Continuous Quality Improvement
Pharmacy Quality Commitment
Quality improvement program designed specifically for community pharmacists
Each year more than 44,000 people are killed as a result of preventable adverse medical events, according to reports from the Institute of Medicine. Medication errors alone are estimated to cause 7,000 deaths annually in the United States, according the institute’s report, To Err is Human. Because pharmacists are human, and humans do make mistakes, errors are a reality. But the healthcare marketplace and new federal guidelines are looking to reduce those errors. In fact, language in Medicare Part D directs Prescription Drug Plan (PDP) sponsors to have in place “quality assurance measures and systems to reduce medication errors and adverse drug interactions and improve medication use.”
Pharmacy Quality Commitment® (PQC) is a quality improvement program designed specifically for community pharmacies. PQC consists of The Sentinel System™ and The Quality Manager™. The Sentinel System outlines a standard workflow with recommended processes and risk management techniques to be employed at each workflow station. Peer Review Audit Forms are used to track every Quality Related Event (QRE), or any deviation from quality. A QRE can be either an error that reaches the patient or a near-miss that is caught before reaching the patient. A near-miss is considered a success and an opportunity for pharmacies to learn and make improvements. A few examples of QREs include: wrong drug, wrong strength, wrong directions, incorrect or omitted refills, use of easy-open caps without patient release, and confidentiality failures such as bag mix-ups with more than one patient’s prescriptions.
The PQC package costs pharmacies $300 for the first year and $200 annually for renewal. Most of the cases WSPA member and lawyer Craig A. Ritchie R. Ph, J.D., handles involve wrong medications or wrong labels. Often, the Board of Pharmacy issues a notice of correction after it receives a complaint from a consumer. The notice is sent to the pharmacist asking for an explanation and the responses are reviewed by the board, Ritchie said. Typically, the Board of Pharmacy will ask his clients what they are going to do prevent these errors in the future. His clients could say they are now using a program like PQC. “I would tell them to pay the $300 and tell the board they will, in the future, be using one of these systems,” Ritchie said.
Congress passed an important federal law for continuous quality improvements in July 2005. The Patient Safety and Quality Improvement Act of 2005 protects any information gathered by a certified patient safety organization for the purpose of improving patient safety from being admissible in criminal, civil, or administrative proceedings. In the past, pharmacists may have been hesitant to document quality-related events occurring in their practice, afraid that they could be used against them for litigious or disciplinary purposes.
The recommended workflow stations in The Sentinel System are: receiving the prescription, data entry, assembly of prescription, professional prescription review and final check, and delivery with patient counseling. One final station is special care prescriptions where prescriptions that require additional time are pulled out of the normal workflow. These prescriptions may require the pharmacist or trained staff member to contact a prescriber or insurance company, special order an item, or compound a medication. Within the standard workflow, a pharmacy must have Best Practice techniques in place. Each workflow station has a recommended list of at least 10 Best Practice, or risk-management techniques. Examples of the Sentinel System’s Best Practice techniques include echo and verify and the two second rule. Echo and verify is a risk-management technique for receiving a telephone prescription. The person taking the phoned-in prescription, after reducing it to writing on a prescription blank, reads back (echoes) each part of the prescription. When the caller verifies what was read back is correct, the pharmacy staff member initials, dates, and places a “V” for verified on the new prescription. The two second rule is a risk-management technique for assembling the prescription. No prescription vial that contains medication should be unlabeled for more than two seconds. One can see how these techniques, when incorporated into a standard workflow, reduce the likelihood of errors. The workflow and risk-management techniques are an important part of The Sentinel System, but are not concrete. They can be modified to fit each practice environment. One of the tools provided with the Quality ManagerSM is the Peer Review Audit form. These forms are daily logs on which every QRE is recorded. The information on these forms includes: where the QRE was caught (e.g. pharmacist final check, patient discovery), QRE type (e.g. wrong drug, wrong directions), where the mistake was made, and medication(s) involved. Other information recorded includes the date and time of each QRE, the pharmacist recording the QRE (in case a question arises later), and the total number of new and refill prescriptions for that date of service. The name(s) of who was involved in the QRE is NOT recorded. This creates a non-punitive environment, so that there is no blame associated with recording QREs. Data collection onto the Peer Review Audit form takes roughly 30 seconds per QRE. At day’s end, this information is entered online through PQC’s website, which should take one to two minutes per 100 prescriptions filled. Once the data is entered, the website offers Quality Management Tools to assist in analyzing each pharmacy’s quality. These tools help pharmacists and pharmacy staff members evaluate the workflow, risk-management techniques, and trends that occur at their site. By performing quarterly analyses, pharmacists are able to learn from past failures of quality and improve quality in the future, ultimately increasing patient safety.
To request more information on the Pharmacy Quality Commitment® program, or to purchase the Pharmacy Quality Commitment® program, visit the PQC website.