A diary study of community pharmacists’ mental workload Dr Hannah Family, Prof Marjorie Weiss, Dr Jane Sutton Department of Pharmacy & Pharmacology When she said she wanted to study my brain, this wasn’t quite what I was expecting

Image source: With thanks to LocumPharmacist on Flikr Why are we interested in community pharmacist’s mental workload?

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“it is just impossible these days it is like a relentless treadmill” (Pharmacist 49) Image Credit: physical-activity M-2021D-019 by MilitaryHealth(2002). Source: 4RLoPV-6LY11P-b75E9M-6XYHki-a93DgW-4yTFMR-DMDsQ-6XX4B8-oNa3ft-85BBbw-4v1SMp-6wkxgF-6wpJBQ-ERoSZ-oXvZoe-EJEkP-bgP7PX-kL7qV-6wkxwH-6wkxYr-pEwkEf-q7nDUQ-7D4Ypf-pPNyrV-6t447u-aevGpq- 6Rkaen-a8bDv5-a88Lmc-arvWre-a88HED-a88HTg-a8bCRN-a88KCt-a88K26-a88Jer-a88JB2-nqzYDQ-s1Poc-pxXX7d-4N44Gw-pxVTf6 Dispensing factory (Gidman, 2011)

Since 2005 the number of dispensed medicines has risen by 39% Since 2005 locally commissioned services have increased by 69.3% Since 2005 MURs have increased by 1789%!! (Prescribing and Primary Care team, 2012, 2013)

Workload isn’t just about the number of services you offer… MENTAL WORKLOAD A multidimensional construct that describes the demands made of an individual’s limited information processing capacity. The level of demand made is the product of the interplay between an individual’s characteristics, the environment in which the task is carried out and the task characteristics. This is the first study of community pharmacists’ mental workload during a typical day in their practice

How do you measure mental workload? The NASA Task Load Index (Hart & Staveland, 1988)

The diary study Part of a larger mixed methods study Ethical review and approval (for whole study) from the University of Bath Research Ethics Approval Committee for Health Recruitment Participants recruited from a group of 104 strategically recruited pharmacists who had taken part in an earlier phase of the research 50 CPs Expressed an interest in participating & were posted/ ed a diary Response Rate 40 diaries returned (response rate 38%) 186 mental workload ratings from the diaries (average 4.65 ratings per participant) Participants paid £5 highstreet voucher on return of diary Diary 7 x Mental Workload Ratings + pharmacy “busyness” Demographics & Services Offered

Participant Demographics Table 1: Characteristics of CPs who participated in the MWL diary study Bivariate correlations revealed no relationship between participant sex, age, pharmacy experience or the type of community pharmacy the CPs worked

Mental workload and working hours Full-time = >35 hours a week, 138 ratings from F/T CPs, 48 from P/T CPs Table 2: MWL and pharmacy busyness ratings made by CPs who work full-time and those who work part-time

Mental Workload Throughout the Day Figure 1: Graph of the NASA-TLX MWL items and pharmacy “busyness” plotted against time of day Peak in performance concern around 7am concern

Mental Workload Throughout the Day Figure 1: Graph of the NASA-TLX MWL items and pharmacy “busyness” plotted against time of day Time pressure Mental demand Mental effort concern

Mental Workload Throughout the Day Figure 1: Graph of the NASA-TLX MWL items and pharmacy “busyness” plotted against time of day Peaks in all facets *except performance* 11am5pm concern Shifts from low to high or high to low volume of work predicted increases in near miss reports (Grasha, 2002)

Mental Workload Throughout the Day Figure 1: Graph of the NASA-TLX MWL items and pharmacy “busyness” plotted against time of day Peaks in time pressure, performance concern and task frustration 2pm concern Dispensing incidents were found to occur during prolonged periods of moderate workload or after a busy period.  Possibly due to a fatigue after- effect James et al (2013)

Image Credit: physical-activity M-2021D-019 by MilitaryHealth(2002). Source: 4RLoPV-6LY11P-b75E9M-6XYHki-a93DgW-4yTFMR-DMDsQ-6XX4B8-oNa3ft-85BBbw-4v1SMp-6wkxgF-6wpJBQ-ERoSZ-oXvZoe-EJEkP-bgP7PX-kL7qV-6wkxwH-6wkxYr-pEwkEf-q7nDUQ-7D4Ypf-pPNyrV-6t447u-aevGpq- 6Rkaen-a8bDv5-a88Lmc-arvWre-a88HED-a88HTg-a8bCRN-a88KCt-a88K26-a88Jer-a88JB2-nqzYDQ-s1Poc-pxXX7d-4N44Gw-pxVTf6 Does it matter if my mental workload is high?

When Mental Workload is high or low, it can affect the way our brain processes information and the way we carry out tasks, and make us more susceptible to making errors This usually happens without conscious awareness that it has changed

Spot the Difference (#EZDrugID)

Conclusions Sufficient evidence to warrant future investigation of mental workload in community pharmacy (and other pharmacy sectors) Mental effort and mental demand underline the high levels of concentration CPs feel they need to maintain throughout their shift Peaks in time pressure, task frustration and performance concern following the lunch hour Performance concern ratings hint at key times of day when CPs need time to mobilise mental resources  Implication for practice = undertake non-safety critical tasks until CPs feel “in the zone” Main Limitations Volume of work wasn’t measured at the time of the ratings Relatively small sample size

Thank you to.. You for listening! My participants The pharmacy organisations and pharmacists who have supported and promoted my research to date

Any Questions?

References Gidman, W. (2011). Increasing community pharmacy workloads in England: causes and consequences. International Journal of Clinical Pharmacy, 33(3), doi: /s x Grasha, A. F. (2002). Tools for the reflective practitioner: using self-monitoring, personal feedback and goal setting to reduce error Health Notes: Quality Assurance - Preventing Medication Errors (Vol. 1, pp ). San Francisco (CA): Calafornia State Board of Pharmacy Hart, S. G., & Staveland, L. E. (1988). Development of the NASA-TLX (Task Load Index); results of empirical and theoretical research. In P. A. Hancock & N. Meskkati (Eds.), Human Mental Workload. Amsterdam, Netherlands: North-Esland. James, K. L., Barlow, D., Bithell, A., Hiom, S., Lord, S., Pollard, M.,... Whittlesea, C. (2013). The impact of automation on workload and dispensing errors in a hospital pharmacy. International Journal of Pharmacy Practice, 21(2), Prescribing and Primary Care team. (2012). General Pharmaceutical Services in England to : Health and Social Care Information Centre. Available at: pharm-eng rep.pdf Prescribing and Primary Care team. (2013). General Pharmaceutical Services in England to : Health and Social Care Information Centre. Available at: pharm-eng rep.pdf