So Bethany, Tuche Mallory, King Michelle A, Hope Denise L, La Caze Adam, Hattingh H Laetitia
School of Pharmacy and Pharmacology, Griffith University, 4072, Queensland, Australia.
School of Pharmacy and Pharmacology, Griffith University, 4072, Queensland, Australia; Quality Use of Medicines Network, Griffith University, 4072, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, 4072, Queensland, Australia.
Res Social Adm Pharm. 2021 Feb;17(2):372-380. doi: 10.1016/j.sapharm.2020.03.011. Epub 2020 Apr 7.
Studies have explored community pharmacy ethical dilemmas; however, limited research exists on hospital pharmacy ethical issues and pharmacists' ethical decision-making processes. Research exploring this is timely, considering developments in hospital pharmacy practices, new hospital pharmacist roles, and evolving responsibilities.
AIM/OBJECTIVES: To explore hospital pharmacists' ethical decision-making and processes for managing ethical challenges in the context of evolving Australian hospital pharmacy practices.
Face-to-face semi-structured interviews with 20 purposively-selected hospital pharmacists from four Queensland Health hospitals. An interview guide with 11 open-ended questions and prompts was developed, validated, and trialed. Pharmacists who consented received the guide prior to interviews. Interviews were audio recorded, transcribed verbatim, and compared with field notes. Transcribed data were imported into NVivo 12 to facilitate coding and thematic analysis.
Participants were interviewed January to April 2019; median interview duration was 17.45 min. Data saturation was reached. Participants' experiences ranged from junior level pharmacists to senior management positions, in clinical and non-clinical roles. Emerging themes were: 1) influences on the development of ethical decision-making skills, 2) ethical decision-making is an integral part of the hospital pharmacist's role, and 3) institutional requirements and settings impact on ethical exposure. A wide range of contemporary ethical issues unique to hospital pharmacy practice, mostly involving complex medication management safety, supply, and cost scenarios, were identified. Junior pharmacists indicated they would benefit from additional training, mentorship, and availability of hospital-specific targeted ethics resources.
The findings highlighted that hospital pharmacists are regularly faced with ethical issues unique to the hospital pharmacy practice context. Application of sound and structured ethical reasoning and decision-making is, therefore, required in this setting. Participants identified many interrelated factors that impacted their ethical reasoning and behaviour. This study identified gaps that, once addressed, will better support ethical reasoning in hospital pharmacy settings.
已有研究探讨了社区药房的伦理困境；然而，关于医院药房伦理问题及药剂师伦理决策过程的研究却很有限。鉴于医院药房实践的发展、医院药剂师新角色以及不断演变的职责，开展此类研究很有必要。
探讨在澳大利亚医院药房实践不断演变的背景下，医院药剂师的伦理决策以及应对伦理挑战的过程。
对来自昆士兰卫生部门四家医院的20名经过有目的挑选的医院药剂师进行面对面半结构化访谈。编制了一份包含11个开放式问题及提示的访谈指南，并进行了验证和试用。同意参与的药剂师在访谈前收到该指南。访谈进行了录音，逐字转录，并与现场笔记进行比较。转录的数据被导入NVivo 12软件以方便编码和主题分析。
2019年1月至4月对参与者进行了访谈；访谈的中位时长为17.45分钟。达到了数据饱和。参与者的经验涵盖从初级药剂师到高级管理职位，涉及临床和非临床角色。新出现的主题有：1）对伦理决策技能发展的影响，2）伦理决策是医院药剂师角色的一个组成部分，3）机构要求和环境对伦理暴露的影响。确定了一系列医院药房实践特有的当代伦理问题，大多涉及复杂的药物管理安全、供应和成本情况。初级药剂师表示，他们将受益于额外的培训、指导以及获取医院特定的针对性伦理资源。
研究结果突出表明，医院药剂师经常面临医院药房实践背景特有的伦理问题。因此，在这种情况下需要运用合理且结构化的伦理推理和决策。参与者确定了许多影响其伦理推理和行为的相互关联因素。本研究确定了一些差距，一旦解决，将能更好地支持医院药房环境中的伦理推理。
