Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, Room 1.132, Stopford Building, Oxford Road, Manchester, M13 9PL, UK.
Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, Room 1.183, Stopford Building, Oxford Road, Manchester, M13 9PT, UK.
Int J Clin Pharm. 2024 Oct;46(5):1114-1123. doi: 10.1007/s11096-024-01743-9. Epub 2024 Jun 1.
Standardisation, a widely accepted concept for risk management, entails designing and implementing task-specific operating procedures. In community pharmacies, Standardised Operating Procedures (SOPs) are a mandatory requirement and are recognised as essential for upholding safety and quality.
This study aimed to investigate community pharmacists' (CPs) compliance with SOPs when checking prescriptions, and the reasons for variations between standardised protocols and practice.
Eight sets of SOPs underwent hierarchical task analysis (HTA) to generate a normative description of clinical checking execution as per protocols. Subsequently, twelve CPs were engaged in a simulated clinical checking exercise, verbalising their thoughts while checking virtual prescriptions. Transcribed data underwent content analysis, aligned with a descriptive model to uncover engagement patterns, and disparities between SOPs and CPs' practices. Finally, a focus group discussion took place to contextualise the observed variations.
HTA aided in constructing a clinical checking model with six primary subtasks and 28 lower subtasks. CPs often omitted subtasks during checks, diverging from prescribed protocols. These deviations, observed in controlled environment, reveal an ingrained aspect within the professional culture of pharmacists, where there may be a tendency not to strictly adhere to protocols, despite variations in work conditions. Contributing factors to this culture include the exercise of professional judgment, reliance on others, and prioritisation of patient preferences.
This study highlights ongoing deviations from SOPs during clinical prescription checks in community pharmacies, suggesting a cultural tendency. Future research should delve into risk management strategies for these deviations and address the delicate balance between flexibility and stringent compliance.
标准化是风险管理中广泛接受的概念，需要设计和实施特定任务的操作程序。在社区药店，标准作业程序（SOP）是强制性要求，被认为是确保安全和质量的关键。
本研究旨在调查社区药剂师（CPs）在检查处方时遵守 SOP 的情况，以及标准化协议与实践之间存在差异的原因。
对八套 SOP 进行层次任务分析（HTA），根据协议生成临床检查执行的规范描述。随后，十二名 CP 参与了一项模拟临床检查练习，在检查虚拟处方时口头表达他们的想法。转录数据进行内容分析，与描述性模型对齐，以揭示参与模式和 SOP 与 CP 实践之间的差异。最后，进行焦点小组讨论，使观察到的差异具有背景。
HTA 有助于构建具有六个主要子任务和 28 个较低子任务的临床检查模型。CP 在检查过程中经常省略子任务，偏离了规定的协议。这些在受控环境中观察到的偏差揭示了药剂师专业文化中的一个固有方面，即存在不严格遵守协议的倾向，尽管工作条件存在差异。造成这种文化的因素包括专业判断的行使、对他人的依赖以及对患者偏好的优先考虑。
本研究强调了社区药店临床处方检查中持续存在的偏离 SOP 的情况，表明存在一种文化倾向。未来的研究应深入探讨这些偏差的风险管理策略，并解决灵活性和严格遵守之间的微妙平衡。
