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1.  Using Link Analysis to Explore the Impact of the Physical Environment on Pharmacist Tasks 
National community pharmacy organizations have been redesigning pharmacies to better facilitate direct patient care. However, evidence suggests that changing the physical layout of a pharmacy prior to understanding how the environment impacts pharmacists' work may not achieve the desired benefits. This study describes an objective method to understanding how the physical layout of the pharmacy may affect how pharmacists perform tasks.
Link analysis is a systems engineering method used to describe the influence of the physical environment on task completion. This study used a secondary data set of field notes collected from nine hours of direct observation in one mass merchandise community pharmacy in Wisconsin. A node is an individual location in the environment. A link is the movement between two nodes. Tasks were inventoried and task themes identified. The mean, minimum, and maximum number of links needed to complete each task were then determined and used to construct a link table. A link diagram is a graphical display showing the links in conjunction with the physical layout of the pharmacy.
A total of 92 unique tasks were identified resulting in 221 links. Tasks were sorted into five themes: patient care activities, insurance issues, verifying prescriptions, filling prescriptions, and other. Insurance issues required the greatest number of links with a mean of 4.75. Verifying prescriptions and performing patient care were the most commonly performed tasks with 36 and 30 unique task occurrences, respectively.
Link analysis provides an objective method for identifying how a pharmacist interacts with the physical environment to complete tasks. This method provides designers with useful information to target interventions to improve the effectiveness of pharmacist work. Analysis beyond link analysis should be considered for large scale system redesign.
PMCID: PMC4826624  PMID: 26508715
2.  Exploring Information Chaos in Community Pharmacy Handoffs 
Research in social & administrative pharmacy : RSAP  2013;10(1):10.1016/j.sapharm.2013.04.009.
A handoff is the process of conveying necessary information in order to transfer primary responsibility for providing safe and effective drug therapy to a patient from one community pharmacist to another, typically during a shift change. The handoff information conveyed in pharmacies has been shown to be unstructured and variable, leading to pharmacist stress and frustration, prescription delays, and medication errors.
The purpose of this study was to describe and categorize the information hazards present in handoffs in community pharmacies.
A qualitative research approach was used to elicit the subjective experiences of community pharmacists. Community pharmacists who float or work in busy community pharmacies were recruited and participated in a face to face semi-structured interview. Using a systematic content data analysis, the study identified five categories of information hazards that can lead to information chaos, a framework grounded in human factors and ergonomics.
Information hazards including erroneous information and information overload, underload, scatter, and conflict, are experienced routinely by community pharmacists during handoff communication and can result in information chaos. The consequences of information chaos include increased mental workload, which can precipitate problematic prescriptions “falling between the cracks”. This can ultimately impact patient care and pharmacist quality of working life.
The results suggest that handoffs in community pharmacies result in information hazards. These information hazards can distract pharmacists from their primary work of assessing prescriptions and educating their patients. Further research on how handoffs are conducted can produce information on how hazards in the system can be eliminated.
PMCID: PMC3766497  PMID: 23665076
handoffs; community pharmacy; human factors; medication safety
3.  E-Prescribing: A Focused Review and New Approach to Addressing Safety in Pharmacies and Primary Care 
Research in social & administrative pharmacy : RSAP  2012;9(6):10.1016/j.sapharm.2012.09.004.
E-prescribing, the health information technology (HIT) that enables prescribers to electronically transmit prescriptions to community pharmacies has been touted as a solution for improving patient safety and overall quality of care. However, the impact of HIT, such as e-prescribing on medication errors in acute care settings has been widely studied and show that if poorly designed or implemented, HIT can pose a risk to patient safety by introducing a source of medication errors. Unlike acute care settings, safety issues related to e-prescribing in primary care settings (where e-prescriptions are generated and transmitted) and pharmacies (where e-prescriptions are received) have not received as much attention in the literature. This paper provides a focused review of patient safety issues related to using e-prescribing systems in primary care and pharmacies. In addition, the paper proposes using human factors engineering concepts to study e-prescribing safety in pharmacies and primary care settings to identify safety problems and recommendations for improvement.
PMCID: PMC3709012  PMID: 23062769
4.  Development of a Scale to Measure Pharmacists’ Self-Efficacy in Performing Medication Therapy Management Services 
Measuring community pharmacists’ self-efficacy in performing medication therapy management (MTM) services can be useful for tailoring interventions and predicting participation.
To identify relevant survey constructs related to the Wisconsin Pharmacy Quality Collaborative (WPQC) MTM program and to evaluate scale validity.
The 31-item MTM Self-efficacy Scale was developed using previous research, identifying critical program components, and beta-testing. After administration to pharmacists in the 53 WPQC pilot sites, summary statistics and exploratory factor analysis (EFA) were conducted. Parallel analysis was used to determine the optimal number of factors. Internal consistency reliabilities were calculated.
Baseline participation rate was 94% (N=76). The 11-point scale (0–10) item means ranged from 2.83±3.05 to 7.82±2.19. Parallel analysis produced a 3-factor solution, accounting for 56% of the variance. Low factor loadings or unacceptably high cross-loadings resulted in 17 item deletions. The final EFA on the remaining 14 items retained the original 3-factor solution and increased the proportion of explained variance (72%). The factors relate to MTM tasks (alpha = 0.92), personal interactions (alpha = 0.86), and goal setting (alpha = 0.84). Overall Cronbach’s alpha = 0.90.
Constructs for measuring self-efficacy were identified that may aid in future research predicting whether pharmacists engage in and persist in providing MTM services.
PMCID: PMC2904078  PMID: 20511114
Self-efficacy; Medication therapy management; Community pharmacy; Scale validation; Research methods

Results 1-4 (4)