Getting the most out of your scpp practice review l. postnikoff
- 1. Getting the most out of your SCPP Practice Review Lori Postnikoff, BSP Complaints Director / Field Officer Saskatchewan College of Pharmacy Professionals www.saskpharm.ca
- 2. Practice Review goals • Assess compliance of pharmacists with NAPRA Model of Standards of Practice for Canadian Pharmacists; • Provide information regarding Safe Medication Practices; • Communicate with members the SCPP priorities and policies;
- 3. Practice Review goals • Provide support and help pharmacists solve practice related challenges; and • Assess pharmacy compliance with The Pharmacy and Pharmacy Disciplines Act, Bylaws, Standards, and Guidelines of SCPP.
- 4. Self Assessment • Review in preparation for the visit • Now online • Reviews SCPP Bylaws and guideline: – All patients are provided the opportunity to speak to the pharmacist – A pharmacist is on duty when the pharmacy is open to the public
- 5. Self Assessment – The dispensary is well lit, clean and neat – Refrigerator requirements – Professional services area (appropriate signage, products) – Narcotic/controlled drug reconciliation – Pharmacy Reference Manual (SHIRP)
- 6. Ratings for indicator stmts (1) Indicator has no activity/compliance – improvement required (WRITTEN ACTION PLAN within 60 days) (2) Indicator has some activity/compliance – improvement required (WRITTEN ACTION PLAN within 120 days)
- 7. Ratings for indicator stmts (3) Indicator has most/complete activity/compliance (4) Indicator was not observed/discussed •(a return visit will be dependent upon observations and recommendations)
- 8. Indicator question ratings • A – no activity/evidence • B – discussed for possible implementation • C – partial implementation or activity • D – implemented for some patients • E – implemented for all patients • (based upon COMPASS*)
- 9. Tips for surviving the Visit • Breathe • Be available and able to answer questions regarding your pharmacy practice • Read the NAPRA Model Standards of Practice at http://scp.in1touch.org/uploaded/web/refmanu
- 10. Indicator Statement #1 • Pharmacists are obtaining and documenting all relevant patient information in order to be able to provide the most appropriate and best possible medication therapy for the patient.
- 11. Indicator questions Questions: A B C D E 1. Patient’s demographic information (name, address, date of birth, home telephone number). 2. Patient’s current/relevant medical conditions. 3. Patient’s relevant social and lifestyle factors (e.g. smoker, social drinker, exercise, etc.). 4. Current medication therapy including prescription drugs, vitamins, herbal/homeopathic and other non-prescription drugs/therapies. 5. Drug allergies and intolerances. 6. Information obtained is periodically (yearly) reviewed and updated with the patient.
- 12. Stats • Documentation (indicator - 3) • 2015 2014 2013 2012 22% 35% 20% 28%
- 13. Indicator Statement #2 • Based on gathered and documented patient information, the pharmacists are assessing the medication therapy, identifying and resolving drug related problems, documenting care provided and providing the best possible medication therapy for the patient.
- 14. Indicator questions Questions: A B C D E 7. The pharmacist determines the indication for use for all patients’ medications. 8. The pharmacist assesses the appropriateness of all new therapy through discussions with the patient and review of patient profile. 9. Patient factors/expectations are considered when assessing appropriateness of therapy (e.g. cost of drug, frequency of administration, swallowing issues, other conditions).
- 15. Indicator Questions 10. When the pharmacist identifies any problems regarding incorrect dosage, possible allergies, drug interactions, drug duplications, inappropriate frequency and drug contraindications, the pharmacist documents who was consulted, any recommendations that were made and if they were accepted, any monitoring required, etc. and how the issue was resolved. 11. Upon identifying concerns regarding inappropriate drug use (over/under-use) the pharmacist documents all discussions and/or consultation with the patient or patient’s practitioner(s).
- 16. Indicator Questions Indicator #2 Questions continued: A B C D E 12. The pharmacist accesses the patient's profile and PIP/e-Health viewer prior to filling of prescriptions to ensure appropriateness of therapy and to determine any other drug related problems. 13. The pharmacist monitors the patient’s progress towards desired therapeutic outcomes and discussing those outcomes with the patient, including reviewing any relevant lab values (e.g. asks about BP, BS, pain). 14. Medication adherence reviewed at each refill. 15. Reviews and discusses issues of adherence with the patient and find mutually agreeable solutions. The reasons for proper adherence are clearly explained to the patient.
- 17. Indicator Questions 16. The pharmacist has access to and refers to best practice guidelines and other clinical practice resources when required. 17. The pharmacist, pharmacy technician(s) and assistant(s) work collaboratively to ensure any computer generated warnings including drug allergy warning, drug duplication warning, drug interaction warning, and drug contraindication warning are resolved. 18. The pharmacist documents all relevant patient care information needed for continuity of care (e.g. monitoring results, patient's progress towards therapeutic goals, follow-up required).
- 18. Indicator Question #3 • The pharmacists are providing best possible medication therapy for the patient by providing appropriate patient education.
- 19. Indicator Questions Questions: A B C D E 19. Discusses medication therapy to ensure patient understands the clinical purpose and goals of therapy. 20. Ensures adequate time is given to provide patient education, including an opportunity for patients to ask questions. 21. Provides sufficient medication information to the patient including drug name, drug strength, indication, directions for use, common side effects, drug-drug and drug-food interactions, how to know if therapeutic response is not occurring and what to do.
- 20. Indicator Questions 22. Provides all patient medication and medical condition information in a manner that is appropriate to the patient. Computer-generated drug information is understandable to the patient and provided with each new prescription. 23. Goals of medication therapy (monitoring, follow-up, etc.) are reviewed when medication is refilled. 24. Provides all patient education in an area that allows for confidentiality and minimizes distractions.
- 21. Indicator Question #4 • Pharmacists are prescribing when in the best interest of the patient to do so.
- 22. Indicator Questions 25. Patient profile and PIP are accessed prior to prescribing. 26. Patient medication history is assessed prior to prescribing to ensure appropriateness of therapy. 27. Pharmacist Assessment Record contains all required information. 28. When prescribing for a minor ailment the pharmacist ensures that the drug therapy is appropriate for the treatment of the patient's self-assessed condition. 29. Pharmacist's minor ailment prescribing decisions based on treatment algorithms. 30. All prescribing decisions, the rationale for prescribing, and any follow-up required is documented on Pharmacist Assessment
- 23. Indicator Question #5 • Pharmacists, when utilizing an advanced scope of practice (injection/lab value interpretation), apply medication use, expertise and knowledge.
- 24. Indicator Questions Questions: A B C D E 31. When administering injections, ensure patient safety is maintained (suitable/safe environment). 32. When administering injections, ensure appropriate procedures are in place to ensure maintenance of the cold chain for medications (vaccines and others as required). 33. When administering injections, ensure there are policies and procedures for handling emergencies and adverse events which are accessible to all appropriate staff. 34. Ensure patient privacy and confidentiality is maintained during the injection process.
- 25. Indicator Questions 34. Ensure patient privacy and confidentiality is maintained during the injection process. 35. Ensure pharmacists have and maintain adequate education, knowledge, training and certification for injections. 36. Ensure pharmacists maintain and provide to applicable sources, all adequate documentation for injections. 37. Pharmacists appropriately inject all medications (follow product monograph, etc.).
- 26. Indicator Questions 38. Refrigerator temperatures are checked twice daily when storing vaccines and adequately monitored to identify a cold chain break. 39. Pharmacists access lab tests only under applicable laws/regs/policies/guidelines. 40. Pharmacists interpret lab results to identify required changes to patients’ medication therapy and manage any required changes (with appropriate documentation). 41. Pharmacists are aware of, and are in compliance with, all applicable legislative requirements, documentation and standards regarding advanced scope of practice.
- 27. Indicator Question #6 • Pharmacy personnel are being employed effectively by the pharmacy manager and support safe medication practices within the optimal workflow.
- 28. Indicator questions Questions: A B C D E 42. The pharmacy manager has ensured that staffing allows pharmacists on duty for all shifts to be able to perform all required tasks, including medication management, prescribing, and additional services such as providing injections , reviewing and interpreting lab tests as well as compliance packaging, long term care services, etc. 43. Pharmacists interact with each patient at prescription drop-off or pick-up or via phone to provide medication management and optimize patient care.
- 29. Indicator questions 44. Workflow provides the pharmacist with opportunities to engage in patient medication management and interaction with each patient. 45. Pharmacy is neat, orderly and free from clutter to allow for safe dispensing practices. 46. Activities which require concentration are segregated to areas which minimize distractions within the physical layout (e.g. patient assessment, compliance packaging).
- 30. Indicator Question #7 • There is a formal system in place in the pharmacy that identifies and resolves all issues involving medication errors, near misses and unsafe practices. All pharmacy staff are aware of the applicable policies and procedures. Quality improvement processes are in place.
- 31. Indicator questions • Key Element #1 – Managing Medication Errors: Manages known, alleged and suspected medication errors that reach the patient consistent with the best practices. Review pharmacy policy and procedure manual to ensure procedure for dealing with medication errors is outlined.
- 32. Indicator questions Questions: A B C D E 47. All medication errors are promptly disclosed to the patient and/or the patient’s agent. 48. An apology and explanation is provided to the patient or patient's agent. 49. Patients are provided with adequate information to manage any medical effects of the medication errors and any follow up required.
- 33. Indicator questions 50. Practitioners are notified of any adverse events/effects of medication errors. 51. All medication errors and near misses are discussed and all pharmacy staff are consulted to determine the contributing factors (causal factors). 52. Potential causal factors are determined and communicated to the patient or patient's agent. 53. Actions are taken to reduce the likelihood of the error occurring again.
- 34. stats Medication error reporting 2015 2014 2013 2012 75% 80% 62% 96%
- 35. Indicator Question #8 • Pharmacists, when providing patient care as part of medication therapy management, obtain the necessary patient consent, document their concerns adequately and perform the necessary follow up to ensure optimal patient care.
- 36. Indicator questions Questions: A B C D E 67. Perform medication reviews with patients who are at risk of experiencing problems with their medication to identify drug-related problems (interactions, contra-indications, adverse events). 68. Educate the patient as to appropriate medication management during the review. 69. Prepare and provide the best medication history as well as recommendations to improve medication management to the patient’s health care providers.
- 37. Indicator questions 70. Determine and discuss with the patient and appropriate care givers and practitioners any medications which are no longer required/appropriate therapy. 71. Perform necessary follow up with the patient and their health care providers to ensure optimal medication management.
- 38. Indicator Question #9 • Failed Transactions: Ensures all information provided to electronic databases (e.g. PIP viewer) is accurate and complete.
- 39. Indicator questions Questions: A B C D E 72. Pharmacists ensure all prescriptions are captured for viewing on PIP (other than non-SK residents). 73. Failed Transactions are being reviewed and resolved daily. 74. Prescriptions transfers into or out of the pharmacy are documented as such in PIP.
- 40. Indicator Question #10 • Drug distribution processes ensure the safe dispensing of medications.
- 41. Indicator questions 75. All drugs are stored appropriately both for temperature and location to maintain stability and integrity (including compounded products). 76. Expiry dates are checked regularly on all inventory including prescription, and non- prescription drugs and where applicable devices. Outdated inventory is removed and stored in a segregated area so as not to be re- entered into active inventory. 77. Ensure the final check of prescription products prepared for dispensing (distribution) has been completed by the appropriate pharmacy professional and adequate documentation will verify the final check.
- 42. Indicator questions 78. There are regular inventory counts of narcotic and controlled drugs and reconciliation of any identified shortages and review of computer adjustments. 79. Prescriptions for Schedule I, II and III medications reviewed are complete and contain all required information. 80. All prescriptions reviewed contain necessary information regarding which pharmacists and support personnel were involved in filling the prescription. 81. All sales/purchases reports for narcotic/controlled drugs are up to date and filed in a manner that allows for audits.
- 43. Special services/considerations • Privacy • Compliance packaging (NOSHI) • Provision of Methadone • Compounding • Depot Services (‘telepharmacy’) • Central Fill
- 44. New developments • Administration of drugs by injection and other routes • Ordering and interpreting lab values • Regulating Pharmacy Technicians • 3rd phase of the COMPASS project • Sinks in the consultation room • Refrigerator requirements • New Compounding Standards – NAPRA
- 45. • Questions? • lori.postnikoff@saskpharm.ca • (306)-584-2292