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Australian Journal of Pharmacy : March 2005
medication management in review Slap a little quality on it and ship it out—QUM aspects of RMMRs By Bill Kelly, CEO, Australian Association of Consultant Pharmacy W HENthe topic of delivering a qual- ity product or service comes up, invariably I’m reminded of a cartoon that found its way into my ‘funnies file’ some years ago. The setting was a production line and the workers were a bit slow in processing the finished product, prompt- ing a remark from the foreman to ‘hurry up and just slap a little quality on the sucker and ship it out of here!’ The quality use of medicines (QUM), from a pharmacy perspective, sometimes has a bit of the above approach to it. It’s a very important part of what we do but how we do it, who does it and why, are equally important parts of the equation. Never is this truer than in the case of residential medication management review services (RMMRs). The proposed changes to the RMMR service model announced by the Department of Health and Ageing late last year raise a number of questions, particularly from a QUM aspect. But back to this a little later. Quality and pharmacy Quality abounds in pharmacy—at least in its lexicon. The overarching national QUM goal of optimising the use of med- icines to improve health outcomes and its accompanying mantra evoking the judi- cious selection of management options, the appropriate choice of medicines where a medicine is considered necessary, and the safe and effective use of such medicines, epitomises this. We also have the Quality Care Phar- macy Program (QCPP) with its Continu- ous Quality Improvement (CQI) element, and not forgetting the Australian Council for Safety and Quality in Healthcare, formed to specifically address medicine- related issues. Each of these programs aims to add an element of ‘quality’ to existing processes and services or products with the aim of delivering a better, even safer, product/service/process. In the case of the RMMR, recognising the value of non-drug therapy, consider- ing costs/benefit of medicines selected (be they clinical, human or economic) and monitoring the outcomes of their use (including taking the appropriate actions to solve medication-related problems) are all quality-related activities encompassed by any such review. Who decides what quality is? So who decides what is quality and how is it applied? Are there parameters of qual- ity? Quality standards textbooks often refer to the ‘ten dimensions to service quality’, namely competence, responsive- ness, reliability, communication, under- standing the customer, tangibles, security, credibility, courtesy and access. In the case of providing pharmacy services, includ- ing RMMRs to residential aged care facil- ities (RACFs), each of these dimensions is evident to a greater or lesser degree as the following illustrate. Competence All accredited pharmacists conducting RMMRs need a high level of knowledge and skills to perform this service. Inherent 162 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 MARCH 2005 in this notion of competence is the ability to apply this knowledge appropriately in context and to the level of the pharma- cist’s duty of care. There is also an onus on the pharmacist to maintain compe- tency by undertaking appropriate educa- tion, training and professional develop- ment, hence re-accreditation. Responsiveness and reliability Providing a service that is responsive to the needs of the facility and resident goes without saying. This applies equally to those functions provided under the Phar- macy Services contract and, if different, by the accredited pharmacist providing RMMRs. Whether it be the recommended fortnightly visits to the facility or adhering to a planned schedule of annual residen- tial reviews, responding to the needs of the customer in a timely manner goes hand-in-hand with providing a reliable service. That is, delivering the promised service dependably and accurately. Communication, courtesy, credibility Where the supply pharmacist and the medication review pharmacist are differ- ent people, good communication between all parties enables responsibilities and roles is understood and enhance the qual- ity of the services provided. Courtesy in such cases is politeness, respect and con- sideration of both parties’ requirements. Credibility of service providers is a given. Access Approachability and ease of contact from both a liaison and logistics point of view seem straightforward but often isn’t the case. Providing RMMR services to a rural facility involving a 400km round trip cer-