Exploring attitudes and opinions of pharmacists toward delivering prescribing error feedback: A qualitative case study using focus group interviews

BACKGROUND: Prescribing error (PE) rates have been extensively reported in the literature. Various interventions at reducing PEs have been studied with some success, yet PEs continue to be a challenge for the health care system. Prescriber feedback has been proposed as one mechanism to reduce PEs in seminal studies. Pharmacists are viewed as an integral safety net in intercepting PEs and have been suggested as best placed to deliver feedback. However, there is very limited literature considering pharmacists; attitudes, views and opinions on facilitating PE feedback. OBJECTIVES: To explore the attitudes and views of hospital pharmacists in delivering feedback on PEs to prescribers. METHODS: Twenty-four pharmacists were recruited for one of four focus groups in a large district general hospital in the Northwest of England to explore the views of pharmacists to delivering feedback on PEs. Focus groups were transcribed verbatim and analyzed using a thematic framework approach to identify current practices, beliefs and attitudes of pharmacists toward delivering PE feedback. Transcripts were independently analyzed by the research team. RESULTS: Pharmacists' views on providing feedback on PEs were organized into eight major themes; Delivery of feedback, impact of feedback, prescription error, work environment, feedback facilitator, working relationships, education and training, and system improvements. Pharmacists recognized that timely feedback on PEs was essential for prescribers to learn from their mistakes and to reduce PEs. However, delivery of feedback appeared to be inconsistent, influenced by time pressures, workload, rapport and PE severity and prescriber availability. 3 / 7 Pharmacists reported that ward-based pharmacists in particular, were suitable to facilitate PE feedback, but expressed concern that the process may adversely affect prescriber-pharmacist rapport. Pharmacists reported limited training on delivery of feedback with formalized training required for improved consistency, and quality, of constructive feedback. CONCLUSIONS: PE feedback should be delivered to prescribers with ward-based pharmacists best suited to the role. Both direct and indirect benefits of PE feedback were reported, although potential barriers to delivering PE feedback were also identified. Pharmacists reported additional anxieties that feedback could create tensions and compromise working relationships with prescribers. PE feedback could be considered an extension of a pharmacist's role and pharmacists welcomed formalization of feedback, but were cognizant of the potential impact on their workload and expressed the need for training in the delivery of feedback.