Application of plan-do-study-act (PDSA) cycle for implementation of good pharmacy practice standards: A quality improvement interventional study in a Tertiary care central Hospital of Nepal

Objectives The global shift toward patient-centered clinical pharmacy services is governed by Good Pharmacy Practice (GPP) standards. However, implementing these in low-middle income countries (LMICs) remains challenging due to resource and infrastructure constraints. This study aimed to implement GPP standards at a central tertiary hospital using the Plan-Do-Study-Act (PDSA) cycle. Methods A prospective, interventional quality improvement study was conducted at a tertiary care central hospital over five months. Intervention included functional decentralization of services, development of 21 Standard Operating Procedure (SOPs) using the ALCOA+ framework, and staff training. Four longitudinal audits were performed using an expanded 125-indicator Department of Drug Administration (DDA) checklist. Root cause analysis (RCA) via the “5 Whys” technique addressed implementation barriers. Results Overall median GPP compliance increased from 57.1% (IQR: 25.0%–77.8%) to 100.0% (IQR: 100.0%–100.0%) by final audit ( p < 0.0001). High-compliance domains rose from 17.6% to 88.2%. The Hodges-Lehmann estimator indicated a median improvement of 43.7% (95% CI: 22.2% - 62.5%). Qualitative analysis revealed that documentation gaps were rooted in ergonomic friction rather than incompetence; relocating logbooks to dispensing counters resolved these issues. A ceiling effect was observed in store management (91.7% compliance) due to fixed architectural constraints. Conclusion The PDSA model is an effective framework for driving rapid quality improvement in resource-limited pharmacy settings. Success was achieved not only through procedural changes but by transitioning staff culture from a “money-driven” mindset to “professional ownership”. This study provides a scalable roadmap for GPP implementation and suggests that national audit tools should adopt tier-specific indicators for tertiary facilities.