Quality in healthcare

International experience has shown that prioritising quality in healthcare services can lead to improved clinical outcomes, safety and patient experience.

In Ireland, quality in healthcare is defined by the four quality domains set out in the Safer Better Healthcare Standards published by HIQA in June 2012. These domains focus on providing a quality of care that is person-centred, safe, effective and promotes better health and well-being. These domains are echoed in the HSE Framework for Improving Quality in our Health Service, published in April 2016.

Having a quality assurance system in place at the pharmacy will facilitate the delivery of high-quality healthcare. It will also support those in pharmacy governance roles to ensure that such care meets the guidance/standards as set out by the Pharmaceutical Society of Ireland (PSI) and is delivered in accordance with legislative requirements. By carrying out quality assurance exercises you are fostering a culture of safety at the pharmacy, providing high-quality services and encouraging the pharmacy team to deliver a positive patient experience. Such practices can also contribute to a more efficient pharmacy by facilitating the day-to-day operation of the pharmacy.

Those in governance positions (i.e., owners, superintendent pharmacists and supervising pharmacists), are required to have policies and procedures in place to support pharmacy practice, ensure that the services offered are safe, and meet the minimum standards. All pharmacists are required to practice in accordance with Code of Conduct for Pharmacists which sets out the professional principles, standards and ethics which the public, patients and other healthcare professionals require, and expect of pharmacists. A robust system of quality assurance supports in meeting these obligations.

Quality assurance tools in pharmacy

Using quality assurance tools in your daily practice will help you to maintain a high service standard. There are several quality assurance tools that will support you in reviewing your practice, and driving a patient safety culture among the pharmacy team, for example:

• Standard Operating Procedures (SOPs): SOPs are the foundation of a robust professional practice and quality assurance system that will support you and the pharmacy team. SOPs accurately describe how processes and procedures are carried out at the pharmacy, and will ensure consistency across the services provided. The pharmacy team is trained on those SOPs relevant to their roles and responsibilities. Reviewing the pharmacy teams’ daily practice will help you to determine if SOPs are working as intended;

• Dispensing error logs: This log promotes the recording of any dispensing errors that take place at the pharmacy. By analysing the error, you may identify gaps in practice, shortfalls in SOPs and/or training needs among the pharmacy team. The recording of the event and the investigation associated with this log, encourage communication between all those in leadership positions in the pharmacy and the pharmacy team. One of the outputs of this log is an action plan, which includes preventative and corrective actions agreed upon to address the areas for improvement identified;

• Near misses logs: A near-miss is a dispensing error that did not materialize, in other words, it was identified before it reached the patient. Maintaining a near-miss log and regularly reviewing it and discussing it within the pharmacy team will identify trends or gaps in practice. Implementing corrective and preventative actions will increase the safety of your practice;

• Date checking log and associated process: This monthly planned activity has associated outputs that will increase the safety of the pharmacy practice. This activity ensures that the medicinal products supplied are in date, and do not pose a risk to public health;

• Temperature logs: Monitoring the maximum and the minimum ambient temperatures and pharmaceutical grade fridge temperature will ensure that medicines are stored in accordance with the manufacturer’s specifications. By monitoring the temperature, the pharmacy team will be alerted if there is a breach in the storage conditions and the necessary remedial actions will be put in place to ensure patient safety; and

• Customer feedback tools: Engaging directly with members of the public and listening to their needs, will enable the pharmacy team to tailor the services provided and ensure that the service offered facilitates a positive user experience.

Implementing a system of quality assurance in your pharmacy

Having a robust quality assurance system in place will enable pharmacists and the pharmacy team to provide a safe environment for members of the public, and foster a patient safety culture amongst the team.

There are a range of quality assurance resources available on the IPU website such as SOP templates, incident/dispensing error log and checklists to help you determine if your practice is in accordance with legislation and/or PSI guidance. These are available at ipu.ie > Pharmacy Services > SOPs and Guidelines, when logged in as an IPU member.

The PSI have also developed a number of different quality assurance and self-audit tools available at psi.ie, such as the Pharmacy Assessment System (Inspection & Enforcement > Pharmacy Assessment System), and COVID-19 Operational Standards for Pharmacies (Inspection & Enforcement > Standards for Pharmacies). Most PSI Guidelines for Retail Pharmacy Businesses contain a checklist that supports you with the auditing of your practice, and identifying gaps or areas for improvement to ensure your practice is safe and compliant, at the end of the guidance (available at psi.ie > Pharmacy Practice > Pharmacy Practice Guidance).

The IPU Professional Services team is available to answer your queries and provide you with guidance in quality assurance matters. Please email us on pharmacists@ipu.ie, or call 01 493 6401.