Jones Christian E L, Phipps Denham L, Ashcroft Darren M
NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, United Kingdom.
Drug Usage and Pharmacy Practice Group, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, United Kingdom.
Saf Sci. 2018 Jun;105:114-120. doi: 10.1016/j.ssci.2018.02.002.
Procedural violations are known to occur in a range of work settings, and are an important topic of interest with regard to safety management. A Safety-I perspective sees violations as undesirable digressions from standardised procedures, while a Safety-II perspective sees violations as adaptations to a complex work system. This study aimed to apply both perspectives to the examination of violations in community pharmacies.
Twenty-four participants (13 pharmacists and 11 pharmacy support staff) were purposively sampled to participate in semi-structured interviews using the critical incident technique. Participants described violations they made during the course of their work. Interviews were digitally recorded, transcribed verbatim and analysed using template analysis.
Community pharmacies located in England and Wales.
31 procedural violations were described during the interviews revealing multiple reasons for violations in this setting. Our findings suggest that from a Safety-II perspective, staff violated to adapt to situations and to manage safety. However, participants also violated procedures in order to maintain productivity which was found to increase risk in some, but not all situations. Procedural violations often relied on the context in which staff were working, resulting in the violation being deemed rational to the individual making the violation, yet the behaviour may be difficult to justify from an outside perspective.
Combining Safety-I and Safety-II perspectives provided a detailed understanding of the underlying reasons for procedural violations. Our findings identify aspects of practice that could benefit from targeted interventions to help support staff in providing safe patient care.
程序违规在一系列工作场景中都有发生，并且是安全管理领域一个重要的研究课题。安全I视角将违规视为对标准化程序的不良偏离，而安全II视角则将违规视为对复杂工作系统的适应。本研究旨在运用这两种视角来审视社区药房中的违规行为。
采用关键事件技术，有目的地抽取了24名参与者（13名药剂师和11名药房辅助人员）参与半结构化访谈。参与者描述了他们在工作过程中所犯的违规行为。访谈进行了数字录音，逐字转录，并使用模板分析法进行分析。
位于英格兰和威尔士的社区药房。
访谈中描述了31起程序违规行为，揭示了该场景下违规行为的多种原因。我们的研究结果表明，从安全II视角来看，员工违规是为了适应情况和管理安全。然而，参与者也会为了保持工作效率而违反程序，结果发现在某些但并非所有情况下这都会增加风险。程序违规往往取决于员工的工作环境，导致违规行为对违规者个人来说被认为是合理的，但从外部角度来看，这种行为可能难以解释。
结合安全I和安全II视角能够详细了解程序违规行为的潜在原因。我们的研究结果确定了一些实践方面，这些方面可能会从有针对性的干预措施中受益，以帮助支持员工提供安全的患者护理。
