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Quality Care Standards Authors: Frokjaer B, Grant RL

Quality Care Standards Authors: Frokjaer B, Grant RL

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Quality Care Standards Authors: Frokjaer B, Grant RL

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  1. Quality Care Standards Authors: Frokjaer B, Grant RL Problem Statement: All practicing pharmacists are obliged to ensure that the service they provide to every patient is of appropriate quality. Standards are an important part in measuring quality of service to the consumer. In a society where customers have become more knowledgeable and demanding, it has become more difficult for pharmacies and pharmacists to meet these demands. Quality care standards can provide an essential support to pharmacies in their efforts to provide appropriate quality. In 1993, the International Pharmaceutical Federation (FIP) compiled international guidelines for Good Pharmacy Practice (GPP), with the goal of concretely raising the quality of pharmaceutical services. These guidelines have been—or are in the process of being—adopted around the world. Objectives: To examine the prevalence of quality care standards in community pharmacy practice worldwide, identify areas for improvement, and assess the impact of implementation of Guidelines for Good Pharmacy Practice on the development of quality care standards, with the ultimate aim of raising the professional standards of community pharmacy. Design: Cross-sectional study with questionnaire. Setting and Study Population: TheFIP Community Pharmacy Section established a Working Group charged with the task of pursuing the objectives above. The Working Group consisted of pharmacists from Australia (chair), Malta, Sweden, Switzerland, The Netherlands, and United Kingdom. A questionnaire was developed and sent to all member organizations of FIP (110 organizations in 81 countries) active within community pharmacy. A reminder was distributed to raise the response rate. Outcome Measures: Percentage of organizations with quality care standards in place; percentage of organizations performing audits/monitoring for quality of care; elements of practice included in quality standards. Results: Twenty-three organizations replied (response rate, 21%), 15 from Europe, 2 from America, 1 from Africa, 3 from Asia, and 1 from Australia. Twenty-one of the 23 organizations reported having quality care standards. Of these 21, 7 of have guidelines and perform audits, whereas 14 have guidelines but do not perform audits. Quality care standards cover almost the same areas in all countries: extemporaneous preparation, handling of stock, interaction with patients, nonprescription medicines, setting of the pharmacy, documentation system, dispensing prescription medicines, equipment, health promotion, research and professional development, audit, diagnostics, and pharmacotherapeutic monitoring. Areas for improvement: Use a generic approach and performance of audits. All countries but one used the GPP Guidelines as background for the development of Quality Care Standards. Conclusions: Quality care standards are widely used within community pharmacy in Europe and in some other countries. The FIP Community Pharmacy Section strongly recommends that all member organizations of FIP embrace the introduction of quality care standards and begin or continue the process as soon as possible Study Funding: International Pharmaceutical Federation (FIP).

  2. FIP Good Pharmacy Practice Guidelines The International Pharmaceutical Federation (FIP) has for the past decade been very much involved in the development of this concept in community pharmacy. FIP was very active in the establishment of baseline standards when in 1993 the Good Pharmacy Practice Guidelines were presented during the FIP congress in Japan. This was the leadership to promote the initiation of the process in different countries. The guidelines were revised in Vancouver in 1997 and were endorsed by the WHO Expert Committee on Specifications for Pharmaceutical Preparations. In 1998 a report on Good Pharmacy Practice in Developing Countries was presented in The Hague.

  3. Problem Statement FIP believes that the Good Pharmacy Practice Guidelines, developed and approved by FIP and WHO, should be used for developing nationally accepted standards of Good Pharmacy Practice.FIP urges national pharmaceutical organisations and governments to work together to introduce appropriate standards or, where national standards already exist, to review these standards in the light of the guidelines set out in the Good Pharmacy Practice document. The Good Pharmacy Practice Guidelines recommend that national standards are set for: • the promotion of health • the supply of medicines and medical devices • patient self care • improving prescribing and medicine use by pharmacists' activities. The Community Pharmacy Section of FIP commenced a Working Group on “Quality Care Standards in Community Pharmacy Practice” with the stated aim of developing guidelines, which member organisations may use to assist in the development and implementation of their own pharmacy standards projects.

  4. Study Questions The Working Group on Quality Care Standards established by the Community Pharmacy Section of FIP undertook a survey in 2002-3. The aim of the working group was: To give recommendations for development and implementation of Quality Care Standards for pharmacy practice and make them available for all FIP members. The ultimate aim is to improve the professional standards of pharmacy. The Working Group shall collect information of available standards for pharmacy practice from national pharmaceutical organisations. In collecting the data the working group will take into consideration: • the purpose and the background for the development of the standards • to which extent it is being used • possible legislative backing for the standards • the pharmacy system under which the standard is developed and being used

  5. Aim and Methods The aim of the study was to examine the availability of standards, identify areas for improvement and assess impact of implementation. A letter was sent to all member organisations (of FIP) asking them to reply to the questions above and to make available a copy of the Quality Standards applicable to the organisation.

  6. Response 23 organizations replied (n=110, 21%) 21 organizations had quality care standards The organisations represented five areas worldwide as follows: AMERICAS: USA, Canada AFRICA: Uganda SOUTH EAST ASIA: India WESTERN PACIFIC: Australia (2 organisations), Indonesia*, Japan EUROPE: Croatia, Denmark, Finland, France, Germany, Israel, Malta, The Netherlands, Norway, Nordic Association, Portugal, Serbia*, Sweden, Switzerland and United Kingdom. *) Two of the responding organizations, Indonesia and Serbia, replied that they did not have quality care standards. Yet they stated that it is an area which is being considered in the near future.

  7. Presentation GUIDELINES Guidelines are presented to create a quality environment, to promote responsibility for quality, to present aims and objectives of service provided and to present standard procedures AUDIT Audits can be internal, performed by special trained staff members or external, performed by qualified auditors. The audit checks that the pharmacy performs according to the quality standards set for the pharmacy in question. (See table 1.)

  8. Presentation (Table 1.)

  9. Areas included in generic standards No. of organizations (n=18) Extemporaneous preparations 15 (83%) Handling of stock 14 (78%) Interaction with patients 13 (72%) Non-prescription medicines 13 (72%) Setting of the pharmacy 13 (72%) Documentation systems 12 (67%) Dispensing prescription medicines 11 (61%) Equipment 10 (56%) Health promotion 10 (56%) Research & professional development 9 (50%) Audit 7 (39%) Diagnostics 7 (39%) Pharmacotherapy monitoring plan 7 (39%) Domiciliary services 4 (22%) On-line services 4 (22%) Pre-registration training 4 (22%) Parapharmaceuticals 3 (17%) Customer perceptions 2 (11%)

  10. Further Considerations • Who should run the method? • Cost of quality system • Voluntary or mandatory? • Reward for improving quality

  11. Recommendations The Working Group strongly recommends that all member organisations embrace the introduction of Quality Care Standards and begin or continue the process as soon as possible. The FIP Community Pharmacy Section will provide assistance and seeks the co-operation of FIP member organisations in the provision of further assistance to those countries seeking such help. More information FIP Community Pharmacy Section Email: fip@fip.org Website: www.fip.org

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