The application of implementation science to the evaluation and implementation of a national community pharmacy patient safety initiative

Background: Approximately 6.5% of hospital admissions are attributed to adverse effects of high-risk medicines, including non-steroidal anti-inflammatory drugs (NSAIDs). Community Pharmacy NSAIDs care bundles were developed focusing on interactions and patient education, and were piloted in 2017-18 in 24 pharmacies across Scotland, using quality improvement methods. This abstract presents the evaluation’s Implementation Science approach and how it informed the national strategy.

Methods: The evaluation utilised the Consolidated Framework of Implementation Research taxonomy to identify determinants of implementation success, through a questionnaire (Jun 2017). Proctors’ Implementation Outcomes informed the implementation fidelity analysis, and Human Factors principles were applied to conduct task analysis within pharmacies to explore their penetration into routine practice (Oct – Nov 2017). Patient perceptions were sought using a satisfaction questionnaire and a semi-structured telephone interview (Apr - Jun 2018).

Results: Success factors included the pharmacy staff having sufficient knowledge of NSAIDs, perceiving the funding and incentives to be sufficient, and not perceiving the bundle to have a negative impact on workload. Patients were satisfied with their experience of the NSAIDs care bundle; it had a positive impact on their knowledge, attitudes, and behaviour.

Conclusion: The findings shaped the national implementation strategy, which included supporting whole team involvement, ensuring pharmacy staff knowledge was sufficient, and incentivising engagement. The care bundle was incorporate into the Scottish community pharmacy contract in 2018/19 to be delivered by all 1253 pharmacies. The pilot evaluation informed a national outcomes analysis which was deferred due to the pandemic. Results are available for presentation May 2023 onwards.