INSTITUTIONAL PHARMACY PRACTICE STANDARDS. Terms closely associated with standards of practice: Quality Quality assurance (QA) Criterion Standards “ Quality ” is a complex concept of a multidimensional phenomenon.
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Terms closely associated with standards of practice: Quality Quality assurance (QA) Criterion Standards “Quality” is a complex concept of a multidimensional phenomenon. Generally, it is the ability to achieve desirable objectives (achievable state of health) using legitimate means.
“Quality assurance” or improvement describes all efforts to measure, assess, ensure, and evaluate health care. • Is to decide • What is to be done • Measuring how well the job was done • If no acceptable results, undertaken corrective actions to ensure that in future they will be acceptable • The abstract and judgement formulations of quality must be translated into more objective criteria and standards that can be used as reliable and valid measuring tools
“Criterion” is an absolute term of what should be found if quality is optimum “Standard” is flexible term that expresses the degree of acceptable variation from the criterion. The standard and criterion are equivalent: If no deviation is acceptable and the criterion must be met. “Empirically derived criteria and standards ” When obtained: by the observation of good or acceptable or average practice.
QUALITY ASSESSMENT Assessment efforts are based on three categories: structure process outcome
Structure is the facilities, equipment, services and manpower and their qualification. Process is the activities take place between the patient and the provider. Process measures include: the procedures or steps followed in providing care. Outcome refers to the result of care. Outcome in pharmacy is simply the result of a set of procedures operating within structure. Outcome measures include:biological changes in disease, ability for self-care, physical function, patient satisfaction.
It is best to include in any system of assessment elements of structure, process and outcome. • Use of Standards: • Aspects of the quality of medical care are compared to predetermined standards • Increase accountability of the profession to the public by articulating, supporting and protecting the rights of patients • Sources of standards for pharmacy practice • Law, regulations, and rules issued by government • Standards developed by accrediting bodies • Standards developed by professional organization.
Legal Standards Readily identifiable standards have legal significance in the practice of institutional pharmacy. The Saudi government through the laws and regulations of practicing pharmacy is responsible for the implementation and for the control and prevention. Accreditation Accreditation is acknowledgement that an institution or program has met predetermined standards of quality (JCAHO): Joint Commission on Accreditation of Healthcare Organization MRQP: Makkah Region Quality Program
Accreditation is important for the hospital in many ways: • It contains the legal requirements. • Most health insurance company pay for care in accredited hospital. • Demonstrates to the public that a hospital meets the standards. • Provides an opportunity for hospitals to assess the strong and weak features and make improvements. • Quality Assurance • The standards used in a quality assurance program must define a level of patient care that is both optimal and achievable, i.e., standards that are high, yet attainable with available resources. • In this program, problems or areas for improvement must be identified first then action must be taken to resolve the problems or bring performance closer to the established standards.
problems or areas for improvement action resolve the problems or bring performance closer to the established standards
Drug Usage Evaluation (DUE) • Drug usage evaluation is a medical staff quality assurance activity, designed to promote appropriate, safe and effective drug use. • Pharmacy professional guide the medical staff through the process. • Recommend drug use criteria • Gather data • Identify departures • Take the action directed by the medical staff.
Agenda for Change • The need for evaluation systems that look beyond what care is given and how it is rendered, to evaluate the patient’s health status • The outcome measurement was favoured more than the structure and process evaluation • This approach is better by • Ensuring value for health car money spent • Controlling the individual components of care • Increasing the likelihood that commonly accepted performance standards are used.
Indicators • Providers of care monitor their own performance and services. • Pharmacy Organizations • One of their prime functions is to establish and implement standards of practice. • Why • To hold members accountable for using standard • To protect the public from individuals who have not attained or follow the standards • To protect individual members of the profession from each other • To maintain and improve standards.
Several pharmacy organizations have been involved in developing standards of practice • ASHP practice standards consist of: • The statements • Guidelines • Residency accreditation regulations • Technical assistance bulletins
Departmental Standards of Practice • and • Performance Standards • Standards are necessary to ensure consistent, comprehensive services for patient. • They serve as important management tools in • Recruitment • Orientation and training • Performance planning and review • Describing staff responsibilities. • Practice standards should be incorporated into the strategic planning and should be consistent with the philosophy, mission, and goals of the department.
Once departmental standards of practice have been developed, audits may be done to determine if the department is compliant. Performance standards must be measurable and challenging, but also they should be realistic and achievable. They can be designed to measure quality, quantity, time or cost associated with the job responsibilities Engineered standard: based on the result the organization needs Historical standard: based on the previous results Comparative standard: based on the results that others are achieving
Future Direction Improving clinical outcomes for a wide variety of disease entities depends on optimising pharmaceutical care. Pharmacy must play a key role in developing and implementing new ways to measure and validate the effectiveness of drug use. Future standards for care should be oriented to the patients desired.