targeted behaviour (i.e. Pharmacists’ self-perception of their professional role: insights into community pharmacy culture. Lavelle Drug Saf. Poon Qual Saf Health Care. As a result, many pharmacists preferred dispensing to clinical services. And because of this, most pharmacists preferred dispensing to clinical services. Much debate around this issue has been documented in the literature.17 Although our work cannot universally endorse the big bang approach, in this case it seemed to be a reasonable choice. Computers in ambulatory care: implications of physician practice patterns for system design. NM Interview guides were translated from English versions to the local language (Amharic) by two non-official translators who are native speakers and working in the health care industry and validated by two of the research group (ABM, DM). Electronic prescribing reduces prescribing error in public hospitals. . Hurley JB Medication reconciliation as a medication safety initiative in Ethiopia: a study protocol. In this study, FGDs were guided by questions designed based on the TDF (Additional file 1). But, later we understood that this domain had significant interactions with hospital pharmacists’ viewpoints expressed in the other domains considered as relevant in this study, such as motivation and goals, social influences and social/professional role. Patient barriers Perceptions and prejudice Administrative and financial barriers Time barriers. Sada O, Melkie A, Shibeshi W. Medication prescribing errors in the medical intensive care unit of Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. 2016;6:e010003. Pharmacy leaders also recognized the importance of training to the system implementation process. 2016;9:7. Hospital pharmacists play a central role in medication safety activities. “There are times when the physicians don’t start round unless the clinical pharmacist is available” [District hospital, Focus group#6]. ADE Prevention Study Group. To identify means to overcome communication barriers. Outside pharmacists, participants highlighted that other HCPs recognition of pharmacist’s roles in medication safety activities was limited; however, a recent local study reported that a large proportion of HCPs had a positive attitude towards clinical pharmacy services but the extent of the available service was below their expectation [44]. Cuthbertson BH, Campbell MK, MacLennan G, Duncan EM, Marshall AP, Wells EC, et al. et al. A consensus statement on considerations for a successful CPOE implementation. As one pharmacist described, “They weren't embracing the system because they were accustomed to doing something for a long time and all of a sudden they had this thrown at them.” For example, pharmacy technicians who had previously spent a significant amount of time crediting unused medications had to eliminate that activity and learn how to use the bar code scanner. Eshetie TC, Hailemeskel B, Mekonnen N, Paulos G, Mekonnen AB, Girma T. Adverse drug events in hospitalized children at Ethiopian university hospital: a prospective observational study. Bilal AI, Tilahun Z, Gebretekle GB, Ayalneh B, Hailemeskel B, Engidawork E. Current status, challenges and the way forward for clinical pharmacy service in Ethiopian public hospitals. PubMed  Various mentions were given for this. T Hersh As one technician reported, “If it didn't scan right away, we would manually override everything.” Another expressed a concern with scanning multiple doses of the same medication. PubMed  Participants expressed mixed views regarding the level of knowledge and skill necessary for complete delivery of clinical services and most believed there was a lack of awareness for those pharmacists’ extended roles. Regarding medication safety activities delivered by hospital pharmacists, it was mentioned that professional compatibility was not a concern but what matters was the lack of understanding of the profession’s mission in the eye of other health care cadres. 2015;8:448. Ranges of resource constraints were raised as barriers. C lack of supportive skills such as blood pressure measurement, and knowledge about rare diseases/diagnosis)—participants associated this with the challenges in the currently designed curricula, hospital pharmacist’s roles in medication safety were poorly understood in the medical community. As compared to interns, the GPs [General practitioners] accept you better” [Referral hospital, Focus group#3]. To address many of these technology issues, pharmacists and pharmacy leaders identified the role of vendors as a critical success factor. However, we adopted the relevance criteria utilized by previous studies for prioritizing domains of potential interventional targets [32, 34]. Another problem occurred when some products had bar codes on reflective surfaces that were difficult to scan. Although hospital pharmacists were very much enthusiastic for new roles, these were in fact, influenced by the lack of acceptance of their role to other members of the health care team and lack of managerial support in implementing clinical pharmacy services. Crit Care. 2013;33:11–21. Method Questionnaires were mailed to owners or … Making psychological theory useful for implementing evidence based practice: a consensus approach. “…as you most satisfied with these [staff benefits], you will going to do more interventions, and these can bring a good outcome” [Referral hospital, Focus group#4]. Tucker To target other domains (e.g. Workarounds to Barcode Medication Administration. Barber Bates 2011;4:377–82. The underpinning theoretical model used in this study is the Theoretical Domains Framework (TDF). It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Fernandez-Llamazares CM, Calleja-Hernández MÁ, Manrique-Rodríguez S, Pérez-Sanz C, Durán-García E, Sanjurjo-Sáez M. Prescribing errors intercepted by clinical pharmacists in paediatrics and obstetrics in a tertiary hospital in Spain. I take it upon myself to fulfill the responsibilities.”. Can the theoretical domains framework account for the implementation of clinical quality interventions? Ten interviews were conducted by two investigators between Dec 2004 and Aug 2005. Participants also believed that, as a result of the cancellation of weakened and duty programs which were practiced before, staffs thought that this was the least incentive they were thinking of, and this had affected their moral negatively. Food, Medicine and Health Care Administration and Control Authority. We analyzed the interview notes for common themes with the aid of ATLAS.ti software (Scientific Software Development, Berlin). To date, standards and guidelines have been endorsed nationally—for example, the Ethiopian Hospital Reform Implementation Guidelines that require pharmacists to deliver direct patient care services, and this is taken as a minimum regulatory standard in the health facilities by the Ethiopian Standards Authority and the Ethiopian Food, Medicine and Health Care Administration and Control Authority (FMHACA) [25]. A However, they are also the major source of patient safety incidents [1]. BD Arch Intern Med. Furthermore, unlike physicians, pharmacy technicians are generally employees of the hospital and not as influential in the decision making process since their activities are not directly tied to hospital revenues. A previous national study has also shown that close to two-thirds of pharmacists delivering clinical pharmacy services are dissatisfied with their job, and this is mainly due to unattractive incentive packages [25].

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