Download:
pdf |
pdfATTACHMENT G
2012 Preliminary Comparative Results:
Pharmacy Survey on Patient Safety Culture
Prepared for:
U.S. Department of Health and Human Services
Agency for Healthcare Research and Quality540 Gaither Road
Rockville, MD 20850
www.ahrq.gov
Contract No. HHSA 290200710037
Managed and prepared by:
Westat, Rockville, MD
AHRQ Publication No. 12-0085-1-EF
September 2012
The authors of this report are responsible for its content. Statements in the report should not be construed as
endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human
Services.
This document is in the public domain and may be used and reprinted without permission except
those copyrighted materials noted for which further reproduction is prohibited without specific
permission of copyright holders.
Suggested Citation:
2012 Preliminary Comparative Results: Pharmacy Survey on Patient Safety Culture. (Prepared
by Westat, Rockville, MD, under Contract No. HHSA 290200710037.) Rockville, MD: Agency
for Healthcare Research and Quality; September 2012. AHRQ Publication No. 12-0085-1-EF.
No investigators have any affiliations or financial involvement (e.g., employment, consultancies,
honoraria, stock options, expert testimony, grants or patents received or pending, or royalties)
that conflict with material presented in this report.
ii
Contents
Purpose and Use of This Document.................................................................................................1
Survey Development ........................................................................................................................1
Characteristics of Pilot Study Pharmacies .......................................................................................3
Characteristics of Pilot Study Respondents .....................................................................................8
Composite-Level and Item-Level Results .....................................................................................10
Composite-Level and Item-Level Results by Staff Position..........................................................16
Composite-Level and Item-Level Results by Number Of Prescriptions Filled Per Week ............22
Tables
Table 1. Patient Safety Culture Composites and Definitions ..........................................................2
Table 2. Overall and Average Response Statistics for 55 Pharmacies ............................................3
Table 3. Distribution of Pharmacies by Type of Store ....................................................................3
Table 4. Distribution of Pharmacies by Type of Store for U.S. Pharmacies and
Pilot Study Pharmacies ..............................................................................................................4
Table 5. Distribution of Pharmacies by Number of Locations/Stores .............................................4
Table 6. Distribution of Pharmacies by Region ...............................................................................4
Table 7. Distribution of Pharmacies by Average Number of Prescriptions Dispensed per Week ..4
Table 8. Distribution of Pharmacies by Hours per Weekday Pharmacy Is Open ............................5
Table 9. Distribution of Pharmacies by Days per Week Pharmacy Is Open ...................................5
Table 10. Distribution of Pharmacies by Whether There Is a Drive-Through Window..................5
Table 11. Distribution of Pharmacies by Whether There Is a Central-Fill for Dispensing
Medications ................................................................................................................................6
Table 12.Distribution of Pharmacies by Staff Positions That Belong to a Union ...........................6
Table 13. Distributions of Pharmacies by Use of Selected Automated (Electronic)
Technologies ..............................................................................................................................6
Table 14. Distributions of Pharmacies by Use of Selected Clinical/Medication Therapy
Management Services ................................................................................................................7
Table 15. Distribution of Pharmacies by Whether They Compound Medications on Site..............7
Table 16. Distribution of Pharmacies That Compound Medications on Site by Type of
Compounding.............................................................................................................................7
Table 17. Distribution of Pharmacies by Whether There Is a System for Documenting
Errors Within the Pharmacy.......................................................................................................8
Table 18. Pharmacies by Reporting of Errors to Selected External Reporting Programs ...............8
Table 19. Distribution of Respondents by Tenure in the Pharmacy ................................................9
Table 20. Distribution of Respondents by Hours Worked per Week in the Pharmacy ...................9
Table 21. Distribution of Respondents by Staff Position ................................................................9
Table 22. Composite-Level Average Percent Positive Response by Staff Position ......................17
Table 23. Item-Level Average Percent Positive Response by Staff Position ................................18
Table 24. Results for Documenting Mistakes by Staff Position ....................................................21
Table 25. Results for Overall Rating on Patient Safety by Staff Position .....................................22
Table 26. Composite-Level Average Percent Positive Response by Number of Prescriptions
Filled per Week ........................................................................................................................23
Table 27. Item-Level Average Percent Positive Response by Number of Prescriptions
Filled per Week ........................................................................................................................24
iii
Table 28. Results for Documenting Mistakes by Number of Prescriptions Filled per Week ........27
Table 29. Results for Overall Rating on Patient Safety by Number of Prescriptions
Filled per Week ........................................................................................................................28
Table 30. Example of How To Calculate Item and Composite Percent Positive Scores...............30
Charts
Chart 1. Composite-Level Results From 55 Pilot Study Pharmacies ............................................10
Chart 2. Item-Level Results From 55 Pilot Study Pharmacies ......................................................11
Chart 3. Results for Documenting Mistakes From 55 Pilot Study Pharmacies .............................15
Chart 4. Results for Overall Rating on Patient Safety From 55 Pilot Study Pharmacies ..............16
Appendix
Appendix: Explanation of Calculations ......................................... Error! Bookmark not defined.
iv
Purpose and Use of This Document
Results from the 55 U.S. pharmacies that participated in a pilot study of the Agency for
Healthcare Research and Quality (AHRQ) Pharmacy Survey on Patient Safety Culture in early
2012 are provided in this document. The results presented here are from limited numbers of staff
and pharmacies and were not derived from a statistically selected sample of U.S. pharmacies.
At this time, there is no central repository to which pharmacies can submit data for comparative
purposes. However, AHRQ plans to support a U.S. comparative database for the pharmacy
survey that will provide more extensive comparative data from pharmacies willing to voluntarily
submit data from the survey. More details will be forthcoming from AHRQ about when data
submission will begin and when updated comparative results will be available.
Survey Development
Patient safety culture can be defined as the set of values, beliefs, and norms about what is
important, how to behave, and what attitudes are appropriate when it comes to patient safety in a
workgroup or organization. The Pharmacy Survey on Patient Safety Culture is intended to help a
pharmacy assess the extent to which its culture emphasizes the importance of patient safety. It is
the fourth survey AHRQ has produced on patient safety culture. Previously developed surveys
address patient safety culture in hospitals, nursing homes, and medical offices. The surveys are
available online at www.ahrq.gov/qual/patientsafetyculture/.
The survey design team conducted a review of the literature on patient and medication safety in
pharmacies, interviewed more than two dozen pharmacy experts and researchers, identified
appropriate survey topics, and drafted survey items for review by a technical expert panel. The
draft survey was cognitively tested with pharmacy staff to ensure that the questions were easy to
understand and answer, and that the items were relevant.
In 2012, a pilot administration was conducted with 60 pharmacies and 496 staff throughout the
United States. Of the 60 pharmacies, only 55 included responses from at least five staff and
therefore were included in the results in this report. The pilot data were analyzed to examine the
survey’s psychometric properties (reliability and factor structure), with the end goal of
shortening the pilot survey, including only the best items.
The final survey includes 36 survey items that measure the 11 areas of organizational culture
pertaining to patient safety described in Table 1. The survey uses either 5-point agreement scales
(“Strongly disagree” to “Strongly agree”) or frequency scales (“Never” to “Always”). Items
include a “Does not apply or Don’t know” option.
The survey also includes three questions that ask respondents to rate the frequency with which
mistakes are documented and one question that provides an overall rating on patient safety.
1
Table 1. Patient Safety Culture Composites and Definitions
Definition: The extent to which…
Patient Safety Culture Composite
Communication About Mistakes
Staff discuss mistakes that happen and talk about ways to
prevent mistakes
Communication About Prescriptions
Across Shifts
Information about prescriptions is communicated well
across shifts, and there are clear expectations and
procedures for doing so
Communication Openness
Staff freely speak up about patient safety concerns and feel
comfortable asking questions, and staff suggestions are
valued
Organizational Learning—Continuous
Improvement
The pharmacy tries to figure out what problems in the work
process lead to mistakes and makes changes to keep
mistakes from happening again
Overall Perceptions of Patient Safety
There is a strong focus and emphasis on patient safety, and
the pharmacy is good at preventing mistakes
Patient Counseling
Patients are encouraged to talk to the pharmacist;
pharmacists spend enough time talking to patients and tell
them important information about new prescriptions
Physical Space and Environment
The pharmacy is well organized and free of clutter, and the
pharmacy layout supports good workflow
Response to Mistakes
The pharmacy examines why mistakes happen and helps
staff learn from mistakes, and staff are treated fairly when
they make mistakes
Staff Training and Skills
Staff get the training they need, new staff receive
orientation, and staff have the skills they need to do their
jobs well
Staffing, Work Pressure, & Pace
There are enough staff to handle the workload, staff do not
feel rushed, staff can take breaks, and work can be
completed accurately despite distractions
Teamwork
Staff treat each other with respect, work together as an
effective team, and understand their roles and
responsibilities
2
Characteristics of Pilot Study Pharmacies
Overall response results for the participating pilot study pharmacies are summarized in Table 2.
Table 2. Overall and Average Response Statistics for 55 Pharmacies
Overall Response Rate Information
Number of respondents
Statistic
479
Number of surveys administered
635
Overall response rate
Average Response Rate Information
Average number of respondents per pharmacy (range: 5 to 20)
75%
Statistic
9
Average number of surveys administered per pharmacy (range: 5 to 36)
12
Average pharmacy response rate (range: 17% to 100%)
83%
Pharmacy characteristics were obtained from a designated point of contact in each pharmacy or
by headquarters staff for a pharmacy chain. Table 3 shows the distribution of pharmacies by
pharmacy type.
Approximately two-thirds of pharmacies (68 percent) were considered either a supermarket
pharmacy or a mass merchant/discount retailer pharmacy that carries a wide variety of
merchandise and has a pharmacy within the store.
Note: In tables in this document, column percent totals may not add to exactly 100 percent
because of rounding.
Table 3. Distribution of Pharmacies by Type of Store
Pilot Study Pharmacies
Number
Percent
19
35%
Pharmacy Type
Mass merchant/discount retailer pharmacy
Supermarket pharmacy
18
33%
Independent pharmacy
8
15%
Integrated health system pharmacy
8
15%
Chain drugstore (local, regional, national)
2
4%
55
100%
Total
The 55 pilot study pharmacies came from 25 States in the United States. However, the
pharmacies that voluntarily participated in these data collection efforts are not statistically
representative of all pharmacies in the United States. To provide a basic comparison of the
number of pilot pharmacies with estimates of the population of pharmacies in the United States,
we provide comparative numbers based on data from the National Association of Chain Drug
Stores (NACDS) 2011-2012 Chain Pharmacy Industry Profile.
The distribution of pharmacies by type is presented in Table 4. The pilot study pharmacies
represent less than 0.001 percent of the total number of U.S. pharmacies. In addition, mass
merchant and supermarket pharmacies are overrepresented in the pilot study.
3
Table 4. Distribution of Pharmacies by Type of Store for U.S. Pharmacies and Pilot Study
Pharmacies
a
Pharmacy Type
Mass merchant/discount retailer pharmacy
U.S. Pharmacies
Number
Percent
8,273
14%
Pilot Study Pharmacies
Number
Percent
19
35%
Supermarket pharmacy
9,333
15%
18
33%
Independent pharmacy
20,835
34%
8
15%
Integrated health system pharmacy/chain
drugstore (local, regional, national)
22,595
37%
10
18%
Total
61,036
100%
55
100%
a
Source of data for U.S. pharmacies: National Association of Chain Drug Stores. NACDS 2011-2012 Chain
Pharmacy Industry Profile. 2011. Statistics for integrated health system pharmacies that are open to the public are
combined with statistics for chain drugstores in the NACDS results.
Seventy-five percent of the pharmacies belonged to an organization with 50 or more stores
(Table 5). The largest proportions of pharmacies were from the East North Central (42 percent)
and the South Atlantic regions (20 percent), as shown in Table 6. Fifty-six percent of pharmacies
dispensed 1,500 or fewer prescriptions per week (Table 7).
Table 5. Distribution of Pharmacies by Number of Locations/Stores
Number of Locations/Stores
1 (This pharmacy is the only location)
Pilot Study Pharmacies
Number
Percent
5
9%
2 to 3
4
7%
4 to 9
3
5%
10 to 24
0
0%
25 to 49
2
4%
50 to 99
8
15%
100 or more
33
60%
Total
55
100%
Table 6. Distribution of Pharmacies by Region
Pilot Study Pharmacies
Number
Percent
5
9%
Region
Mid-Atlantic/New England
South Atlantic
11
20%
E. North Central
23
42%
E. South Central
9
16%
W. Central
3
5%
Mountain/Pacific
4
7%
55
100%
Total
States and territories are categorized into regions as follows: Mid-Atlantic: NJ, NY, PA; New England: CT, MA, ME,
NH, RI, VT; South Atlantic: DC, DE, FL, GA, MD, NC, SC, VA, WV, Puerto Rico, Virgin Islands; East North Central:
IL, IN, MI, OH, WI; East South Central: AL, KY, MS, TN; West Central: AR, IA, KS, LA, MN, MO, ND, NE, OK, SD,
TX; Mountain: AZ, CO, ID, MT, NM, NV, UT, WY; Pacific: AK, CA, HI, OR, WA, American Samoa, Guam, Marshall
Islands, Northern Mariana Islands.
4
Table 7. Distribution of Pharmacies by Average Number of Prescriptions Dispensed per Week
Average Number of Prescriptions
700 or fewer per week
Pilot Study Pharmacies
Number
Percent
3
5%
701 to 1,500 per week
28
51%
1,501 to 3,000 per week
15
27%
3,001 to 6,000 per week
7
13%
6,001 to 12,000 per week
2
4%
More than 12,000 per week
0
0%
55
100%
Total
Almost all pharmacies (91 percent) were open on average 9-12 hours per weekday, with 78
percent of pharmacies open 7 days a week (Tables 8 and 9). One-third of pharmacies (33
percent) had a drive-through window, and few pharmacies (18 percent) had a centrally located
fulfillment center (central fill) for dispensing medications (Tables 10 and 11). Most staff did not
belong to a union (98 percent), as shown in Table 12.
Table 8. Distribution of Pharmacies by Hours per Weekday Pharmacy Is Open
Hours per Weekday Pharmacy Open
8 or fewer hours per weekday
Pilot Study Pharmacies
Number
Percent
0
0%
9 to 12 hours per weekday
50
91%
13 to 15 hours per weekday
4
7%
16 to 23 hours per weekday
0
0%
24 hours per weekday
1
2%
55
100%
Total
Table 9. Distribution of Pharmacies by Days per Week Pharmacy Is Open
Days per Week Pharmacy Is Open
5 or fewer days a week
Pilot Study Pharmacies
Number
Percent
1
2%
6 days a week
11
20%
7 days a week
43
78%
Total
55
100%
Table 10. Distribution of Pharmacies by Whether There Is a Drive-Through Window
Has Drive-Through Window
Yes
Pilot Study Pharmacies
Number
Percent
18
33%
No
37
67%
Total
55
100%
5
Table 11. Distribution of Pharmacies by Whether There Is a Central Fill for Dispensing Medications
Pilot Study Pharmacies
Number
Percent
10
18%
Has Central Fill
Yes
No
45
82%
Total
55
100%
Table 12. Distribution of Pharmacies by Staff Who Belong to a Union
Pilot Study Pharmacies
Number
Percent
0
0%
Staff Who Belong to a Union
Pharmacists
Pharmacy technicians
1
2%
Other pharmacy staff
0
0%
54
98%
No staff in this pharmacy belong to a union
Table 13 presents data on the use of automated electronic technologies in the pharmacies. All of
the pilot study pharmacies (100 percent) had computer alerts for drug interactions, while only 11
percent had a robotic filling system.
Table 13. Distribution of Pharmacies by Use of Selected Automated (Electronic) Technologies
Automated (Electronic) Technologies
Scanner to import paper prescriptions into a pharmacy
computer
Implementation Status
Yes, we
No, but we
currently
plan to in
No, and
use this
the next 6
we do not
tool
months
plan to
49%
4%
47%
Ability to receive electronic prescriptions
98%
0%
2%
Automated system for patients to request prescription
refills (fax, voicemail, interactive voice response [IVR],
touch-tone telephone prompts, email, or Internet)
95%
0%
5%
100%
0%
0%
Barcode verification of medications
65%
4%
31%
Robotic filling system
11%
2%
87%
Automated pill-counting device (nonrobotic)
22%
2%
76%
Picture of drug on computer to compare with prescription
60%
2%
38%
Image of original prescription on computer display during
final check
49%
5%
45%
Automation at pickup to prevent wrong-patient error (e.g.,
cash register programmed to ask for and enter date of
birth through scanning or manual input prior to
dispensing)
33%
25%
42%
Other automated tools
18%
0%
82%
Computer alerts for drug interactions
6
Many of the pharmacies offered medication management services. Table 14 shows that
vaccination or other immunization administration was the medication management service most
fully implemented across pharmacies (80 percent); anticoagulation management (e.g., inpharmacy finger sticks and International Normalized Ratio testing, patient education, dose
adjustments) was the least (2 percent).
Table 14. Distribution of Pharmacies by Use of Selected Clinical/Medication Therapy Management
Services
Clinical/Medication Therapy Management Services
Vaccination or other immunization administration
Implementation Status
No, but we
plan to in
No, and
the next 6
we do not
Yes
months
plan to
80%
2%
18%
Medication therapy management to identify and resolve
medication-related problems
78%
5%
16%
Consultation services for complex medical conditions
38%
16%
45%
Screening and wellness services (e.g., asthma, diabetes,
heart disease, smoking cessation, weight loss)
44%
16%
40%
Coaching and support for disease management (e.g.,
diabetes, asthma, chronic obstructive pulmonary disease,
heart failure, Parkinson’s disease)
35%
24%
42%
Anticoagulation management (e.g., in-pharmacy finger
sticks and International Normalized Ratio testing, patient
education, dose adjustments)
2%
0%
98%
17%
0%
83%
Other clinical services
Most pharmacies (76 percent) compounded medications on site (Table 15). Of those
compounding pharmacies, 93 percent performed only simple compounding (Table 16).
Table 15. Distribution of Pharmacies by Whether They Compound Medications on Site
Compound Medications on Site
Yes
Pilot Study Pharmacies
Number
Percent
42
76%
No
13
24%
Total
55
100%
Table 16. Distribution of Pharmacies That Compound Medications on Site by Type of
Compounding
Pilot Study Pharmacies
That Compound on Site
Number
Percent
39
93%
Type of Compounding
Simple only
Complex only
0
0%
Both simple and complex
3
7%
42
100%
Total
7
As shown in Table 17, nearly all pharmacies (98 percent) had a system for documenting errors,
and 38 percent had both a paper and electronic system.
Table 17. Distribution of Pharmacies by Whether There Is a System for Documenting Errors Within
the Pharmacy
System for Documenting Errors
Yes, a paper and electronic system
Pilot Study Pharmacies
Number
Percent
21
38%
Yes, a paper system only
17
31%
Yes, an electronic system only
16
29%
Don’t know
1
2%
No
0
0%
55
100%
Total
More than half of the pharmacies (53 percent) do not report errors to an external reporting
program, as shown in Table 18.
Table 18. Pharmacies by Reporting of Errors to Selected External Reporting Programs
Reporting Errors That Occur Within the Pharmacy
The Institute for Safe Medication Practices (ISMP) Medication Errors
Reporting Program (MERP)
Pilot Study Pharmacies
Number
Percent
2
4%
MedWatch: The FDA Safety Information and Adverse Event Reporting
System
7
13%
Federally certified Patient Safety Organization (PSO) other than ISMP
2
4%
Private company providing error monitoring services to pharmacies
4
7%
Other
15
27%
Does not report to an external reporting program
29
53%
Characteristics of Pilot Study Respondents
Tables 19 to 21 display distributions of the 479 pharmacy respondents by:
Tenure in the pharmacy.
Hours worked per week in the pharmacy.
Staff position.
According to the data on respondent characteristics shown in these tables:
Sixty-one percent of respondents had worked in their pharmacy at least 3 years.
Sixty-nine percent of respondents worked in their pharmacy at least 32 hours per week.
Fifty-two percent of respondents were pharmacy technicians, 31 percent were
pharmacists, and 17 percent either were pharmacy clerks or pharmacy students or held
another pharmacy position.
8
Table 19. Distribution of Respondents by Tenure in the Pharmacy
Pilot Study Respondents
Number
Percent
31
7%
Tenure
Less than 6 months
6 months to less than 1 year
36
8%
1 year to less than 3 years
112
25%
3 years to less than 6 years
121
27%
6 years to less than 12 years
85
19%
12 years or more
67
15%
452
100%
Total
Missing
27
Overall total
479
Table 20. Distribution of Respondents by Hours Worked per Week in the Pharmacy
Pilot Study Respondents
Number
Percent
56
12%
Hours Worked per Week
1 to 16 hours per week
17 to 31 hours per week
85
19%
32 to 40 hours per week
255
56%
58
13%
454
100%
More than 40 hours per week
Total
Missing
25
Overall total
479
Table 21. Distribution of Respondents by Staff Position
Staff Position
Pharmacist (including pharmacy manager, lead pharmacist, pharmacistin-charge, staff pharmacist)
Pilot Study Respondents
Number
Percent
141
31%
234
52%
Pharmacy clerk
37
8%
Pharmacy student intern/extern
25
6%
Other position
13
3%
450
100%
Pharmacy technician (including lead technician and staff technician)
Total
Missing
29
Overall total
479
9
Composite-Level and Item-Level Results
The charts on the following pages display the composite-level and item-level results from the 55
pilot study pharmacies. Chart 1 shows the average percent positive response on each of the
survey’s patient safety culture composites, in order from most positive to least positive. Chart 2
provides the average percent positive response on the survey items. Chart 3 shows the
distribution of responses for documenting mistakes, and Chart 4 shows the average distribution
of responses for the overall rating on patient safety.
Chart 1. Composite-Level Results From 55 Pilot Study Pharmacies
10
Chart 2. Item-Level Results From 55 Pilot Study Pharmacies
Note: The item’s survey location is shown after the item text. An “R” indicates a negatively worded item, where the
percent positive response is based on those who responded “Strongly disagree” or “Disagree,” or “Never” or “Rarely”
(depending on the response category used for the item).
11
Chart 2. Item-level Results from 55 Pilot Study Pharmacies, continued
Note: The item’s survey location is shown after the item text. An “R” indicates a negatively worded item, where the
percent positive response is based on those who responded “Strongly disagree” or “Disagree,” or “Never” or “Rarely”
(depending on the response category used for the item).
12
Chart 2. Item-level Results from 55 Pilot Study Pharmacies, continued
Note: The item’s survey location is shown after the item text. An “R” indicates a negatively worded item, where the
percent positive response is based on those who responded “Strongly disagree” or “Disagree,” or “Never” or “Rarely”
(depending on the response category used for the item).
13
Chart 2. Item-level Results from 55 Pilot Study Pharmacies, continued
Note: The item’s survey location is shown after the item text. An “R” indicates a negatively worded item, where the
percent positive response is based on those who responded “Strongly disagree” or “Disagree,” or “Never” or “Rarely”
(depending on the response category used for the item).
14
Chart 3. Results for Documenting Mistakes From 55 Pilot Study Pharmacies
Note: Percentages indicate average percent response for each item response category across the pilot pharmacies.
15
Chart 4. Results for Overall Rating on Patient Safety From 55 Pilot Study Pharmacies
Note: Percentages indicate average percent response for each item response category across the pilot pharmacies.
Composite-Level and Item-Level Results by Staff Position
Tables 22 through 25 indicate the average percent positive scores on the survey composites and
items across pharmacies, broken out by staff position. Only the staff positions for which at least
20 pharmacies had at least one respondent in the position are included: pharmacists and
pharmacy technicians.
Pharmacists were more positive than pharmacy technicians on all composites except for Staffing,
Work Pressure, and Pace. Pharmacists were also more positive than pharmacy technicians on
most of the survey’s items.
Note: The number of pharmacies and respondents in each staff position is shown in each table.
However, the precise number of pharmacies and respondents corresponding to each data cell in a
table varies because of individual nonresponse/missing data.
16
Table 22. Composite-Level Average Percent Positive Response by Staff Position
Patient Safety Culture Composites
# Pharmacies
# Respondents
Staff Position
Pharmacy
Pharmacist
Technician
53
55
141
234
1. Patient Counseling
92%
90%
2. Communication Openness
92%
84%
3. Overall Perceptions of Patient Safety
87%
81%
4. Organizational Learning—Continuous Improvement
93%
81%
5. Teamwork
86%
78%
6. Communication About Prescriptions Across Shifts
87%
78%
7. Communication About Mistakes
85%
80%
8. Response to Mistakes
87%
76%
9. Staff Training and Skills
80%
79%
10. Physical Space and Environment
77%
71%
11. Staffing, Work Pressure, & Pace
41%
42%
82%
76%
Average Across Composites
Note: Data are not shown for respondents who selected "Pharmacy clerk," "Pharmacy student intern/extern," or
"None of the above/Other" and those with missing information.
17
Table 23. Item-Level Average Percent Positive Response by Staff Position
Survey Items by Composite
# Pharmacies
# Respondents
Staff Position
Pharmacy
Pharmacist
Technician
53
55
141
234
1. Patient Counseling
1. We encourage patients to talk to pharmacists about their
medications. (B2)
95%
91%
2. Our pharmacists spend enough time talking to patients about how to
use their medications. (B7)
85%
88%
3. Our pharmacists tell patients important information about their new
prescriptions. (B11)
95%
92%
1. Staff ideas and suggestions are valued in this pharmacy. (B1)
89%
76%
2. Staff feel comfortable asking questions when they are unsure about
something. (B5)
93%
89%
3. It is easy for staff to speak up to their supervisor/manager about
patient safety concerns in this pharmacy. (B10)
93%
86%
1. This pharmacy places more emphasis on sales than on patient
safety. (C3R)
80%
80%
2. This pharmacy is good at preventing mistakes. (C6)
92%
78%
3. The way we do things in this pharmacy reflects a strong focus on
patient safety. (C9)
89%
86%
2. Communication Openness
3. Overall Perceptions of Patient Safety
4. Organizational Learning—Continuous Improvement
1. When a mistake happens, we try to figure out what problems in the
work process led to the mistake. (C2)
96%
88%
2. When the same mistake keeps happening, we change the way we
do things. (C5)
93%
77%
3. Mistakes have led to positive changes in this pharmacy. (C10)
89%
77%
1. Staff treat each other with respect. (A2)
83%
78%
2. Staff in this pharmacy clearly understand their roles and
responsibilities. (A4)
89%
76%
3. Staff work together as an effective team. (A9)
87%
80%
5. Teamwork
Note: Data are not shown for respondents who selected "Pharmacy clerk," "Pharmacy student intern/extern," or
"None of the above/Other" and those with missing information. The item’s survey location is shown after the item text.
An “R” indicates a negatively worded item, where the percent positive response is based on those who responded
“Strongly disagree” or “Disagree,” or “Never” or “Rarely” (depending on the response category used for the item).
18
Table 23. Item-level Results by Staff Position, continued
Staff Position
Pharmacy
Pharmacist
Technician
# Pharmacies
53
55
Survey Items by Composite
# Respondents
141
234
6. Communication About Prescriptions Across Shifts
1. We have clear expectations about exchanging important prescription
information across shifts. (B4)
91%
81%
2. We have standard procedures for communicating prescription
information across shifts. (B6)
83%
76%
3. The status of problematic prescriptions is well communicated across
shifts. (B14)
88%
77%
1. Staff in this pharmacy discuss mistakes. (B8)
82%
72%
2. When patient safety issues occur in this pharmacy, staff discuss
them. (B13)
91%
83%
3. In this pharmacy, we talk about ways to prevent mistakes from
happening again. (B15)
82%
84%
1. Staff are treated fairly when they make mistakes. (C1)
90%
76%
2. This pharmacy helps staff learn from their mistakes rather than
punishing them. (C4)
90%
80%
3. We look at staff actions and the way we do things to understand why
mistakes happen in this pharmacy. (C7)
89%
82%
4. Staff feel like their mistakes are held against them. (C8R)
79%
67%
1. Technicians in this pharmacy receive the training they need to do
their jobs. (A3)
80%
84%
2. Staff in this pharmacy have the skills they need to do their jobs well.
(A6)
88%
84%
3. Staff who are new to this pharmacy receive adequate orientation.
(A8)
72%
71%
4. Staff get enough training from this pharmacy. (A10)
80%
75%
7. Communication About Mistakes
8. Response to Mistakes
9. Staff Training and Skills
Note: Data are not shown for respondents who selected "Pharmacy clerk," "Pharmacy student intern/extern," or
"None of the above/Other" and those with missing information. The item’s survey location is shown after the item text.
An “R” indicates a negatively worded item, where the percent positive response is based on those who responded
“Strongly disagree” or “Disagree,” or “Never” or “Rarely” (depending on the response category used for the item).
19
Table 23. Item-level Results by Staff Position, continued
Staff Position
Pharmacy
Pharmacist
Technician
# Pharmacies
53
55
Survey Items by Composite
# Respondents
141
234
10. Physical Space and Environment
1. This pharmacy is well organized. (A1)
91%
81%
2. This pharmacy is free of clutter. (A5)
75%
64%
3. The physical layout of this pharmacy supports good workflow. (A7)
64%
67%
56%
53%
2. We feel rushed when processing prescriptions. (B9R)
5%
18%
3. We have enough staff to handle the workload. (B12)
65%
53%
4. Interruptions/distractions in this pharmacy (from phone calls, faxes,
customers, etc.) make it difficult for staff to work accurately. (B16R)
37%
42%
11. Staffing, Work Pressure, & Pace
1. Staff take adequate breaks during their shifts. (B3)
Note: Data are not shown for respondents who selected "Pharmacy clerk," "Pharmacy student intern/extern," or
"None of the above/Other" and those with missing information. The item’s survey location is shown after the item text.
An “R” indicates a negatively worded item, where the percent positive response is based on those who responded
“Strongly disagree” or “Disagree,” or “Never” or “Rarely” (depending on the response category used for the item).
20
Table 24. Documenting Mistakes by Staff Position
Staff Position
Pharmacy
Pharmacist
Technician
Survey Items
# Pharmacies
53
55
# Respondents
141
234
When a mistake reaches the patient and could cause harm but
does not, how often is it documented? (D1)
Always documented
Most of the time documented
Sometimes documented
Rarely documented
Never documented
1%
1%
4%
20%
74%
1%
2%
8%
12%
76%
1%
1%
9%
27%
62%
2%
5%
7%
16%
71%
23%
26%
26%
15%
9%
17%
18%
14%
23%
28%
When a mistake reaches the patient but has no potential to
harm the patient, how often is it documented? (D2)
Always documented
Most of the time documented
Sometimes documented
Rarely documented
Never documented
When a mistake that could have harmed the patient is corrected
BEFORE the medication leaves the pharmacy, how often is it
documented? (D3)
Always documented
Most of the time documented
Sometimes documented
Rarely documented
Never documented
Note: Data are not shown for respondents who selected "Pharmacy clerk," "Pharmacy student intern/extern," or
"None of the above/Other" and those with missing information.
21
Table 25. Results for Overall Rating on Patient Safety by Staff Position
Overall Rating on Patient Safety
# Pharmacies
# Respondents
Staff Position
Pharmacy
Pharmacist
Technician
53
55
141
234
Excellent
35%
42%
Very Good
53%
40%
Good
10%
11%
Fair
3%
6%
Poor
0%
1%
Note: Data are not shown for respondents who selected "Pharmacy clerk," "Pharmacy student intern/extern," or
"None of the above/Other" and those with missing information.
Composite-Level and Item-Level Results by Number of
Prescriptions Filled per Week
Tables 26 through 29 show the average percent positive scores on the survey composites and
items across pilot study pharmacies by number of prescriptions filled per week (1,500 or fewer
vs. 1,501 or more), which can be considered a proxy for pharmacy size/productivity.
There was no consistent finding by number of prescriptions filled per week. For 6 of 11
composites, pharmacies with 1,500 or fewer prescriptions scored higher. Item-level results also
showed that smaller pharmacies scored higher for some items and larger pharmacies scored
higher for others.
Note: The number of pharmacies and respondents by number of prescriptions filled per week are
collapsed into two categories in each table. However, the precise number of pharmacies and
respondents corresponding to each data cell in a table varies because of individual
nonresponse/missing data.
22
Table 26. Composite-Level Average Percent Positive Response by Number of Prescriptions Filled
per Week
Patient Safety Culture Composites
Number of Prescriptions Filled
1,500 or Fewer 1,501 or More
per Week
per Week
# Pharmacies
31
24
# Respondents
217
262
1. Patient Counseling
89%
91%
2. Communication Openness
87%
86%
3. Overall Perceptions of Patient Safety
81%
86%
4. Organizational Learning—Continuous Improvement
83%
84%
5. Teamwork
82%
79%
6. Communication About Prescriptions Across Shifts
79%
83%
7. Communication About Mistakes
78%
81%
8. Response to Mistakes
83%
74%
9. Staff Training and Skills
80%
79%
10. Physical Space and Environment
77%
66%
11. Staffing, Work Pressure, & Pace
43%
40%
Average Across Composites
78%
77%
23
Table 27. Item-Level Average Percent Positive Response by Number of Prescriptions Filled per
Week
Number of Prescriptions Filled
1,500 or Fewer
per Week
# Pharmacies
31
Survey Items by Composite
# Respondents
217
1,501 or More
per Week
24
262
1. Patient Counseling
1. We encourage patients to talk to pharmacists about their
medications. (B2)
89%
95%
2. Our pharmacists spend enough time talking to patients about how
to use their medications. (B7)
86%
86%
3. Our pharmacists tell patients important information about their
new prescriptions. (B11)
93%
93%
1. Staff ideas and suggestions are valued in this pharmacy. (B1)
83%
78%
2. Staff feel comfortable asking questions when they are unsure
about something. (B5)
91%
91%
3. It is easy for staff to speak up to their supervisor/manager about
patient safety concerns in this pharmacy. (B10)
87%
89%
1. This pharmacy places more emphasis on sales than on patient
safety. (C3R)
77%
84%
2. This pharmacy is good at preventing mistakes. (C6)
84%
85%
3. The way we do things in this pharmacy reflects a strong focus on
patient safety. (C9)
83%
89%
1. When a mistake happens, we try to figure out what problems in
the work process led to the mistake. (C2)
89%
91%
2. When the same mistake keeps happening, we change the way
we do things. (C5)
81%
83%
3. Mistakes have led to positive changes in this pharmacy. (C10)
80%
77%
1. Staff treat each other with respect. (A2)
83%
73%
2. Staff in this pharmacy clearly understand their roles and
responsibilities. (A4)
80%
83%
3. Staff work together as an effective team. (A9)
83%
81%
2. Communication Openness
3. Overall Perceptions of Patient Safety
4. Organizational Learning—Continuous Improvement
5. Teamwork
Note: The item’s survey location is shown after the item text. An “R” indicates a negatively worded item, where
the percent positive response is based on those who responded “Strongly disagree” or “Disagree,” or “Never”
or “Rarely” (depending on the response category used for the item).
24
Table 27. Item-level Average Percent Positive Response by Number of Prescriptions Filled per
Week, continued
Number of Prescriptions Filled
1,500 or Fewer 1,501 or More
per Week
per Week
# Pharmacies
31
24
Survey Items by Composite
# Respondents
217
262
6. Communication About Prescriptions Across Shifts
1. We have clear expectations about exchanging important
prescription information across shifts. (B4)
84%
84%
2. We have standard procedures for communicating prescription
information across shifts. (B6)
74%
83%
3. The status of problematic prescriptions is well communicated
across shifts. (B14)
80%
82%
1. Staff in this pharmacy discuss mistakes. (B8)
73%
75%
2. When patient safety issues occur in this pharmacy, staff discuss
them. (B13)
84%
84%
3. In this pharmacy, we talk about ways to prevent mistakes from
happening again. (B15)
78%
84%
1. Staff are treated fairly when they make mistakes. (C1)
87%
72%
2. This pharmacy helps staff learn from their mistakes rather than
punishing them. (C4)
88%
80%
3. We look at staff actions and the way we do things to understand
why mistakes happen in this pharmacy. (C7)
85%
83%
4. Staff feel like their mistakes are held against them. (C8R)
75%
62%
1. Technicians in this pharmacy receive the training they need to do
their jobs. (A3)
80%
84%
2. Staff in this pharmacy have the skills they need to do their jobs
well. (A6)
86%
87%
3. Staff who are new to this pharmacy receive adequate orientation.
(A8)
75%
68%
4. Staff get enough training from this pharmacy. (A10)
78%
76%
7. Communication About Mistakes
8. Response to Mistakes
9. Staff Training and Skills
Note: The item’s survey location is shown after the item text. An “R” indicates a negatively worded item, where the
percent positive response is based on those who responded “Strongly disagree” or “Disagree,” or “Never” or “Rarely”
(depending on the response category used for the item).
25
Table 27. Item-level Average Percent Positive Response by Number of Prescriptions Filled per
Week, continued
Number of Prescriptions Filled
1,500 or Fewer 1,501 or More
per Week
per Week
# Pharmacies
31
24
Survey Items by Composite
# Respondents
217
262
10. Physical Space and Environment
1. This pharmacy is well organized. (A1)
86%
82%
2. This pharmacy is free of clutter. (A5)
73%
60%
3. The physical layout of this pharmacy supports good workflow.
(A7)
72%
57%
1. Staff take adequate breaks during their shifts. (B3)
52%
61%
2. We feel rushed when processing prescriptions. (B9R)
14%
14%
3. We have enough staff to handle the workload. (B12)
60%
52%
4. Interruptions/distractions in this pharmacy (from phone calls,
faxes, customers, etc.) make it difficult for staff to work accurately.
(B16R)
44%
34%
11. Staffing, Work Pressure, & Pace
Note: The item’s survey location is shown after the item text. An “R” indicates a negatively worded item, where the
percent positive response is based on those who responded “Strongly disagree” or “Disagree,” or “Never” or “Rarely”
(depending on the response category used for the item).
26
Table 28. Results for Documenting Mistakes by Number of Prescriptions Filled per Week
Number of Prescriptions Filled
1,500 or Fewer 1,501 or More
Survey Items
per Week
per Week
# Pharmacies
31
24
# Respondents
217
262
When a mistake reaches the patient and could cause harm but
does not, how often is it documented? (D1)
Always documented
Most of the time documented
Sometimes documented
Rarely documented
Never documented
1%
2%
7%
15%
75%
2%
2%
5%
12%
79%
1%
4%
8%
21%
66%
3%
2%
7%
16%
73%
18%
24%
24%
17%
17%
16%
24%
15%
18%
27%
When a mistake reaches the patient but has no potential to
harm the patient, how often is it documented? (D2)
Always documented
Most of the time documented
Sometimes documented
Rarely documented
Never documented
When a mistake that could have harmed the patient is corrected
BEFORE the medication leaves the pharmacy, how often is it
documented? (D3)
Always documented
Most of the time documented
Sometimes documented
Rarely documented
Never documented
27
Table 29. Results for Overall Rating on Patient Safety by Number of Prescriptions Filled per Week
Overall Rating on Patient Safety
Number of Prescriptions Filled
1,500 or Fewer 1,501 or More
per Week
per Week
# Pharmacies
31
24
# Respondents
217
262
Excellent
39%
42%
Very Good
42%
47%
Good
12%
9%
Fair
6%
2%
Poor
1%
0%
28
Appendix: Explanation of Calculations
Calculating Item Percent Positive Scores
Pharmacy percent positive scores are calculated as follows:
For positively worded items, percent positive is the total percentage of respondents who
answered positively. This total is the combined percentage of “Strongly agree” and
“Agree” responses, or “Always” and “Most of the time” responses, depending on the
response categories used for the item.
For negatively worded items, percent positive is the total percentage of respondents who
answered negatively. This total is the combined percentage of “Strongly disagree” and
“Disagree” responses, or “Never” and “Rarely” responses, since a negative answer on
these items indicates a positive response.
Calculating Composite Percent Positive Scores
A composite score summarizes how respondents answered groups of items that all measure the
same thing. Composite scores on the 11 patient safety culture survey dimensions tell you the
average percentage of respondents who answered positively when looking at the survey items
that measure each safety culture dimension.
To calculate each pharmacy’s composite score on a particular safety culture dimension, calculate
the average percent positive response of the items included in the composite. An example of
computing a composite score for the Response to Mistakes composite follows.
1. There are four items in this composite. Three are positively worded (items C1, C4, and
C7) and one is negatively worded (item C8). Keep in mind that disagreeing with a
negatively worded item indicates a positive response.
2. Calculate the percent positive response at the item level. (See the example in Table 30.)
29
Table 30. Example of How To Calculate Item and Composite Percent Positive Scores
Four Items Measuring
Response to Mistakes
Item C1, positively worded:
Staff are treated fairly when
they make mistakes
For positively
worded items, #
of “Strongly
agree” or
“Agree”
responses
For negatively
worded items, #
of “Strongly
disagree” or
“Disagree”
responses
Total # of
responses to
a
the item
Percent
positive
response
on item
10
NA
14
10/14 = 71%
9
NA
12
9/12 = 75%
7
NA
10
7/10 = 70%
NA
9
14
9/14 = 64%
Item C4, positively worded:
This pharmacy helps staff
learn from their mistakes
rather than punishing them
Item C7, positively worded:
We look at staff actions and
the way we do things to
understand why mistakes
happen in this pharmacy
Item C8, negatively worded:
Staff feel like their mistakes
are held against them
Average percent positive response across the 4 items = 70%
a
Excludes Not applicable/Don’t know and missing responses.
Note: NA = not applicable.
In this example, there were four items, with percent positive response scores of 71 percent, 75
percent, 70 percent, and 64 percent. Averaging these item-level percent positive scores (71% +
75% + 70% + 64%/4 = 70%) results in a composite score of .70, or 70 percent, on Response to
Mistakes. That is, an average of about 70 percent of the respondents responded positively on the
survey items in this composite.
30
| File Type | application/pdf |
| File Title | 2012 Preliminary Comparative Results: Pharmacy Survey on Patient Safety Culture |
| Author | Agency for Healthcare Research and Quality |
| File Modified | 2014-03-19 |
| File Created | 2012-09-21 |