Since 2016, the Scottish Government has committed to making continuous quality improvement a feature embedded into the community pharmacy contractual arrangements, in line with all other NHS bodies and contractor groups. QI methodology can be applied to any number of areas but is of particular value in addressing patient safety issues.

So far, all community pharmacies in Scotland have undertaken the following exercises, with each activity building on the previous year’s experience to help foster a culture of continuous improvement in the profession:

2016-17

• Completion of 8 NHS Scotland Quality Improvement modules by all employee pharmacists

• Benchmarking the safety culture in each community pharmacy by completing the community pharmacy Safety Climate Survey.

2017-18

• Measuring improvement in safety culture by completing the community pharmacy Safety Climate Survey (SCS)

• Creating an action plan based on the results of the SCS which will be used to make further improvements to safety culture in the pharmacy

• Making available a set of Root Cause Analysis tools with which to address the contributing factors to near miss and patient safety incidents

• The introduction of Non-Steroidal Anti-Inflammatory Drug (NSAID) interventions. Pharmacy teams now put the QI methodology learned in 2016-17 to use in ensuring consistent delivery of patient safety messages related to the use of prescribed and purchased NSAID medicines by the whole team

2018-19

• Implementation of the action plan created following 2017-18’s Safety Climate Survey activities

• Continuation of the NSAID interventions and associated QI activity

• Education and training for every community pharmacist employee on the next stage of NSAID intervention: a clinical bundle which helps to identify those at greater risk of harm in order to target interventions appropriately. This part of the NSAID safer care bundle will be implemented as part of 2019-20’s QI activities

• Participation in a profession-wide workforce survey, led by NES

NSAID Toolkit

All pharmacy teams in Scotland were provided with NSAID toolkits in 2018 to allow the national rollout of targeted interventions. Digital copies of all the materials in the pack can be accessed at Healthcare Improvement Scotland’s iHub.

RCA Toolkit

Following on from 2016/17’s Quality Improvement work across the whole community pharmacy network, teams were asked what they felt they needed more support with in order to direct 2017/18’s activities. A few common themes were identified, the strongest of which was that staff felt that they would appreciate a focus on really getting to the bottom of near misses and dispensing errors to learn as a team and prevent them from happening again.

When something doesn’t go to plan, investigating why this might have happened takes a bit of problem-solving, and is also known as Root Cause Analysis (RCA). We have developed this pack which includes several simple RCA tools and explanations of how to use them so that you and your teams can try them out and find one (or more!) that you feel comfortable using. Mistakes can be upsetting for some people, but they can also be seen as a great learning opportunity for everyone, as long as the right tools and attitude are applied.