Development of a quality management system for clinical pharmacy services

Abstract

A quality management system (QMS) can assist a hospital to improve the quality of professional services provided. The aims of this study were to: (1) Analyse current clinical pharmacy service provision at Zammit Clapp Hospital (ZCH) and (2) Develop, validate, implement and evaluate standard operating procedures (SOPs) for the same hospital operating at the Rehabilitation Hospital Karin Grech (RHKG) to match current clinical pharmacy service provision and to guide new service development. A time and motion study was undertaken using a validated data collection form to obtain a detailed description of defined current pharmacy activities within the hospital and to quantify the use of the pharmacists' time in carrying out these activities. During an 18-day period, 6000 minutes of direct observation of the work activities of 3 pharmacists on 3 wards and in the pharmacy were carried out. SOPs for the clinical pharmacy services currently provided and for newly identified clinical pharmacy services were developed. Each SOP was validated twice by a core validation panel of 9 pharmacists and other healthcare professionals from within and outside the hospital included as relevant. The validated SOPs were tested for applicability and practicality through an observation study,. Subsequently, all the pharmacy staff were trained to follow the resulting final version of the SOPs. After 1 month of implementation, an evaluation of each SOP and the QMS was undertaken by the pharmacy staff using two self-administered questionnaires. Out of the 6000 minutes of observation, 3636 minutes (60.60%) were dedicated to 'Clinical' activities. Ward round (1348 minutes), patient discharge (723 minutes) and prescription monitoring (562 minutes) activities were the most predominant 'Clinical' activities. Seventeen SOPs were developed: 'Master', 'Training', 'Patient Admission', 'Patient Profiling', 'Prescription Monitoring', 'Ward Round', 'Patient Discharge', 'Adverse Drug Reactions', 'Patient Medication Trolley Check', 'Emergency Trolley Check', 'Controlled Drugs', 'Medication Errors', 'Student Placements/Practical Sessions', 'Continuing Professional Development Sessions', 'Patient/Carer Interview', 'Clinical Trials' and 'Clinical Pharmacy Services Reports'. The most important validation amendments for all 17 SOPs were the inclusion, modification and/or elimination of information, improved presentation and improved comprehensiveness. From the evaluation of the SOPs post-implementation, all the pharmacy staff agreed that each SOP was fit for purpose, easy to follow during training, user-friendly for reference during daily activities and supports development of a consistent service. During the first month of implementation, the SOPs which were referred to most were the 'Patient Profiling' and 'Continuing Professional Development Sessions' SOPs (both n=7). In the OMS evaluation, all the pharmacy staff agreed that the OMS contributes to meeting the hospital's policies and goals, sets direction to the pharmacy staff and interdisciplinary team and improves service control. The time and motion study extended the definition of the pharmacist's activities undertaken and quantified the amount of time dedicated by pharmacists to the provision of clinical pharmacy services. The SOPs developed draw on standards applicable to health care with the advantage that they provide a comprehensive approach to clinical pharmacy services. The system developed is now implemented, will need to be regularly reviewed and updated and can be transferred to other hospital settings with minor amendments.