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SOPs cause tension in community pharmacies

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SOPs cause tension in community pharmacies

Standard operating procedures (SOPs) can lead to tensions “between standardising practice and the need, at times, for greater flexibility”, it has been revealed.

Researchers from Manchester University’s School of Pharmacy interviewed 24 staff, including pharmacists and support staff, in England and Wales. All participants appreciated that procedures are needed, particularly to ensure patient safety, and found SOPs “useful for highlighting the ‘ideal’ way to work”. Nevertheless, procedures could be restrictive at times and might not always be followed constantly.

For example, community pharmacy staff were required to follow numerous procedures but this “overload of procedures” could create difficulties complying with expected practice.

Several other factors – including work demands, high workload, normal practice within the pharmacy, lack of staff, pressure to hit targets and poor communication – also undermined compliance with SOPs. One participant said: “Easter weekend, the week before Christmas [and] the end of [a] week [are] usually very busy...[then] sticking to the rules becomes less of a priority.”

Feared

Pharmacists feared not being supported by their employer if they worked outside of procedures, even when they acted for patient benefit. Some support staff believed that strictly following procedures kept patients and themselves safe. Dispensers reported that following the pharmacist’s guidance sometimes involved working outside of procedures. Occasionally, dispensers felt unable to voice concerns about not following procedures.

Those working in a large pharmacy chain reported little flexibility, which could result in inappropriate procedures. In contrast, participants from an independent pharmacy felt they had “flexibility and control”, when creating and updating SOPs.

The authors say their study shows that “the use of professional judgement is crucial when deciding whether to comply with a procedure”. They suggest adopting “appropriate and justified flexibility”, which allows “the responsible pharmacist to make professional judgements with the support of their employer in order to ensure patient safety”.

Future work needs to investigate instances in which community pharmacy staff deviate from or bypass procedures, and the role of organisational factors in the decision to do so, say the authors. “More work is needed in practice to ‘realign’ work-as-imagined and work-as-done,” they say.

“These findings should help to inform policy-makers and practitioners with regards to the factors most likely to influence the implementation, or not, of procedures in community pharmacy settings,” says lead researcher Christian Thomas from the Manchester Pharmacy School.

(BMJ Open 2016;6:e010851)

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