Exploring hospital pharmacists’ perceptions of their medication communication with prescribers Dr. Michael Lloyd, Dr. Simon Watmough, Professor Sarah O’Brien, Professor Kevin Hardy, Dr. Niall Furlong 2018 e-mail: michael.lloyd@sthk.nhs.uk

Overview Background Methods Results Discussion Conclusion Questions 2

Background Communication problems between healthcare professionals is prevalent.1 Prescribing errors are common and problematic in hospital settings.2 Poor communication between healthcare professionals is a leading contributing factor.2,3 1. Howard R et al., Qual Saf Health Care 2008;17:109–16. 2. Dornan T., et al. EQUIP study, GMC, 2009 3. Tully M., et al., Drug Saf, 32:819–36 3

Background Pharmacist-doctor communication explored in primary care.1,2 Barriers reported Limited research in hospital settings. Junior doctor perspective recently reported in a UK setting.3 Lack of research exploring pharmacist views.4 Therefore... 1. Bradley F., et al., Res Social Adm Pharm 2012;8:36–46. 2. Van C., et al. J Interprof Care 2011;25:366–72 3. Axon DR, et al. Eur J Hosp Pharm 2018;0:1–5 4.. Astrom K., et al., Pharmacy Education 2007;7:279-85 4

Aim To: Explore the perceptions of hospital pharmacists on their medication communication with prescribers 5

Methods Semi-structured face-to-face interviews. Topic guide. Pilot Purposive sampling. Participants invited via e-mail / team meeting. Verbal and written consent obtained. Interviews audio recorded. Ethical approval via relevant committees. 6

Data analysis Interviews transcribed verbatim. Thematic analysis undertaken manually. Independent coding by second researcher. Themes discussed with team. 7

Results 29 hospital pharmacists recruited. AfC bands 6 (n=9), 7 (n=9), n=8), 8b (n=3) Eight pharmacists did not reply to follow-up e-mails. Mean interview duration 32 (21-48) mins. Data saturation achieved. 8

Results Three key themes Impact on error rates Communication skills training Medication communication with prescribers Pharmacist as a communicator

Communication skills training “You observe other pharmacists, so you can see and hear how they deal with situations. So you learn quite a lot from observational means.” [P22, Band 6] “Communications skills wise, we did pharmacy practice you know talking to patients, counselling patient’s, but very little in multi-disciplinary communication.” [P6, Band 8a] “Your competencies are quite vague and not specific…like communicating in the ‘appropriate manner’, but there is nothing specific about speaking to a doctor.” [P20, Band 6]

Medication communication with prescribers Frequent Inconsistent Various influencing factors “I wasn’t confident enough to speak to a consultant because I wasn’t confident enough in what I knew and I wouldn’t have known if I was right whereas with a junior they are more at my level in here” [P22, Band 6] “It depends where you are, I mean if it is your ward and your doctor then you will speak to them but if it isn’t, you may not speak to them unless it is a really serious error.” [P8, Band 7]

Pharmacist as a communicator Preparedness for practice Unrealistic expectations “I’ve been qualified for three years and I think that where I am now is where you need to be and if they are going to put you out on a ward as a pharmacist from day one then they need to prepare you to speak to doctors because otherwise it leads to errors” [P19, Band 7]

Pharmacist as a communicator Unrealistic expectations Self-confidence Communication anxiety “There is a fear that they are going to ask you a question that you don’t know the answer too” [P12, Band 7] “I have to build myself up to approach them and that is irritating. Talking to doctors that I don’t know on a personal and professional level is anxiety provoking for me.” [P23, Band 6] Expectations of junior pharmacists were considered unrealistic and contributed to unnecessary medication communication apprehensions with prescribers.

Discussion/ Conclusion Pharmacists frequently communicate with doctors in hospital settings Mode of communication inconsistent Barriers highlighted Current training limited More training and experience needed prior to qualification

Questions? Thank you for the opportunity to share this research with you today. I’d now like to invite any questions that you may have.