Hospital pharmacists' experiences of implementing initiatives to improve medication safety: a qualitative study

Background Hospital pharmacists are integral to the provision of safe, patient-centred pharmaceutical care, with many taking on leadership roles within their organisations. Increasingly, pharmacists are proactively seeking to improve medication safety practices through the implementation of interventions aimed at reducing medication-related harm. This study explores the experiences of hospital pharmacists implementing such interventions, applying an implementation science (IS) and human factors and ergonomics (HFE) lens. Methods Semi-structured interviews were undertaken with hospital pharmacists in advanced specialist, medication safety or leadership roles in the Republic of Ireland (ROI) and England. The implementation science framework, EPIS (Exploratory, Preparation, Implementation, Sustainment) was used to inform the topic guide. Transcripts were inductively analysed using reflexive thematic analysis (RTA). Subthemes were mapped to the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Results Fifteen hospital pharmacists were interviewed (12 from ROI and 3 from England). Through RTA, three overarching themes were generated: 1) A Sisyphean Task? Pharmacists' ability to implement improvements in a constrained health system, 2) Nurturing existing relationships, building new alliances, and applying a systems-based approach, 3) Intervention success, failure, and inertia: the impact on patients, healthcare professionals, and organisations . Subthemes were mapped against components of the SEIPS framework. Conclusion The findings of this qualitative study highlight the valuable role hospital pharmacists play as key individuals leading on and improving medication safety practices. However, intervention inertia and failure can have significant negative impacts on patient, healthcare professional, and organisational outcomes. Nurturing existing interprofessional relationships and developing new alliances may support pharmacists' efforts in this challenging but worthwhile endeavour, particularly as health systems seek to innovate and improve within resource-constrained environments.