Enhancing generational change in patient safety in the pharmacy setting: an evaluation of pre-registration educational interventions

The complexity of healthcare systems and the fallibility of humans are responsible for a significant number of medication errors and other preventable patient harms. A major barrier to improving patient safety is the underlying safety culture of an organisation. Although attempts have been made to improve safety culture within medicine and nursing, efforts in pharmacy have been limited despite pharmacists being ideally placed to improve patient and medication safety. Generational change is considered an important element in creating positive change to safety culture (and indirectly safety attitudes), with education regarded as a key driver to change. However, institutions often report capacity and capability issues in delivering patient safety education, which may be addressed by adopting peer education models. The overall aim of the research described in this thesis was to evaluate the effect of education in enhancing generational change in patient safety attitudes among pre-registration pharmacists. Findings from a scoping review of the literature identified that formal and high-quality evaluations of peer led patient safety education are lacking. Validation of two surveys identified a number of common attitudinal domains that affect pharmacy staff and students’ patient safety attitudes relating to: blame culture, learning from errors, being quality improvement focused, open disclosure and comfort to question authority. Additionally, the impact of two educational interventions were evaluated. The first study demonstrated that peer led education is effective in training junior level pharmacy students in basic patient safety principles and in improving attitudes towards patient safety. Furthermore, peer leaders also benefited by further mastery of patient safety concepts. The second study identified that a single face-to-face intervention is effective in having an immediate impact in improving intern pharmacists’ attitudes to patient safety. Although some attitudes remained positive (such as towards blaming individuals), overall, improvements were not sustained in the long-term. Whilst collectively these studies highlight the important role of education in progressing generational change in pre-registration pharmacists’ patient safety attitudes, further longitudinal evaluation of the factors that affect positive patient safety attitudes is needed