At NABP, our mission is to assist our member boards of pharmacy protect public health. One way we go about doing this is by offering comprehensive, high-quality accreditations to pharmacies and distributors. Our accreditation programs help ensure quality and safety, while demonstrating our deep understanding of pharmacy and wholesale distributor operations.
In our expert surveyors’ experience conducting on-site visits, we have observed common deficiencies in facilities seeking accreditation. Let’s break down some of the most common deficiencies and how to solve them.
Incomplete Patient Profiles
One common deficiency that we have identified revolves around incomplete patient profiles. We have found that some pharmacies’ patient profiles contain incomplete information, with critical elements missing. If a pharmacy is not collecting all required patient information, any drug utilization review (DUR) performed by the pharmacist will be incomplete. DURs are key to helping pharmacists evaluate a patient’s prescriptions, medical history, and any drug-related interactions. For example, a DUR could reference a patient’s demographics, medical history, and current conditions such as diabetes, asthma, or high blood pressure. This information greatly impacts the steps a pharmacist would take before dispensing medication to a patient, such as performing patient counseling, or in the event of a potential adverse reaction, work with the prescribing physician for a change in medication.
Additionally, some pharmacies don’t collect information to monitor and track the results of patient treatments. Our accreditation standards ensure the collection, maintenance, and assessment of comprehensive patient information.
To solve this issue, the pharmacy should know the key elements that always need to be included in a patient profile:
Patient’s chart
The diagnosis, medication list, comorbidities, allergies, medication history, whether a patient can self-administer their medications, and have knowledge of their therapeutic goals.
Plan of care
Demographics, the principal diagnosis and pertinent diagnosis, monitoring parameters, current medications, and any equipment and supplies necessary for their care.
Patient education
Proper use, administration and duration of therapy, side effects and their prevention, safe handling and disposal of medications, vaccination recommendations, and any new or changed medications including OTC’s (over the counter drugs) and dietary supplements.
Pharmacies also need to regularly review the above elements. DUR is ongoing, not static. Pharmacies need to build within their processes the ability to update the patient profile as the patient’s medical conditions change. This may be triggered through the start of new medications, questions from the patient during patient consultation, or at an established frequency. This can be particularly challenging when the patient uses multiple pharmacies. Pharmacies should routinely ask patients for a list of all medications, not just the ones filled at a particular pharmacy.
Electronic DUR Alert Systems
The DUR is another area that our experts have noted as commonly deficient. We have observed DURs that are missing key elements of the patient’s full-health history and medication information. Here are some examples of how an electronic DUR alert system can go wrong:
A pharmacy uses new software for processing prescriptions and identifying potential DUR issues, but the system is set to only check prescriptions for interactions against the first 2 medications listed in the patient’s profile.
The system a pharmacy uses to conduct DURs may exclude screenings for current health conditions, for example if a patient is pregnant or lactating.
The system a pharmacy uses to conduct DURs may exclude certain classes of drugs and their interactions. For example, in one pharmacy the following drugs did not trigger an alert: propranolol taken with albuterol, which may reduce the benefits of both drugs.
To solve these issues, pharmacies should implement all the current modules in their electronic DUR alert software system to provide a robust DUR check. Also, all drug products that the pharmacy dispenses need to be up to date in your system, so potential interactions can be checked, including OTCs, herbal medicines, and dietary supplements. Keep track of how often your system is being tested and how that testing is performed and documented.
Ongoing Review
Always keep these common issues in mind when reviewing your patient profiles for DURs. Focus your review to make sure that:
- The patient’s medical conditions are up to date.
- Medication lists are complete and updated.
- Baseline and ongoing patient labs are reviewed.
- Prescriptions are being dispensed regularly and any non-adherence issues are being addressed.
- Any adverse events experienced by the patients are fully addressed.
Make sure you know the patient’s particular disease state laboratory monitoring requirements and comply with them. NABP accreditation standards state that the patient information collected must include all medical conditions, disease states, and any prescription or nonprescription drugs taken by the patient even if they aren’t dispensed by your pharmacy.
Learn more about our accreditation programs and how they can help enhance your business.
This blog post has been adapted from NABP’s presentation at the Asembia AXS25 Summit business session, Navigating the Accreditation Maze: Uncovering Common Deficiencies and Solutions.
