Engineering Resilient Community Pharmacies (ENRICH)

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Project Summary/Abstract The increase of people with complex chronic health conditions is stressing the U.S. healthcare delivery system. People needing chronic care management (CCM) are at a high risk of medication safety issues and health- related harms, such as hospitalizations and emergency department visits. Community pharmacies play a role in ensuring patients’ safe medication use for CCM, but their efforts are undermined by volatile work demands and other system barriers. In preventing medication hazards for people needing CCM, pharmacy staff are further hampered by the historical preoccupation with what “went wrong” (a Safety-I approach), rather than also considering the vast majority of times that things “go right” (a Safety-II approach). This project seeks to reengineer the pharmacy system to advance a combined Safety-I and Safety-II approach to improve CCM. Our transdisciplinary team of pharmacists, health services researchers, engineers, and quantitative and qualitative researchers will partner with pharmacies in 2 large healthcare organizations (Advocate Health, UW Health), and Boscobel and Center independent pharmacies, to design and evaluate a pharmacy work system of care that optimizes resilience. To achieve this objective, we will create the Medication Safety Map (MedSafeMap) for pharmacists and technicians to better navigate complex pharmacy tasks, and to facilitate communication with patients and clinicians, while safely providing medications for patients dealing with CCM. The CARE (Concepts for Applying Resilience Engineering) and SEIPS (Systems Engineering Initiative for Patient Safety) models will be used to define and address the complex pharmacy work system issues that exacerbate medication safety risks for patients needing CCM. Human factors and systems engineering will be used to carry out the AHRQ RFA-required 5-step method. Aim 1 will focus on problem analysis of the work system through pharmacist and technician stakeholder observations and interviews, and analyses of work system information flow and artifacts, which will illustrate relationships among work system features that are then addressed in Aims 2 and 3. Aim 2 will employ participatory design and in-situ simulations to develop and design MedSafeMap detailing pharmacy redesign recommendations to optimize pharmacist and technician interactions within their work system and with patients/caregivers. For Aim 3, we will implement and evaluate MedSafeMap impact on CARE/SEIPS resilience outcomes – pharmacy staff attitudes, behaviors, performance, and work demands (interviews and surveys), time involved in tasks (time and motion analysis), types and quantities of services provided, and perceived changes in medication-related problems (self-reported data). This innovative transdisciplinary PSLL seeks to redesign interactions to strengthen pharmacy staff resilience while ultimately improving medication safety for patients needing CCM. This study, therefore, responds to an AHRQ priority population (i.e., patients with chronic disease) and a patient safety priority “to examine effective ways to make system-level changes to help prevent errors” that span the medication use process continuum.