Good Pharmacy Practice Standardized for Community Pharmacists: The Lebanese Order of Pharmacists Initiative.

OBJECTIVE: The community pharmacist's role is in constant evolution. It shifted from compounding and dispensing to patient-centered services. To guarantee that all pharmacists are providing a service of appropriate quality to every patient, the Lebanese Order of Pharmacists (OPL) took the initiative of developing good pharmacy practice (GPP) guidelines to be applied by community pharmacists for services' quality improvement.
METHODS: Within the OPL, a Scientific Committee, the executive authority to organize scientific and educational activities, is appointed. It decided, in January 2018, to elaborate GPP guidelines for community pharmacists and created the Community Pharmacy Practice Subcommittee, which was in charge of this project. The GPP standards suggested by the OPL were inspired by the ones published by international organizations, namely the International Pharmaceutical Federation and WHO, American, European, and regional countries.
FINDINGS: The GPP standards comprised 15 sections that tackled the following topics: settings of a pharmacy, handling of stock, extemporaneous compounding, provision of medicines, supply of nonprescription medicines, interaction and communication, documentation systems, equipment, resources, health promotion, diagnostics, pharmacotherapy monitoring, research and professional development, trainees, and para-pharmaceuticals.
CONCLUSION: The OPL was able to implement a first draft of the GPP standards for community pharmacists in Lebanon, a developing country with many constraints. The starting project will need to be consolidated by raising awareness and changing misconception among community pharmacists as a first step. Amendments to these guidelines will follow based on the pharmacists' feedback and results of an ongoing national survey conducted by the OPL and academia.

INTRODUCTION

The pharmacist's role is in constant evolution, and it shifted from drug compounding and dispensing to providing drug information and patient care.[1] This entire scope of patient-centered services has been described as pharmaceutical care, a revolution in pharmacy practice.[2] All pharmacists have to ensure that the service they provide to every patient is of appropriate quality. The good pharmacy practice (GPP) includes the principles of pharmaceutical care[3] and is considered a means of meeting and clarifying these obligations.

The International Pharmaceutical Federation (FIP) is a global federation of national organizations that represent pharmacists and pharmaceutical scientists. Its role is to provide leadership for national pharmaceutical organizations and encourage them to focus the attention of the pharmacists in the community and hospital pharmacy sector on developing the elements of service they provide to meet changing circumstances. The GPP guidelines are present in many countries, including but not limited to Australia, South Africa, Thailand, USA, Jordan, and France, but not Lebanon.

Lebanon is a small country in the Middle East with a population of around four million inhabitants. By the end of 2017, it had 3174 community pharmacies and a ratio of 6.48 pharmacies per 10,000 inhabitants. To be allowed to practice, all Lebanese pharmacists must be registered at the Lebanese Order of Pharmacists (OPL). The latter is working to become a leading institution to improve the profession of pharmacy, promoting excellence in patient care and scientific development in Lebanon and the Middle East. It strives to apply the laws, defend the rights of pharmacists, and advance the level of the pharmacy practice while fostering the development of scientific competencies.

The initiative of establishing GPP guidelines for community pharmacists was based on several elements of evidence; the general population in Lebanon has a high expectancy from community pharmacists, but their services are not always well perceived.[4] Furthermore, few community pharmacists use the available electronic platforms[5678] that were made available to them by the OPL (medication safety platform for adverse events reporting, patient profile platform for medication therapy management, and learning management system for continuing education).

Thus, a regulatory framework for quality improvement of community pharmacy was needed. Based on those above, and since a comprehensive, culturally adapted, and well-structured GPP guideline for community pharmacists lacks in the country, the OPL took the initiative of developing these GPP guidelines to be used by community pharmacists.

METHODS

The Lebanese Order of Pharmacists initiative: Procedures and steps

The OPL is the official legal partner of the Ministry of Public Health (MOPH) to organize and supervise the pharmacy profession. It was established by law in 1950. All registered pharmacists (8121 active members) in Lebanon elect the governing body of the OPL every 3 years. Within the OPL, a nominated scientific committee has the role of executive authority to organize educational activities including conferences, educational sessions, and certifications. In January 2018, the OPL Scientific Committee decided to elaborate GPP guidelines for community pharmacists and created the Community Pharmacy Practice Subcommittee, which was in charge of this project.

Creating the Community Pharmacy Practice Subcommittee

A call for volunteer service on the Community Pharmacy Practice Subcommittee has been out at the beginning of 2018. Invited pharmacists were pharmacy practitioners in the community settings. The final structure of the subcommittee included eight pharmacists, with long expertise in the community pharmacy practice.

Designing the good pharmacy practice guidelines for community pharmacists

To create the Lebanese GPP guidelines, we relied on the guidelines already implemented in several countries and tailored them to the Lebanese situation. The reference structure adopted to develop these guidelines was the one of the FIP-WHO to which standards from the following countries were mapped: Canada,[9] Australia,[1011] Jordan,[12] South Africa,[13] Taiwan,[14] and France.[15] After mapping, a synthesis of standards and criteria was elaborated; a new round of brainstorming was launched to adapt the guidelines to the current context. This also allowed adding sections based on decisions of the OPL board and other projects developed by other subcommittees, i.e., the post-graduate training section, the Lebanese Advanced Patient Profile, and the Medication Safety online reporting platform.

RESULTS

The Lebanese GPP guidelines for community pharmacists' document that was prepared by the Community Pharmacy Practice Subcommittee can be found in Appendix 1. The major headlines that compose it are summarized in Table 1.

Table 1

Summary of the headlines of the good pharmacy practice standards for community pharmacists

Settings of a pharmacy (appearance and cleanliness, accessibility, window dressing, dispensing, and counseling areas and staffing)

Handling of stock (purchasing, storage, and maintenance of quality)

Extemporaneous compounding (operating procedures, documentation, and raw material handling)

Provision of medicines (prescription availability, patient identification, and dispensing)

Supply of nonprescription medicines (advice on selection and use, responding to minor ailments)

Interaction and communication (communication skills of pharmacist and staff, provision of advice, promotion of good health, and provision of written information)

Documentation systems (patient medication profile, formulary systems, policies and standard operating procedures, documentation of interventions)

Equipment (availability of a refrigerator and other equipment, equipment status, routine maintenance, and validity)

Resources (availability of drug information systems and resources)

Health promotion (engagement in health promotion, participation in health promotion campaigns)

Diagnostics (provision of diagnostic tests, documentation of tests done)

Pharmacotherapy monitoring (development of pharmaceutical care plans, patient monitoring, identification of medication-related problems, interaction with prescribers, and other healthcare professionals)

Research and professional development (participation in research projects, participation in continuing education)

Trainees (acceptance of trainees, monitoring and documentation, activity description)

Para-pharmaceuticals (availability of medical devices and complementary medicines, display, information)

Click here for additional data file.

DISCUSSION

The OPL took the courageous step of creating the GPP standards for community pharmacists for the first time in the history of profession in Lebanon. These guidelines are essential for the pharmacy practice to ensure that, in Lebanon, the quality of the community pharmacy services is high and close to the worldwide standards. Before launching the GPP guidelines, a series of educational activities must be delivered to increase the pharmacists' awareness to these practices, spread the safety culture, and arm the attendees with the minimum necessary terminologies and background to be able to support and take part of this initiative. The OPL is currently running a national survey to assess GPP in community pharmacies in Lebanon, jointly with the academia. This survey will help implement the guidelines more solidly to promote the quality of services the community pharmacists provide.

These GPP guidelines were submitted to the MOPH for further discussion and approval before implementation. The launching is set to take place as soon as the approval of the MOPH is granted. Adhering to the GPP standards will be optional during the preliminary phase of the guidelines implementation, to be perceived as a quality label mark; it would become mandatory after the trial period.

Training and workshops are warranted to all pharmacists with the collaboration of the MOPH. As drug experts, and as part of their professional responsibility, pharmacists are urged to abide by these GPP guidelines. The most significant incentive would be to optimize patient care.

The OPL was able to generate a first version of the GPP standards for community pharmacists in Lebanon, a developing country with many constraints. The starting project will need to be consolidated by raising awareness among community pharmacists as a first step. Amendments to these guidelines will follow based on the pharmacists' feedback and results of the ongoing national survey.

AUTHORS' CONTRIBUTION

All authors contributed equally to the elaboration of the GPP standards as they all were members of the OPL community pharmacy sub-committee.

Souheil Hallit drafted the manuscript, and reviewed the manuscript; Hala Sacre also drafted the manuscript and corrected it linguistically; all authors reviewed the final manuscript and gave their consent; Pascale Salameh was the project supervisor and approved the final version of the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.