Protocols versus practice: unravelling clinical checking variations in community pharmacies in England-a multi-method...

Area of Science:

• Pharmacy Practice
• Risk Management
• Healthcare Quality Improvement

Background:

• Standardised Operating Procedures (SOPs) are crucial for risk management in community pharmacies, ensuring safety and quality.
• SOPs are mandatory in community pharmacies and essential for maintaining high standards of care.

Purpose of the Study:

• To investigate community pharmacists' (CPs) adherence to SOPs during prescription checking.
• To identify reasons for discrepancies between established protocols and actual pharmacy practice.

Main Methods:

• Hierarchical task analysis (HTA) of eight SOP sets to define normative clinical checking.
• Simulated prescription checking by twelve CPs with verbalized thought processes.
• Content analysis of transcribed data and focus group discussions to identify practice variations.

Main Results:

• A clinical checking model with six primary and 28 subtasks was developed via HTA.
• CPs frequently omitted subtasks, deviating from prescribed SOPs.
• Deviations stem from professional judgment, reliance on colleagues, and patient preference prioritization, suggesting a cultural norm.

Conclusions:

• Community pharmacies exhibit consistent deviations from SOPs in prescription checking, pointing to a cultural inclination.
• Further research is needed on managing risks associated with these deviations.
• Balancing operational flexibility with strict protocol adherence is a key challenge.