ArticleExploratory research in clinical and social pharmacy2026
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.
Article in Exploratory research in clinical and social pharmacy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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 ( 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.
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