Evaluation of a guided continuous quality improvement program in community pharmacies

Chanadda Chinthammit,Michael T Rupp,Terri L Warholak,Edward P Armstrong,Tara Modisett,Rebecca P Snead

doi:10.1186/s40545-017-0114-x

Abstract

BackgroundThe 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.).MethodsTwenty-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.ResultsSixty-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).ConclusionGuided CQI program implementation increased the self-reported patient safety culture attitudes among staff.

Highlights

The importance of creating and sustaining a strong culture of patient safety has been recognized as a critical component of safe medication use
The continuous quality improvement (CQI) philosophy must be embraced throughout the organization and a systematic CQI program must be implemented to analyze the causes of medication errors and to create strategies to prevent future errors [13]
Attitude toward patient safety culture Out of 157 staff working in the pharmacies, 112 (71.3%) responded to the retrospective pre-post Patient Safety Culture questionnaire

Summary

Introduction

The importance of creating and sustaining a strong culture of patient safety has been recognized as a critical component of safe medication use. A study conducted in Canadian community pharmacies found that implementation of continuous quality improvement (CQI) resulted in improvements in 7 key areas that are known to be systems-based sources of medication errors including: patient information; drug information; communication of drug orders; drug labeling and packaging; and drug standardization and distribution [7]. Beyond such targeted strategies, the importance of creating and sustaining a strong culture of patient safety has been recognized as a critical component of safe medication use [8, 9]. This cannot happen unless the organization has a successful, sustainable safety culture

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