Performance indicators can help assess pharmaceutical
care
Delivery of pharmaceutical care can be monitored
using practical, patient-centred performance indicators, say researchers.
Andrew Radley and colleagues from Tayside University
Hospitals NHS Trust, Perth, carried out four audits of clinical pharmacy
practice in an acute hospital setting to establish key elements in the
process of providing pharmaceutical care. Following this, four standard
statements describing the performance of the pharmacy service were developed
and used as indicators to evaluate service performance.
The first audit examined the accuracy of admission
medicine history and involved 90 patients. It identified 179 pharmaceutical
care issues associated with admission drug history, the most frequent
of which was omission of items (98 cases). The second audit examined continuity
of medicine supply. Of 259 patients, 32 per cent missed one or more doses
of a prescribed medicine and a total of 215 doses were missed. The most
common reason for a missed dose was that the medicine was not stocked
on the ward (44 per cent of cases). Identification of medicine-related
care issues was investigated in the third audit and the fourth audit examined
discharge planning. Use of a patients’ own drugs system appeared
to decrease delays at discharge caused by medicines not being ready to
take home.
The four standards statements that were agreed through
peer discussion and use of Scottish Clinical Resource and Audit Group
(CRAG) guidelines were:
- each patient will have an accurate admission
medicine history
- there is seamless continuation of prescribed
therapy to achieve the desired patient outcome
- prescribed therapy for each patient is assessed
and the medicine-related care issues addressed
- timely and effective discharge planning for each
patient is enabled
Follow-up audits based on each of these statements
were then carried out. The first, examining admission drug histories,
found that the drug histories of each of 65 patients admitted on one week
were agreed to be accurate and complete. Seamless continuation of prescribed
therapy was investigated by the second audit. Of 42 patients followed
for seven days, 17 missed doses were identified. Eleven of these were
caused by patients not bringing to hospital medicines from home that were
not ward stock.
The third audit addressed medicine-related care
issues. Care plans were formulated for 52 of 54 new patients admitted
to a ward. Two were not seen by the pharmacist. No additional care issues
were identified that were thought to be of clinical significance, although
33 minor points were raised for discussion. Not all issues were addressed
during the first 24 hours after admission. The fourth audit examined discharge
planning. During a seven-day period, 42 discharges were recorded and data
was collected from 29 of these patients. Prescriptions were not ready
for collection at the desired time of discharge for 7 per cent of patients.
The researchers say that the use of performance
indicators in the study enabled clinical pharmacists readily to examine
their practice against standards. It also resulted in changes to service
delivery and provided a forum that allowed problems with practice to be
discussed and resolved (Pharmacy World and Science 2001;23:111).
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