We know that pharmacies across Ireland offer a quality service, but few have a formalised quality management system in place. Quality is not exactly sexy! It does conjure up an image of an auditor in a white coat with clipboard and checklist. However, quality is part and parcel of every task and activity that you undertake on a daily basis in your pharmacy.

Establishing a strong quality management can help;

1. Reduce work inefficiencies
2. Enhance quality standards
3. Deliver excellent customer and patient service
4. Minimise risk and liability
5. Satisfy legislative demands on the practice
6. Involve employees in continually improving the pharmacy.
7. Enhance internal communications
8. Reduce costs

Simply, a pharmacy quality management system is common sense. The Pharmacy Excellence and Quality model can help pharmacists develop and implement a quality self-audit system. Self-audit is basically a method of checking if your practice satisfies the standards, identifies and plugs the gaps, implements procedures, monitors and improves the practice. Whilst quality is common sense, it can be difficult to know where to start. The Pharmacy Excellence and Quality (PEQ) model is a simple step-by-step method to establishing a self-audit system.

Step 1-Identify the functional areas

A function is a major area of work in the pharmacy. Examples include dispensing, providing advice to patients, managing stock and employees. Of course, depending on the pharmacy and services offered, functions can range from 6 to 15 areas.

Step 2- Identify the processes

Within each functional area, you can identify relevant procedures. For example

Function- Dispensing

Procedure 1- Accepting a Prescription from a patient

To

Procedure 12- returning a Dispensed Prescription to the Patient

Step 3. Create the Current State

Before deciding how to improve your practice, it is essential to outline how things are currently done. This can really open your eyes to what really takes place within your pharmacy. You may think certain things happen in a particular way, only to find out that your employees have a different or better approach. In the worst-case scenario, you may discover that certain areas of work are not carried out as you had initially assumed. Of course some procedures may be absent from the pharmacy and you will have to create the new procedure.

At this stage it is prudent to identify any documents associated with a procedure. For example

Procedure: Managing a delivery discrepancy

Documents:  Claim Form
                  Returns Label

Step 4. Present the Procedure

A procedure can be presented in various ways. Written standard operating procedures are popular but their main drawback is that they can be cumbersome. Because of this, the quality system often ends up as a folder of lengthy SOPs gathering dust on the shelf. 

Flow maps are an excellent way to present a procedure quickly and easily. They are good training tools and are less cumbersome. Flow maps take a little longer to prepare but employees tend to prefer these to long written SOPs.

Involve staff in creating procedures. You will be amazed by the quality of employee's feedback once they are involved in the development of procedures.

Step 5. CIA

We call this step- CIA- Challenge, Improve and Amend. This is the point where you take a long look at your procedures. Involving staff at this point is critical.

Challenge your procedure

-Is this really how we do things?
-Is this the right method?
-How can we do things differently?

At this stage it is common to pick up variances between the procedure on paper and the procedure in practice.

Improve the procedure

-How do we improve this procedure?
-How do we make this better for the customer or patient?
-Are we duplicating work?

Amend the procedure

At this stage, amend your procedure in light of the challenges and improvements identified. Once the procedure is agreed, then you should allocate

1. Date procedure is created
2. Reference number. For example Dispensing1, Dispensing2
3. Version number. The first time you create a procedure or associated document, the version number is 1. When a change occurs, the version will now change from 1 to 2..
4. People responsible for the procedure.

Step 6. Release the System

Before releasing your quality system, you should decide on;

a. Storage of procedures: An electronic version makes it easier to control. If you do decide to keep a paper version, you must maintain the integrity of the information.
b. Training: Employees should know how to access the quality system and be trained in the appropriate procedures.
c. Changes: You should outline clearly how a procedure can be changed.
d. Review Schedule: Identify when you will review the functions and procedures. This can take the format of a simple calendar.

Step 7. Monitor and Review

It is not enough to develop a suite of procedures; you must check and review your work. This can be accomplished through;

a. Individual suggestions
b. Team meetings
c. Internal audits.

Team meetings are a useful way to review procedures and documentation. Employees should feel that they are able to openly contribute without negative comeback. Internal audits are scheduled and planned reviews of your procedures. It is extremely beneficial for the pharmacist and/or manager to be trained as an internal auditor. This allows them to better manage the quality management system in place.

In summary, quality management systems are an essential component of the pharmacy. Creating procedures is only one part of that system. Encouraging a culture of improvement, performing regular audits and involving employees in decision making will ultimately help you to deliver an effective, safe and efficient service to your customer base.

Jacqui Dougan, Senior Partner, TLC Performance

For further information on Self-Audit and Quality Management Systems in the Pharmacy contact Jacqui at

jacqui@tlcperformance.org or

John Bourke (Senior Partner, TLC Performance) at

John Bourke MPSI, Senior Partner, TLC Performance

john@tlcperformance.org

TLC Performance
Suite 3,
Herbert Hall,
16 Herbert Street,
Dublin 2

T: + 353 01 6190247

F: + 353 01 6190298