Practice Standard Safety and Quality

Patient safety is a high-priority issue for all professionals including pharmacists. Patient safety is
defined as the prevention of harm to patients, including through errors of commission and
omission. The role of pharmacists has been clinically proven to improve many outcomes
regarding patient health, including greater patient safety, improved disease and drug therapy
management, effective healthcare spending, improved adherence and improved quality of life
(Canadian Pharmacists Association, 2008).
The focus on patient care stemmed from a 1999 US report by the institute of Medicine titled,
To Err is Human: Building a safer Health System. This report detailed the costs of medical
errors to the US economy and how medical errors numbered higher than deaths due to AIDS,
motor vehicle accidents, and breast cancer, combined. The report went on to descried how errors
can be reduced (Institute of Medicine,1999).
For centuries, pharmacists have been the guardians/safeguards against "poisons" those
substances which could cause harm to the public. Now more than ever pharmacists are charged
with the responsibility to ensure that when a patient receives a medicine, it will not cause harm.
As highlighted in a report produced in November 2009 "Pharmacy Intervention in the
Medication-use Process - the role of pharmacists in improving patient safety", the involvement
of pharmacists in patient safety can be as early at the prescribing phase and up to the
administration of the medicines. In many cases, pharmacists are supported by programmes and
activities from their national associations, as listed in this extensive work completed by Advit
Shah, a final year pharmacy student from the University of Manitoba in Winnipeg, Canada.
National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP)
defines medical errors as "any preventable event that may cause or lead to inappropriate
medication use or patient harm while the medication is in the control of the health care
professional, patient, or consumer. Such events may be related to professional practice, health
care products, procedures, and systems including prescribing; order communication; product
labelling; packaging; and nomenclature; compounding; dispensing; distribution; administration;
education; monitoring; and use." While "harm" includes both "temporary or permanent
impairment of body function/structure requiring intervention and an error resulting in death".
The author Advit, emphasises that medication errors arises throughout the main categories of
prescribing, dispensing and administration of the medication-use process, also he goes on to say
that, the profession of pharmacy and pharmacist, play a key role in reducing these errors by
making appropriate interventions at each stage and by working with other healthcare
professionals, governments and regulating bodies and with pharmacy organizations on global
basis. In his paper, he also mentions the key steps in the medication-use process as much safer.
The article Measurement of pharmacy quality metrics at the pharmacy level should be our
goal by Lawrence M. Brown, Associate Professor and Director, Center for Medication Therapy
Management, College of Pharmacy, University of Tennessee, Memphis; states that a quality
matrix need to be created to ensure better quality medications & services at the pharmacies as
well as better utilization of pharmacists at the health sectors, ultimately ensuring better patient
safety. In his article he mentions that the valuable role of the pharmacist in health care has been
demonstrated in numerous studies examining the improved outcomes resulting from
pharmaceutical care, disease management, or MTM services provided by pharmacists.

But
pharmacists also need to be recognized for the value of the services they provide every day to
millions of patients during the dispensing process.
The author has based his article on the study done by Pillittere-Dugan et al. who in his report
on development and testing of performance measures for pharmacy services emphasised on a
critical issue of the pharmacy world using a case study, wherein he also went on to describe
about the quality metric creation and validation process. However, Lawrence also criticizes one
area in which the article falls short saying that it gives an impression that health plan level
measurement is the only reasonable approach to quality measurement of the pharmacy. Author
through his various studies of researches emphasises that pharmacy quality improvement is too
important an issue to be limited to only 10% of pharmacies. There are a number of great minds
in academia and elsewhere who could take up the challenge of finding a cost-effective means to
measure the quality of care provided by all pharmacies, or at least the vast majority of them.
As highlighted in a report produced on Dec 2001, Pharmacists attitudes towards dispensing
errors: their causes and prevention by G. M. Peterson, University of Tasmania, Hobart,
Tasmania, Australia, that dispensing errors are occurring in numbers well above reports to
regulatory authorities or professional indemnity insurance companies, and seem to be accepted
as part of practice due to high prescription volumes, pharmacist fatigue and overwork but
importantly due to no set practice standards. The basic objective of the study has been to assess
the attitudes of pharmacists towards the issue of dispensing errors wherein anonymous
questionnaires sought opinions on various possible factors.
Most pharmacists (82%) believed that the risk of dispensing errors is increasing. The principal
contributing factors nominated were: high prescription volumes, pharmacist fatigue, pharmacist
overwork, interruptions to dispensing, and similar or confusing drug names. The main factors
identified as being important in reducing the risk of dispensing errors were: having mechanisms
for checking dispensing procedures, having a systematic dispensing workflow, checking the
original prescription (duplicate) when dispensing repeats, improving the packaging and labelling
of drug products, having drug names that are distinctive, counselling patients at the time of
supply, keeping one's knowledge of drugs up-to-date, avoiding interruptions, reducing
workloads on pharmacists, improving doctors handwriting, and privacy when counselling
patients. Most pharmacists (72%) stated that they were aware of dispensing errors that had left
the pharmacy undetected, in their place of practice during the past 6 months. Most pharmacists
(58%) stated that there should be a regulatory guideline for the safe dispensing load in Australia.
The profession needs to be proactive and standards have to be set appropriately high (i.e. zero
error tolerance).