Adapting the US Institute for Safe Medication Practices' Medication Safety Self Assessment tool for community pharmacies in Finland.

OBJECTIVES: To adapt a US Institute for Safe Medication Practices' Medication Safety Self Assessment (MSSA) tool to, and test its usefulness in, Finnish community pharmacies. METHODS: A three-round Delphi survey was used to adapt self-assessment characteristics of the US MSSA tool to Finnish requirements, and to obtain a consensus on the feasibility and significance of these characteristics in assessing the safety of medication practices in community pharmacies. The Delphi modified self-assessment tool was piloted in 18 community pharmacies in order to refine the tool, using a questionnaire containing structured and open-ended questions. KEY FINDINGS: A total of 211 self-assessment characteristics were accepted to the self-assessment tool for pilot use by expert panellists in the Delphi rounds. Most pilot users considered the tool as useful in: identifying medication safety targets for development; medication safety assessment; and identifying the strengths of medication safety. The substance of the self-assessment tool was considered as comprehensive and essential for medication safety. Most criticism was regarding: the multiplicity of self-assessment characteristics; interpretation of some characteristics; and that all the characteristics were not yet available. After the modification, according to the pilot users' comments, the final Finnish tool consisted of 230 medication safety characteristics. CONCLUSIONS: The study indicated the feasibility of adapting a US medication safety self-assessment tool for use in community pharmacy practice in Finland. More efforts should be made to familiarise Finnish community pharmacists with the self-assessment tool and its benefits, and get them to use the tool as part of their long-term quality improvement.

Primary care physicians' perceptions of medication errors and error prevention in cooperation with community pharmacists.

BACKGROUND: Physicians and community pharmacists play a major role in safe use of medication in primary outpatient care. Still, little is known about primary care physicians' perceptions of medication errors and error prevention and how they would like to cooperate with community pharmacists in error prevention and management. OBJECTIVES: To explore primary outpatient care physicians' perceptions of medication errors and error prevention and to examine physicians' perceptions and expectations of cooperation with community pharmacists in error prevention and management. METHODS: A national mail survey containing structured and open-ended questions to a random sample of 15% of Finnish public health care physicians and occupational health physicians (n=639) was carried out. RESULTS: A total of 179 responses were entered into the study (29% response rate). The potential causes of medication errors were most often related to physicians (39%), followed by the causes related to the organization (23%) and patient (19%). The factors concerning physicians' unawareness of patients' comedication arose as the major causes of medication errors. The respondents considered workload as a primary cause for medication errors. The most frequently mentioned actions to prevent medication errors were related to the physician (31%), organization (28%), and information technology (22%). The respondents expected more contacts from community pharmacists than actually occurred, particularly in the cases of potential drug abuse and problems in drug use. CONCLUSIONS: Problems related to polypharmacy because of physicians' unawareness of patients' entire current medication were considered as most challenging in medication safety. Many of the problems were contributed to communication and coordination issues, which could be ameliorated by appropriate use of information technology. The study also indicated a need to develop the cooperation between primary care physicians and community pharmacists to enhance medication safety.

Survey of dispensing error practices in community pharmacies in Finland: a nationwide study.

OBJECTIVES: To assess the actions taken to manage dispensing errors, to investigate pharmacists' perceptions of ideal methods for managing dispensing errors, and to evaluate the reliability of in-house dispensing error reporting systems. DESIGN: National cross-sectional survey. SETTING: Main outlets of all privately owned Finnish community pharmacies (n = 599) in March 2005. PARTICIPANTS: Owners and operational managers of Finnish community pharmacies. INTERVENTION: Mail survey containing structured and open-ended questions. MAIN OUTCOME MEASURES: Current actions taken in the dispensing error managing process, pharmacist perceptions on the ideal ways of action to manage dispensing errors, and reported dispensing error rates. RESULTS: 340 participants responded to the survey (response rate 57%). Almost 90% of the responding outlets documented dispensing errors at least occasionally, 47% always documented, and 29% almost always documented. Discussion about dispensing errors was considered the most ideal method for managing dispensing errors in the pharmacy (76% of the respondents), followed by documenting them (45%). The error rate collected from in-house error reporting systems was 14 per 100,000 prescriptions dispensed in 2004. CONCLUSION: Most Finnish community pharmacies have an in-house dispensing error reporting system, but reporting has not been fully implemented in all pharmacies. The actual error reporting in most Finnish community pharmacies is not reliable and needs further development and coordination. Discussing dispensing errors and documenting dispensing errors were reported as the most ideal methods for managing errors. Respondents indicated a hope that dispensing errors would be discussed more frequently with the whole staff. These findings demonstrate that Finnish community pharmacists are aware of some of the principles of managing dispensing errors based on the system approach and the benefits of error reporting systems in managing dispensing errors.

A system approach to dispensing errors: a national study on perceptions of the Finnish community pharmacists.

OBJECTIVE: To examine pharmacists' perceptions and opinions on the potential causes of dispensing errors and the ways to prevent them in community pharmacies, and to assess whether pharmacists' perceptions reflect the system approach. METHOD: A survey instrument was mailed to privately owned Finnish community pharmacies (n = 599) in March 2005. The survey included two open-ended questions to assess the pharmacists' perceptions on potential causes and prevention of dispensing errors. Furthermore, the questionnaire contained 20 structured, Likert-type, statements of dispensing errors and their management. The survey was addressed to the owner or operational manager of the pharmacy. The emphasis in the analysis of the study was on the open-ended questions which were analysed using the content analysis method. All quantitative data was analysed using the SPSS for Windows. MAIN OUTCOME MEASURE: The community pharmacists' perceptions and opinions on the potential causes and preventive factors of dispensing errors. RESULTS: A total of 340 responses were entered in the study (response rate 57%). The content analysis revealed that factors related to organization and those related to individual professionals were the most frequently mentioned as the potential causes of dispensing errors (37% and 30% of all potential causes given, respectively; number of respondents n = 326; total number of given items n = 967). The organizational factors (46% of all the preventive factors given), and factors related to individual professionals (41%) were also the most frequently considered as preventive (number of respondents n = 323; total number of given items n = 916). The analysis of the structured statements revealed that discussion about the dispensing errors with pharmacy staff and changes in working routines based on the dispensing error incidents were considered to be the most important factors in error prevention. A heavy workload and the similarity of drug packages were considered as the most important potential causes of the dispensing errors in the structured statements. CONCLUSION: Finnish community pharmacists still, to some extent, have the person-centred approach to medication safety although signs of the system approach were also evident. Attitudinal changes still have to take place, as well as changes to the practice environment, in order to get the system approach fully implemented in the Finnish community pharmacies.