Procedures meet practice in community pharmacies

High workload, rigid rules, and conflicting pressures from their employers are all leading to community pharmacy staff deviating from standard procedures at times to ensure patients receive the tailored care they require, a new study from The University of Manchester has found.

The research which was funded by the National Institute for Health Research (NIHR) and published in BMJ Open, analysed interviews with 24 practising staff working at a variety of levels in pharmacies. The interviewees discussed their views and experiences of complying with procedures that had been laid down either for safety or for other company purposes. Participants came from a variety of pharmacy types and from a range of locations across England and Wales.

In this study, funded by the NIHR Greater Manchester PSTRC, some interviewees raised concerns that they were asked to follow rigid procedures that didn't allow staff to use their professional judgement when caring for patients. In such circumstances, pharmacists felt that they should do what they judged to be best for safe patient care rather than following procedures to the letter. A further challenge for pharmacy staff was the need to balance safe patient care with the achievement of company targets for services such as medicines usage reviews. However, some respondents felt that they weren't able to express their concerns about strict adherence to the procedures.

The study also highlighted that during peak times, staff were still expected to follow procedures but often had many tasks to complete at the same time, which made following procedures more difficult. For example, one participant said: "Easter weekend, the week before Christmas [and] the end of [a] week [are] usually very busy…[then] sticking to the rules becomes less of a priority."

Lead researcher, Ms Christian Thomas said: "It's clear that pharmacists under pressure don't always follow procedures exactly. In the interests of individual patients this isn't always the wrong thing to do, but the scale, complexity and inefficiency of some of these procedures is creating an atmosphere where staff think it isn't realistic to know or follow every procedure to the letter."

"Pharmacy companies should look to involve their staff more in developing procedures and ensuring they can be used in practice."

Ms Thomas added: "The study highlights the tension between standardising practice on the one hand and the need, at times, for greater flexibility on the other hand to deliver effective patient care."

"These findings should help to inform policy makers and practitioners with regards to the factors most likely to influence the implementation, or not, of procedures in community pharmacy settings."