Research in Social and Administrative Pharmacy
Volume 7, Issue 1 , Pages 93-107 , March 2011

Determinants of medication incident reporting, recovery, and learning in community pharmacies: A conceptual model

  • Todd A. Boyle, Ph.D.

      Affiliations

    • Schwartz School of Business and Information Systems, St. Francis Xavier University, Antigonish, Nova Scotia B2G 2W5, Canada
    • Corresponding Author InformationCorresponding author. Tel.: +1 902 867 5042; fax: +1 902 867 3352.
  • ,
  • Thomas Mahaffey, Ph.D.

      Affiliations

    • Schwartz School of Business and Information Systems, St. Francis Xavier University, Antigonish, Nova Scotia B2G 2W5, Canada
  • ,
  • Neil J. MacKinnon, Ph.D., F.C.S.H.P.

      Affiliations

    • Dalhousie University, Halifax, Nova Scotia, Canada, B3H 3J5
  • ,
  • Heidi Deal, B.Sc.(Pharm)

      Affiliations

    • Dalhousie University, Halifax, Nova Scotia, Canada, B3H 3J5
  • ,
  • Lars K. Hallstrom, Ph.D.

      Affiliations

    • Schwartz School of Business and Information Systems, St. Francis Xavier University, Antigonish, Nova Scotia B2G 2W5, Canada
  • ,
  • Holly Morgan

      Affiliations

    • Schwartz School of Business and Information Systems, St. Francis Xavier University, Antigonish, Nova Scotia B2G 2W5, Canada

References 

  1. Ashcroft DM, Quinlan P, Blenkinsopp A. Prospective study of the incidence, nature and causes of dispensing errors in community pharmacies. Pharmocoepidemiol Drug Saf. 2005;14:327–332
  2. Flynn EA, Barker KN, Carnahan BJ. National observational study of prescription dispensing accuracy and safety in 50 pharmacies. J Am Pharm Assoc. 2003;43:191–200
  3. Kelly W. Medication errors: lessons learned and actions needed. Prof Saf. 2004;49:35–41
  4. Ashcroft DM, Morecroft C, Parker D, Noyce PR. Likelihood of reporting adverse events in community pharmacy: an experimental study. Qual Saf Health Care. 2006;15:48–52
  5. Boshoff C. RECOVSAT: an instrument to measure satisfaction with transaction-specific service recovery. J Serv Res. 1999;1:239–249
  6. Ashcroft DM, Parker D. Development of the pharmacy safety climate questionnaire: a principal components analysis. Qual Saf Health Care. 2009;18:28–31
  7. Greenall J, Walsh D, Wichman K. Failure mode and effects analysis: A tool for identifying risk in community pharmacies. Canadian Pharmacists Journal. 2007;140:191–193
  8. US Institute of Medicine . To Err is Human, Building a Safer Health System. Washington, DC: National Academy Press; 2002;
  9. Leape L. Error in medicine. J Am Med Assoc. 1994;272:1851–1857
  10. Evans SM, Berry JG, Smith BJ, et al. Attitudes and barriers to incident reporting: a collaborative hospital study. Qual Saf Health Care. 2006;15:39–43
  11. UK Department of Health . An Organisation with a Memory. London, UK: Stationary Office; 2000;
  12. Australian Council for Safety and Quality in Health Care. Safety in numbers: a technical options paper for a national approach to the use of data for safer health care. In: Proceedings of the Australian Health Ministers Conference. Canberra, Australia. August 1, 2001.
  13. Santell J, Hicks R, McMeekin J, Cousins D. Medication errors: experience of the United States Pharmacopeia (USP) MEDMARX reporting system. J Clin Pharmacol. 2003;43:760–767
  14. Szeinbach S, Seoane-Vazquez E, Parekh A, Herderick M. Dispensing errors in community pharmacy: perceived influence of sociotechnical factors. Int J Qual Health Care. 2007;19:203–209
  15. Malone DC, Abarca J, Skrepnek GH, et al. Pharmacist workload and pharmacy characteristics associated with the dispensing of potentially clinically important drug-drug interactions. Med Care. 2007;45:456
  16. Davidhizar R, Lonser G. Strategies to decrease medication errors. Health Care Manag. 2003;22:211–218
  17. Wilkins K, Shields M. Correlates of medication error in hospitals. Health Rep. 2008;19:7–19
  18. Moeller N. Noise considerations: distractions, errors and privacy. Can Pharm J. 2003;136:18
  19. Shannon RC, De Muth JE. Comparison of medication-error detection methods in the long term care facility. Consult Pharm. 1987;2:148–151
  20. Varadarajan R, Barker KN, Flynn EA, Thomas RE. Comparison of two error-detection methods in a mail service pharmacy serving health facilities. J Am Pharm Assoc. 2008;48:371–378
  21. Wiederholt JB, Schommer JC, Mount JK, McGregor TD, Braatz PD. The Wisconsin pharmacy self-inspection project: an application of Berwick's theory of continuous improvement. Am J Pharm Educ. 2002;66:27–36
  22. Ashcroft DM, Morecroft C, Parker D, Noyce PR. Safety culture assessment in community pharmacy: development, face validity, and feasibility of the Manchester Patient Safety Assessment Framework. Qual Saf Health Care. 2005;14:417–421
  23. Osborne J, Biais K, Hayes J. Nurses' perceptions: when is it a medication error?. J Nurs Adm. 1999;29:33–38
  24. Wakefield DS, Wakefield BJ, Uden-Holman T, Blegen MA. Perceived barriers in reporting medication and administration errors. Best Pract Benchmarking Healthc. 1996;1:191–197
  25. McArde D, Burns N, Ireland A. Attitudes and beliefs of doctors towards medication error reporting. Int J Health Care Qual Assur. 2003;16:326–333
  26. Force MV, Deering L, Hubbe J, et al. Effective strategies to increase reporting of medication errors in hospitals. J Nurs Adm. 2006;36:34–41
  27. Hartnell NR. Identifying, Understanding, and Overcoming Barriers to Medication Error Reporting in Hospitals in Nova Scotia. [Ph.D. thesis] Halifax, NS: Dalhousie University; 2009;
  28. Nathan A. Reporting errors: can a “fair blame” culture really work for pharmacists. Pharm J. 2004;272:707
  29. Davis FD. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MISQ. 1989;13:319–339
  30. Frambach R, Schillewaert N. Organizational innovation adoption: a multi-level framework of determinants and opportunities for future research. J Bus Res. 2002;55:163–176
  31. Tornatzky LG, Fleischer M. The Process of Technological Innovation. Toronto, ON: Lexington Books; 1990;
  32. Wiktorowicz M. Emergent patterns in the regulation of pharmaceuticals: institutions and interests in the United States, Canada, Britain, and France. J Health Polit Policy Law. 2003;28:615–658
  33. Schwarzer R. Modeling health behavior change: how to predict and modify the adoption and maintenance of health behaviors. Appl Psychol Int Rev. 2008;57:1–29
  34. Jerusalem H, Schwarzer R. Self-efficacy as a resource factor in stress appraisal processes. In:  Schwarzer R editors. Self-Efficacy: Thought Control of Action. Washington, DC, USA: Hemisphere Publishing; 1992;p. 195–213
  35. Igbaria M. End-user computing effectiveness: a structural equation model. Omega. 1990;18:637–652
  36. Reason J, Parker D, Lawton R. Organizational controls and safety: The varieties of rule-related behavior. Journal of Occupational and Organizational Psychology. 1998;71:289–304
  37. Kanousi A. An empirical investigation of the role of culture on service recovery expectations. Manag Serv Qual. 2005;15:57–69
  38. Boshoff C. A re-assessment and refinement of RECOVSAT: an instrument to measure satisfaction with transaction-specific service recovery. Manag Serv Qual. 2005;15:410–425

PII: S1551-7411(09)00147-8

doi: 10.1016/j.sapharm.2009.12.001

Research in Social and Administrative Pharmacy
Volume 7, Issue 1 , Pages 93-107 , March 2011