Risk-based revalidation of pharmacists: What characteristics should we consider? Denham Phipps 1,2 ; Peter Noyce 2 ; Dianne Parker 1,2 ; Kieran Walshe

Risk-based revalidation of pharmacists: What characteristics should we consider?Denham Phipps1,2; Peter Noyce2; Dianne Parker1,2; Kieran Walshe3; Darren Ashcroft1,2

1. NIHR GM PSTRC, University of Manchester2. Manchester Pharmacy School, University of Manchester3. Manchester Business School, University of Manchester

The NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre is funded by the National Institute for Health Research (NIHR) and is a partnership between the University of Manchester and Salford Royal NHS Foundation Trust

NIHR Greater ManchesterPrimary Care Patient SafetyTranslational Research Centre

The agenda

• Requirement for healthcare professions with statutory regulation to have arrangements for revalidating members’ fitness to practice (Department of Health, 2007)

• Revalidation scheme should be proportionate to the level of risk posed by practitioners (Royal Pharmaceutical Society of Great Britain, 2009)

• What are the risks in pharmacy practice?

NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre

Risk


• “A process owned by pharmacy stakeholders, in which a pharmacist’s actions have an undesirable effect on one or more of the stakeholders”

• Stakeholders: pharmacy staff; manufacturers; regulator; other care professionals; patients; employers; general public

Phipps et al. (2010)

Risk


• Types of risk in pharmacy practice• Clinical risks (e.g. dispensing error; incorrect

advice given)• Conduct risks (in work; outside of work)• Health risks (ill health; substance misuse)

Phipps et al. (2011a)

Sources of practitioner risk


• Individual variables?• Demographic variables (age; gender; ethnicity;

socio-economic background)• Length of experience• Training location• Individual differences• Behavioural history

Phipps et al. (2011a,b)

Sources of practitioner risk


• Contextual variables?• Specialty / sector• Lone working• Organisational culture

Phipps et al. (2011a,b)

Study aims


• Identify factors associated with practitioner risk

• Assess the presence of risk factors across a sample of practising pharmacists

Identify factors associated with practitioner risk


• Interviews with 32 pharmacy practitioners and stakeholders in England• What can go wrong in pharmacy practice?• What makes a pharmacist “high risk”?• What makes a pharmacist “low risk”?



• Using template analysis, three main themes were identified:• The pharmacist• The task• The organisation



• The pharmacist• Knowledge, skill and attitude• Employment history• Engagement in CPD• Health and lifestyle• Communication skills• Length of service



• “[When I spot minor but frequent mistakes], that shows that the pharmacist hasn’t got to grips with what needs to be done. If I’m picking these up then what’s the bigger picture?” [Pharmacy technician]

• “Another [pharmacist] I referred to [the RPSGB], […] she’d worked for various other companies who I think had dismissed her, but not informed [the RPSGB] about her.” [Superintendent pharmacist]

• “Pharmacists who have a willingness to develop themselves […] are professionally engaged and […]self motivated […] so I think they would be my low risk individuals.” [Hospital pharmacy manager]



• The task• Type of product• Specialty• Seniority• Advisory / consultation role• Advanced or specialist practice• Staffing• Workload and work design



• “Junior staff do a lot of the day-to-day work [such as] checking prescriptions, but as you climb the ladder, […] you do a lot less of that sort of work and you do a lot more towards the prevention side of things with SOPs, guidelines, working with the team, so it’s slightly different.” [Pharmacist, Teaching hospital 1]

• “I think the higher we go or the further away from the pharmacy we go sometimes to dip into new areas, I think that its kind of fraught with risk, but the key is actually how that risk is managed rather than saying it’s more risky.” [Pharmacist, Specialist hospital]

• “I think at the moment pharmacists are being asked to be in too many places at the same time and that is a huge risk, because then you’re not giving any one job your full attention and therefore things can slip through and that can be risky.” [Locum pharmacist]



• The organisation• Business demands• Risk management• Organisational culture



• “In times of financial difficulties budgets will be cut but workload tends not to be cut and so […] it’s always a pressure to do more and provide more service for less.” [Pharmacy manager, Teaching hospital]

• “In a company like ours, we do everything we can to minimise risk by having strict procedures and SOPs to follow so, although you’ll never eliminate risk, making errors will be minimised […] and in any other big company I’m sure would be exactly the same.” [Superintendent pharmacist]

• Every time something goes wrong we have a reporting system, and we look at why it’s gone wrong and what we can do to prevent it happening again. So we have a different mind set here, and we have a no-blame policy…which is important, or else people won’t report. [Technician, Teaching hospital]

Assess the prevalence of risk factors in a sample of pharmacists


• Survey of registered pharmacists in Northern Ireland (N = 504)

• Contained the following self-report measures:• Work history (type of pharmacy; career break; change of

sector)• Psychosocial job characteristics (autonomy; demand;

feedback)• Pharmacy safety climate (organisational learning; working

conditions; blame culture; safety focus)• Individual well-being (competence; general health)• Frequency of engaging in risk-increasing or risk-reducing

behaviours



• Multivariate analyses of variance identified the following patterns (p < 0.05)• Community pharmacists – most favourable

ratings for organisational learning • Hospital pharmacists – most favourable ratings

for blame culture• Other roles – most favourable ratings for

autonomy, demand, and feedback



• Multivariate analyses of variance identified the following patterns (p < 0.05)• Managers vs non-managers – more favourable

ratings on safety climate, less favourable scores on risk behaviours

• (NB – “Managers” = NHS Band 8/9, community pharmacy owners and managers)



• Multivariate analyses of variance identified the following patterns (p < 0.05)• Patient-facing roles – less favourable ratings for

working conditions and autonomy• Recently returned from career break – less

favourable ratings for autonomy, demand and competence



• Correlation analysis identified the following pattern (p < 0.05)• Respondents with more years’ experience – more

favourable ratings for safety climate, autonomy and competence

Conclusions


• Identifying “high-risk” pharmacists involves a range of factors – individual and contextual

• A more complex picture than provided by looking just at basic demographics

• The occurrence of risk factors varies across the pharmacy workforce

Implications


• Routine data recording about registrants – should be more detailed if better prediction of risk is needed

• Further work recommended to develop and validate practitioner risk assessment

• Incorporate contextual factors into assessment – e.g. link to data from GPhC site inspections

References


• Department of Health (2007). Trust, Assurance and Safety: The regulation of health professionals in the 21st Century. Norwich: The Stationery Office.

• Phipps, D.L. et al. (2010). Risk assessment in pharmacy practice. Report to the Royal Pharmaceutical Society of Great Britain.

• Phipps, D.L., et al. (2011a). Risk-based regulation of healthcare professionals: what are the implications for pharmacists? Health, Risk & Society, 13(3), 277-292.

• Phipps, D.L., et al. (2011b). Pharmacists subjected to disciplinary action: characteristics and risk factors. International Journal of Pharmacy Practice, 19, 367-373.

• Royal Pharmaceutical Society of Great Britain (2009). A draft model for revalidation in pharmacy. Unpublished report, RPSGB.

A partnership between

Thank you for your attention.Any [email protected]

The work described in this presentation was funded by the Department of Health, and commissioned by the Royal Pharmaceutical Society of Great Britain and the Pharmaceutical Society of Northern Ireland. The views expressed are those of the authors only.

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Risk-based revalidation of pharmacists: What characteristics should we consider? Denham Phipps 1,2 ; Peter Noyce 2 ; Dianne Parker 1,2 ; Kieran Walshe