Practice Standard – Safety and Quality
Patient safety is a high-priority issue for all professionals including pharmacists. Patient safety is defined as ‘the prevention of harm to patients, including through errors of commission and omission’. The role of pharmacists has been clinically proven to improve many outcomes regarding patient health, including greater patient safety, improved disease and drug therapy management, effective healthcare spending, improved adherence and improved quality of life (Canadian Pharmacists Association, 2008).
The focus on patient care stemmed from a 1999 US report by the institute of Medicine titled, ‘To Err is Human: Building a safer Health System’. This report detailed the costs of medical errors to the US economy and how medical errors numbered higher than deaths due to AIDS, motor vehicle accidents, and breast cancer, combined. The report went on to descried how errors can be reduced (Institute of Medicine,1999).
For centuries, pharmacists have been the guardians/safeguards against "poisons" those substances which could cause harm to the public. Now more than ever pharmacists are charged with the responsibility to ensure that when a patient receives a medicine, it will not cause harm.
As highlighted in a report produced in November 2009 "Pharmacy Intervention in the Medication-use Process - the role of pharmacists in improving patient safety", the involvement of pharmacists in patient safety can be as early at the prescribing phase and up to the administration of the medicines. In many cases, pharmacists are supported by programmes and activities from their national associations, as listed in this extensive work completed by Advit Shah, a final year pharmacy student from the University of Manitoba in Winnipeg, Canada. National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) defines medical errors as "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems including prescribing; order communication; product labelling; packaging; and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use." While "harm" includes both "temporary or permanent impairment of body function/structure requiring intervention and an error resulting in death".
The author Advit, emphasises that medication errors arises throughout the main categories of prescribing, dispensing and administration of the medication-use process, also he goes on to say that, the profession of pharmacy and pharmacist, play a key role in reducing these errors by making appropriate interventions at each stage and by working with other healthcare professionals, governments and regulating bodies and with pharmacy organizations on global basis. In his paper, he also mentions the key steps in the medication-use process as much safer.
The article “Measurement of pharmacy quality metrics at the pharmacy level should be our goal” by Lawrence M. Brown, Associate Professor and Director, Center for Medication Therapy Management, College of Pharmacy, University of Tennessee, Memphis; states that a quality matrix need to be created to ensure better quality medications & services at the pharmacies as well as better utilization of pharmacists at the health sectors, ultimately ensuring better patient safety. In his article he mentions that the valuable role of the pharmacist in health care has been demonstrated in numerous studies examining the improved outcomes resulting from pharmaceutical care, disease management, or MTM services provided by pharmacists. But pharmacists also need to be recognized for the value of the services they provide every day to millions of patients during the dispensing process.
The author has based his article on the study done by Pillittere-Dugan et al. who in his report “on development and testing of performance measures for pharmacy services” emphasised on a critical issue of the pharmacy world using a case study, wherein he also went on to describe about the quality metric creation and validation process. However, Lawrence also criticizes one area in which the article falls short saying that it gives an impression that health plan level measurement is the only reasonable approach to quality measurement of the pharmacy. Author through his various studies of researches emphasises that pharmacy quality improvement is too important an issue to be limited to only 10% of pharmacies. There are a number of great minds in academia and elsewhere who could take up the challenge of finding a cost-effective means to measure the quality of care provided by all pharmacies, or at least the vast majority of them.
As highlighted in a report produced on Dec 2001, “Pharmacists’ attitudes towards dispensing errors: their causes and prevention” by G. M. Peterson, University of Tasmania, Hobart, Tasmania, Australia, that dispensing errors are occurring in numbers well above reports to regulatory authorities or professional indemnity insurance companies, and seem to be accepted as part of practice due to high prescription volumes, pharmacist fatigue and overwork but importantly due to no set practice standards. The basic objective of the study has been to assess the attitudes of pharmacists towards the issue of dispensing errors wherein anonymous questionnaires sought opinions on various possible factors.
Most pharmacists (82%) believed that the risk of dispensing errors is increasing. The principal contributing factors nominated were: high prescription volumes, pharmacist fatigue, pharmacist overwork, interruptions to dispensing, and similar or confusing drug names. The main factors identified as being important in reducing the risk of dispensing errors were: having mechanisms for checking dispensing procedures, having a systematic dispensing workflow, checking the original prescription (duplicate) when dispensing repeats, improving the packaging and labelling of drug products, having drug names that are distinctive, counselling patients at the time of supply, keeping one's knowledge of drugs up-to-date, avoiding interruptions, reducing workloads on pharmacists, improving doctors’ handwriting, and privacy when counselling patients. Most pharmacists (72%) stated that they were aware of dispensing errors that had left the pharmacy undetected, in their place of practice during the past 6 months. Most pharmacists (58%) stated that there should be a regulatory guideline for the safe dispensing load in Australia. The profession needs to be proactive and standards have to be set appropriately high (i.e. zero error tolerance).