AT the recent 54th Todd Lecture, Patient Safety in Pharmacy – (Y)our Focus, hosted by the Strathclyde Institute of Pharmacy & Biomedical Sciences (SIPBS), in conjunction with the Royal Pharmaceutical Society (RPS) West Central Scotland local practice forum (LPF), Andrea Smith, RPS Scotland board member and Scottish Patient Safety Programme (SPSP) National Clinical Lead (Pharmacy) explained about the programme.
The Scottish Patient Safety Programme (SPSP) is a unique national initiative in Scotland that aims to improve the safety and reliability of healthcare and reduce harm whenever care is delivered. The Healthcare Quality Strategy for Scotland (2010) set the direction for the role of continuous quality improvement (CQI) in delivering the highest quality healthcare services to people in Scotland, and this has progressively extended from acute hospitals to primary care and now includes community pharmacy and dentistry.
Since July 2014, NHS Fife, NHS Grampian, NHS Greater Glasgow and Clyde, and NHS Highland have been taking part in a collaborative to enhance communications between GPs and pharmacists working in primary care.
The collaborative has been developing and implementing tools to:
- Improve process reliability for the safer prescribing, monitoring and dispensing of high risk medicines, such as warfarin and non-steroidal anti-inflammatory drugs (NSAIDs).
- Improve the reliability of medicines reconciliation when patients are discharged from an acute hospital.
- Raise awareness of the factors that contribute to ‘safety culture’ through the use of a safety climate survey.
SPSP pharmacy collaborative #pharmcollab
The pharmacy collaborative, led by Andrea, focuses on four main areas:
- Reducing harm.
- Developing a ‘safety culture’.
- Improving patient safety and (person-centred) pharmaceutical care.
- Increasing patient education and understanding of their medicines by using simple tools such as teachback.
A total of 27 pharmacies plus two dispensing practices were involved in the four health board areas. Pharmacy teams underwent quality improvement training to help them deliver the bundles and achieve the aims of the programme.
Year one started with 2 teams testing a warfarin bundle and 2 teams testing an NSAID bundle. In year 2, testing commenced with a medicines reconciliation bundle. Further testing is required to refine and finalise the bundles however, an outline of the work is provided below. For more details on the background behind the questions, click on the links.
- Is the yellow oral anticoagulation therapy (OAT) record booklet up to date/current including completed information (indication, duration of treatment and therapeutic range)?
- Is the OAT alert card up to date/current including completed information (indication, duration of treatment and target range)?
- Is the patient/carer aware that the Yellow OAT record booklet is taken to EVERY healthcare intervention?
- Is the patient/carer aware that they should carry the Alert Card at all times?
- Have all measures been met?
Non-steroidal anti-inflammatory drugs (NSAIDs) bundle
- Has the patient been informed to take it with or after food?
- Has the patient been informed to report any GI side effects to their pharmacist or GP?
- Has the patient been asked if they have a Medicines Sick Day rules card?*
(*or an NSAIDs card)
- Have all measures been met?
1a: Is the patient in a high risk group requiring gastroprotection?
1b: If yes, has gastroprotection been prescribed?
2a: Is the patient prescribed the triple whammy combination?
2b: If yes, has the triple whammy combination been highlighted to the prescriber?
Medicines reconciliation bundle
- Is there a record that the GP10 prescription has been reconciled with a minimum of two other sources?
- Have identified differences been discussed with the prescriber?
- Have the changes been explained to the patient/carer?
- Has the patient/carer been counselled on their medicines?
- Have all measures been met?
- Can you tell me what your medicines are for?
- Can you tell me how much of your medicines you should take?
- Can you tell me what time of day you should take your medicines?
- Can you tell me how you take or use your medicines?
(Note: as mentioned above, participating pharmacies were trained on delivering these bundles, these details are provided for information only.)
Community pharmacy involvement
All this work has informed the process for involving all community pharmacies in quality improvement. The Scottish Government have now published three circulars about quality improvement and closer working. The pharmacy champions will have a key role in supporting community pharmacy contractors in their improvement activities during 2016-17 and beyond.
It is expected that continuous quality improvement will become embedded in community pharmacy practice, introducing and applying improvement methodology and changing practice.
The starting place is completion of a series of modules and a pharmacy safety climate survey.
Pharmacy Quality Roadshows will be held across Scotland, they are a collaboration between key strategic bodies within Scotland who have a common aim of driving improvement in the quality of pharmacy services and practice in response to the Department of Health Rebalancing Programme.
The Quality Roadshows involve the delivery of a strategic presentation and workshops to raise awareness and commitment to quality improvement and also to highlight the opportunity that future legislative changes to reduce criminal sanctions for inadvertent dispensing errors gives the profession. These regulations are expected to be laid in the early part of 2017.
The Quality Roadshows include a suite of resources:
- A high level presentation during Autumn 2016.
- A standard workshop for delivery in every health board in Scotland between November 2016 and April 2017.
- Follow on workshops and webinars facilitated by NES on specific topics to provide further learning opportunities as part of the NES Spring Programme.
- Short videos and podcasts available online and as part of the other resources.
The first Pharmacy Quality Roadshow is on November 28 in Edinburgh.
See the SPSP website for further information, as well as tools and resources, including a warfarin video designed to help patients, carers and family members.
Foundation level modules (x6)
Practitioner level modules (x2)
Tools to support improvement activities