Pharmacists’ Perceptions About the Effect of Work Environment Factors on Patient Safety in Large-Chain Retail Pharmacies

Abstract

This commentary evaluates large-chain retail pharmacists’ perceptions on their work environment factors’ effects on patient safety from the July 2020 survey conducted by the Ohio Board of Pharmacy. Respondents rated 7 questions using a 5-point Likert scale to rate how they perceive work environment factors in large-chain retail pharmacies influence patient safety. Weighted average, weighted sums, and weighted total scores were calculated to determine if pharmacists’ perceptions were positive or negative. Low scores indicated pharmacists’ negative perceptions. Work factors in large-chain retail pharmacies need to change to improve pharmacists’ perception about work environment factors on patient safety.

Introduction

According to the Agency for Healthcare Research and Quality, patient safety “includes prevention of diagnostic errors, medical errors, injury or other preventable harm to a patient during the process of health care and reduction of risk of unnecessary harm associated with health care.” ¹ The increasing workload of community pharmacists and inadequate pharmacy staffing may endanger patient safety and the well-being of community pharmacists.^2,3 Pharmacy staffing and workload were found to be concerning in medication dispensing, and increased pharmacist and pharmacy workloads can lead to increased drug-drug interaction errors.^4,5 The retail pharmacy work environment’s effect on patient safety has even reached mainstream media. ⁶ This study examines the perceptions of Ohio pharmacists surveyed in 2020 working in large-chain retail pharmacies with 12 or more Ohio locations regarding the influence of the work environment factors on patient safety.

Methods

In July 2020, an inaugural voluntary workload survey was sent to all the 15 747 pharmacists working in Ohio from the State of Ohio Board of Pharmacy, and 4159 responded, garnering a response rate of 26.4%. ⁷ The results of this survey are available online and available for open access. Participants completed a total of 16 questions, 7 of which were related to patient safety. The 7 patient safety-related questions used a 5-point Likert-type scale to rate pharmacists’ perceptions about work factors’ effects on patient safety. Respondent data were measured using a 5-point scale (1 = Strongly Disagree to 5 = Strongly Agree) for questions 1 through 4 and 7, and questions 5 and 6 were reverse coded (1 = Strongly Agree to 5 = Strongly Disagree).

According to the survey designations, large-chain retail pharmacies fall into 2 categories: pharmacies attached to large-chain grocery or big-box stores are classified as “large-chain grocer” pharmacies in the survey, and freestanding large-chain retail pharmacies are classified as “large-chain standalone” pharmacies in the survey. Based on the large-chain classifications, a weighted average based on setting was calculated. A weighted average score was calculated for each question. The individual weighted average scores for each setting were calculated to produce a summed score. Theoretically, summed scores can range from 7 to 35.

As 3 is a neutral score based on the Likert coding stated above, weighted scores above 3 are rated as positive and scores below 3 are rated as negative. To analyze the data, it was hypothesized that the perception of work environment factors on patient safety in large-chain community pharmacy would be negative, and weighted average scores for each setting and each question would be less than 3 (H₁: µ < 3). The statistical significance of the data was tested using α = 0.05.

There are 7 questions with a score of 3 being neutral; therefore, a neutral summed total and summed weighted total score is 21. Summed scores above 21 are considered positive, and scores below 21 are considered negative.

Results

Of the 4159 responding pharmacists, 2268 (54.5%) reported working in large-chain retail pharmacies. The power of the study was calculated to be greater than 0.80. One thousand of these pharmacists reported working in a large-chain grocery store pharmacy, and 1268 of the pharmacists reported working in a large-chain standalone pharmacy. The list of survey questions about work environment and patient safety is reported in Table 1.

Table 1.

Work Environment Factors and Patient Safety Survey Questions.

Q1. I feel that I have adequate time to complete my job in a safe and effective manner. Strongly Agree, Agree, Neutral, Disagree, or Strongly Disagree

Q2. I feel that my employer provides a work environment that allows for safe patient care. Strongly Agree, Agree, Neutral, Disagree, or Strongly Disagree

Q3. I feel that my work environment has sufficient pharmacist staffing that allows for safe patient care. Strongly Agree, Agree, Neutral, Disagree, or Strongly Disagree

Q4. I feel that my work environment has sufficient pharmacy technician staffing that allows for safe patient care. Strongly Agree, Agree, Neutral, Disagree, or Strongly Disagree

Q5. I feel that inadequate staffing at my pharmacy results in delays in patients receiving medications in a timely manner. Strongly Agree, Agree, Neutral, Disagree, or Strongly Disagree

Q6. I feel pressure by my employer or supervisor to meet standards or metrics that may interfere with safe patient care. Strongly Agree, Agree, Neutral, Disagree, or Strongly Disagree

Q7. I feel the workload-to-staff ratio allows me to provide for patients in a safe and effective manner. Strongly Agree, Agree, Neutral, Disagree, or Strongly Disagree

All scores and weighted scores are negative with values less than 3. The value of scores ranges from a minimum of 1.57 based on question 6 for large-chain standalone retail pharmacies to a maximum of 2.81 for question 2 for large-chain grocery retail pharmacies. For all calculated scores and weighted scores P < .05, indicating statistical significance when compared to the null hypothesis (H₀: µ = 3); therefore, the null hypothesis was rejected in every case. Summed totals and weighted totals were calculated. The summed totals (16.36 for large-chain grocery pharmacies and 13.22 for standalone large-chain pharmacies) and weighted totals (14.61) all fell below 21 and are considered negative. The entire list of calculated values appears in Table 2.

Table 2.

Weighted Work Environment Factors and Patient Safety Survey Questions Results.

Question	Large-chain grocer	Large-chain standalone	Weighted score
1	2.43	1.93	2.15
2	2.81	2.14	2.44
3	2.39	2.10	2.23
4	2.22	1.66	1.91
5	2.10	1.88	1.98
6	2.04	1.57	1.78
7	2.37	1.94	2.13
Summed totals	16.36	13.22
Weighted total			14.61

Discussion

The results of this survey show that pharmacists in large retail chains have concerns about their ability to provide safe and effective patient care due to the time to complete tasks, pharmacy staffing, workload ratio, work environment, and expected metrics. According to the pharmacists surveyed, the pressure to meet standards and metrics is perceived as the most negative of the factors in terms of providing safe patient care with 55% strongly disagreeing and 27% disagreeing with the statement in question 6.

Although all questions had negative weighted scores, the question perceived most positively by pharmacists is question 2 which is related to the overall work environment. Only 32% of respondents strongly disagreed, and 27% disagreed that their employers provided work environments that allowed for safe patient care. A 2021 follow-up study has shown that the negative perceptions of Ohio’s retail pharmacists regarding work environment factors’ effect on patient safety persist. ⁸

Limitations

This survey review only focuses on the attitudes of pharmacists in large-chain retail pharmacies regarding patient safety; it does not focus on or correlate actual medication errors or patient safety issues. Safe and effective patient care and time to receive medication were considered patient safety-related measures for the purpose of this study. Raw data were unavailable because the author did not take part in developing the survey and used publicly available data for this commentary; therefore, there was an inability to correlate the data based on individual respondent answers. In addition, due to the absence of access to raw data, the total number of pharmacists in each employment category was unknown, and power of the study was unable to be calculated with certainty. Statistical differences between settings were not calculated. Similar surveys were conducted by the states of Missouri, Maryland, Tennessee, and Vermont, but the data were unavailable for comparison; consequently, the results of this survey are not generalizable because only one state was studied.

Conclusions

In the large-chain retail pharmacy, pharmacists’ perceptions about patient safety based on the work environment are negative. Currently, pharmacists perceive that patient care and safety may suffer based on the work environment factors present in large-chain retail pharmacies. From the responses to the 7 analyzed survey questions, providing adequate time, sufficient pharmacist staffing, sufficient pharmacy technician staffing, improved workload-to-staff ratios, and reduced pressure to meet metrics could improve pharmacists’ perception of the work environment factors on patient safety.

Further research should be conducted to determine which pharmacy work environment factors influence one another and which work environment factors have an actual effect on patient safety.