Using functional resonance analysis method (FRAM) approach to describe prescription dispensing in community pharmacies
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Published on: August 22, 2017
Shiying Mai1, Katherine G Moore2, James H Ford1
1Clinical Practice, Innovation, and Research Division (CliPIR), University of Wisconsin-Madison, School of Pharmacy, 777 Highland Avenue, Madison, WI, USA.
Background:
Prescription dispensing in community pharmacies is a complex process requiring pharmacy staff to continually adjust to changing situations while ensuring medication safety. However, limited research has described how prescription dispensing is carried out in everyday practice. This study used the Functional Resonance Analysis Method (FRAM) to describe prescription dispensing in community pharmacies to characterize how tasks are interconnected, how variability arises in routine practice, and how pharmacy staff adapt for safety.
Methods:
A qualitative observational study was conducted in two community pharmacies within a U.S. healthcare organization. Two trained researchers completed three rounds of direct observations, totaling 36 h. Observation notes were independently analyzed to develop a FRAM model of prescription dispensing. The model was refined through discussions among the research team and validated with the pharmacy manager.
Results:
The final FRAM model included 66 interconnected functions across 8 stages, from prescription received by the pharmacy to medication picked up by the patient, showing that dispensing is not a simple step-by-step process. Pharmacy staff frequently adjusted their work to manage insurance problems, medication shortages, prescription clarifications, and patient requests. Small changes in earlier tasks often affected later steps, requiring staff to reorganize work, coordinate with each other, and recover from disruptions to keep the process moving safely. The model also showed that pharmacists play a key role in making clinical decisions and managing unexpected situations.
Conclusions:
FRAM provides a detailed picture of how prescription dispensing is performed in everyday practice. By showing how different tasks are connected and how pharmacy staff adapt to changing conditions, FRAM provides a foundation for improving pharmacy workflows, supporting new pharmacy services, and designing interventions to strengthen medication safety.
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