Using the Human Factors Framework to understand the origins of medication safety problems in community pharmacy:A qualitative study

BACKGROUND: Community pharmacy practice in the Kingdom of Saudi Arabia (KSA) faces many challenges. In KSA, there is a lack of empirical research about medication safety in this setting. OBJECTIVE: To explore the safety problems associated with medication supply from community pharmacies in KSA and compare different stakeholder perspectives. METHODS: Four focus groups and individual interviews were conducted in Riyadh, KSA, in February-May 2013. All group discussions were recorded, transcribed and translated from Arabic into English, except the professional group, which was conducted in English. Thematic analysis was performed using the Human Factors Framework (HFF). RESULTS: The groups comprised "professionals" (n = 8; one female), community pharmacists (n = 4; all male) and two pharmacy user groups (females, n = 11 and males, n = 8). Medication safety problems identified were categorised into nine categories representing the HFF. Seven main themes were identified from these categories: commercial pressure on community pharmacy; illegal supply of prescription medication; lack of enforcement of regulations; the healthcare system; self-medication; patient trust in pharmacists: and communication failure. Themes that emerged only from the "professionals" and community pharmacists were the different role of the regulatory organisations and the reasons behind lack of enforcement, while the community pharmacist group focused on the relationship between owners and managers. Pharmacy users expressed a need for information about medication and that the primary role of the pharmacist should be as an information provider. Furthermore, they perceived pharmacists to be vendors rather than healthcare professionals. CONCLUSION: Many medication safety problems were identified, attributable to individuals (patient, pharmacist), pharmacy and organisational factors. These results will be used to develop interventions to improve medication safety.