Medication safety problems priorities in community pharmacy in Saudi Arabia : a multi-stakeholder Delphi study using the human factors framework

Al Juffali, Lobna Abdullah and Knapp, Peter and Al-Aqeel, Sinaa and Watson, Margaret C (2019) Medication safety problems priorities in community pharmacy in Saudi Arabia : a multi-stakeholder Delphi study using the human factors framework. BMJ Open, 9. pp. 1-10. e032419. ISSN 2044-6055 (

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Aim To achieve multi-stakeholder consensus and prioritisation of medication safety problems in community pharmacies in Saudi Arabia. Design and intervention A theoretically-underpinned, three-round Delphi study. Setting Saudi Arabia. Participants Patients and public (pharmacy users), pharmacy-related professionals (policymakers, academics, medication safety officers and pharmacy owners) and community pharmacists. Methods Round 1 comprised 84 statements derived from a qualitative study. The items were grouped according to the Human Factors Framework (HFF). Rounds 1 and 2 aimed to achieve consensus, 6-point Likert response scale (agreement/disagreement) was used. Round 3 aimed to prioritise the items for which consensus was achieved in Rounds 1 and 2 indicated on a 5-point scale (very important to unimportant). Consensus was predefined as any item that achieved ≥70%. Results The number of respondents in Rounds 1, 2 and 3 was 161, 120 and 112, respectively. In all three rounds, the majority of respondents were pharmacy users (Round 1 77% (n=124), Round 2 74% (n=89), Round 3 72% (n=81)). Consensus was achieved with 28/84 items. The top five medication safety priorities were: lack of pharmacy facilities such as counselling area, lack of communication between pharmacists and physicians, lack of patient databases, lack of post-registration pharmacist education and pharmacists' long working hours. The professional and pharmacy user groups achieved consensus on similar items through different categories of the HFFs. Community pharmacists had the highest percentage of consensus among the three groups for factors related to work, such as high workload and low salaries. Conclusion This multi-stakeholder study used the HFF to identify and prioritise the main medication safety challenges facing community pharmacy in Saudi Arabia. It indicates the need for changes to practice and policy and further research to address these priorities and promote medication safety at an individual, pharmacy and population level.