Assessing Administrative and Political Factors in Implementing a Living Wage Ordinance

Since 2000, the number of living wage ordinances has steadily increased throughout the country. While most of the current research has focused on the beneficial outcomes of living wages, little has been published on their administrative practices. To address this shortcoming, this study focused on the identification of key administrative and political factors involved impacting the implementation of living wage ordinances in Miami-Dade and Broward Counties. The study utilized a triangulation of interviews, surveys, and direct observation. The author conducted interviews of administrators and members of the living wage oversight boards in both counties and observed the monthly meetings held by each county’s oversight board from January 2006 to June 2007. These findings were buttressed with a national survey of senior staff in other living wage communities. The study utilized descriptive statistics, Chi Square, Cronbach’s Alpha, and Spearman’s Rank Correlation Coefficient (Spearman’s rho). Interviews indicated that administrators in Dade and Broward are seriously under-staffed and budgeted. Ambiguities in the enabling ordinances have lead to loopholes that undermine implementation and accountability for participating contractors. Survey results showed that policy ambiguity, organizational politics, and a lack of organizational capacity were significant negative factors in the implementation process while an organizational culture emphasizing consistent enforcement was a positive factor. Without the proper inputs, an organization hinders itself from meeting its outputs and outcomes. This study finds that Broward and Miami-Dade Counties do not provide the necessary administrative support to implement a living wage effectively – in stark contrast to the high hopes and strong political support behind their passage. For a living wage to succeed, it first needs an organizational culture committed to providing the necessary resources for implementation as well as transparent, consistent accountability mechanisms.

Experimental data of CO2, CO3, Omega calcite saturation, pH values, alpha and epsilon fractionation factors, and Dd18O calctite-water

The oxygen isotopic composition (d18O) of calcium carbonate of planktonic calcifying organisms is a key tool for reconstructing both past seawater temperature and salinity. The calibration of paloeceanographic proxies relies in general on empirical relationships derived from field experiments on extant species. Laboratory experiments have more often than not revealed that variables other than the target parameter influence the proxy signal, which makes proxy calibration a challenging task. Understanding these secondary or "vital" effects is crucial for increasing proxy accuracy. We present data from laboratory experiments showing that oxygen isotope fractionation during calcification in the coccolithophore Calcidiscus leptoporus and the calcareous dinoflagellate Thoracosphaera heimii is dependent on carbonate chemistry of seawater in addition to its dependence on temperature. A similar result has previously been reported for planktonic foraminifera, supporting the idea that the [CO3]2- effect on d18O is universal for unicellular calcifying planktonic organisms. The slopes of the d18O/[CO3]2- relationships range between -0.0243 per mil/(µmol/kg) (calcareous dinoflagellate T. heimii) and the previously published -0.0022 per mil/(µmol/kg) (non-symbiotic planktonic foramifera Orbulina universa), while C. leptoporus has a slope of -0.0048 per mil/(µmol/kg). We present a simple conceptual model, based on the contribution of d18O-enriched [HCO3]- to the [CO3]2- pool in the calcifying vesicle, which can explain the [CO3]2- effect on d18O for the different unicellular calcifiers. This approach provides a new insight into biological fractionation in calcifying organisms. The large range in d18O/[CO3]2- slopes should possibly be explored as a means for paleoreconstruction of surface [CO3]2-, particularly through comparison of the response in ecologically similar planktonic organisms.

Factors driving territory size and breeding success in a threatened migratory songbird, the Canada Warbler

Successful conservation of migratory birds demands we understand how habitat factors on the breeding grounds influences breeding success. Multiple factors are known to directly influence breeding success in territorial songbirds. For example, greater food availability and fewer predators can have direct effects on breeding success. However, many of these same habitat factors can also result in higher conspecific density that may ultimately reduce breeding success through density dependence. In this case, there is a negative indirect effect of habitat on breeding success through its effects on conspecific density and territory size. Therefore, a key uncertainty facing land managers is whether important habitat attributes directly influence breeding success or indirectly influence breeding success through territory size. We used radio-telemetry, point-counts, vegetation sampling, predator observations, and insect sampling over two years to provide data on habitat selection of a steeply declining songbird species, the Canada Warbler (Cardellina canadensis). These data were then applied in a hierarchical path modeling framework and an AIC model selection approach to determine the habitat attributes that best predict breeding success. Canada Warblers had smaller territories in areas with high shrub cover, in the presence of red squirrels (Tamiasciurus hudsonicus), at shoreline sites relative to forest-interior sites and as conspecific density increased. Breeding success was lower for birds with smaller territories, which suggests competition for limited food resources, but there was no direct evidence that food availability influenced territory size or breeding success. The negative relationship between shrub cover and territory size in our study may arise because these specific habitat conditions are spatially heterogeneous, whereby individuals pack into patches of preferred breeding habitat scattered throughout the landscape, resulting in reduced territory size and an associated reduction in resource availability per territory. Our results therefore highlight the importance of considering direct and indirect effects for Canada warblers; efforts to increase the amount of breeding habitat may ultimately result in lower breeding success if habitat availability is limited and negative density dependent effects occur.

Frontline employees’ innovative service behavior as key to customer loyalty:insights into FLEs’ resource gain spiral

Many service firms require frontline service employees (FLEs) to follow routines and standardized operating procedures during the service encounter, to deliver consistently high service standards. However, to create superior, pleasurable experiences for customers, featuring both helpful services and novel approaches to meeting their needs, firms in various sectors also have begun to encourage FLEs to engage in more innovative service behaviors. This study therefore investigates a new and complementary route to customer loyalty, beyond the conventional service-profit chain, that moves through FLEs' innovative service behavior. Drawing on conservation of resources (COR) theory, this study introduces a resource gain spiral at the service encounter, which runs from FLEs' emotional job engagement to innovative service behavior, and then leads to customer delight and finally customer loyalty. In accordance with COR theory, the proposed model also includes factors that might hinder (customer aggression, underemployment) or foster (colleague support, supervisor support) FLEs' resource gain spiral. A multilevel analysis of a large-scale, dyadic data set that contains responses from both FLEs and customers in multiple industries strongly supports the proposed resource gain spiral as a complementary route to customer loyalty. The positive emotional job engagement-innovative service behavior relationship is undermined by customer aggression and underemployment, as hypothesized. Surprisingly though, and contrary to the hypotheses, colleague and supervisor support do not seem to foster FLEs' resource gain spiral. Instead, colleague support weakens the engagement-innovative service behavior relationship, and supervisor support does not affect it. These results indicate that if FLEs can solicit resources from other sources, they may not need to invest as many of their individual resources. In particular, colleague support even appears to serve as a substitute for FLEs' individual resource investments in the resource gain spiral.

Understanding Antenatal Genetics Services in Sri Lanka: Current Landscape of Screening and Diagnostic Services and Contextual Factors Influencing Their Availability and Uptake

Background: Too little information is available on Sri Lanka’s current capacity to provide community genetic services—antenatal genetic services in particular—to understand whether building that capacity could further improve and reduce disparity in maternal and child health. This qualitative research project seeks to gather information on congenital disorders, routine antenatal care, and the current state of antenatal screening testing services within that routine antenatal to assess the feasibility of and the need for scaling up antenatal genetics services in Sri Lanka. Methods: Nineteen key informant (KI) interviews were conducted with stakeholders in antenatal care and genetic services. Seven focus group discussions were held with a total of 56 Public Health Midwives (PHMs), the health workers responsible for antenatal care at the field level. Transcripts for all interviews and FGDs were analyzed for key themes, and themes were categorized to address the specific aims of the project. Results: Antenatal genetic services play a minor role in antenatal care, with screening and diagnostic procedures available in the private sector and paid for out-of-pocket. KIs and PHMs expect that demand for antenatal genetic services will increase as patients’ purchasing power and knowledge grow but note that prohibitive abortion laws limit the ability of patients to act on test results. Genetic services compete for limited financial and human resources in the free public health system, and inadequate information on the prevalence of congenital disorders limits the ability to understand whether funding for services related to those disorders should be increased. A number of alternatives to scaling up antenatal genetic services within the free health system might be better suited to the Sri Lankan structural and social context. Conclusions: Scaling up antenatal genetic services within the public health system is not feasible in the current financial, legal, and human resource context. Yet current availability and utilization patterns contribute to regional and economic disparities, suggesting that stasis will not bring continued improvements in maternal and child health. More information on the burden of congenital disorders is necessary to fully understand if and how antenatal genetic service availability should be increased in Sri Lanka, but even before that information is gathered, examination of policies for patient referral, termination of pregnancy, and government support for individuals with genetic disease are steps that might bring extend improvements and reduce disparity in maternal and child health.

PROGNOSTIC FACTORS PREDICTING FUNCTIONAL OUTCOME AT FOUR MONTHS FOLLOWING ACUTE ANKLE SPRAIN

PROGNOSTIC FACTORS PREDICTING FUNCTIONAL OUTCOME AT FOUR MONTHS FOLLOWING ACUTE ANKLE SPRAINBleakley C.M.1, O'Connor S.R.1, Tully M.A.2, Rocke L.G.3, MacAuley D.C.1, Bradbury I.4, Keegan S.4, McDonough S.M.11University of Ulster, Health & Rehabilitation Sciences Research Institute, Newtownabbey, United Kingdom, 2Queen's University, UKCRC Centre of Excellence for Public Health (NI), Belfast, United Kingdom, 3Royal Victoria Hospital, Department of Emergency Medicine, Belfast, United Kingdom, 4Frontier Science (Scotland), Kincraig, Inverness-shire, United KingdomPurpose: To identify clinically relevant factors assessed following acute ankle sprain that predict functional recovery at four months post-injury.Relevance: Ankle sprains are one of the most common musculoskeletal injuries with an estimated 5000 new cases occurring each day in the United Kingdom. In the acute phase, ankle sprains may be associated with pain and loss of function. In the longer-term there is a risk of residual problems including chronic pain or reinjury. Few studies have sought to examine factors associated with a poor long-term prognosis.Participants: 101 patients (Age: Mean (SD) 25.9 (7.9) years; Body Mass Index (BMI): 25.3 (3.5) kg/m2) with an acute grade 1 or 2 ankle sprain attending an accident and emergency department or sports injury clinic. Exclusion criteria included complete (grade 3) rupture of the ankle ligament complex, bony ankle injury or multiple injuries.Methods: Participants were allocated as part of a randomised controlled trial to an accelerated intervention incorporating intermittent ice and early therapeutic exercise or a standard protection, rest, ice, compression, and elevation intervention for one week. Treatment was then standardised in both groups and consisted of ankle rehabilitation exercises focusing on muscle strengthening, neuromuscular training, and sports specific functional exercises for a period of approximately four to six weeks. On initial assessment age, gender, mechanism of injury, presence of an audible pop or snap and the presence of contact during the injury were recorded. The following factors were also recorded at baseline and at one and four weeks post-injury: weight-bearing dorsi-flexion test, lateral hop test, presence of medial pain on palpation and a positive impingement sign. Functional status was assessed using the Karlsson score at baseline, at week four and at four months. Reinjury rates were recorded throughout the intervention phase and at four months.Analysis: A mixed between-within subjects analysis of variance (ANOVA) was used to determine the effect of each factor on functional status at week four and at four months. Significance was set at a Bonferroni adjusted level of 0.0125 (0.05/4).Results: Eighty-five participants (84%) were available at final follow-up assessment. Pain on weight-bearing dorsi-flexion and lateral hop tests at week four were both associated with a lower functional score at four months post-injury (P = 0.011 and P = 0.001). No other significant interactions were observed at any other timepoint (baseline or week one). There were only two reinjuries within the four month follow-up period with a further two reported at approximately six months post-injury. We were therefore unable to determine whether any factors were associated with an increased risk of reinjury.Conclusions: Potential prognostic factors on initial or early examination after acute ankle sprain did not help predict functional recovery at four months post-injury. However, pain on weight-bearing dorsi-flexion and lateral hop tests observed at four weeks were associated with a slower rate of recovery.Implications: Some clinical tests may help identify patients at risk of poor functional recovery after acute ankle sprain. However, further work is required to examine factors which may be predictive on initial assessment.Key-words: 1. Prognostic factors 2. Recovery 3. Ankle sprainFunding acknowledgements: Physiotherapy Research Foundation, Chartered Society of Physiotherapy, Strategic Priority Fund; Department of Employment and Learning, Northern Ireland.Ethics approval: Office for Research Ethics Committee (UK).

Organisational and systems factors impacting on patient safety in acute care organisations: lessons from four multi-site research studies

Background Patient safety is concerned with preventable harm in healthcare, a subject that became a focus for study in the UK in the late 1990s. How to improve patient safety, presented both a practical and a research challenge in the early 2000s, leading to the eleven publications presented in this thesis. Research question The overarching research question was: What are the key organisational and systems factors that impact on patient safety, and how can these best be researched? Methods Research was conducted in over 40 acute care organisations in the UK and Europe between 2006 and 2013. The approaches included surveys, interviews, documentary analysis and non-participant observation. Two studies were longitudinal. Results The findings reveal the nature and extent of poor systems reliability and its effect on patient safety; the factors underpinning cases of patient harm; the cultural issues impacting on safety and quality; and the importance of a common language for quality and safety across an organisation. Across the publications, nine key organisational and systems factors emerged as important for patient safety improvement. These include leadership stability; data infrastructure; measurement capability; standardisation of clinical systems; and creating an open and fair collective culture where poor safety is challenged. Conclusions and contribution to knowledge The research presented in the publications has provided a more complete understanding of the organisation and systems factors underpinning safer healthcare. Lessons are drawn to inform methods for future research, including: how to define success in patient safety improvement studies; how to take into account external influences during longitudinal studies; and how to confirm meaning in multi-language research. Finally, recommendations for future research include assessing the support required to maintain a patient safety focus during periods of major change or austerity; the skills needed by healthcare leaders; and the implications of poor data infrastructure.

Synthetic lethal targeting of oncogenic transcription factors in acute leukemia by PARP inhibitors

Acute myeloid leukemia (AML) is mostly driven by oncogenic transcription factors, which have been classically viewed as intractable targets using small molecule inhibitor approaches. Here, we demonstrate that AML driven by repressive transcription factors including AML1-ETO and PML-RARα are extremely sensitive to Poly (ADP-ribose) Polymerase (PARP) inhibitor (PARPi), in part due to their suppressed expression of key homologous recombination genes and thus compromised DNA damage response (DDR). In contrast, leukemia driven by MLL fusions with dominant transactivation ability is proficient in DDR and insensitive to PARP inhibition. Intriguing, depletion of an MLL downstream target, Hoxa9 that activates expression of various HR genes, impairs DDR and sensitizes MLL leukemia to PARPi. Conversely, Hoxa9 over-expression confers PARPi resistance to AML1-ETO and PML-RARα transformed cells. Together, these studies describe a potential utility of PARPi-induced synthetic lethality for leukemia treatment and reveal a novel molecular mechanism governing PARPi sensitivity in AML.

Key determinants of organisational silence for non-standard workers

Purpose – The purpose of this paper is to identify the key determinants of organisational silence from the perspective of non-standard workers (NSWs). The study focuses on three research themes: first, analysing the experiences motivating NSWs to remain silent; second, analysing the role of the NSW life cycle in the motivation to remain silent, the final theme is evaluation of the impact on organisational voice of an organisation employing a workforce in which NSWs and standard workers (SWs) are blended. Design/methodology/approach – The study utilises a phenomenological approach, as defined by Van Manen (2007), to collect and analyse the phenomenon of organisational silence from the perspective of NSWs. The NSWs are defined as individuals operating via Limited Liability UK registered companies created for the purpose of delivering services to organisations via a contract of services. This study employed a combination of phenomenology and hermeneutics to collect and analyse the data collected from the NSWs using semi-structured interviews (Lindseth and Norberg, 2004). Findings – The study concludes with three core findings. NSWs experience similar motivational factors to silence as experienced by standard workers (SWs). The key differential between a SW and a NSW is the role of defensive silence as a dominant motivator for a start-up NSW. The study identified that the reasons for this is that new NSWs are defensive to protect their reputation for any future contract opportunities. In addition, organisations are utilising the low confidence of new start up NSWs to suppress the ability of NSWs to voice. The research indicates how experienced NSWs use the marketing stage of their life cycle to establish voice mechanisms. The study identified that NSWs, fulfiling management and supervisory roles for organisations, are supporting/creating climates of silence through their transfer of experiences as SWs prior to becoming NSWs. Research limitations/implications – This study is a pilot study, and the findings from this study will be carried forward into a larger scale study through engagement with further participants across a diverse range of sectors. This study has identified that there is a need for further studies on organisational silence and NSWs to analyse more fully the impact of silence on the individuals and the organisation itself. A qualitative phenomenological hermeneutical study is not intended to be extrapolated to provide broad trends. The focus of the phenomenological hermeneutic research methodology is on describing and analysing the richness and depth of the NSW’s experiences of silence in organisational settings. Originality/value – This paper draws together the studies of worker classification, motivators for organisational silence, and the impact of blending SWs and NSWs in an organisational setting. The study demonstrates that academic research to date has focused predominantly on SWs to the exclusion of the 1.5 million, and growing, NSWs in the UK. This study examines these under-represented workers to analyse the participants’ experiences of organisational silence, and its consequences in organisational settings, demonstrating a need for further studies.

The Kinome of Pacific Oyster Crassostrea gigas, Its Expression during Development and in Response to Environmental Factors

Oysters play an important role in estuarine and coastal marine habitats, where the majority of humans live. In these ecosystems, environmental degradation is substantial, and oysters must cope with highly dynamic and stressful environmental constraints during their lives in the intertidal zone. The availability of the genome sequence of the Pacific oyster Crassostrea gigas represents a unique opportunity for a comprehensive assessment of the signal transduction pathways that the species has developed to deal with this unique habitat. We performed an in silico analysis to identify, annotate and classify protein kinases in C. gigas, according to their kinase domain taxonomy classification, and compared with kinome already described in other animal species. The C. gigas kinome consists of 371 protein kinases, making it closely related to the sea urchin kinome, which has 353 protein kinases. The absence of gene redundancy in some groups of the C. gigas kinome may simplify functional studies of protein kinases. Through data mining of transcriptomes in C. gigas, we identified part of the kinome which may be central during development and may play a role in response to various environmental factors. Overall, this work contributes to a better understanding of key sensing pathways that may be central for adaptation to a highly dynamic marine environment.

Factors that drive Female Entrepreneurship in Armenia

Entrepreneurs play a key role in any economy. Entrepreneurship includes creativity, innovation, risk taking, planning and management and is described as transferring ideas into action. Female entrepreneurship, in particular, is considered an important tool in enabling female empowerment and emancipation. In the light of recent world events, this has become a crucial area to study and understand, especially with respect to motivations, obstacles, constraints and consequences of female entrepreneurship. Having the previous framework in attention, this thesis focuses on female entrepreneurship in a developing country - Armenia – and proposes a conceptual framework of the phenomenon. A joint cooperation between the World Bank and the European Bank for Reconstruction and Development allowed to conduct an enterprise survey in the country and from that survey a microeconomic dataset was released and applied in this research study. A logistic regression econometric method is applied to the dataset to identify and measure the relationship between female entrepreneurship and several factors such as the location, size, legal status, market and obstacles faced by Armenian firms. The study concludes that women entrepreneurs in Armenia share many common features and obstacles with their male counterparts. Moreover, gender of the top managers, the firm’s location, size, main market type, the number of competitors and full-time employees, the adoption of new marketing methods, the access to land, the tax administration system and an inadequately educated workforce are found to be statistical significant factors in the explanation of female entrepreneurship in Armenia.

A review of risk factors for hamstring injury in soccer: a biomechanical approach

The aim has been to review the literature about the risk factors of hamstring injury in soccer from a biomechanical point of view. METHODOLOGY. Data bases of bibliography references were Medline, Scopus and SportDiscuss. RESULTS AND DISCUSSION. Many prospective studies have shown that the previous injury is the greatest risk factor of sustaining the injury. However the primary causes of the injury are unclear in soccer. A lack of hamstring flexibility has been one of the main injury risk factors with controversies on the results. Imbalance of isokinetic force is a risk factor but electrical coactivation of all muscles participating during knee flexion and extension are unknown in football. While the importance of lumbopelvic-hamstrings muscles synchronization during running seems to be crucial for understanding the risk of injury, no research has been developed in this topic in football. CONCLUSIONS. More research using new data recording procedures as Dynamic Scanners, Surface EMG, Inverse Dynamic Analysis are needed. The analysis of more specific movements as running, kicking or jumping is clearly required. Managers, coaches, physical trainers, physiotherapists, sport physicians and researchers should work together in order to improve the injury prevention and rehabilitation programs of football players. Key Words: sports biomechanics, soccer, hamstring injury, risk factors

UTILIZING ELECTRONIC NOSE AND GC-MS TO EXAMINE CRITICAL FACTORS INFLUENCING THE FORMATION OF ODOROUS VOC’S IN BIOSOLIDS.

Despite the efforts to better manage biosolids field application programs, biosolids managers still lack of efficient and reliable tools to apply large quantities of material while avoiding odor complaints. Objectives of this research were to determine the capabilities of an electronic nose in supporting process monitoring of biosolids production and, to compare odor characteristics of biosolids produced through thermal-hydrolysis anaerobic digestion (TH-AD) to those of alkaline stabilization in the plant, under storage and in the field. A method to quantify key odorants was developed and full scale sampling and laboratory simulations were performed. The portable electronic nose (PEN3) was tested for its capabilities of distinguishing alkali dosages in the biosolids production process. Frequency of recognition of unknown samples was tested achieving highest accuracy of 81.1%. This work exposed the need for a different and more sensitive electronic nose to assure its applicability at full scale for this process. GC-MS results were consistent with those reported in literature and helped to elucidate the behavior of the pattern recognition of the PEN3. Odor characterization of TH-AD and alkaline stabilized biosolids was achieved using olfactometry measurements and GC-MS. Dilution-to-threshold of TH-AD biosolids increased under storage conditions but no correlation was found with the target compounds. The presence of furan and three methylated homologues in TH-AD biosolids was reported for the first time proposing that these compounds are produced during thermal hydrolysis process however, additional research is needed to fully describe the formation of these compounds and the increase in odors. Alkaline stabilized biosolids reported similar odor concentration but did not increase and the ‘fishy’ odor from trimethylamine emissions resulted in more offensive and unpleasant odors when compared to TH-AD. Alkaline stabilized biosolids showed a spike in sulfur and trimethylamine after 3 days of field application when the alkali addition was not sufficient to meet regulatory standards. Concentrations of target compounds from field application of TH-AD biosolids gradually decreased to below the odor threshold after 3 days. This work increased the scientific understanding on odor characteristics and behavior of two types of biosolids and on the application of electronic noses to the environmental engineering field.

Determination of factors related to the abandonment of the practice of swimming by former costa rican swimmers

The objective of this study was to determine the importance of different dimensions as the possible causes for the abandonment of the practice of swimming by former Costa Rican swimmers.  Subjects: 51 former swimmers participated, including 17 men (22 ±3.4 years of age) and 34 women (22.5 ±3.4 years of age) from different Costa Rican swimming teams.  The Questionnaire of Reasons for Attrition in the Practice of Sports (Gould et al, 1982; cited by Salguero, Tuero, and Márquez, 2003) was used.  Results:  A positive relationship was noted between perceptions of low skill and low performance (r: 0.372), while negative relationships were noted between years of practice and low skill (r:-0.337), years of practice and influence from others (r:-0.286), and years of practice and starting age for swimming (r:-0.622).  A significant interaction was found in the dimensions gender of participants (F: 2.952; p<0.05) and starting age for swimming (F: 3.147; p<0.01).  An interaction was also found between dimensions and the desire to swim again (F: 2.485; p>0.05).  There were also significant differences in the years of practice; that is, subjects who started before the age of 10 had a higher average of years of practice than those who started later (F: 21.465; p<0.05).  Additionally, a significant interaction was found in weekly hours of swimming practice (F: 2.072; p<0.05).  There were no significant differences (F: 2.535; p>0.05) according to weekly hours of training when subjects were actively swimming. Conclusions: Possible reasons for dropping out were lack of enjoyment and poor physical condition for men and perception of lack of team spirit for women.  The group that started after the age of ten gives similar importance to all the dimensions as possible reasons for dropping out, while the group that began swimming before the age of ten sees lack of team spirit, lack of enjoyment, and poor physical condition as the key reasons for dropping out.  The most important dimensions that represented the reasons for abandonment in subjects who wanted to swim again were lack of team spirit, poor physical condition and low skill, while lack of enjoyment was the most important reason for subjects who do not want to swim again.  In the group of subjects who would swim less than six hours, lack of team spirit is the most important cause, while the dimension lack of enjoyment was the most important reason for subjects who would swim 6 to 12 hours.  Additionally, the highest dropout percentages were observed in the transition from secondary school to college.

A retrospective study examining the nature, contributory factors and predictors of dispensing errors in community pharmacy

Introduction: Since 2005, the workload of community pharmacists in England has increased with a concomitant increase in stress and work pressure. However, it is unclear how these factors are impacting on the ability of community pharmacists to ensure accuracy during the dispensing process. This research seeks to extend our understanding of the nature, outcome, and predictors of dispensing errors. Methodology: A retrospective analysis of a purposive sample of incident report forms (IRFs) from the database of a pharmacist indemnity insurance provider was conducted. Data collected included; type of error, degree of harm caused, pharmacy and pharmacist demographics, and possible contributory factors. Results: In total, 339 files from UK community pharmacies were retrieved from the database. The files dated from June 2006 to November 2011. Incorrect item (45.1%, n = 153/339) followed by incorrect strength (24.5%, n = 83/339) were the most common forms of error. Almost half (41.6%, n = 147/339) of the patients suffered some form of harm ranging from minor harm (26.7%, n = 87/339) to death (0.3%, n = 1/339). Insufficient staff (51.6%, n = 175/339), similar packaging (40.7%, n = 138/339) and the pharmacy being busier than normal (39.5%, n = 134/339) were identified as key contributory factors. Cross-tabular analysis against the final accuracy check variable revealed significant association between the pharmacy location (P < 0.024), dispensary layout (P < 0.025), insufficient staff (P < 0.019), and busier than normal (P < 0.005) variables. Conclusion: The results provide an overview of some of the individual, organisational and technical factors at play at the time of a dispensing error and highlight the need to examine further the relationships between these factors and dispensing error occurrence.