Risk-based analysis of the ‘Pharmacy Of Your Choice’ scheme

Abstract

Background: The dispensing process may be at risk of error if proper guidelines are not adhered to since dispensing is a complex process and not just supplying the medication according to the patient’s prescription. Objective: To identify risk factors in dispensing, evaluate pharmaceutical dispensing processes and establish the best practice for dispensing Pharmacy Of Your Choice medicines. Design: A survey data sheet, pharmacist questionnaire and time-motion study form were developed and validated to identify risk factors in dispensing Pharmacy Of Your Choice medicines and to evaluate pharmaceutical dispensing processes. In Malta, an island with an area of 316km2, there are 201 community pharmacies which provide Pharmacy Of Your Choice services. Pharmacy Of Your Choice prescriptions being dispensed were observed through visits in 40 community pharmacies and recorded via survey data sheets. Pharmacists ranked risks according to their probability of occurrence and severity of consequences using a Likert scale from 1 (lowest score) to 5 (highest score) via a questionnaire. Risk was calculated by multiplying probability of occurrence with severity of consequences, giving a risk priority number of 1 to 25. A standard operating procedure for dispensing Pharmacy Of Your Choice medicines was developed and pharmacists’ perception recorded after implementation in 10 pharmacies via an evaluation questionnaire. Setting: Community pharmacies Main outcome measures: Establishment of risk mitigation strategies and a standard operating procedure Results: The risks with the highest scores were illegible prescriptions (risk priority number = 13.6) and incorrect prescriptions (risk priority number = 12.0). All participating pharmacists stated that they deal with customers individually (N = 40). All 10 pharmacists participating in the SOP implementation stated that the standard operating procedure represents the content clearly and concisely, while nine agreed that it is useful. Nine pharmacists agreed that the changes made during COVID-19 were effective to limit contamination, eight stated that they created new risks and seven agreed to permanently going paperless. Conclusions: The processes identified as having the highest risk were illegible prescriptions and incorrect prescriptions. Individual attention to customers was identified as being the best mitigation factor to risk occurrence. This demonstrates a good feature of Maltese pharmacy practice. Using a risk-based approach to evaluate pharmacy practices is time-consuming, but identifies high-risk processes to the patient and allows for a greater understanding of the nature and occurrence of dispensing errors.