Quality pharmacy services and key performance indicators in Polish NICUs: a Delphi approach

  • Natalia Krzyżaniak
  • Iga Pawłowska
  • Beata Bajorek
Research Article
  • 32 Downloads

Abstract

Background Currently, there is no literature describing what a quality level of practice entails in Polish neonatal intensive care units (NICUs), nor are there any means of currently measuring the quality of pharmaceutical care provided to NICU patients. Objective To identify a set of essential pharmacist roles and pharmacy-relevant key performance indicators (KPI’s) suitable for Polish neonatal intensive units (NICUs). Setting Polish hospital pharmacies and NICUs. Method Using a modified Delphi technique, potential KPI’s structured along Donabedian’s domains as well as pharmacy services were presented to an expert panel of stakeholders. Two online, consecutive Delphi rounds, were completed by panellists between August and September 2017. Main outcome measure To identify the minimum level of pharmacy services that should be consistently provided to NICU patients. Results A total of 16 panellists contributed to the expert panel. Overall, consensus of 75% was reached for 23 indicators and for 28 roles. When considering pharmacy services for the NICU, the experts were found to highly value traditional pharmacy roles, such as dispensing and extemporaneous compounding, however, they were still eager for roles in the other domains, such as educational and clinical services, to be listed as essential for NICU practice. Panellists were found to positively value the list of indicators presented, and excluded only 9 out of the total list. Conclusion There is a need for future research to establish a minimum standard of practice for Polish pharmacists to encourage the progression and standardisation of hospital pharmacy services to meet the level of practice seen in NICUs worldwide.

Keywords

Delphi technique Key performance indicators Neonatal Intensive Care Unit Pharmaceutical care Poland Quality measurement 

Notes

Acknowledgements

The authors would like to express their sincere gratitude to all of the experts in Poland who participated in this research.

Funding

None

Conflicts of interest

The authors declare no conflicts of interest.

References

  1. 1.
    Dooley MJ, Allen KM, Doecke CJ, Galbraith KJ, Taylor GR, Bright J, et al. A prospective multicentre study of pharmacist initiated changes to drug therapy and patient management in acute care government funded hospitals. Br J Clin Pharmacol. 2004;57(4):513–21.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Gilbar P, Stefaniuk K. The role of the pharmacist in palliative care: results of a survey conducted in Australia and Canada. J Palliat Care. 2002;18(4):287–92.PubMedGoogle Scholar
  3. 3.
    Bond CA, Raehl CL. Clinical pharmacy services, pharmacy staffing, and hospital mortality rates. Pharmacother J Hum Pharmacol Drug Therapy. 2007;27(4):481–93.CrossRefGoogle Scholar
  4. 4.
    Cotter S, Barber N, McKee M. Survey of clinical pharmacy services in United Kingdom National Health Service hospitals. Am J Health Syst Pharm. 1994;51(21):2676–84.Google Scholar
  5. 5.
    Fertleman M, Barnett N, Patel T. Improving medication management for patients: the effect of a pharmacist on post-admission ward rounds. Qual Saf Health Care. 2005;14(3):207–11.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Łasocha P, Merks P, Olszewska A. Farmacja szpitalna i kliniczna w Wielkiej Brytanii (Hospital and Clinical Pharmacy in the United Kingdom). Farmacja Polska. 2013;69(9):527–30.Google Scholar
  7. 7.
    Pawłowska I, Pawłowski L, Kocić I, Krzyżaniak N. Clinical and conventional pharmacy services in Polish hospitals: a national survey. Int J Clin Pharm. 2016;38(2):271–9.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Piecuch A, Kozłowska-Wojciechowska M, Jaszewska E, Makarewicz-Wujec M. Farmaceuta kliniczny—odpowiedź na zmieniające się potrzeby społeczne (The Clinical Pharmacist—response to societal needs). Farm Pol. 2014;70(7):395–9.Google Scholar
  9. 9.
    Urbańczyk K. Czym właściwie jest Farmacja kliniczna? [What is clinical pharmacy?] Opieka Farmaceutyczna. 2017. http://opieka.farm/doniesienia/czym-wlasciwie-jest-farmacja-kliniczna/. Accessed 28 Oct 2017.
  10. 10.
    da Silva NMM. The impact of pharmacist participation in a multidisciplinary team on an oncology ward compared with a ward clinical pharmacy service. Eur J Hosp Pharm Sci Pract. 2012;19(2):259–60.Google Scholar
  11. 11.
    Koshman SL, Charrois TL, Simpson SH, McAlister FA, Tsuyuki RT. Pharmacist care of patients with heart failure: a systematic review of randomized trials. Arch Intern Med. 2008;168(7):687–94.CrossRefPubMedGoogle Scholar
  12. 12.
    Viktil KK, Blix HS. The impact of clinical pharmacists on drug-related problems and clinical outcomes. Basic Clin Pharmacol Toxicol. 2008;102(3):275–80.CrossRefPubMedGoogle Scholar
  13. 13.
    Krzyzaniak N, Bajorek B. Medication safety in neonatal care: a review of medication errors among neonates. Ther Adv Drug Saf. 2016;7(3):102–19.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Dice J, Burckart G, Woo J, Helms R. Standardized versus pharmacist-monitored individualized parenteral nutrition in low-birth-weight infants. Am J Health Syst Pharm. 1981;38(10):1487–9.Google Scholar
  15. 15.
    Dunkley M. Neonatal intensive care–an Australian survey of the pharmacist’s role. Aust J Hosp Pharm. 1991;21:104–8.Google Scholar
  16. 16.
    Gray JE, Goldmann DA. Medication errors in the neonatal intensive care unit: special patients, unique issues. Arch Dis Child Fetal Neonatal Ed. 2004;89(6):F472–3.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Simpson J, Lynch R, Grant J, Alroomi L. Reducing medication errors in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed. 2004;89(6):F480–2.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Stavroudis TA, Miller MR, Lehmann CU. Medication errors in neonates. Clin Perinatol. 2008;35(1):141–61.CrossRefPubMedGoogle Scholar
  19. 19.
    Kruk ME, Kelley E, Syed SB, Tarp F, Addison T, Akachi Y. Measuring quality of health-care services: what is known and where are the gaps? WHO: Bull World Health Organ. 2017;95:389–389A.  https://doi.org/10.2471/BLT.17.195099.CrossRefGoogle Scholar
  20. 20.
    Banks M, Board N, Curtis I, Davis E, Dunbar N, Jorm C. Developing a safety and quality framework for Australia. Darlinghurst: Australian Commission on Safety and Quality in Health Care; 2017.Google Scholar
  21. 21.
    European Directorate for the Quality of Medicines and HealthCare (EDQM). Pharmaceutical Care—policies and practices for a safer, more responsible and cost-effective health system. Strasbourg: Directorate for the Quality of Medicines and HealthCare of the Council of Europe, 2012.Google Scholar
  22. 22.
    Scobie S, Thomson R, McNeil JJ, Phillips PA. Measurement of the safety and quality of health care. Med J Aust. 2006;184(10):S51.PubMedGoogle Scholar
  23. 23.
    Wilson S, Hauck Y, Bremner A, Finn J. Quality nursing care in Australian paediatric hospitals: a Delphi approach to identifying indicators. J Clin Nurs. 2012;21(11–12):1594–605.  https://doi.org/10.1111/j.1365-2702.2011.04004.x.CrossRefPubMedGoogle Scholar
  24. 24.
    Krzyzaniak N, Bajorek B. Quality use of medicines in neonatal care: a review of measures of quality used to evaluate the appropriateness and rational use of medication within the NICU. Drugs Therapy Perspect. 2016;32(9):392–402.CrossRefGoogle Scholar
  25. 25.
    Krzyżaniak N, Pawłowska I, Bajorek B. The role of the clinical pharmacist in the NICU: a cross-sectional survey of Australian and Polish pharmacy practice. Eur J Hosp Pharm. 2018:ejhpharm-2017-001432.Google Scholar
  26. 26.
    Fernandes O, Gorman SK, Slavik RS, Semchuk WM, Shalansky S, Bussieres JF, et al. Development of clinical pharmacy key performance indicators for hospital pharmacists using a modified Delphi approach. Ann Pharmacother. 2015;49(6):656–69.  https://doi.org/10.1177/1060028015577445.CrossRefPubMedGoogle Scholar
  27. 27.
    Mullen PM. Delphi: myths and reality. J Health Organ Manag. 2003;17(1):37–52.CrossRefPubMedGoogle Scholar
  28. 28.
    Christie CA, Barela E. The Delphi technique as a method for increasing inclusion in the evaluation process. Can J Program Eval. 2005;20(1):105–22.Google Scholar
  29. 29.
    Giannarou L, Zervas E. Using Delphi technique to build consensus in practice. Int J Bus Sci Appl Manag. 2014;9(2):66–82.Google Scholar
  30. 30.
    Keeney S, Hasson F, McKenna H. Consulting the oracle: ten lessons from using the Delphi technique in nursing research. J Adv Nurs. 2006;53(1):205–12.CrossRefPubMedGoogle Scholar
  31. 31.
    Krzyzaniak N, Bajorek B. A global perspective of the roles of the pharmacist in the NICU. Int J Pharm Pract. 2017;25(2):107–20.CrossRefPubMedGoogle Scholar
  32. 32.
    World Health Organization. Health Systems—Equity. 2017. http://www.who.int/healthsystems/topics/equity/en/. Accessed 02 Oct 2017.
  33. 33.
    Smoliński D. Farmacja szpitalna wychodzi z jaskini. RynekAptek. 2016. http://www.rynekaptek.pl/wywiad/farmacja-szpitalna-wychodzi-z-jaskini,16169_2.html. Accessed 02 Oct 2017.
  34. 34.
    Folli HL, Poole RL, Benitz WE, Russo JC. Medication error prevention by clinical pharmacists in two children’s hospitals. Pediatrics. 1987;79(5):718–22.PubMedGoogle Scholar
  35. 35.
    Joint FIP/WHO guidelines on good pharmacy practice: standards for quality of pharmacy service. Geneva: World Health Organization, 2011 Contract No.: 961.Google Scholar
  36. 36.
    Engels Y, Campbell S, Dautzenberg M, van den Hombergh P, Brinkmann H, Szécsényi J, et al. Developing a framework of, and quality indicators for, general practice management in Europe. Fam Pract. 2005;22(2):215–22.CrossRefPubMedGoogle Scholar
  37. 37.
    Department of Health and Human Services, Defining Levels of Care for Victorian Newborn Services, Melbourne; Victorian Government; 2015. Available from: www.health.vic.gov.au/maternitycare. Accessed 20 Nov 2017.
  38. 38.
    NICE. Specialist neonatal care quality standard. skilled and multidisciplinary staff. Manchester: NICE; 2010.Google Scholar
  39. 39.
    BAPM. Service standards for hospitals providing neonatal care. Pharmacy. London: BAPM; 2010.Google Scholar
  40. 40.
    Roughead L, Semple S, Rosenfeld E. Literature review: medication safety in Australia. Sydney: Australian Commission on Safety and Quality in Health Care 2013.Google Scholar
  41. 41.
    Medication Safety in the Neonatal Intensive Care Unit, Position Statement#3060 National Association of Neonatal Nurses, Chicago. 2014. http://nann.org/uploads/About/PositionPDFS/1.4.7_Medication Safety in the NICU.pdf. Accessed 15 Feb 2016.
  42. 42.
    Mikeal RL, Brown TR, Lazarus HL, Vinson MC. Quality of pharmaceutical care in hospitals. Am J Health Syst Pharm. 1975;32(6):567–74.Google Scholar
  43. 43.
    WHO. Making pregnancy safer; assessment tool for the quality of hospital care for mothers and newborn babies. Advanced newborn care (for intensive care units). Copenhagen: WHO; 2009.Google Scholar
  44. 44.
    Clinical Pharmacist Intensive Care (PCICU, PICU, ED and NICU)—Pharmacy. Sidra Medical and Research Center. 2015. http://www.bayt.com/en/job/clinical-pharmacist-intensive-care-pcicu-picu-ed-and-nicu-pharmacy-in-qatar-50043520/. Accessed 04 Mar 2015.
  45. 45.
    Lucas AJ. Improving medication safety in a neonatal intensive care unit. Am J Health Syst Pharm. 2004;61(1):33–7.PubMedGoogle Scholar
  46. 46.
    Simons SL. Designing medication safety in the NICU. Neonatal Netw. 2007;26(6):407–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Position Description: NICU Clinical Pharmacist Specialist. University of Kentucky Hospital 2009. http://www.hosp.uky.edu/pharmacy/departpolicy/PH14-45.pdf. 04 Mar 2007.
  48. 48.
    Cousins D KN, Walser S,. Pharmaceutical care: policies and practices for a safer, more responsible and cost effective health system. Strasbourg: Directorate for the Quality of Medicines & HealthCare of the Council of Europe, 2012.Google Scholar
  49. 49.
    Kunac DL, Reith DM. Identification of priorities for medication safety in neonatal intensive care. Drug Saf. 2005;28(3):251–61.CrossRefPubMedGoogle Scholar
  50. 50.
    Chedoe I, Molendijk HA, Dittrich ST, Jansman FG, Harting JW, Brouwers JR, et al. Incidence and nature of medication errors in neonatal intensive care with strategies to improve safety. Drug Saf. 2007;30(6):503–13.CrossRefPubMedGoogle Scholar
  51. 51.
    Ng J, Harrison J. Key performance indicators for clinical pharmacy services in New Zealand public hospitals: stakeholder perspectives. J Pharm Health Serv Res. 2010;1(2):75–84.CrossRefGoogle Scholar
  52. 52.
    Patel SJ, Saiman L. Principles and strategies of antimicrobial stewardship in the neonatal intensive care unit. Sem Perinatol. 2012;36(6):431–6.CrossRefGoogle Scholar
  53. 53.
    Sharek PJ, Powers R, Koehn A, Anand KJ. Evaluation and development of potentially better practices to improve pain management of neonates. Pediatrics. 2006;118(Supplement 2):S78–86.CrossRefPubMedGoogle Scholar
  54. 54.
    Chawla D, Suresh GK. Quality improvement in neonatal care—a new paradigm for developing countries. Indian J Pediatr. 2014;81(12):1367–72.CrossRefPubMedGoogle Scholar
  55. 55.
    Elverson CA, Samra HA. Overview of structure, process, and outcome indicators of quality in neonatal care. Newborn Infant Nurs Rev. 2012;12(3):154–61.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Graduate School of Health (Pharmacy)University of Technology SydneyUltimoAustralia
  2. 2.Department of PharmacologyMedical University of GdanskGdańskPoland

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