Organizational ethnography of direct drugs distribution in Parma AUSL [Etnografia organizzativa in punti di distribuzione diretta dei farmaci]

The locations where healthcare organizations directly distribute medications to patients in specific circumstances, such as at hospital discharge, are settings at risk of professional errors. Using organizational ethnography methodology, we sought to explore the characteristics of points of direct distribution of drugs (PDD) in the AUSL of Parma and identify aspects of the delivery process that could potentially generate errors. We conducted 75 3-hour observations (225 hours at total) of the two Parma AUSL PDDs. The nature of the observations was known by PDD professionals but blinded to PDD patients. In one PDD, we shadowed the pharmacist responsible for the entire drug distribution process, as well as followed the pattern of drug packaging from the Centralized Logistic Pharmacy Unit in Reggio Emilia to the Parma Pharmaceutical Department. In the other PDD, we carried out observations in the patient waiting room and conducted interviews with patients and PDD professionals. Collected data were evaluated via content analysis and study results were presented to the study-working group for further discussion. Research findings highlighted a limited number of errors in drug delivery process. The most frequently observed errors by pharmacists were incorrect interpretation of prescriptions, dispensation of wrong dosage, and failure to deliver a prescribed drug to the patient. Potential sources of error were repeated interruptions of the pharmacist workflow, such as phone calls, helping colleagues in emergency situations and serving an excessive number of patients. Based on these results, the study-working group proposed logistical and organizational modifications of PDD and delivery process to improve quality and reduce risks.