Understanding Risk Factors for Complaints Against Pharmacists: A Content Analysis.

OBJECTIVES: Pharmacists constitute a crucial component of the healthcare system, significantly influencing the provision of medication services and ensuring patient safety. This study aims to understand the characteristics and risk factors for complaints against pharmacists through Health and Disability Commissioner (HDC) published decisions. METHODS: This study adopts a retrospective, qualitative approach. An inductive content analysis technique was used to analyze 37 complaints against pharmacists published decisions from the New Zealand Health and Disability Commissioner website to investigate a range of underlying risk factors contributing to the occurrence of complaints against pharmacists. RESULTS: A set of 20 categories of risk factors emerged through the content analysis and were subsequently grouped into five overarching themes: pharmacist individual factors, organizational factors, system factors, medication-specific factors, and external environmental factors. CONCLUSIONS: The findings of this study provide valuable insights that expand the understanding of risk management in pharmacist practice, serving as a valuable resource for regulatory bodies, policymakers, educators, and practitioners. It is recommended not only to focus solely on individual pharmacists but also to consider integrating their environment and individual behaviors to proactively address situations prone to errors and subsequent complaints.

Characteristics and risk factors of pharmacist misconduct in New Zealand: a retrospective nationwide analysis.

BACKGROUND: Professional misconduct has evolved into a worldwide concern, involving various forms and types of behaviours that contribute to unsafe practices. This study aimed to provide insights into the patterns characterising pharmacist misconduct and uncover underlying factors contributing to such instances in New Zealand. METHODS: This research examined all cases of pharmacist misconduct sourced from the Health Practitioners Disciplinary Tribunal (HPDT) database in New Zealand since 2004. Characteristics of the sampled pharmacists and cases were extracted, followed by a systematic coding of the observed misconduct issues. Identification of risk factors was accomplished through content analysis techniques, enabling an assessment of their prevalence across various forms of misconduct. RESULTS: The dataset of pharmacist misconduct cases comprised 58 disciplinary records involving 55 pharmacists. Seven types of misconduct were identified, with the most commonly observed being quality and safety issues related to drug, medication and care, as well as criminal conviction. A total of 13 risk factors were identified and systematically classified into three categories: (1) social, regulatory, and external environmental factors, (2) systematic, organisational, and practical considerations in the pharmacy, and (3) pharmacist individual factors. The most frequently mentioned and far-reaching factors include busyness, heavy workload or distraction; health impairment issues; and life stress or challenges. CONCLUSIONS: The patterns of pharmacist misconduct are complicated, multifaceted, and involve complex interactions among risk factors. Collaborative efforts involving individual pharmacists, professional bodies, responsible authorities, policy-makers, health funders and planners in key areas such as pharmacist workload and well-being are expected to mitigate the occurrence of misconduct. Future research should seek to uncover the origins, manifestations, and underlying relationships of various contributing factors through empirical research with appropriate individuals.

Pharmacists' Attitudes towards Medically Assisted Dying.

AIMS: We aimed to explore pharmacists' attitudes and support toward medically assisted dying (MaiD) through the End of Life Choice Act 2019 (EOLC), their willingness to provide services in this area of practice, and the influences on their decisions. METHODS: The study was conducted via an anonymous, online QualtricsTM survey of pharmacists. Registered New Zealand pharmacists who agreed to receive surveys from the two Schools of Pharmacy as part of their Annual Practicing Certificate renewal were invited to participate through an email with a Qualtrics URL link. The survey contained questions regarding demographics, awareness, knowledge, support for, and attitudes and willingness to participate. RESULTS: Of the 335 responses received, 289 were valid and included in the analysis. Most participants supported legally assisted medical dying (58%), almost a third of participants did not support it (29%), and 13% of respondents were unsure. The five primary considerations that participants perceived to be beneficial included support from legislation, respect for patient autonomy, discussions around morality, ending suffering, and preserving dignity. The main concerns were legal, personal bias, palliation, stigmatisation, and vulnerability. CONCLUSIONS: The influences on the decision by pharmacists to support and willingness to participate in the provision of services consistent with the EOLC are complex and multifactorial. Diverse factors may influence attitudes, of which religion is the most significant factor in not supporting the Act or willingness to participate. Clarity and standardised guidance to ensure that assisted dying queries are appropriately managed in practice would help to address any potential access issues.

Risk identification and prediction of complaints and misconduct against health practitioners: a scoping review.

Identifying the risk and predicting complaints and misconduct against health practitioners are essential for healthcare regulators to implement early interventions and develop long-term prevention strategies to improve professional practice and enhance patient safety. This scoping review aims to map out existing literature on the risk identification and prediction of complaints and misconduct against health practitioners. This scoping review followed Arksey and O'Malley's five-stage methodological framework. A comprehensive literature search was conducted on MEDLINE, EMBASE, and CINAHL databases and finished on the same day (6 September 2021). Articles meeting the eligibility criteria were charted and descriptively analysed through a narrative analysis method. The initial search generated 5473 articles. After the identification, screening, and inclusion process, 81 eligible studies were included for data charting. Three key themes were reported: methods used for identifying risk factors and predictors of the complaints and misconduct, synthesis of identified risk factors and predictors in eligible studies, and predictive tools developed for complaints and misconduct against health practitioners. The findings reveal that risk identification and prediction of complaints and misconduct are complex issues influenced by multiple factors, exhibiting non-linear patterns and being context specific. Further efforts are needed to understand the characteristics and interactions of risk factors, develop systematic risk prediction tools, and facilitate the application in the regulatory environment.

Understanding the Risk Factors and Stressors Impacting Optimal Work Practices in New Zealand Pharmacies: A S.H.E.L.L Model Analysis.

(1) Background: The safe performance of pharmacists is an important issue for patients and regulators. It is recognized that pharmacists interact with a variety of healthcare professionals and act as a bridge between other healthcare providers and systems and patients in the health setting. There has been growing activity in exploring factors that impact optimal performance and determinants that are linked with medication errors and practice incidents. The aviation and military industries have used S.H.E.L.L modeling to identify how personnel interact with factors that affect outcomes. A human factors approach is a useful angle to take when trying to improve optimal practice. Little is known about the experiences of New Zealand pharmacists and S.H.E.L.L factors that affect day-to-day practices in their work environment. (2) Methods: We investigated environment, team, and organizational considerations as the determining factors of optimal work practices using an anonymous online questionnaire. The questionnaire was built from a modified version of the software, hardware, environment, and liveware (S.H.E.L.L) model. This identified components of a work system that were vulnerable and that provided risks to optimal practice. Participants were New Zealand pharmacists approached through a subscriber list provided by the regulatory authority of the profession. (3) Results: We received responses from 260 participants (8.56%). The majority of participants indicated that optimal practice was occurring. More than 95% of respondents agreed that knowledge, fatigue interruptions, complacency, and stress affected optimal practice. Equipment and tools, medication arrangement on the shelf, lighting, physical layout, and communication with staff and patients were important factors for optimal practice. A smaller cohort of participants, 13 percent (n = 21), stated that dispensing processes, dissemination, and enforcement of standard operating procedures and procedural guidance did not affect pharmacy practice, 21.3% responded that professional and ethical requirements did not affect optimal practice, 20% stated that having a staffroom affected optimal practice, 20% did not think substance use affected optimal practice, and 30% did not state that cultural differences affected optimal practice. Optimal practice is constrained when there is a lack of experience, professionalism, and communication among staff, patients, and external agencies. COVID-19 also has had an impact on pharmacists both personally and in their work environments. Exploring how the pandemic has affected pharmacists and their work environment warrants further research. (4) Conclusions: Pharmacists across New Zealand agreed that optimal practices were occurring and considered other factors that were perceived to not affect optimal practice. A human factor S.H.E.L.L framework has been used to analyze themes to understand the optimal practice. The rising body of international literature on the effect of the pandemic on pharmacy practice serves as a foundation for many of these themes. Longitudinal data would be useful in exploring some factors, such as pharmacist well-being over time.

Professionals' attitudes towards the use of cognitive enhancers in academic settings.

INTRODUCTION AND AIMS: The non-medical use of prescription stimulants such as methylphenidate, dexamphetamine and modafinil is increasing in popularity within tertiary academic settings. There is a paucity of information on awareness, attitudes, and acceptability by professionals of use in this context. This study aimed to investigate professionals' knowledge of and attitudes towards the use of cognitive enhancers (CEs) in academic settings, and their willingness to use a hypothetical CE. DESIGN AND METHODS: A mail survey was sent to doctors, pharmacists, nurses, accountants and lawyers in New Zealand. These disciplines were chosen as they require professional registration to practice. The questionnaire comprised four sections: (1) demographics, (2) knowledge of CEs, (3) attitudes towards the use of CEs, and (4) willingness to use hypothetical CEs. RESULTS: The response rate was 34.5% (414/1200). Overall, participants strongly disagreed that it was fair to allow university students to use CEs for cognitive enhancement (Mdn = 1, IQR: 1,3), or that it is ethical for students without a prescription to use cognitive enhancers for any reason (Mdn = 1, IQR: 1,2). Professions differed in their attitudes towards whether it is ethical for students without a prescription to use CEs for any reason (p = 0.001, H 31.527). DISCUSSION AND CONCLUSION: Divergent views and lack of clear consensus within professions and between professionals on the use of CEs have the potential to influence both professionals and students as future professionals. These divergent views may stem from differences in the core values of self-identity as well as extrinsic factors of acceptability within the profession in balancing the elements of opportunity, fairness and authenticity in cognitive enhancement. Further research is required to inform the development of policy and guidelines that are congruent with all professions.

Attitudes Toward Cognitive Enhancer Use Among New Zealand Tertiary Students.

BACKGROUND: Cognitive enhancement is the use of prescription stimulant medicines by healthy individuals for nonmedical use in academic settings. Commonly used cognitive enhancers (CEs) include methylphenidate, amphetamines, and modafinil. To understand the motivation to use CEs, it is important to look beyond prevalence and explore the extent to which attitudes, beliefs, and intentions predict the decision to use CEs. OBJECTIVE: The study aimed to investigate what factors explain the decision to use CEs among tertiary students in New Zealand, using the Theory of Planned Behaviour (TPB). METHODS: Students from the Schools of Pharmacy, Nursing, Medicine, Law, and Accounting at a university in New Zealand were invited to complete a paper-based questionnaire. The questionnaire elicited students' attitudes, subjective norms, and perceived control toward illicit use of CEs using TPB. An exploratory factor analysis was conducted. RESULTS: Response rate was 88.6% (442/499). Students who perceived CE use to be socially and ethically acceptable were more likely to use CEs (odds ratio, OR: 1.56, 95% confidence interval, 95% CI: 1.153-2.105, p = 0.004). Students who were concerned about the health impact of CE use were less likely to use CEs (OR: 0.54, 95% CI: 0.492-0.826, p = 0.001). Students who believed that CE use was approved were more likely to use them (OR: 1.648, CI: 1.193-2.278, p = 0.002). CONCLUSION: This research supports the notion that the decision to use CEs is not just an autonomous choice that occurs in isolation. Attitudes on the ethical and social acceptability of CE use were more likely to drive the decision to use CEs. The study provides the impetus for an integrative discussion by health care professionals and academics on the impact of attitudes, social norms, and advocates on the decision to use CEs.

Prevalence of cognitive enhancer use among New Zealand tertiary students.

INTRODUCTION AND AIMS: Cognitive enhancers (CE) such as methylphenidate, amphetamines and modafinil are becoming more commonly used in non-medical situations. This study explored the prevalence and motivations for CE use in a New Zealand university. DESIGN AND METHODS: Students from the Schools of Pharmacy, Nursing, Medicine, Law and Accounting at a university in New Zealand were invited to complete a paper-based questionnaire that elicited their views on the prevalence, reasons for use and attitudes towards use of CEs. Questionnaires were distributed at the end of a third-year lecture (August-October 2012). Reasons for use and attitudes towards use was measured using a 7-point Likert scale from strongly agree (1) to strongly disagree (7). Descriptive and prevalence statistics were calculated. Inferential statistics were generated to explore the overall associations between CE use and how the respondents had first learnt about CEs, and to investigate reasons for CE use. RESULTS: The response fraction was 88.6 % (442/499) and the prevalence of CE use was 6.6% (95% confidence interval 4.5-9.0). Commonly cited reasons for use were to get high [M = 4.43, standard deviation (SD) 2.36], experimentation (M = 4.17, SD 2.36), increase alertness (M = 3.55, SD 2.48), to help concentrate (M = 3.48, SD 2.42), to help stay awake (M = 3.20, SD 2.33), to help study (M = 3.10, SD 2.47) and to concentrate better while studying (M = 3.00, SD 2.43). DISCUSSION AND CONCLUSIONS: Use of CEs was uncommon in contrast to the prevalence reported in the USA. The reasons for use also varied depending on which CE was used. Students who use CEs have differing attitudes towards their acceptability, which warrants further research about how these attitudes influence their use and attitudes towards academic performance. [Ram S(S), Hussainy S, Henning M, Jensen M, Russell B. Prevalence of cognitive enhancer use among New Zealand tertiary students. Drug Alcohol Rev 2016;35:245-351].