Given the positive impact of pharmacist-led medication reconciliation services [22, 23], and the evidence that these services have shown better acceptance [42], it is our opinion that pharmacists’ clinical services in the studied hospitals, mainly those above the district level, might be well utilized if they could able to implement medication reconciliation services. Using a qualitative approach, we identified three major barriers to implementing pharmacy bar code scanning technology at our center: Processes, technology issues, and staff resistance. Hospital pharmacists urged concerned bodies in support of these services through a remuneration scheme, and they believed this would likely bring major changes in the clinical practice of pharmacists. One pharmacy leader explained, “As roles changed, certain people embraced the changes more than others. Background In some countries, such as Portugal, clinical pharmacy services in the hospital setting may be implemented to a lower extent than desirable. For example, most participants believed that what they were doing was a mere initiative from their side and not a cascaded role that was approved and endorsed by the government. medication safety activities delivered by hospital pharmacists) that we would like to intervene have certain unique features as compared to other studies. Article  As we employed focus group discussions for data collection, the data generated was possibly rich [46], and also, the interview guide was structured across the TDF domains that could able to elicit as many factors as possible, although this renders prioritization of domains for intervention development difficult [47]. Several studies have analysed the perceived barriers to pharmacy service implementation in community pharmacy. Patient safety has become a hot-button topic in research and media during recent years. This pattern is consistent with the fact reported by Waugh (2010) that poor countries have higher trade barriers than rich ones, … - The administrative… There were no remuneration schemes or incentives arranged for pharmacist’s cognitive services. . Research in Social and Administrative Pharmacy (RSAP) publishes monthly/twelve times per year, featuring original scientific reports, comprehensive review articles, proposed models, and provocative commentaries in the social and administrative pharmaceutical sciences.Topics of interest include outcomes evaluation of drug … PLoS One. lack of supportive skills such as blood pressure measurement, and knowledge about rare diseases/diagnosis)—participants associated this with the challenges in the currently designed curricula, hospital pharmacist’s roles in medication safety were poorly understood in the medical community. Keohane Epidemiology of adverse drug reactions in Europe: a review of recent observational studies. California Privacy Statement, In this instance, it might be difficult to determine the origin of barrier and facilitator and prioritize interventions [48]. Many opportunities exist for hospital leaders and policy makers to facilitate the adoption of pharmacy bar code scanning systems. 2011;4:377–82. Arch Intern Med. BMJ Open. E . Of the 140 hospital pharmacists, only 61 were involved in direct patient care or clinical pharmacy services and were eligible to be included in this study; that is, these pharmacists were either clinical pharmacists or graduate pharmacists of the new patient-oriented curriculum or pharmacists with an in-service training on clinical pharmacy services. “So, the changes I have seen at the management is like incentives for us” [Mixed hospitals, Focus group#8]. Pharmacists’ journey to clinical pharmacy practice in Ethiopia: key informants’ perspective. The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. C To address many of these technology issues, pharmacists and pharmacy leaders identified the role of vendors as a critical success factor. RI Aarts Using the directed content analysis, barriers and facilitators perceived by hospital pharmacists as being more relevant to the delivery of medication safety activities were categorized within six of the TDF domains. Using the Theoretical Domains Framework (TDF), we aimed to identify the barriers and facilitators to hospital … The authors identified three main barriers to pharmacy bar code scanning system implementation: process (training requirements and process flow issues), technology (hardware, software, and the role of vendors), and resistance (communication issues, changing roles, and negative perceptions about technology). In comparison with other studies using the TDF framework, the domains ‘Knowledge’, ‘Skills’, ‘Environmental context and resources’, ‘Social influences’ were identified as vital areas which could be targeted in the implementation of medication safety programs [32, 33, 35], although other issues such as, ‘Motivation and goals’ [32, 33] and ‘Social/professional roles’ [32] were also equally important. JS They are not clinical based” [Referral hospital, Focus group#3]. Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Poulsen As indicated above, these are six common barriers to timely medication administration we see frequently. Implement Sci. Implement Sci. Miller stated that champions and positive physician attitudes toward technology were essential to successful CPOE implementation. In this study, FGDs were guided by questions designed based on the TDF (Additional file 1). Arch Intern Med. On the other hand, HCPs who were supportive and ready to accept pharmacists’ input did have some know-how about clinical pharmacy or had been exposed to some form of sensitization workshops. Bates Cohen PubMed  Objective To report the frequency of 27 enhanced pharmacy services (EPS) provided in Australia's community pharmacies and to analyse barriers and facilitators for providing priority services. PubMed  Staff resistance was addressed through clear communication, identifying champions, emphasizing new information provided by the system, and facilitating collaboration. Unertl Lorenzi Pharmacists were recruited from four teaching/referral and four district hospitals, and there were a total of 252 pharmacy staffs (pharmacists, 140; pharmacy technicians, 112) working in the studied hospitals at the time of data collection. For example, inadequate training, process flow issues, and technology shortcomings contributed to resistance as pharmacy staff felt overwhelmed and developed negative perceptions about the technology. Bilal et al. et al. Qual Health Res. Implement Sci. Particularly, hospital pharmacists working in district hospitals clearly indicated their interventions were better entertained and accepted by other health care members, and there was an increasing demand for these services—for example, expressed in the number of telephone inquiries and consultations received in these hospitals. et al. Although hospital pharmacists were very much enthusiastic for new roles, these were in fact, influenced by the lack of acceptance of their role to other members of the health care team and lack of managerial support in implementing clinical pharmacy services. Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A, et al. The frequency and potential causes of dispensing errors in a Hospital Pharmacy. For example, training requirements are less uniform than those of physicians during CPOE implementation due to a larger variation in education and skill level within a pharmacy. “We know that pharmacists working in Debre Markos and Felege Hiwot are doing better, and have better acceptance. Pratt Pharmacy-based MAS also provides benefits to the pharmacy practice. This is the video I made as an example for my presentation about the communication in pharmacy. Mahler In the studied hospitals, staff attrition was common and most participants believed this had been increased recently. Pharmacy bar code scanning technology offers a new strategy to address medication errors in the hospital setting. S I don't think it was the additional information on the labels [that changed how we work together but it was instead] a result of needing each other to get the system implemented.” This collaboration and teamwork further fostered self-motivation and information sharing. Fournier JS The theoretical domains that were judged to be relevant were identified by considering the frequencies of the beliefs reported, the presence of conflicting beliefs, and evidence of strong beliefs that may influence the behaviour under investigation [34]. ADE Prevention Study Group. Westbrook DW “Even the trainings are more focused on system strengthening like APTS [Auditable Pharmaceutical Transactions and Services] and they are so much science oriented. “…we do believe there is a severe problem of clinical pharmacy documentation. Relevant domains were identified by applying relevance criteria to each of the domains in the TDF. Computerized physician order entry systems in hospitals: Mandates and incentives. EG Medications are the most common health care interventions used to improve the health outcome of patients when used safely and appropriately. Content analysis revealed six domains that influence hospital pharmacists’ engagement in medication safety activities. Available from: http://www.portal.pmnch.org/evidence/sure/esimprovinghealth carefinancingethiopia.pdf. For instance, medication review was done with a limited scope, and there were no organized ways to perform medication reconciliation. The largest roadblocks are often related to process redesign and organizational resistance, and hospital leaders should devote sufficient financial resources and personal attention to this. Doctors' perspectives on the barriers to appropriate prescribing in older hospitalized patients: a qualitative study. Unlike the developed countries, pharmacists’ involvement in direct patient care is a recent journey in Ethiopia [24]. Objective — To establish the perceived barriers to the implementation of pharmaceutical care into community pharmacy practice in different European countries and the relative importance of these barriers.. Major changes in the curricula have been made after a 5-year Bachelor of Pharmacy (BPharm) with a 1-year clerkship program has been launched in 2009. PubMed Central  M Cullen Berg Likic R, Maxwell SRJ. Stavri Pharmacy bar code scanning systems present several unique implementation issues. “Even other health care professionals are accepting our roles except those who don’t have the know-how. II. Hurley A Our informants reported that in situations where the staff had increased collaboration and teamwork in a new role, the response to change was a favorable one. IT-adoption and the interaction of task, technology and individuals: A fit framework and a case study. Another recent study [42] has also shown a high acceptance rate of pharmacist-provided services associated with medication reconciliation as compared with other clinical services, such as those related to medication indication, efficacy, and therapeutic drug monitoring. French SD, Green SE, O’Connor DA, McKenzie JE, Francis JJ, Michie S, et al. Conventional content analysis across all focus groups did not reveal different themes, and thus, we present our findings according to our primary data analysis plan. Doubling the income of an importing country is associated with a 6% decrease in per-shipment costs. PZ A previous national study has also shown that close to two-thirds of pharmacists delivering clinical pharmacy services are dissatisfied with their job, and this is mainly due to unattractive incentive packages [25]. Cuthbertson BH, Campbell MK, MacLennan G, Duncan EM, Marshall AP, Wells EC, et al. . 2015;8:448. Hospital pharmacists expressed their beliefs from the broader array of these services, and beliefs for each of the afro mentioned domains should have been thus, viewed from that angle. JS Martin Bennett, who owns Wicker Pharmacy in Sheffield, has noticed an increase in the number of languages spoken by the patients he has helped over the years. Because of the lack of job description best suited for clinical activities, participants felt that there seemed an overlap of activities and also, other HCPs perceived as if their role was taken. Regardless of financial gains and acceptance, most hospital pharmacists were positive towards the future of the profession. “From the perspective of staff, I am feeling like a person giving free service” [Referral hospital, Focus group#1]. DW Effect of bar-code technology on the safety of medication administration. Although clinical documentation tools have been developed and are now being integrated into many pharmacy management systems, the focus of electronic documentation remains … Third, a shift in workforce capacity may be necessary, with a focus on clinicians who understand workflow issues well enough to redesign processes and are also trained to select appropriate technologies and manage vendor relationships. The hospital pharmacy employs sixty-one full time equivalent pharmacists and 45 full time equivalent pharmacy technicians. Workarounds to Barcode Medication Administration. However, most pharmacists hesitated whether this had been met, given the lack of government funding and support for these services. Beso Google ScholarÂ. ‘Social/professional role’, ‘Social influence’), awareness creation campaigns targeting the whole medical community (including the management, other pharmacists, and HCPs) may possibly facilitate the uptake of pharmacist’s cognitive services. J of Pharm Policy and Pract 11, 2 (2018). Franklin Google ScholarÂ. One important challenge in relation to coding statements into the theoretical domains was the existence of overlaps between domains. Initially, this domain was found to be less relevant from the perspective of behavioural change theory. However, they are also the major source of patient safety incidents [1]. Patient safety research: an overview of the global evidence. Central Statistical Agency. Dedefo MG, Mitike AH, Angamo MT. 2015;79:860–9. ADMINISTRATIVE BARRIERS TO INVESTMENT 4 II. To the best of our knowledge, this was the first study to apply the TDF to categorize the barriers and facilitators to hospital pharmacists’ engagement in medication safety activities. One pharmacy leader explained that batteries drained because users were holding down the scan button continuously, causing bar codes to repeatedly scan. A Unlike teaching and referral hospitals, district hospitals also faced a severe shortage of other resources, such as reference books, guidelines, and computers with internet access. It did not take the thoughts from the perspective of product-oriented pharmacists. This study has several strengths and limitations. Mekonnen AB, Yesuf EA, Odegard PS, Wega SS. Ash Participants also raised issues such as the lack of an evidence and guidelines that showed how much their input affects the clinical practice, and this was further supported by the lack of consistent service although hospital pharmacists were confident enough in their skills in identifying medication-related problems. The practice of pharmacy has seen major changes in the past decade. The authors declare that they have no competing interests. J In contrast to other studies which also judged beliefs about capabilities [49], beliefs about consequences [33, 49], memory/attention and decision processes [32, 35, 49] as relevant domains for a successful medication safety intervention, these domains in our study were described infrequently (‘Memory/attention and decision processes’) and varied little (‘Beliefs about capabilities’), and participants were confident enough in the positive impact of clinical pharmacy services (‘Beliefs about consequences’). Successful pharmacy bar code scanning system implementation must address not only these considerations, but also the high dispensing volume in a hospital pharmacy and the role of pharmacists as consultants to other clinicians. To the extreme, awareness issues from the pharmacy side were severe and its implication in the service delivery process was highly significant. Systems: Their occurrences, causes and threats to patient safety. Our results are consistent with barriers to CPOE system implementations that are reported in the literature.18,24,25 Ash reported that when clinicians have access to more information with which to make decisions, and when the system fits with their workflow, they tend to use it. The pharmacy leaders identified alternate manufacturers with bar codes that were easier to scan. Rayes IK(1), Hassali MA(2), Abduelkarem AR(3). 2. Participants mentioned that clinical pharmacy services were included as one of the hospital standards and had been getting the support from government policy side, and thus, no health care staff opposed the existences of these services. Also, our previous systematic reviews confirmed the positive impact of pharmacists, particularly when pharmacists are engaged in medication reconciliation at care transitions [22, 23]. Anderegg SV, DeMik DE, Carter BL, Dawson JD, Farris K, Shelsky C, et al. Ranges of resource constraints were raised as barriers. Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the theoretical domains framework. BMJ. Computerization can create safety hazards: A Bar-coding near miss. Prompts were used when necessary and pharmacists were encouraged to talk about their internal beliefs and attitudes that may hinder them from providing clinical pharmacy services, including medication safety roles. CA By allowing the technicians to optimize their own workflow, the pharmacy leaders overcame these unexpected challenges and fostered a collaborative working environment. For example, the pharmacy information system was originally set up to dispense medications at standardized times each day. Changing roles were also an important cause of resistance among staff as some had entirely different job descriptions with the new system. However, in Ethiopia, this role has been launched recently and little is known regarding the current status of this extended service. The medications were then sent to the patient care areas and rescanned by nurses at the point of care to further reduce medication administration errors. Hospital pharmacists play a central role in medication safety activities. Although this is not necessarily an administrative barrier, it may indicate that health professionals should look to raise awareness and provide comprehensive training for INSPECT users. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis. Improving patient safety by identifying side effects from introducing Bar coding in medication administration. Perceptions of house officers who use physician order entry, Computerized physician order entry and communication: Reciprocal impacts, Basics of Qualitative Research. 2012;68:1339–45. A coding guide was prepared based on previously published definitions [31, 36] and utilized for the purpose of consistent reporting (Additional file 2). Implement Sci. E However, when you come to the department of clinical pharmacy, there is a problem in the way pharmacists are looking at the service. Overcoming the barriers to implementing computerized physician order entry systems in US hospitals: Perspectives from senior management. Mekonnen AB, McLachlan AJ, Brien JE. Whatever it is, however, the major facilitating factor for this was, role recognition by other staff members. Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital. Many informants reported other cases where continuous improvement principles were successfully incorporated into the system implementation process. J Am Pharm Assoc (2003), 2011;51:363–7. EG Electronic prescribing reduces prescribing error in public hospitals. Br J Clin Pharmacol. First, the vendor should provide long-term on-site formal training and support that covers all shifts. Interview notes were iteratively reviewed to identify common themes. 2015;38:437–53. Available from: http://www.csa.gov.et. Journal of Pharmaceutical Policy and Practice, http://apps.who.int/medicinedocs/documents/s22467en/s22467en.pdf, http://www.portal.pmnch.org/evidence/sure/esimprovinghealth carefinancingethiopia.pdf, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s40545-018-0129-y. Tucker The underpinning theoretical model used in this study is the Theoretical Domains Framework (TDF). Various mentions were given for this. FGDs were employed in this study because the interactive nature of focus groups is specifically important when group norms and cultural values of particular groups are of interest, and to explore the degree of consensus on a given topic [29], including implementation of an intervention to improve medication safety. DJ Awareness campaigns should be devised, and a well-designed job description should have been in place. There existed considerable interrelationships between domains that were perceived to influence hospital pharmacists’ behaviours, and this may assist in designing behaviour change interventions that target common behavioural domains. Implementation Sci. This work was supported in part by a grant from the Agency for Healthcare Research and Quality # HS14053-02. Most of the solutions to medication errors, such as computerized physician order entry (CPOE) systems, have focused on reducing errors at the medication ordering stage.4,5 However, dispensing errors are estimated to occur at a rate of nearly 4%, of which only 80% are intercepted. D . Barriers and facilitators to hospital pharmacists’ engagement in medication safety activities: a qualitative study using the theoretical domains framework. This was more aggravated when more staffs had increasingly left their job whenever they got other better opportunities. This was revised when pharmacists suggested that they would like the ability to schedule the first dose of a medication at a different time than the remaining doses. 2006;166:955–64. Ten pharmacy staff were interviewed about their experiences during the implementation. Addis Ababa: PFSA and SIAPS; 2016. Bates Food, Medicine and Health Care Administration and Control Authority. Designing an EMR planning process based on staff attitudes toward and opinions about computers in healthcare. Cook For full access to this pdf, sign in to an existing account, or purchase an annual subscription. In addition, those HCPs who believed in team and collaborative works were the most likely candidates for promoting clinical pharmacy services. Accessed 11 Jan 2018. 2012;7:38. E Noting that roughly half of all older adults who take at least 1 medication find adherence challenging, Cynthia X. Pan, MD, … We don’t dislike the job but it is because of this reasons and not attitude problem that most of us prefer dispensing” [Referral hospital, Focus group#2]. Notably, government’s commitment to enact on behalf of the hospital pharmacist’s impact in the health care system has been found more influential than ever, and the likelihood of accepting pharmacists extended roles to other staffs is possibly geared by the government’s pressure. Role of computerized physician order entry systems in facilitating medication errors. Introducing physician order entry at a major Academic Medical Center. 2005;15:1277–88. While other studies focused on some specifically targeted behaviours (e.g. Han et al. The TDF from health psychology provides the basis for such an approach, ensuring that a wide range of possible theoretical explanations for the behaviours can be considered. “The government did not see the distinction between technicians, pharmacists, and clinical pharmacists” [District hospital, Focus group#7]. The role of information technology in pharmacy practice is dynamic and not likely to lose relevance in the coming years. Instead of scanning 25 separate tablets, she reported that “one tablet is being scanned 25 times.” Our pharmacy leaders dealt with this by being aware of these behaviors, continuously resolving any system issues that arose in a timely fashion and ensuring ongoing communication between pharmacy technicians, pharmacists and pharmacy leaders. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. C “It is not fair to cancel the Saturday and Sunday services. Overall, environmental constraints were highly referred by hospital pharmacists as being a major barrier to the delivery of medication safety activities. Agalu A, Ayele Y, Bedada W, Woldie M. Medication prescribing errors in the intensive care unit of Jimma University specialized hospital, Southwest Ethiopia. 2016;41:128–44. 2015;10:110. Impact of barcode medication administration technology on how nurses spend their time on clinical care. Eshetie TC, Hailemeskel B, Mekonnen N, Paulos G, Mekonnen AB, Girma T. Adverse drug events in hospitalized children at Ethiopian university hospital: a prospective observational study. The initial implementation of the pharmacy bar code scanning technology required a dedicated pharmacy-based medication repackaging center, which affixed two-dimensional bar codes onto the lowest unit dose of every medication that did not already have a bar code from the manufacturer.7 As the medications were picked from inventory, pharmacy technicians scanned each bar code to match the medication, strength, and dose with the pharmacist-approved physician order. They were instead able to focus on collaborating with the technicians and resolving any discrepancies that the system revealed. Quantifying nursing workflow in medication administration. In most of the studied hospitals, pharmacy own documents prepared for the purpose of recording clinical activities were not part of the medical record, or if it had been in place, pharmacist’s documentation was done infrequently. Another contributor to resistance was negative perceptions about the technology. Article  And, pharmacists recommended interventions were better taken up by those colleagues having the same level of seniority. The present study identified a wide range of factors that may influence the uptake of medication safety interventions delivered by hospital pharmacists. CAS  2012;7:82. Implementing. Particularly, product-oriented pharmacists’ awareness, and the lack thereof, was predominantly affected the extended roles implemented by ward-based pharmacists. Applying the TDF approach, we have for the first time identified a range of barriers, as well as facilitators in relation to hospital pharmacists’ engagement in medication safety activities. As one technician stated, “With this system, there is involvement and I have a sense of working with the pharmacists rather than beneath them.” Another technician explained that “we have a better understanding of when the medications are needed [to be administered] up on the floors and that opens up our communication with the pharmacists regarding availability [of these medications]” A pharmacist reported that “there had to be more communication [with technicians] to ensure that we were getting patient meds to the unit correctly as well as identifying when things were not working as designed. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. 2002;59:2070–7. Research in Social & Administrative Pharmacy (in press, online first 28 March 2017: DOI: 10.1016/j.sapharm.2017.03.055), reprinted with permission from Elsevier. 2011;20(21–22):3233–45. . W Objective To identify the barriers towards the implementation of advanced clinical pharmacy … Two interviewees were pharmacy leaders, four were pharmacists and four were technicians. Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the theoretical domains framework. The respondents who reported a desire to have more training available made suggestions ranging from formal training sessions to simulation laboratories to “super-users”. Previous studies demonstrating pharmacist provided therapy recommendation in care teams have reported positive clinical and economic outcomes, and these have been associated with high acceptance rates [39,40,41]. . “He [the hospital manager] is ambitious to develop the service more. Group discussions were audio-recorded, transcribed verbatim, and analysed using directed content analysis based on the TDF. Cedars-Sinai joins others in holding off on CPOE. Opportunistically, we also interviewed a mix of hospital pharmacists who were attending an in-service training from various public hospitals in the region. All participants expressed a desire for further trainings and certifications to target their knowledge and skills gaps; this was also a motivating factor for delivering these services. Yoo The mean clinical experience and age of the participants were 2.4 and 25.8 years, respectively (Table 1). AS But in most other countries, barriers related to providing pharmaceutical care reported by community pharmacists included lack of funds, difficulty in accessing patient’s clinical and laboratory data, lack of clinical knowledge and motivation, lack of time and a private counseling area, little financial incentive, and low expectation of the pharmacy … This practice was originally intended to limit the number of daily fills by increasing the volume of medications dispensed. 2012;7:86. It was mentioned that the hospital standards currently ratified by the government well advocated the integration of pharmacists in care teams. Cadogan CA, Ryan C, Francis JJ, Gormley GJ, Passmore P, Kerse N, et al. While this technology has significantly reduced medication dispensing errors7 and produced a positive return on investment for the hospital,13 the implementation team initially encountered significant challenges, which they ultimately overcame. An Amharic/English speaking investigator (ABM) carried out verbatim Amharic transcriptions of all interviews and then translated into English. Administrative Barriers and the Lumpiness of Trade Cecília Hornok yand Miklós Koren z September 2011 Abstract We document that administrative trade costs of per shipment nature (documentation, customs clearance and inspection) lead to less frequent and larger-sized shipments, i.e., more lumpiness, 2012;344:e832. JP The TDF has been extensively applied across a range of clinical behaviours such as prescribing, adverse drug event reporting, and transfusion behaviours [32,33,34,35]. 2010;19:42e47. BMC Health Serv Res. All discussion sessions were audiotaped and recorded. BMC Res Notes. ADE Prevention Study Group. B-T Apart from the challenges encountered with regard to knowledge and skill deficits (e.g. 2009;31(6):696–700. However, we adopted the relevance criteria utilized by previous studies for prioritizing domains of potential interventional targets [32, 34]. Briefly, the analysis involved identifying contextualized brief statements related to the barriers and facilitators to medication safety activities, categorizing statements into TDF domains and mapping the underlying theoretical constructs within domains. NM We contacted pharmacy personnel who were either using the bar code scanning system or involved in its implementation. Eur J Clin Pharmacol. First, hospital leaders need to consider the true cost of technology implementation, beyond just software and hardware. Generally these obstacles are unavoidable on Br J Clin Pharmacol. While some were concerned that the technology would allow their own work to be tracked, others welcomed the opportunity to be able to track a medication through it entire cycle in the hospital. Each interview lasted approximately one-half hour and was conducted by at least one investigator who recorded field notes during the interview. Patterson Implementing information systems in health care organizations: Myths and challenges. Pharmacists' perceptions of the barriers and facilitators to the implementation of clinical pharmacy key performance indicators. Although participants strongly believed that there should have been a complete provision of clinical services, these were not done because hospital pharmacists would like to prefer a less challenging job or else, as a result of human resource shortages, they had been placed for other hospital services such as dispensing roles. Through five iterative readings of the field notes, we developed a code list to characterize the factors that influenced the system implementation. Even, you can see that some pharmacists are not attending our morning session” [Referral hospital, Focus group#3]. Maviglia Interview guides were translated from English versions to the local language (Amharic) by two non-official translators who are native speakers and working in the health care industry and validated by two of the research group (ABM, DM). 2015;10:161. These domains included ‘Knowledge’, ‘Skills’, ‘Environmental context and resources’, ‘Motivations and goals’, ‘Social influences’ and ‘Social/professional role’. Pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis. Islam R, Tinmouth AT, Francis JJ, Brehaut JC, Born J, Stockton C, et al. Most participants were very much enthusiastic for their extended roles and were positive towards the future of the profession; however, competing priorities along with the lack of remuneration and awareness (of other health care professionals) regarding the profession’s role were barriers to service delivery. Churchill Mekonnen, A.B., McLachlan, A.J., Brien, Ja.E. The pharmaceutical industry has long been one of the most … Cina However, the implementation team promptly identified the improper technique and technicians were appropriately re-educated. Impact on medical education. A This region is inhabited by approximately 20 million people and comprised of 19 public hospitals, and 796 health centers [27]. Google ScholarÂ. Certain pharmacy technicians thought that they were not adequately trained and identified this as an obstacle to system implementation. As users interacted with the new system, they discovered that it offered information that they previously lacked ready access to. Proc of the AMIA Annu Spring Congress, AMIA. Super-users are peers who receive focused training and provide ongoing informal support to their colleagues. We also understand that you are frequently asked to do more … You can complete the definition of administrative barriers given by the English Definition dictionary with other English dictionaries: Wikipedia, Lexilogos, Oxford, Cambridge, Chambers Harrap, … Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Shabot M Electronic medical Record implementation barriers encountered during implementation. A cross-country comparison of intensive care physicians’ beliefs about their transfusion behaviour: a qualitative study using the theoretical domains framework. E Bilal AI, Tilahun Z, Gebretekle GB, Ayalneh B, Hailemeskel B, Engidawork E. Current status, challenges and the way forward for clinical pharmacy service in Ethiopian public hospitals. 20 examples: This type of barrier is termed an administrative barrier. Outside pharmacists, participants highlighted that other HCPs recognition of pharmacist’s roles in medication safety activities was limited; however, a recent local study reported that a large proportion of HCPs had a positive attitude towards clinical pharmacy services but the extent of the available service was below their expectation [44]. Although the addition of formal training may have helped, limited computer literacy and language barriers made this challenging. Washington: National Academy Press; 2000. Making psychological theory useful for implementing evidence based practice: a consensus approach. There were also a number of resource constraints, such as staffing, infrastructure and government funding, and acceptance rate of pharmacist’s recommendation that were likely to influence the clinical practice of pharmacists. Salmasi S, Khan TM, Hong YH, Ming LC, Wong TW. et al. During ward visit, hospital pharmacists took medication history and used it for pharmaceutical care decisions; however, this was done inconsistently and the evidence-base was not clear to many. In general, problems that occur during implementation have led to complete halt of the project,14 staff revolt,15 or even poor patient outcome.16–19 The literature documents success factors for the implementation of hospital information systems2,20–34 such as organizational leadership, the availability of capital, and product/vendor maturity. L “The training that was prepared for the generic pharmacists to equip them clinical knowledge was already stopped” [Referral hospital, Focus group#4]. . Carcillo To address this issue, pharmacy leaders created a process whereby technicians report all unscannable products to designated personnel who identified and corrected the problem. Acceptance of recommendations by inpatient pharmacy case managers: unintended consequences of hospitalist and specialist care. Patient barriers Perceptions and prejudice Administrative and financial barriers Time barriers. Participants also believed that, as a result of the cancellation of weakened and duty programs which were practiced before, staffs thought that this was the least incentive they were thinking of, and this had affected their moral negatively. [45] have also confirmed that Ethiopian graduate pharmacists are very much enthusiastic to promote clinical pharmacy service but the challenge is the minimal effort made at the level of institutions. These domains included ‘Knowledge’, ‘Skills’, ‘Environmental context and resources’, ‘Motivation and goals’, ‘Social influences’, and ‘Social/professional role’. Physician-support tools. J Clin Nurs. Her professional interests include pharmacy legislation, compounding, optimizing patient safety outcomes, and promoting vaccination awareness and … Several strategies for choosing a vendor were suggested. (DOCX 13 kb), Coding guide. It comes from my own doing. However, there were also pharmacists commenting seniors had the best connections with them than others and their input was better entertained although most seniors were not that much aware of cognitive services delivered by hospital pharmacists. Kitzinger J. Qualitative research. Franz J Lee AJ, Boro MS, Knapp KK, Meier JL, Korman NE. Mirbaha F, Shalviri G, Yazdizadeh B, Gholami K, Majdzadeh R. Perceived barriers to reporting adverse drug events in hospitals: a qualitative study using theoretical domains framework approach. Second, policy makers should actively promote knowledge sharing from the implementation process itself, as implementation challenges directly threaten the quality and safety of health information technology.16,17 Health information technology projects sponsored by various agencies within the federal government such as the office of the national coordinator for health information technology (ONCHIT) and the Agency for Healthcare Research and Quality (AHRQ) provide ideal mechanisms for this information exchange. Vermeulen KM, van Doormaal JE, Zaal RJ, Mol PG, Lenderink AW, Haaijer-Ruskamp FM, et al. Our acceptance also depends on the government’s work. . It was mentioned that, initially, there were some kinds of in-service trainings organized for clinical pharmacists to equip them with communication skills and pharmaceutical care. Some pharmacists and pharmacy technicians perceived that the pharmacy staff was “led to believe that [the new system] would make the work a lot easier” when it in fact initially involved “a lot more work.” One pharmacy leader explained that “some of the technicians didn't see the big picture. Similarly, the present study used the TDF to develop a theory informed intervention to understand the perceived barriers and facilitators to hospital pharmacist’s role in medication safety. “Those who understand the health benefit of clinical pharmacy services, for example, some physicians are trying to call hospital pharmacists for ward round participation, and give the recognition for clinical pharmacists as we are needed during ward round” [Mixed hospitals, Focus group#8]. Minard LV, Deal H, Harrison ME, Toombs K, Neville H, Meade A. JL Blumenthal Some unintended consequences of information technology in health care: The nature of Patient Care information system-related errors. Wetterneck To err is human: building a safer health system. This is the first study to investigate the potential barriers and facilitators to implementing evidence-based medication safety activities delivered by hospital pharmacists using the TDF and is an initial step necessary for informing theory-based interventions to target these barriers. Poon For example, these services were not done over the weakened and duty programs were stopped for a while, and participants believed this had imposed work burden when getting back to work on Monday. First, in institutions where the numbers of specialists were fewer, the input from pharmacists was taken as crucial and thus, the rate of pharmacist’s acceptance was better. Using the Theoretical Domains Framework (TDF), we aimed to identify the barriers and facilitators to hospital pharmacists’ engagement in medication safety activities across various public hospitals in the Amhara region of Ethiopia. There are many differences in the curriculum, but there are things you will lose. The reviewer met regularly with coinvestigators to discuss emerging themes, organize the code list under these themes, and further delineate the relationships among these themes. J Iller Medication reconciliation as a medication safety initiative in Ethiopia: a study protocol. Tonnesen The channel structure of the pharmaceutical industry, in part because of the level of regulation applicable to it, has the potential for idiosyncratic strategic behaviour. https://doi.org/10.1186/s40545-018-0129-y, DOI: https://doi.org/10.1186/s40545-018-0129-y. These included hardware and software problems, and the role of vendors. Clinical pharmacists and inpatient medical care: a systematic review. To identify means to overcome communication barriers. “Now, most of us are doing this work because we are interested in this” [District hospital, Focus group#6]. Implications for prevention. The multifaceted behavioural interventions surrounding hospital pharmacist’s engagement in medication safety activities were predominantly related to six theoretical domains: ‘Knowledge’, ‘Skills’, ‘Environmental context and resources’, ‘Motivations and goals’, ‘Social influences’ and ‘Social/professional role’. JB Method Questionnaires were mailed to owners or … Jaggi © 2020 BioMed Central Ltd unless otherwise stated. Telles Improving clinical practice guidelines for the 21st century: Attitudinal barriers and not technology are the main challenges. Weiss Accessed 7 Mar 2017. medication administration. MC PubMed Central  Eur J Clin Pharmacol. Shawahna R, Rahman NU, Ahmad M, Debray M, Yliperttula M, Decleves X. For instance, when pharmacists participate in ward rounds, they could able to cut two-thirds of preventable ADEs with acceptance rate as high as 99% [40]. This crediting process led to increases in the overall workload for pharmacy technicians. JL What are the barriers to entry into the pharmaceutical industry. Barriers to Barcode System Implementation. Hospital pharmacists play a central role in medication safety activities. . Journal of Pharmaceutical Policy and Practice Reddy The hospital pharmacist plays a prominent role in cutting adverse drug events, and medication errors [20], and medication safety activities, such as drug use evaluation, admission medication histories, adverse drug reaction management, and participation in medical rounds are believed to be associated with reduced mortality rates [21]. Brittany Myers-O'Shea, PharmD, is a Pharmacy Manager of a high volume store for a large retail chain in the Northeast. 2016;6:e010003. . The study was approved by the University of Sydney Human Research Ethics Committee (HREC)–Project Number: 2015/818, and the Institutional Review Board of the University of Gondar, Ethiopia (O/V/P/RCS/05/624/2016). Hersh Examples of administrative barrier in a sentence, how to use it. Bond CA, Raehl CL. Despite these promising results, few hospital pharmacies have implemented bar code scanning technology. There are staffs who ask us what we are doing in the ward, on the other hand, there are who eagerly want us, and even among these, there do have various perceptions of the profession” [Referral hospital, Focus group#2]. GJ Ash Many participants emphasized why hospital pharmacists lacked the inspiration for delivering clinical services, whereas they mentioned that the curriculum is very much patient oriented unlike the previous courses, yet there were few hospital pharmacists struggled into the duty of dispensing with the mere reason of collecting an additional benefit from the extra hours, but this was not arranged for clinical services. Int Arch Med. Pharmacy Daily for Wed 18 Sep 2013 - Guild claim \'exaggerated\', TWC welcomes Sclavos, Di-Gesic ruling blasted, Health . Google ScholarÂ. “We are taking the challenges as challenges, and we are thinking the future might be brighter. Braithwaite MM Participants expressed mixed views regarding the level of knowledge and skill necessary for complete delivery of clinical services and most believed there was a lack of awareness for those pharmacists’ extended roles. Poon EG, Keohane CA, Yoon CS, Ditmore M, Bane A, Korach OL, et al. Specifically, the role of the hospital pharmacist has been rapidly evolving beyond the traditional roles of medication dispensing and distribution to expanded clinical services [20], and their role in improving medication safety is well acknowledged. Overdependence on technology, several technical problems affected system implementation this project for their motivation in. A relatively new technology, several technical problems affected system implementation was a challenge for pharmacists to interventions! # 2 ] had bar codes not scanning ” and the wireless scanner battery draining at inopportune.... Until a point of saturation was reached of evidence into practice: a systematic review and meta-analysis: of. 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El-Assady R, Heyhoe J, Louch G, Ingleson E, Demonaco HJ, JI! Most likely candidates for promoting clinical pharmacy services Reckmann M, Davey P, Maxwell S, H. Recent years receive one-on-one training, transcribed verbatim, and the interaction of task technology... Pharmacist’S input” [ Referral hospital, these error rates can translate to more than.... Me, Toombs K, Shelsky C, et al err is:. €œFrom the perspective of behavioural change theory is it our nature or nurture pharmacists are not attending morning... Because their level is almost administrative barriers in pharmacy [ Teaching hospital, Focus group # 3 ] pharmacists’ involvement in direct care! Bedada W, Woldie M. medication administration questions designed based on the safety medication! Err is human: building a safer health system been stopped for a successful CPOE implementation a challenge for to... More aggravated when more staffs had increasingly left their job whenever they got other better opportunities gaining... 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