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| Recording pharmacist interventions would be useful for reviewing clinical activity |
The issues surrounding the role of pharmacists in implementing clinical governance was discussed at the British Pharmaceutical Conference in a session chaired by Miss Alison Ewing (Council member, Royal Pharmaceutical Society) on September 11
Clinical governance and accountability were not optional extras in pharmaceutical
care, Mr David Pruce (audit development fellow, the Royal Pharmaceutical Society)
told Conference participants.
Clinical governance had been practiced by pharmacists for years and brought
together:
The focus of clinical governance had been on accountability and there was a
danger of missing its most important aspect, that of improving quality, he said.
Pharmacists needed to be able to admit to making mistakes and needed to be able
to learn from them. To facilitate this, pharmacists had to move away from a
culture of blame towards one of learning.
Poor performance was not acceptable but a change of emphasis was needed as there
was a fear that once weaknesses were exposed those who had made a mistake would
be pounced upon by health authorities and the National Health Service. Often
individuals got the blame when it was the system that was wrong.
Audit
Audit was a tool that could be used by pharmacists to learn from their own practice
along with the examples set by best practice.
Community pharmacists, who were often sole practitioners, had to find ways to
support each other. One major problem faced by community pharmacists trying
to make use of audit was the lack of funding and local expertise. Also, clinical
activity was often not recorded when interventions had been made. Such information
would be useful to both general practitioners and pharmacists to enable them
to review clinical activity.
Some hospital pharmacy departments were not as involved in clinical governance
as they should be and a lack of common data meant that comparisons between hospitals
could not be made. There was also the problem of inconsistent nomenclature across
the NHS.
The Society was working closely with the National Institute for Clinical Excellence
(NICE) to produce clinical guidelines and audit for the NICE. Pharmacists were
involved at all stages and had been welcomed equally with other clinical professionals
into the process.
The Commission for Health Improvement (CHI), was involved in producing clinical
governance reviews and was recruiting pharmacists for this purpose. The CHI
was a modern agency that the Society would be working with as it developed.
In terms of audit support, the Society had developed many audit tools for use
by its members. These included model standards and detailed audit templates
and the services of an audit support fellow (Mr Pruce himself). Audits had been
funded by primary care groups across the United Kingdom and templates had been
produced on reducing dispensing errors, smoking cessation (to help measure the
quality of advise given) and drug wastage.
The future
Clinical governance was already mandatory for all general medical practitioners.
The Department of Health had recently issued a press release instructing GPs
to improve their practice of clinical governance by doing 30 hours of continuing
professional education and three clinical audits per year. In the future, all
health care professionals would have contracts which included provision for
clinical governance, Mr Pruce suspected.
Concluding, Mr Pruce said that the Society would continue to support members
in attaining improvements in quality but that clinical governance really had
to be done at a local level.
Pharmacists and the NICE
Underachievement, variations in practice, conflicting budgetary pressures and
demands for improved quality of care were some of the reasons that clinical
governance was needed, Ms Anne-Toni Rodgers (director of public relations, NICE)
said in her address to Conference participants. There was also now a duty to
whistle-blow on colleagues, not to just stand back and allow poor performance.
Pharmacists were leading the way in assessment of evidence-based practice and
were key to the dissemination of this information, she said.
Pharmacists were key stakeholders in the NICE process of developing and producing
clinical guidelines. In terms of evaluation of the clinical guidelines that
the NICE produced, more feedback had been received from pharmacists than any
other clinical profession. However, clinical governance was a local responsibility
as the NICE would only be producing a certain number of guidelines each year.
Learning from each other
Responding to a question from the audience on how to encourage community pharmacists
to participate in clinical governance, Mr Pruce said that the most important
thing was to bring pharmacists together. Pharmacists wanted to talk about their
practice and to learn from each other. The Society was looking at the possibility
of mandatory continuing professional development but the greatest improvements
would be achieved through encouragement rather than threats.
In terms of empowering pharmacists to actually perform clinical governance rather
than produce lots of reports, Mr Pruce said that it was important to keep things
simple. People only remembered three things from a report or paper so the major
messages had to be kept clear and simple. Access to expertise was also needed.
Sole practitioners should not all be designing their own audits. This could
be done at the health authority level.
Asked if the change from a culture of blame to one of learning would be setting
up pharmacists who admitted their mistakes to litigations, Ms RODGERS said that
clinical governance allowed a team to work to help individuals improve their
practice. In court, the sin would be if a pharmacist had made a mistake and
not reviewed his or her practice in order to improve.