Adherence to minimum service standards of hospital pharmacy practice by provincial hospitals of Nepal: a retrospective secondary study

Background There is a positive growth in the hospital pharmaceutical services within provinces of Nepal. This growth reflects the continuous quality improvement by the hospital using tools such as minimum service standards (MSS), as such, this study aims to assess the adherence to MSS of hospital pharmacy practice by the provincial hospitals of Bagmati province, Nepal. Methods A retrospective secondary analysis was conducted of provincial hospitals from Bagmati Province, Nepal executing hospital pharmacy practice services where the tools used within the study included the MSS Checklist to identify the Gaps in Quality Improvement of Primary Hospitals, MSS assessment tool (Self and Joint) for Secondary A Hospital, and the MSS assessment tool (self and Joint) for Secondary B Hospital endorsed by the Quality Standards and Regulation Division, Ministry of Health and Population, Government of Nepal. The analysis was then reflected in terms of MSS scores (%) such as poor (<50), state of improving status emphasizing specific target areas (50 to <70), acceptance level that requires careful specific interventions (70 to <85) and 85-100 optimal level of readiness to provide services that require sustained efforts to maintain the level and move towards 100%. Results The survey included 13 hospitals located in the Bagmati Province of Nepal: 3 categorized as Primary hospitals, 4 as Secondary A hospitals, and 6 as Secondary B hospitals. Overall, the findings indicate better MSS performance in secondary B level hospitals compared to secondary A and primary hospitals. Out of 13 hospitals, the majority showed acceptance level (70 to <85) that requires careful intervention (n=7; 54%), followed by hospital pharmacy within very poor and alarming status (<50) that needs to be addressed first (n=2, 15%), improving status (50 to <70) requiring specific targeted areas support (n=2, 15%), and pharmacies with optimal level (85-100) of readiness to provide the service that require sustained efforts to maintain the level (n=2, 15%). Despite positive growth in the development of hospital formulary within hospitals, standards such as good procurement practice, staffing, information to patients, pharmacovigilance and ADR reporting, and pharmaceutical waste management were still poorly complaint. Conclusions Out of 13 provincial hospitals majority revealed an acceptance level that requires careful intervention. The findings emphasize the need for integrated approach from the Ministry of health, hospital development committee, and the drug and therapeutic committee to fulfil the standards and help in the proper pharmaceutical care continuum with provincial based hospital pharmacies.