Standard Procedures vs. Real-World Practice: Exploring Variations in Clinical Prescription Checks in English Community Pharmacies—A Multi-Method Investigation

Standardisation is a well-established approach to managing risks, involving the creation and application of detailed instructions for specific activities. Within community pharmacy settings, the use of Standardised Operating Procedures (SOPs) is compulsory and viewed as vital for maintaining patient safety and service quality. The objective of this research was to explore the extent to which community pharmacists (CPs) follow SOPs during the process of reviewing prescriptions clinically, as well as to identify underlying causes for any discrepancies between formal guidelines and actual behaviours. A collection of eight SOP documents was subjected to hierarchical task analysis (HTA) to develop a benchmark model of how clinical checks should be performed according to the guidelines. Next, twelve CPs participated in a simulated prescription review activity, articulating their reasoning aloud as they evaluated fictitious prescriptions. The recorded transcripts were analysed through content analysis, compared against the benchmark model to identify patterns of engagement and differences between the SOPs and real-world actions of the pharmacists. A focus group session was then conducted to provide further context for the identified discrepancies. The HTA process facilitated the development of a framework for clinical checking consisting of six main components and 28 subordinate elements. Pharmacists frequently skipped certain elements during their reviews, departing from the outlined guidelines. Such departures, noted even in a distraction-free setting, indicate a deeply embedded element in pharmacists' professional norms, potentially reflecting a general inclination to adapt rather than rigidly follow guidelines, irrespective of workplace variability. Key influences on this norm encompass the application of clinical discretion, dependence on colleagues or external aids, and emphasis on accommodating patient needs. Findings from this research underscore persistent departures from SOPs in the clinical review of prescriptions within community pharmacies, pointing to an underlying normative pattern. Subsequent investigations ought to examine approaches to managing risks arising from these departures and to navigate the nuanced interplay between adaptability and rigorous adherence.