Effective communication is important for medication safety and high quality of care. We have explored contributing factors to effective communication:
In a study exploring handoff communication between pharmacists during shift changes, we found that there is a lack of standardization in communication. Irregularities in communication lead to patient issues “falling between the cracks” which, in turn, lead to pharmacist frustration, delays in patients receiving prescriptions, and medication errors. Although handoff communication has been well documented among nurses and physicians, my research is the first to describe how handoffs take place in community pharmacies.
The need for physicians and pharmacists to work as a team is greater now than ever, given the recent push for improved coordination of health care. One of my studies examined barriers to standardized communication between physicians and pharmacists located in different settings. In this project, we facilitated and studied a structured interaction between physicians and pharmacists located in the same community. The results showed that they could identify common goals and work together to solve problems in a mutually beneficial way, despite having never met each other before. However, despite a sincere interest in working together, physicians and pharmacists identified significant barriers that prevent collaboration, including lack of time, lack of necessary patient information, legal and insurance constraints, and poor electronic prescribing technology design.
Communication lapses also exist between pharmacists and patients. One of our projects explored contributing factors to pharmacists making safe over-the-counter (OTC) medication recommendations to patients. Unsafe OTC medication use is well documented, and it is estimated to increase as the baby boomers age. One important result of this study is that the identified factors did not include pharmacist knowledge and confidence. This is a significant result since most studies designed to improve OTC recommendations mainly focus on educational interventions for pharmacists. Other identified factors that impact the ability of pharmacists to safely and effectively provide OTC recommendations to patients were related to the organizational culture, supervisory support, and physical layout of the work setting.
Our research confirms that communication in a pharmacy is not a simple process. Building on our previous work, we are moving forward on two projects. First, to address handoff communication between pharmacists, we are currently conducting a survey to examine more broadly the specific characteristics of handoffs and how they are associated with safety culture and pharmacy characteristics. We are planning to leverage the results of these two projects to inform an intervention that will be designed to improve handoff communication in community pharmacies. Second, in order to move the research stream associated with communication between pharmacists and patients forward, we are collaborating on a proposal to the National Institute on Aging (NIA) focused on improving OTC safety in older adults.
In summary, our research, which draws from the human factors discipline, has provided significant groundwork to move forward on several rigorous and systematic interventions. Because our research is theory-driven and contributing work system factors have been well studied, it is likely that future interventions will be successful.