Medication review and supply by pharmacists involves both cognitive and technical\nskills related to the safety and appropriateness of prescribed medicines. The cognitive ability of\npharmacists to recall, synthesise and memorise information is a critical aspect of safe and optimal\nmedicines use, yet few studies have investigated the clinical reasoning and decision-making processes\npharmacists use when supplying prescribed medicines. The objective of this study was to examine the\npatterns and processes of pharmacists� clinical reasoning and to identify the information sources used,\nwhen making decisions about the safety and appropriateness of prescribed medicines. Ten community\npharmacists participated in a simulation in which they were required to review a prescription and\nmake decisions about the safety and appropriateness of supplying the prescribed medicines to the\npatient, whilst at the same time thinking aloud about the tasks required. Following the simulation\neach pharmacist was asked a series of questions to prompt retrospective thinking aloud using\nvideo-stimulated recall. The simulated consultation and retrospective interview were recorded\nand transcribed for thematic analysis. All of the pharmacists made a safe and appropriate supply\nof two prescribed medicines to the simulated patient. Qualitative analysis identified seven core\nthinking processes used during the supply process: considering prescription in context, retrieving\ninformation, identifying medication-related issues, processing information, collaborative planning,\ndecision making and reflection; and align closely with other health professionals. The insights from\nthis study have implications for enhancing awareness of decision making processes in pharmacy\npractice and informing teaching and assessment approaches in medication supply.
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