|Continuous Quality Improvement|
Pharmacy Quality Commitment
Quality improvement program designed specifically for community pharmacists
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.
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