BackgroundThere is a need to shed light on the pathways through which complex interventions mediate their effects in order to enable critical reflection on their transferability. We sought to explore and understand key stakeholder accounts of the acceptability, likely impact and strategies for optimizing and rolling-out a successful pharmacist-led information technology-enabled (PINCER) intervention, which substantially reduced the risk of clinically important errors in medicines management in primary care.MethodsData were collected at two geographical locations in central England through a combination of one-to-one longitudinal semi-structured telephone interviews (one at the beginning of the trial and another when the trial was well underway), relevant documents, and focus group discussions following delivery of the PINCER intervention. Participants included PINCER pharmacists, general practice staff, researchers involved in the running of the trial, and primary care trust staff. PINCER pharmacists were interviewed at three different time-points during the delivery of the PINCER intervention. Analysis was thematic with diffusion of innovation theory providing a theoretical framework.ResultsWe conducted 52 semi-structured telephone interviews and six focus group discussions with 30 additional participants. In addition, documentary data were collected from six pharmacist diaries, along with notes from four meetings of the PINCER pharmacists and feedback meetings from 34 practices. Key findings that helped to explain the success of the PINCER intervention included the perceived importance of focusing on prescribing errors to all stakeholders, and the credibility and appropriateness of a pharmacist-led intervention to address these shortcomings. Central to this was the face-to-face contact and relationship building between pharmacists and a range of practice staff, and pharmacists’ explicitly designated role as a change agent. However, important concerns were identified about the likely sustainability of this new model of delivering care, in the absence of an appropriate support network for pharmacists and career development pathways.ConclusionsThis embedded qualitative inquiry has helped to understand the complex organizational and social environment in which the trial was undertaken and the PINCER intervention was delivered. The longitudinal element has given insight into the dynamic changes and developments over time. Medication errors and ways to address these are high on stakeholders’ agendas. Our results further indicate that pharmacists were, because of their professional standing and skill-set, able to engage with the complex general practice environment and able to identify and manage many clinically important errors in medicines management. The transferability of the PINCER intervention approach, both in relation to other prescribing errors and to other practices, is likely to be high.

ObjectivesTo compare prevalence and types of dispensing errors and pharmacists’ labelling enhancements, for prescriptions transmitted electronically versus paper prescriptions.DesignNaturalistic stepped wedge study.Setting15 English community pharmacies.InterventionElectronic transmission of prescriptions between prescriber and pharmacy.Main outcome measuresPrevalence of labelling errors, content errors and labelling enhancements (beneficial additions to the instructions), as identified by researchers visiting each pharmacy.ResultsOverall, we identified labelling errors in 5.4% of 16 357 dispensed items, and content errors in 1.4%; enhancements were made for 13.6%. Pharmacists also edited the label for a further 21.9% of electronically transmitted items. Electronically transmitted prescriptions had a higher prevalence of labelling errors (7.4% of 3733 items) than other prescriptions (4.8% of 12 624); OR 1.46 (95% CI 1.21 to 1.76). There was no difference for content errors or enhancements. The increase in labelling errors was mainly accounted for by errors (mainly at one pharmacy) involving omission of the indication, where specified by the prescriber, from the label. A sensitivity analysis in which these cases (n=158) were not considered errors revealed no remaining difference between prescription types.ConclusionsWe identified a higher prevalence of labelling errors for items transmitted electronically, but this was predominantly accounted for by local practice in a single pharmacy, independent of prescription type. Community pharmacists made labelling enhancements to about one in seven dispensed items, whether electronically transmitted or not. Community pharmacists, prescribers, professional bodies and software providers should work together to agree how items should be dispensed and labelled to best reap the benefits of electronically transmitted prescriptions. Community pharmacists need to ensure their computer systems are promptly updated to help reduce errors.

Background Prescribing errors in primary care are problematic. The electronic prescription service (EPS) is an English electronic system linking prescribing, dispensing and reimbursement, designed to rectify some of the problems associated with paper-based prescribing. Objective To document the numbers and types of interventions made by community pharmacists and their staff using EPS release 2 (EPSR2), compare these with those made for other prescription types, and comment on potential effects of EPSR2 on pharmacy practice. Methods We invited staff in 15 community pharmacies to record problems encountered arising from failures in prescribing, dispensing or supply systems for prescribed medication, for a 2 week period. Results Eight pharmacies participated, of which five used EPSR2. These pharmacies reported 69 problems with 68 prescriptions (median 7.5 problems per pharmacy, range 2–22). A total of 33 problems were clinical in nature and 6 were organisational or logistical in origin. Thirty unsigned prescriptions were reported, all non-EPSR2. Of the 69 problems, eight were primarily related to EPSR2 functionality. Conclusion EPSR2 should reduce the number of unsigned prescriptions in circulation. However, prescribers should avoid the use of Latin abbreviations that cannot be interpreted directly by patients, and consider the compatibility of regularly prescribed items with the NHS dictionary of medicines and devices.

(2014) Training pharmacists to deliver a complex information technology intervention (PINCER) using the principles of educational outreach and root cause analysis. International Journal of Pharmacy Practice, 22 (1). pp. 47-58. ISSN 0961-7671Access from the University of Nottingham repository: http://eprints.nottingham.ac.uk/2511/1/Sadler_Tarining.pdf Copyright and reuse:The Nottingham ePrints service makes this work by researchers of the University of Nottingham available open access under the following conditions. This article is made available under the Creative Commons Attribution licence and may be reused according to the conditions of the licence. For more details see: http://creativecommons.org/licenses/by/2.5/ A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription. AbstractObjective To describe the training undertaken by pharmacists employed in a pharmacist-led information technology-based intervention study to reduce medication errors in primary care (PINCER Trial), evaluate pharmacists' assessment of the training, and the time implications of undertaking the training. Methods Six pharmacists received training, which included training on root cause analysis and educational outreach, to enable them to deliver the PINCER Trial intervention. This was evaluated using self-report questionnaires at the end of each training session. The time taken to complete each session was recorded. Data from the evaluation forms were entered onto a Microsoft Excel spreadsheet, independently checked and the summary of results further verified. Frequencies were calculated for responses to the three-point Likert scale questions. Free-text comments from the evaluation forms and pharmacists' diaries were analysed thematically. Key findings All six pharmacists received 22 h of training over five sessions. In four out of the five sessions, the pharmacists who completed an evaluation form (27 out of 30 were completed) stated they were satisfied or very satisfied with the various elements of the training package. Analysis of free-text comments and the pharmacists' diaries showed that the principles of root cause analysis and educational outreach were viewed as useful tools to help pharmacists conduct pharmaceutical interventions in both the study and other pharmacy roles that they undertook. The opportunity to undertake role play was a valuable part of the training received. Conclusions Findings presented in this paper suggest that providing the PINCER pharmacists with training in root cause analysis and educational outreach contributed to the successful delivery of PINCER interventions and could potentially be utilised by other pharmacists based in general practice to deliver pharmaceutical interventions to improve patient safety.

In the summer of 1993 Birmingham City Council commissioned MEL Research to undertake a survey of health promotion activity within small and medium-sized enterprises located in Birmingham's inner city, an area of material deprivation. The purpose of the survey was to build up a baseline of information which would underpin service planning. The research team found the responding companies to be enthusiastic about occupational health issues in principle rather than practice. Nevertheless, about a third had a smoking policy and a similar number an alcohol policy. They were generally happy to promote physical activity and were keen to apply for Heartbeat Awards. Many wanted help in developing an HIV/AIDS policy. This article concludes with a description of the services provided in response to the needs identified by this survey.