Christian Thomas, University of Manchester
Introduction: Medicines management in primary healthcare relies on sociotechnical processes, both within and between the different organisations that make up the work system. These organisations are making increasing use of information technology (IT) to facilitate medicines management; however, it is important to understand the relationship between IT usage and the work practices of healthcare staff across the system. Our study sought to understand how one aspect of medicines management – adherence to rules and procedures in community pharmacy – was affected by IT usage within and outside the pharmacy.
Methods: We purposively recruited 24 participants, all working in community pharmacy (13 pharmacists and 11 support staff), through departmental contacts and social media. We interviewed participants using the critical incident technique; during the interview, participants were asked to discuss situations in which they had bypassed or deviated from procedures in practice. Data was analysed for factors that influenced participants’ decision to violate procedures, using a thematic analysis approach. Ethical approval was granted by the University of Manchester research ethics committee.
Results: We found the use of IT systems, both within and outside the pharmacy, had an impact on participants’ ability to follow procedures. Within the pharmacy, IT-related issues included the electronic prescription service failing to download prescriptions to the pharmacy computers, leading to the pharmacist dispensing without a valid prescription. Outside the pharmacy, the technological systems of GPs greatly impacted on how procedures were followed in the pharmacy. For example, when attempting to order medication, if the GPs computer system noted the medication as ‘not due’ this meant the receptionist could not generate a prescription. Participants occasionally felt a lack of understanding from receptionists for patients’ immediate need and this sometimes resulted in a tense relationship between the pharmacy and certain GPs. For example, patients may need their medication early due to going on holiday or may have run out of medication completely. This sometimes led to increased time pressure and participants having to bypass or deviate from procedures. Participants frequently felt frustrated and sometimes obstructed from providing patient care by restrictive GP IT systems. At times, participants would bypass contacting GPs based on past experiences of particular GP’s being especially inflexible. The intention was not to be purposively evasive with information, but rather to ensure a safe and beneficial outcome could be reached promptly for the patient.
Conclusions: Technology plays a crucial part in assisting community pharmacy staff with dispensing medications to patients. However, an over-reliance on technology with regards to timeliness of medications can have a negative impact on pharmacy employees’ ability to follow procedures. This study highlighted the resilience of community pharmacy employees, who spoke of utilising expertise and professional judgement to adapt when IT systems did not allow them to work within procedures. Implications for practice include increased open communication between pharmacies and GPs regarding patient need. Increased flexibility so as technological systems can be overridden when judged to be appropriate by both pharmacy and GP professionals, may enable patients to receive their medication safely and when needed.