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Workplace stress part 1: Hitting breaking point

Academic Hannah Family explains how workplace stress could increase your risk of making dispensing errors – and how to combat the problem

Academic Hannah Family explains how workplace stress could increase your risk of making dispensing errors – and how to combat the problem

I am rushing to check a pile of prescriptions in under 10 minutes. Just as I establish a routine of checking drug name, strength and dosage instructions, a loud conversation interrupts my train of thought. As a result, I begin to doubt whether or not I have checked the medicine name on the last prescription, which forces me to start the entire check again.

Sound familiar? This is because I'm undertaking an exercise designed to replicate the stresses and strains of the pharmacy environment, led by Hannah Family, lecturer in pharmacy practice and psychologist at the University of Bath. Granted, it's probably not the best time to test our mental abilities. It is 8am on the second day of the Royal Pharmaceutical Society conference and,looking around the room, few are looking fresh-faced and ready for the early start.

But the exercise successfully demonstrates the effect of time pressure and interruptions on our abilities. As a non-pharmacist, I am surprised to be one of the first to complete the task. Realising this is not down to a natural pharmaceutical ability, I go over the prescriptions again – only to find I have neglected to check the patient names against the item labels. It is a mistake I doubt I would have made if I was in a quiet environment with plenty of time to make the checks.

These pressures formed the basis of Dr Family's research into the effect of pharmacy working environments (see The research, below), released this month, which was a much more in-depth version of the exercise we've been doing. She recognised there were growing concerns over the workload of pharmacists. With this in mind, her research evaluated the relationship between what is known as "mental workload" – a term that covers the amount of effort the brain needs to perform a task – and the frequency of dispensing errors.

Her findings make interesting reading for anyone feeling the pressures of dispensary life. But if you're feeling that it's all too much, Dr Family says there are steps you can take to reduce these pressures.

Brain overload

Your brain, Dr Family explains, can only cope with a certain amount. We commonly blame ourselves when we are unable to get mammoth tasks done. When deadlines come all at once at C+D, I often joke that my brain is too small to cope with the amount of information being thrown at me. But it seems that there is some truth to this concept – and stressed-out pharmacists should take note.

Dr Family gives the example of trying to remember a mobile phone number: "If I gave you the number, it's highly likely you would forget the first few numbers because they decay to make space for new memories." On average, people can only remember seven chunks of information at a time – equating to a seven-digit phone number.

For this reason, Dr Family was keen to see how remembering information affected pharmacists' ability to accurately check prescriptions. In her research, she gave pharmacists 50 items to check in 25 minutes. But there was a catch.

Twenty-six of these pharmacists had to remember a string of six two-digit numbers while carrying out the checks – representing a high mental workload – while the other 26 only had to remember one two-digit number (see The research, below). The results were not what you might expect: those who had a high mental workload actually detected a larger number of errors than those who only had two numbers to remember.

Mental frustration

But that doesn't mean pharmacists are thriving in stressful environments. Mental workload doesn't just take into account the amount of actual work you're doing – it also involves other influences, including time pressure, doubts over your performance, stress levels and the amount of frustration involved in the task (see Rate your mental workload). "[Pressure] can change the way our mental processes work and we start to rely more on shortcuts," Dr Family says.

Perhaps unsurprisingly, frustration emerged as a recurring theme when Dr Family asked pharmacists about their work in her qualitative research. One pharmacist reported feeling frustrated because there were "a whole load of tasks to be done" and they lacked the time to complete them.

Another said they felt they were "pulled in many directions all at once" – a feeling that will be familiar to many who work in a busy dispensary environment. This all increases mental workload. Although Dr Family did not quantitatively evaluate the effect of these negative feelings, they are unlikely to be doing much in the way of good.

Wait a minute...

Interruption was another trend that emerged from the study. One pharmacist said they found the background noise of the pharmacy "distracting" and "hard to filter out". Others reported being distracted by queries from patients and the need to monitor the pharmacy team.

Such interruptions could well be adversely affecting your performance. In another experiment, Dr Family gave pharmacists 50 items to check in 25 minutes. This time, half were distracted a total of six times and the other half worked uninterrupted. Although the results were not clear-cut – both sets of pharmacists performed at similar levels initially – the distracted set of pharmacists went on to miss "significantly" more errors.

This effect is quite natural, says Dr Family. The brain filters information to concentrate on what is most important, which explains the "cocktail party effect" – when your attention is suddenly diverted by someone saying your name mid-conversation.

If you are constantly being distracted by things your brain sees as a priority – for example, a staff member giving the wrong advice – you won't be able to concentrate on the task at hand. Often, it will also take you time to adjust your focus back to what you were doing initially.

It is possible to multi-task effectively, Dr Family says, but only where the tasks are different in nature – for example, typing while looking elsewhere. It isn't possible to listen to two people effectively, however much those working in a busy pharmacy environment may wish this was the case.

The solution

So what can you do when you're feeling the strain? Dr Family admits it's hard for pharmacists to take action when their work environment is so unpredictable. Pharmacists are at the mercy of how many prescriptions and patients happen to come in that day. Some pharmacists told Dr Family they had taken drastic action to gain control over their workloads. One pulled the phone out of its socket and another resorted to using the fire alarm to get patients out of the pharmacy – "a trick he learned from his pre-reg tutor" – Dr Family says.

While she may not recommend setting off the fire alarm every day, Dr Family believes there are some steps pharmacists and organisations can take to reduce mental strain (See 4 tips for reducing mental fatigue). Pharmacy organisations could emphasise the effect of unnecessary interruptions and set a code to make clear when interruptions are genuinely vital.

Where possible, pharmacists should try to take a break from repetitive mental tasks to minimise mental fatigue. Dr Family also believes increasing the use of automation could help reduce the burden on pharmacists and the risk of human error.

Clearly, some of these cultural changes will take time. But for now, Dr Family's research is proof you shouldn't be beating yourself up for struggling to cope with unrealistic workloads and pressures. So next time you're wondering whether you really can justify a short break, it's worth remembering that it could prove beneficial for both you and the patient.

The research

Experiment 1

Fifty-two pharmacists were given 25 minutes to perform checks on a set of 50 prescription items against the prescriptions and labels. The pharmacists were split into two groups with different working conditions. In the first round, the two groups had different mental workloads and in the second round, one group was interrupted during their checks.

Experiment 2

Forty pharmacists rated their mental workloads during their working lives according to how busy, stressed and time-pressured they felt they were.

Experiment 3

Dr Family interviewed 14 of the participants in experiment two for qualitative research.

See part two: Identifying the signs and tips for dealing with the problem

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