Gerald Schwartz School of Business, St. Francis Xavier University, Antigonish, Nova Scotia, Canada B2G 2W5.
Res Social Adm Pharm. 2014 Jan-Feb;10(1):45-57. doi: 10.1016/j.sapharm.2013.01.006. Epub 2013 Mar 23.
Given the significant potential of continuous quality improvement (CQI) programs in enhancing overall levels of patient safety, community pharmacies in North America are under increasing pressure to have a formal and documented CQI program in place. However, while such initiatives may seem great on paper, in practice the outcomes of such programs to community pharmacy practice remain unclear.
To explore the perceived outcomes identified by community pharmacies that adopted and actively used a standardized (i.e., common across pharmacies) CQI program for at least 1 year and to develop a framework for how such outcomes were achieved.
A multi-site study of SafetyNET-Rx, a standardized and technologically sophisticated (e.g., online reporting of medication errors to a national database) CQI program, involving community pharmacies in Nova Scotia, Canada, was performed. During the summer and fall of 2011, 22 interviews were conducted with the CQI facilitators in 12 Nova Scotia community pharmacies; equally split between independent/banners and corporate chains. Of the CQI facilitators, 14 were pharmacists, while the remaining eight were pharmacy technicians. Thematic analysis following the procedures presented by Braun and Clarke was adopted to identify and explore the major outcomes.
Results of the thematic analysis highlighted a number of perceived outcomes from the use of a standardized CQI program in community pharmacies, specifically: (1) perceived reduction in the number of medication errors that were occurring in the pharmacy, (2) increased awareness/confidence of individual actions related to dispensing, (3) increased understanding of the dispensing and related processes/workflow, (4) increased openness to talking about medication errors among pharmacy staff, and (5) quality and safety becoming more entrenched in the workflow (e.g., staff is more aware of their roles and responsibilities in patient safety and confident that the dispensing processes are safe and reliable). In achieving such outcomes, pharmacies had to balance customizing the CQI program to address a number of operational challenges, with ensuring that the core standardized components remained in place.
This research identified the perceived outcomes of CQI program use by CQI facilitators. Additionally, the findings are incorporated into a framework for CQI implementation that can be used by pharmacy managers, corporate head offices, and regulatory authorities to leverage greater CQI adoption and success.
鉴于持续质量改进（CQI）计划在提高整体患者安全水平方面的巨大潜力，北美的社区药房面临着越来越大的压力，需要建立一个正式的、有文件记录的 CQI 计划。然而，尽管这些举措在理论上似乎很好，但实际上，这些计划对社区药房实践的结果尚不清楚。
探索采用并积极使用标准化（即各药房通用）CQI 计划至少 1 年的社区药房所感知到的结果，并制定一个实现这些结果的框架。
对 SafetyNET-Rx 进行了一项多地点研究，这是一个标准化且技术先进的（例如，向国家数据库在线报告药物错误）CQI 计划，涉及加拿大新斯科舍省的社区药房。2011 年夏季和秋季，对 12 家新斯科舍省社区药房的 12 名 CQI 协调员进行了 22 次访谈；独立/连锁药店和连锁药店各占一半。14 名 CQI 协调员是药剂师，其余 8 名是药剂技术员。采用 Braun 和 Clarke 提出的主题分析程序来识别和探索主要结果。
主题分析的结果突出了社区药房使用标准化 CQI 计划的一些感知结果，特别是：（1）药房发生的药物错误数量减少，（2）个人配药相关行动的意识/信心增强，（3）对配药和相关流程/工作流程的理解增加，（4）药房员工更愿意谈论药物错误，（5）质量和安全在工作流程中更加根深蒂固（例如，员工更了解自己在患者安全方面的角色和责任，并相信配药过程是安全可靠的）。为了实现这些结果，药房必须平衡定制 CQI 计划以解决一些运营挑战，同时确保核心标准化组件保持不变。
本研究确定了 CQI 协调员使用 CQI 计划的感知结果。此外，研究结果被纳入一个 CQI 实施框架，该框架可供药房经理、公司总部和监管机构使用，以促进更多的 CQI 采用和成功。
