Evaluation of a guided continuous quality improvement program in community pharmacies

Abstract

Background: The importance of creating and sustaining a strong culture of patient safety has been recognized as a critical component of safe medication use. This study aims to assess changes in attitudes toward patient safety culture and frequency of quality-related event (QRE) reporting after guided implementation of a continuous quality improvement (CQI) program in a panel of community pharmacies in the United States (U.S.). Methods: Twenty-one community pharmacies volunteered to participate in the project and were randomly assigned to intervention or control groups. Pharmacy staff in the intervention group received guided training to ensure full implementation of a CQI program while those in the control group partially implemented the program. Pharmacy staff in both groups completed retrospective pre-post safety culture questionnaires and reported medication errors and near misses that occurred in their practices. Rasch analysis was applied to assess questionnaire validity and reliability and to confirm if the ordinal level data approximated interval level measures. Paired t-tests and repeated measure analysis of covariance tests were subsequently used to compare observed changes in the attitudes of subjects and frequency of QREs reporting in intervention and control groups. Results: Sixty-nine employees completed the questionnaire, a 43.9% response rate. Improvement in attitudes toward patient safety was statistically significant in the intervention group in six domains: staff, training, and skill (p = 0.017); patient counseling (p = 0.043); communication about mistakes (p < 0.001); response to mistakes (p < 0.001); organizational learning -continuous improvement (p < 0.001); and overall patient safety perceptions (p = 0.033). No significant differences were observed in QRE reporting rates between intervention and control groups. However, differences were observed in the types of QREs reported (e.g., incorrect safety cap) and the point in the prescription processing workflow where a QRE was detected (e.g., partner check station, and drug utilization review station) in the intervention group (p < 0.001). Conclusion: Guided CQI program implementation increased the self-reported patient safety culture attitudes among staff.

Engaging community pharmacists in quality improvement (QI): a qualitative case study of a partnership between a Higher Education Institute and Local Pharmaceutical Committees

“…For instance, a QI intervention study in the USA found that after a follow-up period of 2 months, investigators were unable to detect the impact either on quality related events or patient safety attitudes. 34 The impact of a QI learning intervention appear therefore to take time to imbed in practice and that any assessment of patient-related outcomes should acknowledge that outcomes are likely to be gradual or incremental. Others have suggested that regular repetition of QI messages are needed to sustain improvements in practice.…”

A Quantitative and Qualitative Analysis of Electronic Prescribing Incidents Reported by Community Pharmacists

“…These two reporting systems are available to U.S. community pharmacies as part of a continuous quality improvement program created to assist pharmacy personnel in documenting, monitoring, and analyzing quality-related events. 13,14 PQC is a two-part system that enables a pharmacy to identify, document, and analyze workflow. It enables pharmacists to document medication incidents (i.e., near misses, unsafe conditions, and errors that reached the patient) on a standardized electronic form.…”

A Systematic Review and Narrative Synthesis: Determinants of the Effectiveness and Sustainability of Measurement-Focused Quality Improvement Trainings

“…Studies measuring participant behavior also reported positive results except two quantitative descriptive studies. 63,65 Two randomized control trial studies 24,53 and a controlled interrupted time series study 50 reported not achieving the clinical outcomes being measured. A cohort study also reported not achieving the outcome of developing a culture of QI.…”

“…In addition, while planning evaluations, it is important to assess learner involvement and QI project outcomes beyond completion of the programme. 52 A strategic approach requires taking a system-level view 20,21 of improvements with a blameless culture focusing on systems rather than individuals, 24,53 which considers challenges as system issues rather than staff issues. 28 Supportive organizational practices encourage QI by removing barriers, 26 investing in workforce capacity and culture change 28 and providing a conducive environment for teamwork.…”