Academic journal article American Journal of Pharmaceutical Education

A UK Perspective on Human Factors and Patient Safety Education in Pharmacy Curricula

Academic journal article American Journal of Pharmaceutical Education

A UK Perspective on Human Factors and Patient Safety Education in Pharmacy Curricula

Article excerpt


Growing awareness of health care-related "harm" can be tracked through public responses to landmark events. In 1990, the US Institute of Medicine (IOM) published "To Err is Human," which estimated that 100,000 deaths per year were a result of preventable medical errors. (1) Recent updates suggest this figure is closer to 200,000, making it the third leading cause of death in the US. (2) Similar stories are seen worldwide, including the UK, where medical errors at Mid-Staffordshire NHS Foundation Trust led to 1200 unnecessary deaths. (3) While these medical errors ultimately resulted in poor care, they were considered to be the result of a wider lack of care and safety management. The personal and financial costs of such events have triggered considerable strategic documentation (including the UK's "Berwick Report"), committing to "place quality of... care, especially patient safety, above all other aims," and also influenced the emergence of patient safety as a distinct discipline. (4)

Cresswell and colleagues described patient safety as "a product... of a highly complex sequence of actions by multiple people and technologies." (5) One challenge is to understand the systems that produce safety-related outcomes and the cultures that influence the behavior of the "actors" within these systems. Recognition of harm as an outcome suggests that the primary goal should be to design and maintain work systems that support good performance. (6) There is an increasing realization that Human Factors/Ergonomics (HFE) approaches have much to offer in this regard. (7) HFE takes a systems-level approach to optimize system performance and human well-being. HFE approaches are design-based, ensuring that tasks are fitted to workers, rather than the other way round. In the UK, this recognition has resulted in increased interest in this approach. For example the Human Factors Concordat outlines the commitment made by professional, statutory, and regulatory bodies to support front-line staff in realizing the benefits of HFE practices. (8) Other UK recommendations are to include HFE in serious incident investigations. (9) One of the initiatives to implement the Concordat was a series of HFE taster workshops by the UK professional body for HFE, the Chartered Institute of Ergonomics & Human Factors (CIEHF). (10)

Changes in professional priorities must be reflected in educational curricula, but development with respect to patient safety has been slow. Regulatory bodies have a growing safety focus, but provide little direction for teaching. In 2011, the World Health Organization (WHO) published a patient safety curriculum for educational staff, but little is known about how education providers ensure learners develop patient safety competencies and even less about teaching HFE principles. (5,11-16)

In Scotland, 15% of hospital admissions are drug-related and preventable with over half resulting from monitoring and/or prescribing errors. While these errors have complex causality, the pharmacist represents a key point in the error chain. It is proposed that developing capacity in pharmacist safety knowledge and skills could contribute to improving work systems to support not only medication safety, but also other aspects of patient safety. Undergraduate pharmacy courses in the UK are regulated by the General Pharmaceutical Council, which provides a framework for guiding course design as Educational Standards for Pharmacists. (18) Standard 1 states the importance of patient safety, but there is limited recurrence of the term; where it is mentioned, it is generally negative ("students... must not... jeopardise patient safety"), rather than a positive requirement for developing patient safety skills.

A similar picture is seen across the world. In the US, for example, the Accreditation Council for Pharmacy Education 2016 Standards for PharmD programs describe how output from the IOM report led to recognition of the need to improve safety and outcomes and was a significant driver for the development of the Standards. …

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