Evaluating the role of the Ghanaian pharmacist in medication safety strategies in hospitals

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Healthcare has always been a risky venture with a lot of harm associated with it. Medicines form a major and vital part of the healthcare delivery system. The World Health Organisation and many national safety organisations have created a lot of awareness about the importance of enhancing patient safety in the healthcare system. Evidence available suggests that a lot of adverse drug events especially medication administration errors occur during the medication use process. Consequently, it is important to detect and prevent errors at the drug administration stage, since it is also the last step before these errors could reach patients. In Ghana, little is known of the prevalence and contributory factors of medication administration errors. Current literature suggests the existence of many medication safety strategies that are being employed. Pharmacists in particular, have been identified to contribute immensely to the safe use of medicines globally. The aim of this study was to determine the existence of adverse drug events with emphasis on medication administration errors, explore the perceived roles and documented evidences of pharmacists’ roles in the safe use of medicines and understand the experiences and expectations of doctors and nurses on such roles. Methods The methods used were the following: • A direct non-participatory observation of medication administration by nurses followed by face-to-face interview with a sample of these nurses at the Surgical Medical Emergency Department of Korle Bu Teaching Hospital. • Survey of pharmacists working in Ghanaian hospitals across the country using a structured questionnaire. • Retrospective evaluation of documented clinical intervention reports followed by key informant interviews of pharmacists involved in the reporting. • Open and close-ended questionnaires administered to a conveniently sampled doctors and nurses at the hospital to explore their perceptions and expectations. Key findings • Medication administration errors occurred at a rate of 27.2% at the emergency setting. It was also shown that most of the causes of the errors were related to staff and environmental factors such as workload, and lack of adequate knowledge about medication and their use. • Pharmacists in Ghanaian hospitals perceived their services to be useful in preventing adverse drug events. They indicated that they spent more time on activities with perceived greatest impact on patient care such as reviewing pharmacotherapies, monitoring adverse drug reactions and counselling patients on medication use. • Documented evidence of Pharmacist’s clinical interventions activities revealed that 24 pharmacists made 1019 clinical interventions in 448 handwritten reports. Majority (76.1%) of the interventions related to drug therapy changes. The pharmacists reported that the major barrier to their medication safety roles was the perceived discrepant attitude of doctors and nurses. • In contrast, doctors and nurses indicated that they interacted frequently with pharmacists and acknowledged their roles to be useful in contributing to medication safety. Conclusions and Recommendations • Medication administration errors were observed in over a quarter of the activities of the nurses involved in the study. • There was an overwhelming evidence of the strategic role of hospital pharmacists in identifying and preventing adverse drug events. • Unlike the perception that pharmacists had about the discrepant attitudes of doctors and nurses, the clinicians acknowledged and appreciated the role of the pharmacist in medication safety. • The clinical role of pharmacist in hospitals should be intensified to enhance safety and patient care.
A thesis submitted in fulfillment of the requirements for the degree of Doctor of Philosophy In the Department of Clinical and Social Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences College of Health Sciences, 2015