Evaluation of safety culture in community pharmacies

Abstract

Objective: The objectives of this study were to describe and compare safety culture measured using the Agency for Healthcare Research and Quality (AHRQ) Community Pharmacy Survey on Patient Safety Culture and assess predictors of overall safety culture. Method(s): A cross-sectional survey using a randomly selected sample of Wisconsin community pharmacists was conducted. The AHRQ survey has 36 items, grouped into 11 composites. Demographic variables included pharmacist and pharmacy characteristics. Data were aggregated into three categories of positive, neutral, and negative responses, and analyzed using descriptive statistics, chi2, and multivariate logistic regression analyses. Result(s): A total of 445 surveys were completed (response rate 82%). Nearly 60% of the respondents were male and the median age was 52 years. Most of the pharmacists worked in national chain/ mass merchandizer/grocer (51%) or independent pharmacies (31%). Six of the composite scores differed significantly from results of a national pilot study conducted by AHRQ (communication openness, overall patient safety, organizational learning, communication across shifts, communication about mistakes, response to mistakes). Consistent with the pilot study, the composite describing staffing, work pressure, and pace had the lowest score (37.6%). Multivariate logistic regression analysis showed that being an independent pharmacy (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.11-2.57), being associated with a health maintenance organization or clinic (OR, 2.25; 95% CI, 1.34-3.78), being somewhat familiar (OR, 3.35; 95% CI, 1.82-6.19) or very or extremely familiar with patients (OR, 8.8; 95% CI, 4.68-16.59) were all positively associated with safety culture. Conclusion(s): For pharmacists to assure patient safety, pharmacies must have a work environment that supports a culture free from blame and that encourages learning from mistakes and adapting through a process of continuous organizational learning. Understanding safety culture of community pharmacies can provide valuable input for identifying areas of strength and those that require improvement, possibly focusing on areas of staffing, work pressure, and pace.