Failure-Free Pharmacies? : An Exploration of Dispensing Errors and Safety Culture in Swedish Community Pharmacies

Quality in pharmacies includes aspects such as error management and safety issues. The objective of this thesis was to explore these aspects of quality in Swedish community phar-macies. The specific aims were to compare a paper-based and a web-based reporting system for dispensing errors, regarding reporting behaviour and data quality. The impact of an intervention; a technical barrier, for preventing dispensing errors was evaluated. A survey tool, the Safety Attitudes Questionnaire (SAQ), was adapted to Swedish pharmacies and used to describe the safety culture in these pharmacies. The potential relationship between safety culture and dispensing errors was also explored. Data was retrieved from the paper- and web-based reporting systems, semi-structured interviews as well as from a survey, using SAQ. The change in reporting system for dispensing errors increased the reporting of errors and enhanced the completeness of reported data. The web-based system facilitated follow-up and identification of preventive measures, but was associated with implementation problems. The intervention was associated with a significant decrease in the overall number of dispensing errors and, specifically, reports on errors with the wrong strength, and errors caused by registration failure in the pharmacy computers. The Swedish version of the survey tool, SAQ, demonstrated satisfying psychometric properties. No correlation between the SAQ Safety Climate dimension and dispensing errors was seen, while a positive relationship between the SAQ Stress Recognition dimension and dispensing errors was established. A number of other pharmacy characteristics, such as number of dispensed prescription items and employees, displayed positive relationships with dispensing errors. Staff age demonstrated a negative relationship with dispensing errors while other demographic variables such as national education background showed a positive relationship

Trends in pharmacy staff’s perception of patient safety in Swedish community pharmacies after re-regulation of conditions

Background: All changes in the regulation of pharmacies have an impact on the work carried out in pharmacies and also on patient safety, regardless of whether this is the intention or not.Objective: To compare staff apprehension regarding some aspects of patient safety and quality in community pharmacies prior to and after the 2009 changes in regulation of the Swedish community pharmacy market.Methods: Questionnaires targeted at pharmacy staff before and after the changes in regulation (in 2008, 2011/12, and 2012/13 respectively) used four identical items, making comparisons of some aspects possible.Results: All four items demonstrated a significant decrease in the first survey after the changes as compared to before. In the second survey significant differences were found on the two items representing safety climate whereas the items representing team climate and management showed no significant differences.Conclusions: The comparison carried out in this study indicates a negative effect in Swedish community pharmacies on safety and quality issues, as experienced by pharmacy staff. It is recommended that the possible effects of healthcare reforms are assessed before implementation, in order to counteract conceivable decline in factors including patient safety and working conditions.

Exploring the relationship between safety culture and reported dispensing errors in a large sample of Swedish community pharmacies

The potential for unsafe acts to result in harm to patients is constant risks to be managed in any health care delivery system including pharmacies. The number of reported errors is influenced by a various elements including safety culture. The aim of this study is to investigate a possible relationship between reported dispensing errors and safety culture, taking into account demographic and pharmacy variables, in Swedish community pharmacies. A cross-sectional study was performed, encompassing 546 (62.8%) of the 870 Swedish community pharmacies. All staff in the pharmacies on December 1st, 2007 were included in the study. To assess safety culture domains in the pharmacies, the Safety Attitudes Questionnaire (SAQ) was used. Numbers of dispensed prescription items as well as dispensing errors for each pharmacy across the first half year of 2008 were summarised. Intercorrelations among a number of variables including SAQ survey domains, general properties of the pharmacy, demographic characteristics, and dispensing errors were calculated. A negative binomial regression model was used to further examine the relationship between the variables and dispensing errors. The first analysis demonstrated a number of significant correlations between reported dispensing errors and the variables examined. Negative correlations were found with SAQ domains Teamwork Climate, Safety Climate, Job Satisfaction as well as mean age and response rates. Positive relationships were demonstrated with Stress Recognition (SAQ), number of employees, educational diversity, birth country diversity, education country diversity and number of dispensed prescription items. Variables displaying a significant relationship to errors in this analysis were included in the regression analysis. When controlling for demographic variables, only Stress Recognition, mean age, educational diversity and number of dispensed prescription items and employees, were still associated with dispensing errors. This study replicated previous work linking safety to errors, but went one step further and controlled for a variety of variables. Controlling rendered the relationship between Safety Climate and dispensing insignificant, while the relationship to Stress Recognition remained significant. Variables such as age and education country diversity were found also to correlate with reporting behaviour. Further studies on the demographic variables might generate interesting results

Dry Distillation of Radioiodine from TeO2 Targets

As medical cyclotrons are becoming more abundant, 123I and 124I are getting more attention as alternatives to 131I for diagnostics of thyroid disease. Both 123I and 124I provide better diagnostics, deliver less dose to patients and both reduce the risk of thyroid stunning, facilitating subsequent therapy. Dry distillation of radioiodine from tellurium dioxide targets has become the standard approach to producing these radioiodines. Setting up such a production of radioiodine is associated with a lengthy optimization of the process and for this purpose natural tellurium is often used for economical reasons. In this paper, the distillation parameters are scrutinized to ensure optimal distillation temperature, in order to minimize time spent and prevent loss of expensive target material. It is further demonstrated how the individual iodine isotopes, produced from proton bombardment of natTe, will diffuse out of the target in a time dependent ratio. We believe the effect is due to the isotopes having their maximum cross section at different energies. The individual isotopes produced will thus have their highest concentration at different depths in the target. This results in individual mean diffusion lengths and diffusion times for the different isotopes

Clima de segurança no bloco operatório: tradução, validação e aplicação do questionário de atitudes de segurança

Background Safety climate assessment is increasingly recognized as an important factor in healthcare quality improvement, especially in operating rooms (OR). One of the most commonly used and rigorously validated tools to measure safety culture is the Safety Attitudes Questionnaire (SAQ). This study presents the validation of the Operating Room Version of the SAQ (SAQ-OR) for use in Portuguese Hospitals. The psychometric properties of the translated questionnaire are also presented. Methods The original English version of the SAQ-OR was translated and adapted to the Portuguese setting by forward-backward translation method and applied in a central public hospital. Scale psychometrics were analyzed using Cronbach's alpha and inter-correlations among the scales. Results The internal consistency test yielded values around 0.9 for all 73 items. The CFA and its goodness-of-fit indices (SRMR 0.05, RMSEA 0.002, CFI 0.90) showed an acceptable model fit. Inter-correlations between the factors safety climate, teamwork climate, job satisfaction, perceptions of management, and working conditions showed moderate correlation with each other. 82 valid questionnaires were analyzed revealing significant differences in communication ratings between different jobs, mainly between surgeons (4.2) and between nurses and surgeons (2.9). Working conditions and job satisfaction have the highest score with 3.8 and 3.5, respectively, and perceptions of management have the lowest score (2.8). Conclusion The Portuguese translation of the SAQ-OR reveals good psychometric properties for studying the organizational safety climate, however larger and further studies are required to compensate the lack of subjects in some items. Like other studies, this scale seems to be an acceptable to adequate tool to evaluate the safety climate. Results allowed to conclude that working conditions and job satisfaction are satisfactory. However, there is latitude for improvement, especially in the involvement of the management bodies as this factor has the lowest score for the majority of healthcare professionals