The focus of patient safety culture assessments in healthcare has been primarily on hospital settings, with less attention given to community pharmacies. Although patient safety in community pharmacies has been evaluated in several global studies, this study is the first of its kind to be conducted in Cairo to investigate the patient safety culture among pharmacists working in 210 community pharmacies located in the central and southern regions of Cairo.

We found that a considerable proportion of the pharmacies were run without a working pharmacist at the time of the visit. This is an alarming patient safety issue that should be highlighted [9]. The response rate was high (95.5%), which is comparable to a study conducted in Malaysia with a response rate of 93.5% [10], but higher than a study conducted in the Emirates with a response rate of 70.6% [11]. The difference in response rates may be attributed to variations in populations, cultures, and research methods. In this study, the investigator personally visited the community pharmacies, explained the purpose of the study, provided the questionnaires, and returned the following day to collect the completed questionnaires.

The majority of the study participants were junior pharmacists and 26% of them held a managerial role in the pharmacy. These results align with a study conducted in China, where 80% of participants were junior pharmacists. However, the gender distribution differed between the two studies, with women constituting 72% of the Chinese study sample and 54% in this study [12].

The Patient Safety Organizational Patient Safety Culture (PSOPSC) questionnaire measures 11 composites of organizational patient safety culture, six composites measured perception, and five measured practices. The overall mean percentage of positive responses for patient safety culture was 57.4%, which is lower than earlier studies conducted in China, Malaysia, Taiwan, and Kuwait, respectively [7, 10, 12, 13]. This study's findings suggest that patient safety may not be a top priority for community pharmacies in Cairo, despite being a crucial aspect of healthcare quality. This highlights the need for increased focus on patient safety in community pharmacies in the future.

The study also examined pharmacists’ perceptions of their work in community pharmacies across three domains: physical space and environment, teamwork, and staff training and skills. Among these domains, the highest positive response percentage (PRP) was found in the domain of teamwork (68.97%). This result is consistent with previous studies [7, 13, 14] and may be attributed to the small number of personnel and the close proximity of work settings which may facilitate teamwork [15].

The practices of community pharmacies related to communication and work pace were classified into 5 domains. Patient counseling received the highest PRP (61.8%). These results partially agree with a study conducted in Malaysia, where patient counseling PRP was the second highest (78.7%) after the teamwork domain (81%) [10].

These findings are consistent with a study conducted in Qatar, where patient counseling and teamwork composites of patient safety culture had the highest positive responses (95% and 93.7%, respectively), while the “staffing, work pressure, and pace” composite had the lowest positive response (50.6%) among the 11 composites [16].

The results demonstrate the commitment and willingness of pharmacy personnel to spend adequate time with patients. Notably, patient counseling is an essential aspect of pharmacy practice since many community pharmacy service users seek advice from pharmacy personnel during their visits. Comparable results were reported in other studies [7, 12, 16].

In this study, pharmacists’ perceptions of responses to mistakes were classified into two domains: response to mistakes and Organization learning-continuous improvement. The Organization learning-continuous improvement domain received a higher score (64.9%), reflecting pharmacists’ acceptance of a learning culture that promotes patient safety.

This particular area still needs to be enhanced, especially when compared with previous studies on patient safety culture conducted in different demographic regions, where PRP ranged from 81 to 84%. These results were obtained from the 2012 preliminary comparative study, which surveyed 60 pharmacies and 496 staff across the USA, titled “Pharmacy Survey on Patient Safety Culture” [17].

The study also evaluated pharmacists’ overall perception of patient safety through three items: the pharmacy’s focus on sales versus patient safety, the pharmacy’s effectiveness in preventing mistakes, and the pharmacy’s overall commitment to patient safety. Two-thirds of the pharmacists reported that their pharmacies focus more on patient safety, compared to one-third who reported that their pharmacies focus more on sales. Furthermore, 58.7% of pharmacists reported that their pharmacies are good at preventing mistakes, indicating a positive perception of patient safety in community pharmacies.

The results are promising, as the top three PRP of all patient safety composites were for teamwork (68.97%), organization learning-continuous improvement (64.93%), and patient counselling (61.83%). This indicates that practicing pharmacists have a learning culture to improve services that ensure patient safety.

However, the PRP was less than 60% in communication openness (56.90%), response to mistakes (55.33%), communication about mistakes (55.30%), overall perceptions of patient safety (52.13%), and communication about prescriptions across shifts (49.87%). These findings emphasize the importance of improving communication in community pharmacies, which requires collaborative efforts to plan and implement an effective improvement project. Previous studies have highlighted the role of effective communication in reducing problems related to drug prescription and dispensing [18, 19].

The lowest PRP was given to the “staffing, work pressure, and pace domain,” which scored 34.98%. This reflects insufficient staff to handle the workload, which may lead to rushing in handling prescriptions. This finding is consistent with low PRP found in earlier studies conducted in different geographic areas such as Ethiopia (45%) [15] and Malaysia (46.18%) [10]. Moreover, the results of the current study were not far from the results of a cross-sectional survey conducted in a pharmacy department consisting of staff members who provide dispensing, clinical, and support services within an integrated health delivery system in the USA, where PRP of staffing and work pressure was 44.7% [20].

These findings are also consistent with data obtained from three of the largest public hospital pharmacies and three of the largest private hospital pharmacies in Kuwait, where the results of the positive response rate of the 11 composites ranged from 36 to 87%. The lowest score per composite was 36% for “Staffing, work pressure, and pace,” while the highest score was 87% for “Teamwork” [21].

The respondents’ perceptions of inadequacy of staff allocation in handling the overwhelming workload, especially interruptions and distractions in a community pharmacy, emphasize the importance of addressing this issue. This finding is particularly alarming because inadequate staff can severely limit pharmacists’ ability to safely dispense prescriptions, thus increasing the risk of patient harm [2]. Given these drawbacks, it is essential to ensure adequate allocation of pharmacy staff during working shifts and provide all staff with the breaks they are entitled to during each shift. These measures can help reduce medication errors in busy community pharmacies and enhance patient safety culture.

In this study, personal and job-related factors that may affect patient safety culture composites in community pharmacies were also investigated. Age was found to be a significant factor affecting eight patient safety culture composites, while years of experience significantly affected two composites. Pharmacists with managerial roles had a significantly higher overall perception of patient safety. The findings suggest that patient safety culture improves as pharmacists age, which may explain the significant association between years of experience and some patient safety composites. This is consistent with previous studies that also have discussed the influence of age on patient safety culture [22,23,24,25]. Moreover, a recent study in Qatar showed that respondents with six or more years of practice experience in significantly responded more positively to survey items, these findings may be related to the fact that greater work experience grants pharmacy personnel the ability to effectively manage patient safety-related issues, as well as adapt to the immense workload adequately, than those with less experience [16].

This study is novel in addressing how medication safety is handled in community pharmacies in Egypt. The results highlight the need to prioritize patient safety on the top of strategic priorities at the community pharmacy level.

The study was conducted on only 210 pharmacies, representing less than 1% of the total number of community pharmacies in Cairo geographic market, using a convenience sampling method. Therefore, the results may not provide a comprehensive picture of the patient safety culture in all Cairo pharmacies. Additionally, while pharmacists play a crucial role in community pharmacies, it is essential to consider the safety culture of all employees.