Design for a Medication Safety Plan

The problem of creating a quality professional pharmacy practice for community pharmacy is often in conflict with the metrics required to provide a solid business infrastructure.
Without a sound infrastructure there is no support to underpin a professional practice, so Codes of Conduct and minimum levels for Standards of Practice have to be developed.

Increased complexity generated by these mandatory levels of compliance adds to the difficulty in providing a quality pharmacy service.
Continuous upgrading of pharmacy culture ought to ensure that quality practice improvements occur in a measured and positive fashion – but this is not the case.
The conflict that develops between clinical services (including dispensing) and retailing often sees retailing decisions taken to offset revenue losses and disruptions – particularly those induced by government or third-party payers.

A recent communication (found here)  from Daniel Hussar, a prominent US academic pharmacist describes an investigative report prepared by Chicago Tribune journalists who investigated 225 pharmacies and their response to a range of common drug interactions presented to them in prescription format.

That mainstream media publications have lacked integrity due to their appalling breaches of their own code of conduct makes you wonder whether they are still responsible corporate citizens fulfilling a valid investigative role, without distortion and dishonesty.

In this instance the answer is yes, even though the results show pharmacy in a very bad light and if you did not click on Daniel’s publication link above, please do so now.
After reading his message, reflect on what state of affairs currently exists in your own pharmacy and decide what corrections you may need to formulate.

The US-based Institute for Safe Medication Practices (ISMP) has recently released a monitoring tool for Community and ambulatory pharmacy settings that will allow pharmacists to review and improve their medication safety practices.(access tool here

The 2017 Institute for Safe Medication Practices Medication Safety Self Assessment for Community/Ambulatory Pharmacy is designed to help pharmacies evaluate their current systems, proactively identify opportunities for improvement and track their efforts over time.

An advisory panel of experts helped the ISMP update items from the 2001 self-assessment, as well as add items to address new practices and processes, including the pharmacist’s emerging role in immunization administration.
New research findings about error prevention and evolving technologies previously not widely adopted are also covered.

The ISMP recommends that each pharmacy site convene its own team of staff members (i.e., owners/managers, pharmacists, technicians and student pharmacists) to complete this comprehensive assessment, and use the information as part of their ongoing safety and quality improvement efforts.

The assessment covers 10 key areas that significantly affect safe medication use:
1. patient information;
2. drug information;
3. communication of drug orders and other drug information;
4. drug labeling, packaging and nomenclature;
5. drug standardization, storage and distribution;
6. use of devices;
7. environmental factors, workflow and staffing patterns;
8. staff competency and education;
9. patient education; and
10. quality processes and risk management.

Pharmacy teams working on the community/ambulatory pharmacy self-assessment can deveop a manual or online form to record their responses.
Information entered should be saved for future reviews.

The pharmacy should use their findings for each of the assessment items to identify and prioritise opportunities for improvement as a part of their medication safety action plan.

Given that pharmacy professional life is not getting any easier, adopting these types of internal projects is a positive method for all of staff engagement over time.
Creating good system design acts as a stimulus for creativity and innovation at a level that you do have control over to create positive culture change.

Note that PSA has recently prepared a new draft Code of Conduct for Australian pharmacists.
Feedback and comment is requested.
All pharmacists should engage with this document because there is potential for both positive and negative guidelines.
The positives will allow you to practice to the full extent of your licence and delineate minimum standards, while negatives may appear, usually from external source lobbying, that will see the Code as an opportunity to constrain pharmacist professional development by influencing Code content.
Some of these negative influences have already found their way into previous versions of the Code.
Take the time to ensure that this new PSA Code of Conduct is one that you can align with comfortably.

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