Perceived barriers to pharmacist engagement in adverse drug event prevention activities in Ghana using semi-structured interview

Abstract

Background: Pharmacist involvement in the prevention of medication errors is well documented. One such method, the process by which hospital pharmacists undertake these clinical interventions needs to be described and documented. The perceived barriers to pharmacists succeeding in getting their recommendations accepted could inform future safety strategy development. This study was therefore to trace the typical process involved and explore the perceived barriers to pharmacists' medication safety efforts.

Methods: This study involved a retrospective evaluation of routine clinical interventions collected at a tertiary hospital in Ghana over 23 months. A sample of pharmacists who had submitted these reports were then interviewed.

Results: The interventions made related to drug therapy changes (76.0%), monitoring (13.0%), communication (5.4%), counselling (5.0%) and adverse drug events (0.6%). More than 90% of interventions were accepted. The results also showed that undertaking clinical interventions by pharmacists followed a sequential order with two interlinked subprocesses: Problem Identification and Problem Handling. In identifying the problem, as much information needed to be gathered, clinical issues identified and then the problems prioritised. During the problem handling stage, detailed assessment was made which led to the development of a pharmaceutical plan. The plan was then implemented and monitored to ensure appropriateness of desired outcomes. The main barrier mentioned by pharmacist related to the discrepant attitudes of doctors/nurses. The other barriers encountered during these tasks related to workload, and inadequate clinical knowledge. The attitudes were characterised by conflicts and egos resulting from differences in status/authority, responsibilities, and training.

Conclusions: Though the majority of recommendations from pharmacists were accepted, the main barrier to hospital pharmacist engagement in medication error prevention activities related to discrepant attitudes of doctors and nurses. Proper initiation and maintenance of collaborative working relationship in hospitals is desired between the healthcare team members to benefit from the medication safety services of hospital pharmacists.

Fig. 1

Stages of Thematic Content analysis of interviews recommended by Braun and Clarke adopted from ‘Identifying the Latent Failures Underpinning Medication Administration Errors: An Exploratory Study’ by Lawton et al. [36]

Fig. 2

Schematic representation of clinical interventions process