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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.
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.