How do interruptions and distractions affect pharmacy practice? A scoping review of their impact and interventions in dispensing.

BACKGROUND

Pharmacists play a crucial role in reducing medication errors, identifying 30-70 % of medication-ordering errors. However, they can also contribute to dispensing errors. Interruptions and distractions during dispensing have been known to account for approximately 9.4 % of these errors, with reported occurrences of every two to six min.

OBJECTIVE

To review existing knowledge on the impact of interruptions and distractions in pharmacy practice, including their frequency, types, and previously implemented or proposed strategies for mitigation.

METHODS

This scoping review followed the Joanna Briggs Institute (JBI) methodology and was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive search of Ovid Medline, Web of Science, Embase, CINAHL, and Scopus databases was conducted on June 26, 2024, November 13, 2024, and January 16, 2025. Studies were selected based on predefined inclusion and exclusion criteria. Descriptive statistics summarised study characteristics, while content analysis identified common types of interruptions and distractions, their frequency, impact, and the interventions used or recommended.

RESULTS

After removing duplicates, 7884 studies proceeded to title and abstract screening. Following the application of inclusion and exclusion criteria, 141 full-text studies were assessed, and 51 were included in the review. Pharmacists and technicians experience interruptions and distractions at varying rates, from less than 5 to more than 20 times per hour. The most common external interruptions and distractions were phone calls, face-to-face inquiries from consumers, as well as interruptions and distractions from shop staff who needed to interrupt the pharmacist to manage customer queries that were out of their scope. Internal interruptions included self-initiated task-switching, checking on staff, and non-work-related web browsing. These disruptions primarily impacted the dispensing process, pharmacists' workload, performance, well-being, and patient wait times. Few interventions have been implemented, falling into three main categories: facility modification (adjusting the physical environment), system modification (altering workflow processes), and communication adjustments (limiting direct access to pharmacists during dispensing).

CONCLUSION

There are both limited reported interventions in the pharmacy workplace, and a lack of educational initiatives at the university setting, to mitigate the impact of interruptions and distractions. These findings highlight the need to establish better foundational dispensing habits and develop methods to reduce the frequency of directly accessing the pharmacist during dispensing. Avoiding having a single pharmacist on duty at any given time and clearly defining the roles of different pharmacists during various shifts may be effective ways to reduce dispensing errors.