Pharmaceutical Care Network Europe definition of quality indicators for pharmaceutical care: a systematic literature review and international consensus development

Background Over the past 40 years, the tasks of pharmacists have shifted from logistic services to pharmaceutical care (PhC). Despite the increasing importance of measuring quality of care, there is no general defnition of Quality Indicators (QIs) to measure PhC. Recognising this, a working group in a European association of PhC researchers, the Pharmaceutical Care Network Europe (PCNE), was established in 2020. Aim This research aimed to review existing definitions of QIs and develop a definition of QIs for PhC. Method A two-step procedure was applied. Firstly, a systematic literature review was conducted to identify existing QI definitions that were summarised. Secondly, an expert panel, comprised of 17 international experts from 14 countries, participated in two surveys and a discussion using a modifed Delphi technique to develop the definition of QIs for PhC. Results A total of 182 QI definitions were identifed from 174 articles. Of these, 63 QI definitions (35%) cited one of fve references as the source. Sixteen aspects that construct QI definitions were derived from the identifed definitions. As a result of the Delphi study, the panel reached an agreement on a one-sentence defnition of QIs for PhC: “quality indicators for pharmaceutical care are validated measurement tools to monitor structures, processes or outcomes in the context of care provided by pharmacists”. Conclusion Building upon existing defnition of QIs, an international expert panel developed the PCNE definition of QIs for PhC. This definition is intended for universal use amongst researchers and healthcare providers in PhC

Store ulikskapar i innhald, utforming og kvalitet på dei generelle skriftelege direktiva

Bakgrunn: Generelle skriftlege direktiv, utarbeida av sjukeheimslegen, har vore retningsgivande for sjukepleiarane når dei skal vurdere om det skal gis behovsmedisin når legen ikkje er til stades. Det er bekymring for om variasjonen mellom og kvaliteten på slike lokale skjema går utover pasienttryggleiken. Formål: Å kartlegge innhaldet på dei generelle skriftlege direktiva ved sjukeheimar i Bergen kommune, samt kvaliteten på desse. Metode: Dei 33 sjukeheimane i Bergen kommune blei bedt om å sende inn kopi av sine generelle skriftlege direktiv. Det blei deretter gjort ei innhaldsanalyse av dei innsamla direktiva ved hjelp av eit kodeskjema i SPSS. Resultat: Til saman på dei 24 innsamla direktiva fanst det 39 ulike indikasjonar, og 51 ulike legemiddelsubstansar. Talet på indikasjonar på det enkelte direktiv låg i median på 11,5 (variasjon 3–17), medan talet på legemiddel hadde ein median på 13 (variasjon 3-21). For tre fjerdedelar av legemidla var både styrke og ei klar normaldosering oppgitt. Maksimaldosering og når ein skal kontakte lege, var oppgitt for høvesvis 61 prosent og 37 prosent av legemidla. Konklusjon: Fleire legemiddelval per indikasjon og uklar informasjon om styrke, dosering og når ein skal kontakte lege kan gjere det vanskeleg for sjukepleiarane å ta ei avgjersle om behovsmedisinering skal gis. Samstundes kan det setje pasienttryggleiken i fare. Ei fornying av retningslinjene, samt ei meir overordna kvalitetsbetring av direktiva anbefalast

General practitioners' role in safeguarding patients with dementia in their use of dietary supplements. A qualitative study

Objective - The use of dietary supplements (DS) may cause harm through direct and indirect effects. Patients with dementia may be particularly vulnerable. This study aims to explore general practitioners’ (GPs’) experiences with DS use by these patients, the GPs perceived responsibilities, obstacles in taking on this responsibility, their attitudes toward DS, and suggestions for improvements to safeguard the use of DS in this patient group. Design - Qualitative individual interview study conducted February - December 2019. Data were analysed using systematic text condensation. Subjects - Fourteen Norwegian GPs. Findings - None of the informants were dismissive of patients using DS. They were aware of the possible direct risks and had observed them in patients. Most GPs showed little awareness of potential indirect risks to patients with dementia who use DS. They acknowledged the need for caretaking of these patients. Although there were differences in practice styles, most of the GPs wished to help their patients safeguarding DS use but found it difficult due to the lack of quality assurance of product information. Furthermore, there were no effective ways for the GPs to document DS use in the patients’ records. Several suggestions for improvement were given by the GPs, such as increased attention from GPs, inclusion of DS in the prescription software, and stricter regulatory systems for DS from the authorities. Conclusion - The GPs had initially little awareness of this safety risk, but there were differences in practice style and attitudes towards DS. The GPs did not perceive themselves as main responsible for safe use of DS in patient with dementia. The most important reason to disclaim responsibility was lack of information about the products. One suggestion for improvement was better integration of DS in patients’ medical record