A quality assurance program for clinical pharmacy services provided to a long-term care unit in a community hospital.

This paper describes the development of a quality assurance program for the clinical pharmacy services being provided to a long term care unit in a community hospital. The functions, standards and criteria of these clinical services are presented and the results and impact of four completed audits are discussed. It is the intent of this article to demonstrate the ease with which a quality assurance program for clinical pharmacy services may be instituted and the potential benefits it may offer.     

Assuring the quality of a clinical pharmacokinetics service

A quality assurance program for a clinical pharmacokinetics service that meets current Joint Commission on Accreditation of Hospitals (JCAH) requirements for quality assurance is described. The clinical pharmacokinetics service is provided by pharmacists who have been certified through a staff development program. The clinical pharmacokinetics quality assurance program is part of the department's overall quality assurance program. Information from records maintained by pharmacists who are involved in the pharmacokinetics service is reviewed monthly and compared with 14 criteria that were approved by the pharmacy and therapeutics committee. Results of the monthly audits are summarized in a trend report; these results are communicated to the pharmacists involved, and any necessary corrective actions are taken. The program has led to more appropriate selection of target peak and trough serum drug concentrations, improved documentation of patient data, and better monitoring of each patient's renal function. Physician use of the service has increased as the quality of the service has improved. The quality assurance program has provided mechanisms for monitoring the quality of patient-care services and satisfying current JCAH requirements.     

A first-phase quality assurance program for intravenous admixture aseptic technique

Results of initial departmental quality assurance audits revealed noncompliance with the intravenous admixture service criteria concerning aseptic technique. In order to better assess this problem, a quality assurance program for aseptic technique was developed. The criteria consisted of 16 characteristics and/or functions that are indicative of aseptic technique. An audit of 13 technicians revealed a number of problems (noncompliance) related to aseptic technique. An educational program was developed and implemented on an individual basis. A reaudit two to four weeks later revealed compliance with the aseptic technique criteria. This study indicates that the audit method is effective in determining compliance to the aseptic technique criteria and standards.     

Use of generic screening criteria for clinical interventions that link prescribing to credentialing

Current JCAHO standards require hospitals to link the use of drugs to prescriber credentialling. The pharmacy service at the Veterans Affairs Medical Center, Iowa City, Iowa, has developed a prescriber-specific program that documents clinical interventions and links that information to physician credentialling through the Pharmacist Intervention Report and associated quality assurance (QA) program. A severity index level was also developed to rate the significance of the interventions. The Pharmacist Intervention Report is used by all medical departments in their respective QA programs.     

Program used by a national home infusion therapy provider to prepare for Joint Commission site surveys

A process developed by a national provider of home infusion therapy to prepare branch pharmacy centers for site surveys by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is described. Each of the 20 branches to be surveyed by JCAHO was visited three times by a corporate quality assurance team, which consisted of a pharmacy quality assurance manager and a nursing quality assurance manager. During the initial visit, the team performed a baseline quality assurance audit based on pre-established audit criteria. During the second visit, the team conducted a mock survey that replicated the official JCAHO survey. The final visit was scheduled to coincide with the JCAHO survey; its purpose was to provide support to the branch. Results from each of the visits were documented and reviewed with branch and corporate management. As of January 1990, 19 branches and the corporate service had been surveyed. Sixteen branches received a three-year JCAHO accreditation; the JCAHO accreditation status of the remaining three branches is pending. The JCAHO surveyor made only minor recommendations during the oral summary of the survey results. A program for preparing the staff at branch facilities of a major home infusion therapy provider for JCAHO surveys was successful.     

JCI标准下的医院药学质量管理

目的根据JCI（joint commission internationa1）标准,建立医院药学质量管理体系,加强药学质量管理。方法参照JCI标准,建立和完善药事管理体系及药品质量管理规程,加强药品使用环节管理和合理用药环节的管理,持续改进药学服务质量,探讨并指导医院药学质量管理各个环节工作。结果及结论基于JCI标准的药学质量管理体系有利于药学部门规范药学质量管理,改进药学管理水平,提高药学服务质量,保证医疗质量和患者安全。     

基于JCI 标准的药学保障与服务管理体系的实践和应用

目的:根据JCI(joint commission international)标准,建立药学保障与服务管理体系,促进我院药学服务质量的提高.方法:基于JCI 标准,总结经验,根据我院药学服务实际情况建立药学保障与服务管理体系,并在工作中实践和改进.结果:我院药学部门各科室根据药学保障与服务管理体系的要求进行了工作的改进和完善,健全了各项工作制度,规范了药房内药品分类目录,统一了药品标识,提高了药师药学服务水平.结论:基于JCI 标准的药学保障与服务管理体系有利于药学部门规范药学服务操作,提高药学服务质量,提升药学部门形象,促进医院整体医疗质量的提高.     

Concurrent quality assurance for a nutrition-support service

A pharmacy-based quality assurance program for a nutrition support service (NSS) is described. The NSS, located in a university teaching hospital, is consulted to provide nutritional therapies, primarily total parenteral nutrition (TPN). A planning group from the NSS developed a quality assurance program to monitor specific activities of the service. Four categories of indicators were selected: discretionary, including the indication for TPN and length of TPN therapy; complications, including metabolic, septic, and mechanical; nutritional outcomes, such as nitrogen balance determinations and visceral protein status; and miscellaneous, such as frequency of missing nutrition-related laboratory data. The planning group developed a TPN monitoring checklist that defined the absolute ranges acceptable for each monitored laboratory test, and standards for each indicator were developed. The program was designed to allow daily evaluation, provide weekly reviews, and generate monthly reports on quality assurance issues. The TPN monitoring checklist was incorporated into the daily monitoring form. Data were compiled from 248 patients over a six-month period beginning on January 1, 1988. Noncompliance with standards was rare for discretionary indicators. A majority of indicators of metabolic complications were in compliance with the standards, as were all indicators of septic complications. Both indicators of nutritional outcome were above the standard, except nitrogen balance during months 4 and 5. The TPN wastage rate was noncompliant with standards during four of the six months. Missing TPN laboratory data (n = 94) in January prompted identification of individual laboratories on the TPN order form. If the mean percentage compliance during this six-month period was higher than the initial standard, then the standard was upgraded.(ABSTRACT TRUNCATED AT 250 WORDS)     

质量考核标准在医院药学管理工作中的成效研究

目的：完善药学管理制度,促进药学事业的高质量发展,提高医院药学服务水平。方法：根据《三级妇幼保健院评审标准实施细则（2016年版）》和《JCI医院评审标准（第6版）》查找医院药学服务在运行过程中出现的质量管理方面的问题,并依此建立我院药学质量考核体系。结果：质量考核标准的执行,使我院药学管理工作取得一定成效,完善了药学相关制度,促进信息化平台的建设,提高了药学服务质量,从而保障了患者的用药安全。结论：质量考核标准的建立和实施有利于规范医院药学管理,提高药学服务质量,保障患者用药安全。     

专业学位水平评估视角下药学硕士培养体系优化

专业学位水平评估是提升专业学位研究生培养质量的重要手段,对学位授权点围绕专业学位教育应用性、实践性等特点完善人才培养体系有指导性意义。从培养目标契合度、师资队伍支撑度、培养过程匹配度、职业需求吻合度、社会满意度、质量保障体系有效度六个维度对专业学位评估指标进行解读。在此基础上,建议药学硕士的培养应在工业药学、临床药学、管理药学三个领域分别聚焦,构建人才培养方案,打造专业化的导师队伍,开展案例教学与实践基地建设,重视学位论文实践意义,完善人才培养质量保障体系建设,最终实现药学硕士专业学位教育与制药工程师、临床药师等职业人才有机衔接,促进医药行业发展。     

Review of nuclear pharmacy practice in hospitals

An operational profile for nuclear pharmacy practice is presented, and the technical and professional role of nuclear pharmacists is reviewed. Key aspects of nuclear pharmacy practice in hospitals discussed are the basic facilities and equipment for the preparation, quality control, and distribution of radioactive drug products. Standards for receiving, storing, and processing radioactive material are described. The elements of a radiopharmaceutical quality assurance program, including the working procedures, documentation systems, data analysis, and specific control tests, are presented. Details of dose preparation and administration and systems of inventory control for radioactive products are outlined.     

Evaluating the accuracy of technicians and pharmacists in checking unit dose medication cassettes.

The accuracy rates of board-registered pharmacy technicians and pharmacists in checking unit dose medication cassettes in the inpatient setting at two separate institutions were examined. Cedars-Sinai Medical Center and Long Beach Memorial Medical Center, both in Los Angeles county, petitioned the California State Board of Pharmacy to approve a waiver of the California Code of Regulations to conduct an experimental program to compare the accuracy of unit dose medication cassettes checked by pharmacists with that of cassettes checked by trained, certified pharmacy technicians. The study consisted of three parts: assessing pharmacist baseline checking accuracy (Phase I), developing a technician-training program and certifying technicians who completed the didactic and practical training (Phase II), and evaluating the accuracy of certified technicians checking unit dose medication cassettes as a daily function (Phase III). Twenty-nine pharmacists and 41 technicians (3 of whom were pharmacy interns) participated in the study. Of the technicians, all 41 successfully completed the didactic and practical training, 39 successfully completed the audits and became certified checkers, and 2 (including 1 of the interns) did not complete the certification audits because they were reassigned to another work area or had resigned. In Phase II, the observed accuracy rate and its lower confidence limit exceeded the predetermined minimum requirement of 99.8% for a certified checker. The mean accuracy rates for technicians were identical at the two institutions (p = 1.0). The difference in mean accuracy rates between pharmacists (99.52%; 95% confidence interval [CI] 99.44-99.58%) and technicians, (99.89%; 95% CI 99.87-99.90%) was significant (p < 0.0001). Inpatient technicians who had been trained and certified in a closely supervised program that incorporated quality assurance mechanisms could safely and accurately check unit dose medication cassettes filled by other technicians.     

Development of a multihospital pharmacy quality assurance program

Seven community hospitals have worked cooperatively for 18 months to develop an initial hospital pharmacy quality assurance program. Auditing criteria were developed for nine service areas corresponding to the model program developed by the American Society of Hospital Pharmacists. Current plans are to implement and modify this program as required at each participating hospital. Follow-up programs will also be essential to a functional, ongoing program, and these will be developed in the future.     

Pharmacy-managed patient-controlled analgesia service

The implementation and functioning of a patient-controlled analgesia (PCA) service operated by staff pharmacists are described. The pharmacy-managed PCA service was introduced into the hospital in 1988. Pharmacists initiate PCA therapy upon physician request. Standard narcotic-dosing guidelines were developed for patients receiving PCA; criteria were also developed to allow the pharmacist to adjust the narcotic dose based upon the patient's response. The dosing guidelines were approved by the pharmacy and therapeutics committee. A hospitalwide education program introduced nurses and physicians to the pharmacy-managed PCA service. Of 299 patients who received PCA therapy in 1989, more than 90% were managed by staff pharmacists. Pharmacists calculate and program initial narcotic doses and are responsible for daily patient monitoring to determine the success of therapy. Using the established guidelines, pharmacists adjust the narcotic dose based upon patient response. A quality assurance review of the PCA service has documented its safety and success. A pharmacy-managed PCA service has increased the clinical involvement of pharmacists and provided safe and effective pain management for postsurgical patients.     

Clinical privileges program for pharmacists.

A clinical privileges program for pharmacists is described. In 1985 and 1989 the Department of Veterans Affairs (VA) issued circulars defining policy on clinical privileges for pharmacists at its medical centers. Pharmacists at one large VA medical center responded by developing a clinical privileges program. Bylaws under which medical staff members are granted clinical privileges were used as a model for the pharmacist program. A pharmacist seeking privileges prepares an application detailing his or her background and the practice areas involved in the request; the applicant also drafts a quality assurance protocol. The application is reviewed by a pharmacist clinical privileges review board (PCPRB). The PCPRB uses the quality assurance plan to verify that adequate measures are in place to meet standards of care. If a question of patient safety arises, the board meets to review the pharmacist's activities. Each pharmacist who is granted privileges must have a physician sponsor. Since the first meeting of the PCPRB in 1990, clinical privileges have been requested by all 24 clinical pharmacy specialists at the center. No pharmacist has been denied privileges, although the board has required additional training or improved quality assurance protocols for many. Acceptance of the program by the medical staff has been good. A clinical privileges program at a VA medical center offers pharmacists the opportunity to practice pharmaceutical care.     

Quality assurance program for a drug information center

The objective of this study was to develop a quality assurance program for the drug information service using outcome measurements. Criteria of timeliness, accuracy, objectivity, completeness, and use of the information in patient care were measured by a questionnaire sent to users of the service. A response rate of 86 percent showed that the criteria were met in 92, 97, 92, 75, and 69 percent of cases, respectively. The autoreputational approach was utilized in altering procedures to attempt to meet the previously set standards. It was concluded that measuring outcome is a useful method for assuring the quality of a drug information service.     

Drug information quality assurance program used to appraise students' performance.

A quality assurance program developed for a drug information service was used to objectively measure the performance of doctor of pharmacy degree students on rotation in the service. Two five-point rating scales based on objective criteria were developed so that judgmental and nonjudgmental drug information responses could be evaluated separately. Preceptors used the scales to evaluate 30 randomly selected responses from each of 22 Pharm.D. students (15 responses from midrotation and 15 from the end of the rotation). Written responses were also evaluated on a five-point scale by the requesters. In all of the evaluations, a score of 5 was excellent and a score of 1 was unacceptable. The preceptors assigned a score of 5 to 52.3% of the 660 responses evaluated, 4 to 29.1%, 3 to 12.9%, 2 to 4.5%, and 1 to 1.2%. No significant difference was found based on the academic quarter during which the rotation took place. The difference in scores between judgmental and nonjudgmental responses was not significant. End-of-rotation scores tended to be higher than midrotation scores, although the difference was not significant. Testing for interrater reliability revealed moderate agreement between raters. Requesters gave mean scores higher than 4 for accuracy, completeness, objectivity, and usefulness of the written responses. Timeliness scores were significantly lower but still acceptable. A drug information quality assurance program provided a structured, objective means of evaluating student performance.     

Quality assurance program for a drug information center

Development of a quality assurance (QA) program for a drug information center (DIC) at a large community teaching hospital is described. Criteria were written for each activity performed by the DIC. An assessment form was devised that included instructions for evaluating the service with respect to each criterion. New procedures had to be implemented before some DIC activities could be assessed (e.g., a survey of the readership of the nursing newsletter, and a peer review program for evaluating responses to drug information questions). Initial assessment results revealed that failure to meet the practice criteria was attributable to inadequacies in the instructions to the evaluator and incomplete documentation by the DIC providers. After evaluation and revision of the criteria, the program was formally included in the overall pharmacy department QA program.     

A Community-Based Clinical Pharmacy Teaching,Research, and Service Program in Zimbabwe

In an effort to optimize limited resources, a community-based clinical pharmacy program was initiated to promote service, teaching, and research. This program sponsored the recruitment of pharmacy personnel to carry out distributive and clinical functions. This service enabled the development of new clinical attachment sites for pharmacy students. Students on these attachments carried out supervised projects that enhanced their learning while providing essential services to the community. This program resulted in the enhancement of stock levels of drugs and medical equipment, improvement in the drug budget through on-site manufacturing and proper stock management, and the creation of a favorable working partnership with other health professionals as well as the community. A number of research projects were initiated and completed, and a teaching program was established. This program demonstrated that integration of the triple functions of clinical pharmacy service, teaching, and research is feasible in a rural setting and can achieve goals that are mutually beneficial to all facets of the pharmacy profession.     

信息化服务在临床药学工作中的重要性

目的从药品不良反应、药物咨询服务、药学教育3个侧面反映信息服务在现代临床药学工作实践中的重要性,揭示信息系统与医院药学、临床药学密不可分的关系。方法分析了信息服务对药品不良反应监测、药学教育以及药物咨询等药学服务工作的推动、促进作用。结果信息化系统的持续改进是全面提升临床药学和药学服务质量的保证。结论信息服务是药学服务的精髓,只有进一步完善信息化服务系统,才能为广大患者和医务工作者提供更加完善的药学服务。