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Safe Assured: Positioning Nova Scotia as the North American leader in community pharmacy safety

Posted by Erin Elaine Casey on April 16, 2020 in Research
Members of the Safe Assured team, left to right: Chris Hartt, Katherine Fierlbeck and James Barker. (Nick Pearce photo)

For many of us, the pharmacist is one of our most relied-upon and trusted health-care professionals. They know your health history and medications, listen to your concerns, and counsel you on taking care of yourself and your family.  

“Pharmacists are professionals – they want to be safe and they want their patients to be safe,” says James Barker, Herbert S. Lamb Chair in Business Education at the Rowe School of Business. “All Canadians have a vested interest in safe and sustainable community pharmacies, especially in light of the changes brought about by COVID-19.

“Pharmacists will be involved in whatever happens to meet this crisis. The novel coronavirus has brought major changes to our grocery stores and pharmacies. Pharmacists have to integrate safety and sanitation measures, and must adapt to changes in prescribing and other processes in light of any new vaccines or medications. People will want to talk to their pharmacists, so pharmacists have to stay abreast of any new medications or false claims that are out there. We need them to perform that role as safely as possible and to be able to pivot as quickly as possible.”

Community pharmacists play a key role in keeping us healthy. A community pharmacy is any pharmacy outside a health-care facility, and these businesses are becoming more and more critical to the well-being of Canadians.

A prestigious honour

In March, a team led by Dr. Barker received the prestigious Robert L. Wears Patient Safety Leadership Award from the QSEN Institute for Patient Safety in Jacksonville, Florida. The award honours an individual or group that has significantly impacted the field of patient safety through critical analysis, research, education or knowledge sharing.

In 2010, Nova Scotia became the first province in Canada to mandate community pharmacies to report prescribing errors. This pioneering system was created by SafetyNET-Rx, a collaborative provincial research effort to study error reporting in the province’s community pharmacies. It was led by St. Francis Xavier University and included the Nova Scotia College of Pharmacists and Dalhousie’s College of Pharmacy.

Dr. Barker came on board to evaluate SafetyNET-Rx in 2014 and took over as principal investigator in 2017. “It’s now very much a Dal project,” he explains. “The research team now includes scholars from Dalhousie, St. F.X., Queens University, the University of Cincinnati and Manchester University along with several industry partners.”

Finding and tracking errors is about much more than individual patient safety — it’s about ensuring the systems that support pharmacists are generating information that make those systems safer and more reliable through evidence-based education and improved processes.

“This is the pathway to safe and sustainable community pharmacies. They’re already very safe, but they face challenges like any profession,” says Dr. Barker. “We work to keep them safe as they do more. This can require new practices based on new evidence that is drawn from what’s happening today in pharmacies.”

Ontario has since followed suit and implemented its own mandatory pharmacy error reporting system. “The award was given for our work on SafetyNET-Rx in Nova Scotia, but we’ve taken what we learned and applied it on a national level,” says Dr. Barker. “We are working with the Ontario database provider, PharmaPod.” PharmaPod is also the provider for error reporting in the UK and works with Shoppers Drug Mart, making it easier to collaborate with industry and access large quantities of data.

Expanding the scope

What’s next for Dr. Barker and his team? First, a name change: the project is now called Safe Assured, to better reflect its national scope. Next, it’s data analytics.

“What exactly can we learn from the analytics?” asks Dr. Barker. “How can we make safety enhancements within the community pharmacy? What is the patient safety benefit? Current analytics will tell us what happened, but not what the risks are that contributed to that. We need to leverage new research techniques with the data to create useful evidence so we can make evidence-based decisions.”

This in turn leads to in-store operations, especially as pharmacists increase their responsibilities and scope of practice. “How do we create the conditions in the store so the pharmacist can work safely? It’s in everybody’s best interests: patients, pharmacists, regulators, and insurance companies.”
Finally, there’s public policy. “If we are going to have national impact, we must be able to make claims about what needs to be in public policy.”

Dr. Barker shares the Patient Safety Leadership Award with Neil MacKinnon, formerly with Dalhousie and now dean of the Winkle College of Pharmacy at the University of Cincinnati; Todd Boyle, formerly Canada Research Chair in Quality Assurance in Community Pharmacy and now acting dean of business at St. F.X.; and Bev Zwicker, registrar of the Nova Scotia College of Pharmacists.

Asked what this award means to him, Dr. Barker says, “This was the first research done in North America on a mandatory reporting system. Nova Scotia was the first North American jurisdiction to have mandatory community pharmacy error reporting. The award recognizes the building and implementation of the system and the first steps towards learning from it. It also recognizes the vision that Bev Zwicker brought. It wouldn’t be happening in Ontario right now, or anywhere else, without her leadership.”

Making pharmacies even safer

You might be wondering why a business school professor is researching pharmacy safety. “We’ve made a business decision that community pharmacy is for-profit, so we have to make the business case for patient safety,” explains Dr. Barker. “We can’t just say, ‘It’s a business so we can’t touch it from a public health perspective.’ If rural pharmacies cease operations, for example, we’ve got a big problem. If we want pharmacies that can effectively meet aging populations and pandemics, we’ve got to have that integration.

“How do we make community pharmacies safe? We integrate public health into the business work of the pharmacy. Pharmacists want that. It’s even more important now that we are able to assess and understand how we can support pharmacists in doing their critical work. We have to identify and create the right conditions for pharmacists to do their jobs safely, professionally, and effectively.”

Dr. James Barker is a global expert on employee and management behaviour within highly complex and high-risk private, public and non-profit organizations. His research focuses on how internal behaviour affects an organization’s ability to improve and sustain safety and safety-related knowledge, to manage change and to innovate. The Safe Assured research team is based in the Rowe School of Business and includes Benoit Aubert, Paola Gonzalez, Bo Yu, and Hamed Aghakhani as well as Katherine Fierlbeck in the Faculty of Arts and Social Sciences and Chris Hartt in the Faculty of Agriculture. Find out more about Safe Assured here.