Each participant was interviewed individually using a semi structured interview technique and then the transcripts were analysed using Action Research methodology identifying key themes from reoccurring words (bold typeface) . The content of the interviews were made by means of the interviewer taking notes.
It was decided not to use the resulting data, as although of interest it didn’t add to the outcomes data sufficiently to be of use.
Key Themes and Comments
MS 20/02/08
What does experienced checker technician mean? o Confident?
Reasons for Checkers being interrupted include
o To clarify something on a prescription often by technicians not used to being in the dispensary TRAINING
o To clarify something that a Clinical Checker has passed i.e. incomplete documentation of clinical decisions CLARIFICATION
o Loud noise can be intrusive. NOISE
o Would prefer to sit but its quicker to stand and also doesn’t obstruct gangway.
WORKPLACE DESIGN
ERROR missed an expiry dateàmissed step in checking process CLUTTERED
PRESCRIPTIONà PAPERWORK DESIGN
Labels are difficult to check on ASCribe
o Reasoning as to why a particular quantity was selected o Also to identify just who produced the label
PMRs There is no uniform approach and drug amendments are not being moved into History and so can easily select incorrect dose. TRAINING & PROCEDURES
MMcM 18/03/08
Content to check Prefer to stand DISTRACTIONS
o Pressure from wards PRESSURE TO WORK FASTER
o Pressure if know patient is waiting at Hatch PRESSURE TO WORK FASTER o Door opening and closing NOISE
o Phone ringing, especially if left to ring Position in Dispensary not an issue
Checking system
o Check prescription o Check item
o Check dose and volume (Calculate) o Check
§ Name § Strength § Date
§ Name on label § Drug and dose ERROR
o Returned from ward and found no staff …felt angry EMOTION
o Needed a drug releasing from bond for a patient who had already been down three times PRESSURE
o Staff absent at a safety group meeting OWNERSHIP
When there’s pressure to check more rapidly or to check items out of sequence
PRESSURE
SO 27/3/08
Mood acceptable
o Mood affects session if away from normal work i.e. ward and know that work on ward is backing up DISTRACTED
o Also if in dispensary for several back to back sessions i.e. dispensing and then checking
Prefers to Stand
Positioning of workstation WORKPLACE DESIGN o Long walks helps to clear mind
o a/c too cold
o Hatch is distracting Interruptions include
o Bleep
o Asked questions about Ward 15 work PRESSURE àEXPECTATIONS to
know everything o Noise
o Phone
§ When distracted start again Length of session is OK 75 minutes
ERROR
o Dispensing Omeprazole MUPS § Checked Box
§ Checked label
§ Took strips out and checked them § Bagged items
§ Had second thoughts and rechecked contents and found that one tablet strip was an incorrect strength
Distractions
o Name called out allowed in dispensary particularly if its sounds like my name o When checking try to zone out NOISE
o People walking down gangway directly behind me WORKPLACE DESIGN o People working close by me WORKPLACE DESIGN
Retain some outers and discard others? o Retain box to protect bottle
o Discard box to prevent wards confusing item with ward stock If harassed by ward feel PRESSURE
LW 28/3/08
Content to check Prefer to stand
Don’t like to walk to pigeon holes as can get called to the Hatch, as feel worried that I’m not checking, but can’t ignore people at hatch WORKPLACE DESIGN
PRESSURE
Interruptions
o At lunchtime am often the only available technician so get asked questions, including from Pharmacists who just pop in and out àannoying EMOTION o My Own ward phones to speak with me
o Have to block out noises NOISE
o As am skilled with computer often get asked how to do things, if busy have to say NO! EMOTION PRESSURE
o Also if tired tell people not to ask questions! EMOTION o Multiple interruptions
o A/C distracting as too cold ENVIRONMENT o Being near to Hatch
o Colleagues walking close behind in gangway WORKPLACE DESIGN o Colleagues working close behind in gangway WORKPLACE DESIGN Sessions are right length (75 minutes)
ERROR
o late night, very busy and feeling tired at end of long extended day
EMOTION
o worrying about drug being dispensed (Thalidomide) o also about quantity being issued
o was most senior technician on duty….felt responsibilities PRESSURE o Phones ringing NOISE
o Colleague (the Porter) harassing to be able to leave PRESSURE
DISTRACTION
o Labelling error with respect to the strength Procedures
o We don’t use tracker properly TRAINING
o Clinical pharmacists do not make their decisions clear so that anyone could simply dispense what they are recommending. TRAINING
o Insufficient workspace WORKPLACE DESIGN
o People have a Lack of confidence in using ASCribe TRAINING
o PMRS colleagues do not put the same thing in the record and hence on the label as on the prescription. TRAINING
o Labels are attached to containers obscuring information TRAINING
DR 28/3/08
Content to Check Prefer to sit
Workplace positioning
o It’s a problem if too near to the Hatch o Walking to various destinations is ok
o Not distracted by people walking in gangway or working behind me o Noise not an issue
o A/C not an issue
o Talking if too loud does distract NOISE o Too crowded WORKPLACE DESIGN Distractions
o Students asking questions DISTRACTED o Phone Calls
o Being called to the hatch to deal with an issue
o Often am asked questions because of my role as dispensary senior technician o If distracted then start checking again
o Takes 10 minutes to get into checking zone. If asked a question especially if one knows the answer then drop out of checking zone EMOTION
DISTRACTION
Checking session is right length (75 minutes) ERROR
o Incorrect paracetamol dose on label that had dispensed.
o Calculated dose in Head and volume required was incorrect and as was dose. § It was a busy Monday p.m. PRESSURE
§ Worried about late night coming up EMOTION
§ Varied from own usual checking procedure DISTRACTED § Brain saturated frazzled EMOTION
§ Cut corners SM 31/3/08
Neutral to checking
o Usually stand unless dealing with a complex prescription i.e. cystic then prefer to sit and to be somewhere quieter NOISE WORKPLACE DESIGN
Walking to destinations is OK otherwise become uncomfortable Interruptions
o Sounds can distract as can complete silence NOISE SILENCE o Might ask for person to be quiet
o If interrupted will start checking item again Length of session is ok (75 minutes)
ERROR
o Complex Outpatient prescription
o 11-12 items on prescription FORM DESIGN CLUTTERED o missed a dose i.e. was 2.5mLs but gave 5mLs
o spotted by parent at home o Felt Gutted as a result
o Was removed from checking rota as was third error in six months (!!!) Processes
o Dispensary bench becoming cluttered
o If other colleagues are working too close to me WORKPLACE DESIGN o Hatch is an issue i.e.
§ If people are looking at me , burning eyes or § Get caught at the hatch to deal with something o Talks out load to self through checking steps
RA 14/4/08
Neutral to checking Prefers to Sit
Sitting of accuracy checking station not good as often get interrupted but getting up to walk to places is ok. WORKPLACE DESIGN
Interruptions tend to be due to o Hatch
o Phone Calls
o Dispensing and labelling queries TRAINING o NOISE i.e. Children outside hatch
o Blocks out dispensary hubbub……not too much of a distraction…get used to it.
If interrupted half way through checking an item then will start again from where interruption occurred
Prefer shorter time slots i.e. 1.25 hours is Ok even up to 2 hours but if longer then will split the time with someone else.
ERROR prescription was for Codeine tablets tds
o Directions were correct but the warning was left unchanged which said that no more than four doses to be taken in 24 hours.
o Comment: was dealing with a problem on a prescription with a pharmacist but was called back to check this prescription urgently as someone was waiting.
PRESSURE
Dispensary System
o Previously labelled and dispensed but now these two functions have been separated.
o Harder to track the person who had labelled an item . o Now the dispenser is asked to be responsible for their work
o PMRs are completed by the clinical pharmacist but the same information isn’t put onto the prescription and so intention is not communicated with rest of team. INFORMATION/TRAINING?
o Don’\t go by PMR
§ Incorrect item is often selected by the Pharmacist § Or wrong form
§ Or wrong directions
§ Or information has been added by a tech and not a pharmacist
TRAINING ….
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Appendix 4 – Focus groups (Chapter 4)
The final stage of the study described in chapter 4 was to hold two focus groups, one for the pharmacist cohort and one for the technician cohort. These lasted 60 minutes and each cohort was asked the same question, “How many steps do you think it takes to accuracy check a simple medicine request, for example a request for Paracetamol liquid”? Each group answered as a group having taken a consensus and then this response was compared with the observations made and described in chapter 4.
Then each group was asked to describe the individual steps that comprise the accuracy checking process and these were mapped using SSADM (Structured system and design methodology) flow diagrams. The steps asked for, were what they actually did not what they thought needed to be done. These flow diagrams were constructed one for each group, using a flip chart with A1 paper.
The Pharmacists’ group response