Exploring hospital pharmacists’perceptions of their medication communication with prescribers

Published Date: 16th May 2018

Publication Authors: Furlong NJ, Hardy KJ, Lloyd M

Abstract

Prescribing errors are common and problematic in hospital settings in the UK. Pharmacists have been described as integral in the interception of prescribing errors, with effective medication communication between pharmacists and prescribers important to resolve and optimize prescribing outcomes. However, poor communication between healthcare professionals, including pharmacists and prescribers, is considered a leading cause of prescribing error. 

Pharmacists' medication communication with prescribers has been reported as limited in the literature, whilst they have been described as working independently to doctors. Additionally, pharmacists have previously described communication apprehensions with doctors, with these apprehensions creating barriers to effective medication communication with prescribers. 

The aim of this study was to explore the perceptions and views of hospital pharmacists on their medication communication with prescribers. 

The study was undertaken in a large acute teaching hospital in the North West of England. All (n = 37) hospital pharmacists were eligible to participate. An invitation to participate was communicated verbally at a departmental meeting and via e-mail. 

In-depth, semi-structured, face-to-face interviews were used to explore pharmacists' perceptions of medication communication with prescribers. The topic guide was informed by the literature and previous research to explore how pharmacists communicate with prescribers about medications, and how they have learnt inter-professional medication communication skills. 

All interviews were digitally recorded and transcribed by the researcher. Interviews lasted an average of 32 minutes (21-48 minutes) and data saturation was achieved by the fifteenth interview. A thematic analysis was performed manually by the researchers with initial codes discussed and consensus achieved through regular meetings. 

Relevant hospital and University of Liverpool ethics committees' approval was obtained before commencing this study. 

Twenty-nine pharmacists volunteered to participate and were interviewed. A range of pharmacist grades (Agenda for change band 6-8b) were recruited. 

Three key themes emerged from the data: Communication skills training, medication communication with prescribers, and pharmacist as a communicator. Pharmacists reported that training in medication communication with prescribers was limited with these skills developed mainly through postgraduate experience and reflection. Medication communication was inconsistent between pharmacists with a range of written and verbal communication reported. Barriers to medication communication with prescribers included pharmacy service provision, workload, perceived urgency of the medication issue, prescriber rapport and communication anxiety. Expectations of junior pharmacists were considered unrealistic and contributed to unnecessary medication communication apprehensions with prescribers. The limited medication communication reported appeared to contribute to a sense that hospital pharmacists worked in parallel to the clinical team. The need for greater contextualized training in inter-professional communication was reported to prepare pharmacists for the challenges of hospital practice. 

This is a qualitative case study with limited generalizability, although a wide range of pharmacists were interviewed typical of a UK hospital pharmacy department. This is the first known UK study exploring pharmacistprescriber medication communication in a hospital setting in-depth, and has raised awareness of barriers to effective medication communication, and the need for enhanced communication-skills training to support the hospital pharmacist workforce.

 

Lloyd M; Watmough, SD; O'Brien, SV; Furlong, N; Hardy, K. (2018). Exploring hospital pharmacists’perceptions of their medication communication with prescribers . International Journal of Pharmacy Practice. 26 (Suppl S1), p27-28

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