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When procedures meet practice in community pharmacies: qualitative insights from pharmacists and pharmacy support staff

Authors : Christian E L Thomas, Denham L Phipps, Darren M Ashcroft

Abstract

Objectives

Our aim was to explore how members of community pharmacy staff perceive and experience the role of procedures within the workplace in community pharmacies.

Setting Community pharmacies in England and Wales.

Participants 24 community pharmacy staff including pharmacists and pharmacy support staff were interviewed regarding their view of procedures in community pharmacy. Transcripts were analysed using thematic analysis.

Results

3 main themes were identified. According to the ‘dissemination and creation of standard operating procedures’ theme, community pharmacy staff were required to follow a large amount of procedures as part of their work. At times, complying with all procedures was not possible. According to the ‘complying with procedures’ theme, there are several factors that influenced compliance with procedures, including work demands, the high workload and the social norm within the pharmacy. Lack of staff, pressure to hit targets and poor communication also affected how able staff felt to follow procedures. The third theme ‘procedural compliance versus using professional judgement’ highlighted tensions between the standardisation of practice and the professional autonomy of pharmacists. Pharmacists feared being unsupported by their employer for working outside of procedures, even when acting for patient benefit. Some support staff believed that strictly following procedures would keep patients and themselves safe. Dispensers described following the guidance of the pharmacist which sometimes meant working outside of procedures, but occasionally felt unable to voice concerns about not working to rule.

Conclusions

Organisational resilience in community pharmacy was apparent and findings from this study should help to inform policymakers and practitioners regarding factors likely to influence the implementation of procedures in community pharmacy settings. Future research should focus on exploring community pharmacy employees' intentions and attitudes towards rule-breaking behaviour and the impact this may have on patient safety.

Citation: Christian E L Thomas, Denham L Phipps, Darren M Ashcroft When procedures meet practice in community pharmacies: qualitative insights from pharmacists and pharmacy support staff BMJ Open 2016;6:e010851 doi:10.1136/bmjopen-2015-010851

Received: 17 December 2015 Revised: 2 March 2016 Accepted: 14 April 2016 Published: 6 June 2016

Copyright: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

Contributors

CELT, DLP and DMA conceived and designed the study. CELT conducted the interviews. CELT, DLP and DMA analysed the data. CELT, DLP and DMA wrote the paper.

Funding

This publication/paper is independent research by the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Competing interests CELT, DLP and DMA receive grants from the National Institute of Health Research (NIHR).

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