Patient Safety Culture in Handling Prescriptions and Interprofessional Collaboration Practices Amongst Community Pharmacists: An Investigative Simulated Patient Study from the United Arab Emirates

Readiness for Interprofessional Education Among Health Profession Students in a University in the United Arab Emirates

Introduction

Inter-Professional Education (IPE) is an educational engagement between students from two or more professions possibly leading to better collaboration among them in the future workplace. Several organizations have advocated, developed, and updated guidelines for IPE.

Objective

This study was aimed at assessing the medical, dental, and pharmacy students' readiness toward interprofessional education (IPE), and to identify the association between readiness and the demographic profile of students in a university in the United Arab Emirates (UAE).

Methods

A cross-sectional questionnaire-based exploratory study involving 215 medical, dental, and pharmacy students at Ajman University, UAE, using convenience sampling. The survey questionnaire (Readiness for Interprofessional Learning Scale, RIPLS) had a total of 19 statements. The first 9 items were related to "teamwork and collaboration", items 10-16 were related to "professional identity", and the remaining three (items 17-19) were related to "roles and responsibilities". The individual statements' median (IQR) scores were calculated and the total scores were compared with the demographic characteristics of the respondents with suitable non-parametric tests at alpha=0.05.

Results

Altogether, 215 undergraduate students (medical (n= 35)), pharmacy (n=105), and dental (n=75) responded to the survey. The median (IQR) score for the 19 individual statements was '5 (4-5)' for 12 of the statements. The total scores and domain-specific scores (teamwork and collaboration, professional identity, and roles and responsibilities) according to respondents' demography showed significant differences only in the case of the educational stream with professional identity score (p=<0.001), and the total RIPLS score (p=0.024). Further, post hoc pairwise comparison showed a significant difference between medicine-pharmacy (p<0.001), and dentistry-medicine (p=0.009), for professional identity, and medicine-pharmacy (p=0.020) for the total RIPLS score.

Conclusion

A high readiness score among students offers the possibility of conducting IPE modules. A favorable attitude can be considered by curriculum planners while initiating IPE sessions.

A Systematic Literature Review of Safety Culture in Hemodialysis Settings

Background

Safety culture is an important aspect of quality in healthcare settings. There are many risks that patients can encounter in hemodialysis settings one of which is the infection risks due to the regular need to access bloodstreams using catheters and needles. Implementation of prevention guidelines, protocols and strategies that reinforce safety culture excellence are essential to mitigate risks. The objective of this study was to identify and characterize the main strategies that enhance and improve patient safety culture in hemodialysis settings.

Methods

Medline (via PubMed) and Scopus were searched from 2010 to 2020 in English. Terms defining safety culture, patient safety were combined with the term hemodialysis during the search. The studies were chosen based on inclusion criteria.

Results

A total of 17 articles reporting on six countries were identified that met inclusion criteria following the PRISMA statement. From the 17 papers, practices that were successfully applied to improve safety culture in hemodialysis settings included (i) training of nurses on the technologies used in hemodialysis treatment, (ii) proactive risk identification tools to prevent infections (iii) root cause analysis in evaluating the errors, (iv) hemodialysis checklist to be used by the dialysis nurses to reduce the adverse events, and (v) effective communication and mutual trust between the employee and leadership to support no-blame environment, and improve the safety culture.

Conclusion

This systematic review provided significant insights on the strategies that healthcare safety managers and policy makers can implement to enhance safety culture in hemodialysis settings.

Evaluation of Community Pharmacists' Competences in Identifying and Resolve Drug-Related Problems in a Pediatric Prescription Using the Simulated Patient Method

Background: Drug-related problems (DRPs) are a global issue that impacts the efficacy and safety of the therapy, and pediatric patients are considered to be more vulnerable to DRPs, thus requiring more attention. Community pharmacists (CPs) are in a position that allow them to identify and alleviate these DRPs. Objectives: This study evaluated the ability of CPs in identifying and resolving DRPs in a pediatric prescription. Methods: A cross-sectional study was carried out in 235 community pharmacies to evaluate the ability of CPs working in the Khartoum locality to identify DRPs in a pediatric prescription and how they intervene to resolve these problems. Fifth-final year B. Pharm. Students were selected and trained to act as simulated patients (SPs) for this study. The visits were performed by using a simulated prescription that contains three different types of DRPs. The information obtained from the visits was documented immediately by the SPs after leaving the pharmacy in a data collection form. Results: All planned SPs visits were completed. Of the 235 community pharmacies, only 50 (21.3%) CPs were able to identify at least one of the DRPs. The most common type of DRP identified was the wrong duration of the treatment 19%, followed by the wrong dose 4%. The interventions made by CPs to mitigate the identified DRPs included recalculation and correction of the dose according to weight, which was made by 10 CPs, and correction of the duration, which was done by 45 CPs. None of the CPs who identified the presented DRPs communicated with the physician or referred the SP to the prescriber. The average dispensing time of the CPs was 68.18 ± 36.1 s. Conclusions: The majority of the CPs in the Khartoum locality were unable to identify DRPs in a pediatric prescription. Correction of the dose and duration of treatment were from the attempts of CPs to resolve DRPs. However, no collaboration was observed between CPs and physicians. In general, the practice of CPs in Khartoum locality in this area requires substantial improvement.

Critical appraisal of simulated patient methodology to assess the practice of community pharmacist in the Middle East and North Africa region: A systematic review

Background

The use of simulated patient (SP) methodology in pharmacy practice settings has increased recently. However, its applications can vary significantly within a region, hence affecting the quality of the SP methodology.

Objective

The purpose of this systematic review is to critically assess the use of the SP methodology for assessing the practice of community pharmacists (CP) in the Middle East and North Africa (MENA) region.

Methods

A comprehensive literature search was conducted using EMBASE, MEDLINE, ProQuest, and SCOPUS to identify articles published from 2011 to 2022. The selection of relevant studies for inclusion in the systematic review was based on the pre-determined inclusion criteria. The Mixed Method Appraisal Tool (MMAT) was used to assess the methodological quality of the included studies.

Results

Electronic search yielded 478 publications. A total of 45 studies were reviewed. The studies were conducted in 12 countries of the MENA region. The sample size between the reviewed articles ranged from 20 to 1000 (median= 129). A greater number of the included studies measured the adequacy of skill (pre-dispensing and/or post-dispensing) 38 (84.4%). The vast majority of the studies reported unsatisfactory results regarding the competencies of CP. The number of the SP ranged from 1 to 37 (median= 2). Most of the studies recruited only one SP per pharmacy 35 (77.8%). The most common data collection method was written data collection form 42 (93.3%). Few studies only had a detection system for SP visits 11 (24.4%), and only six studies incorporated performance feedback (13.3%). More than two-thirds of the studies provided a training session for SP 37 (82.2%). There was variation in the symptoms and drugs used in the SP scenarios in the studies.

Conclusion

Although the results demonstrate the growth in the use of the SP method in MENA region countries, studies showed high variability in the level of reporting the study methodology. Consequently, we argue the need for standardized reporting of these studies.

The Practice of the Community Pharmacists in Managing Potential Drug-Drug Interactions: A Simulated Patient Visits

Background

Drug-drug interactions (DDIs) can cause treatment failure and serious adverse drug reactions, leading to morbidity and mortality. Due to their significant effects on the patient’s health, community pharmacists (CPs) competence in detecting and preventing these interactions is essential to provide optimal health services. Thus, this study aimed to explore the performance of the CPs in situations involving the presence of potential DDIs.

Methods

A cross-sectional, simulated patient study was conducted in 235 community pharmacies in the Khartoum locality. Two scenarios were used to evaluate the performance of the CPs. Ten final year B. Pharm. students were selected to act as simulated patients (SPs); they were trained for two weeks to familiarize their roles. All encounters were documented immediately after leaving the pharmacy by the SPs in the data collection form.

Results

All planned SPs visits were completed, resulting in 470 visits. None of the CPs asked about the patients’ medication history in both scenarios. After the SPs provided information about the drug used currently by the patient, 13.6% and 23.4% of the CPs had identified the potential DDIs in scenario 1 and scenario 2, respectively. In scenario 1, 59.4% distinguished the interaction of simvastatin with both drugs, while, in scenario 2, 74.5% recognized the interaction of warfarin with both drugs. In identifying DDIs, around half of the CPs were dependent on their knowledge or using drug interaction checker programs. The most common intervention made by the CPs was referring the patient to the prescriber (56.3% CPs in scenario 1 and 60% CPs in scenario 2).

Conclusion

CPs practice in identifying and managing potential DDIs was poor. The current CPs practices need substantial improvement. Therefore, professional education and the use of software programs in community pharmacies should be encouraged.