DEPARTMENT OF PHARM
ACY
UNIVERSI
TY OF MA
LTA
Evaluation of the Clinical Pharmacy Services at a
Rehabilitation Hospital
Jonathan Agius, Anthony Serracino Inglott, Lilian M. Azzopardi
Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
email: jagi0010@um.edu.mt
University of Malta
Department of Pharmacy
INTRODUCTION
AIMS
Auditing of professional services provided in the
healthcare sector is a process that is gaining importance
1
and in some instances is a requirement . Standard
Operating Procedures (SOPs) that were developed by
2
Wirth were audited as recommended in a study entitled
3
Validation of Clinical Pharmacy Service . The setting of
this project was the Rehabilitation Hospital Karin Grech
(RHKG) located in Pieta’, Malta.
 To audit the SOPs implemented at RHKG and to use the
audit of the SOPs to:
 assess good practice
 identify if there was room for improvement in
practice
METHOD
 SOPs implemented at RHKG Pharmacy were identified, namely: patient admission, patient profiling, patient discharge,
patient interview and patient medication trolley check.
Audit Process
 Audit tools were developed for each SOP from the flowcharts designated on
Identify procedure to be audited
each procedure and they were used as the accepted standards for best practice
Set standards
against which actual practice had to be measured.
Observe and audit
 Audit techniques used were observation, documentation and questionnaires.
 Data collected was analysed with IBM SPSS Statistics v21.0 using the chi-square
Evaluate data and compare to
standards
test.
Implement changes if necessary
 Convenience sampling was the method of sampling applied.
Re-audit
 The audit results were presented in an audit report for each procedure.
Figure 1: The audit process
RESULTS
 The SOPs Patient Admission and Patient Profiling (both n=42) were audited in the first 3 months, observing 6 pharmacists. The
SOP Patient Discharge (n=30) observing 5 pharmacists and the SOP Patient Medication Trolley Check (n=30) observing 3
pharmacy technicians were audited in the following 3 months.
 The activities for patient admissions, profiling and medication trolley checks were all performed according to the relevant
SOPs.
Procedure: Admission
 Steps were not being followed in the SOP Patient Discharge; ‘Step
6.2.4 PIL for each medication was printed from Medicine’s
Authority website’ was outdated and recommended to be
omitted, ‘Step 6.3.1 Forms and prescriptions for free medications
were filled in’ was carried out by other healthcare professionals
YES NO COMMENTS
Newly admitted patients 1
were identified and patient labels were obtained
WPRS of the new admis- 1
sion was obtained
The full name, grade and 1
initials were written on the
WPRS
due to shortage of pharmacists and ‘Step 6.8 Another pharmacist WPRS,
was asked to double check Discharge Medication Information
Food Supplement 1
sheet + IV Therapy/Fluids
sheet were checked
Sheet and Medications with Discharge Summary’ was not Newly
followed due to time constraints.
 Patient Interviews were not executed by the pharmacists due to
staff shortage and increased workload.
Procedure: Profiling
YES NO COMMENTS
Pharmacy patient profile 1
and IPCD was obtained
Patient name was written 1
on IPCD pg 2
The place from where the 1
patient was admitted and
the carer details were recorded
Reason for referral was 1
recorded
admitted patients 1
were identified from the
admission book
Past medical history was 1
recorded
Medication entries were 1
complete, legible and correct
Drug history was recorded
1
Table 1: Extract from the Patient Admission audit tool Table 2: Extract from the Patient Profiling audit tool
CONCLUSION
Overall, the objectives of the SOPs Patient Admission, Patient Profiling, Patient Discharge and Patient Medication Trolley Check were
achieved ensuring quality and standardisation of professional services. The SOP Patient Interview was affected by staff shortage to the extent
that the objective could not be reached. The auditing exercise highlighted the importance of the pharmacists’ interventions to identify and
correct any discrepancies and missing information related to drug therapy as well as areas for improvement in the procedure.
Reference(s)
1. Boult M, Maddern GJ. Clinical Audits: Why and for Whom. Anz J. Surg. 2007; 77: 572-578
2. Wirth F. Development of a Quality Management System for Clinical Pharmacy Services *dissertation+. Msida (Malta): Department of Pharmacy, University of Malta; 2011
3. Mamo M. Validation of Clinical Pharmacy Services *Bpharm project+. Msida (Malta): Department of Pharmacy, University of Malta; 2011.