NADC PHARMACY DIABETES SERVICE ACCREDITATION APPLICATION

Name of pharmacy service :      

Does your pharmacy hold current QCPP accreditation? Yes No

Is your pharmacy an NDSS Access Point? Yes No

Would you like the NADC to provide your service contact details to diabetes related Yes Nopharmaceutical and product companies, with the aim to assist in building connections and receiving product education?

Is your pharmacy a multi-site pharmacy service? Yes No

List other associated sites (if any):      

Location of service being accredited:      

Name of contact person for this application:      

Contact person’s email       Contact person’s Ph. No.      

Mailing Address      

DETAILS ABOUT YOUR PHARMACY DIABETES SERVICE1. Please tick all health professional disciplines available at your pharmacy service from the list below and the full

time equivalent (FTE) employment in your pharmacy diabetes service. List any other disciplines involved in your services in the blank boxes.

STAFFING FTE STAFFING FTEPharmacist       Exercise Physiologist      Diabetes educator (non ADEA-credentialled)       Podiatrist      Registered Nurse Credentialled Diabetes Educator

      Psychologist / counsellor      Pharmacist Credentialled Diabetes Educator      

             

Dietitian Credentialled Diabetes Educator                  Dietitian                  Diabetes Nurse Practitioner                  Administration service                  Ophthalmologist/optometrist                  Pathology/pathologist                  Physician                  

2. Please list the names of the key health professionals employed at your service, starting with service leaders. If there is not enough space, further columns can be added.

STAFFING STAFFING STAFFINGPharmacist Ophthalmologist/optometrist Vascular SurgeonDiabetes educator (non-ADEA credentialled)

Pathology/pathologist PhysiotherapistCredentialled Diabetes Educator Physician Diabetes Nurse PractitionerDietitian

  Endocrinologist

  Social Worker

Podiatrist General Practitioner Practice NursePsychologist / counsellor Cardiologist      Exercise Physiologist Nephrologist      Administration service Emergency Services      

3. Please list the names of the key health professionals employed at your service, starting with service leaders. If there is not enough space please attach an additional page to the application.

Name Position Email FTE1                        2                        3                        4                        5                        6                        7                        8                        9                        10                        11                        12                        

4. Please list any specialist clinics or services that your pharmacy diabetes service offers and estimate of consumer numbers per month for each service. List any other services in the blank boxes.

SERVICE Pt/mnth SERVICE Pt/mnthType 1 diabetes       Paediatric type 1 diabetes service      Type 2 diabetes       CGM initiation and support      Newly Diagnosis type 1 diabetes       Diabetes MedsChecks      Newly Diagnosis type 2 diabetes       Product Advice / Training      Gestational diabetes       Product Supply / NDSS Access point      Newly diagnosed GDM       HbA1c Testing      Diabetes Foot Clinic       Home Medication Reviews (HMRs)      Insulin pump initiation       Diabetes Screening      Insulin pump support/titration       Residential Care Services      

5. What areas does your diabetes service excel in?

     

6. Please list any programs, initiatives, tools or experiences that are examples of Best Practice that your pharmacy diabetes service shares, or could share, with other NADC services:

     

Signature of the pharmacy services’ manager / lead pharmacist, CEO or other senior leader that this application is a true and accurate reflection of the organisation’s systems.

Signature: Name:       Position:      

Date of application: Select date from dropdown.

FINAL CHECKLISTEnsure the following are attached to your application and that all attachments are saved in PDF format and saved as per the naming conventions outlined in the workbook.

Accreditation application Timetable of clinicsOrganisational Structure Pharmacy Diabetes Service Quality Improvement PlanEvidence of referral processes/guidelines Details of health professionals referred to

Section 1: Healthcare ImprovementStandard 1.1 Diagnosis and Treatment

Criterion 1.1.1: Evidence based careIndicator Met Not met Partially Met Not Applicable Comment

A      

B      

C      

D

     

E      

Criterion 1.1.2: Multidisciplinary careIndicator Met Not met Partially Met Not Applicable Comment

A      

B      

C

     

D      

E

If any of the services in Indicator C are Not Met, Partially Met or N/A - Please provide evidence of referral processes and referral guidelines

     

FPlease provide the contact details of all health professionals referred to as per question 2 above

     

Criterion 1.1.3: Medication managementIndicator Met Not met Partially Met Not Applicable Comment

A      

B      

C      

D      

Criterion 1.1.4: Consumer rights and privacyIndicator Met Not met Partially Met Not Applicable Comment

A      

B      

C      

D      

Standard 1.2 Promotion of Consumer Self-ManagementCriterion 1.2.1: Contribution to health improvement through consumer empowermentIndicator Met Not met Partially Met Not Applicable Comment

A

     

B

     

C      

D      

Criterion 1.2.2: Improved consumer health literacyIndicator Met Not met Partially Met Not Applicable Comment

A      

B      

C      

D      

E      

F      

G      

Criterion 1.2.3: Consumer remindersIndicator Met Not met Partially Met Not Applicable Comment

A      

B      

Criterion 1.2.4: Individualised Consumer CareIndicator Met Not met Partially Met Not Applicable Comment

A      

B      

Standard 1.3 Improved Consumer Health OutcomesCriterion 1.3.1: Demonstrated activities to achieve desired health targetsIndicator Met Not met Partially Met Not Applicable Comment

A      

B

     

C      

D      

E      

F      

G      

Standard 1.4 Integrated CareCriterion 1.4.1: Engagement with other servicesIndicator Met Not met Partially Met Not Applicable Comment

A

     

B      

C      

D      

Criterion 1.4.2: Continuity of comprehensive careIndicator Met Not met Partially Met Not Applicable Comment

A

     

B      

C      

D      

Standard 1.5 Decision SupportCriterion 1.5.1: Clinician RemindersIndicator Met Not met Partially Met Not Applicable Comment

A      

B      

C      

D      

Section 2 Governance and ProcessesStandard 2.1 Service Structure and Management

Criterion 2.1.1: Organisational structureIndicator Met Not met Partially Met Not Applicable Comment

A      

B      

C      

Criterion 2.1.2: Leadership and accountabilityIndicator Met Not met Partially Met Not Applicable Comment

A      

B      

C      

D      

Standard 2.2 Service CommunicationCriterion 2.2.1: Information about the serviceIndicator Met Not met Partially Met Not Applicable Comment

A

     

B      

C      

D      

E      

F      

G      

H      

Section 3 Management of Quality and SafetyStandard 3.1 Risk Mitigation

Criterion 3.1.1: Risk mitigation processesIndicator Met Not Partially Not Applicable Comment

A      

B      

C      

D      

E      

Standard 3.2 Infection ControlCriterion 3.2.1: Mitigation of infection related incidentsIndicator Met Not Partially Not Applicable Comment

A      

B      

C

     

D      

Standard 3.3 Quality Improvement and InnovationCriterion 3.3.1: Quality improvement practicesIndicator Met Not Partially Not Applicable Comment

A      

B      

C      

D      

E      

F      

Criterion 3.3.2: Innovation programsIndicator Met Not Partially Not Applicable Comment

A      

B      

C      

Criterion 3.3.3: TechnologyIndicator Met Not Partially Not Applicable Comment

A

     

B      

C      

D      

E      

F      

Standard 3.4 Education and TrainingCriterion 3.4.1: Qualification and professional development of staffIndicator Met Not Partially Not Applicable Comment

A      

B      

C      

D      

Criterion 3.4.2: HR management of staff qualificationsIndicator Met Not Partially Not Applicable Comment

A      

B      

C      

D      

Criterion 3.4.3: Participation in knowledge-sharingIndicator Met Not Partially Not Applicable Comment

A      

B      

C      

Criterion 3.4.4: Consumer education programsIndicator Met Not Partially Not Applicable Comment

A      

B      

C      

D      

Section 4 Service ManagementStandard 4.1 Safety and Welfare of Staff, Consumers and Visitors

Criterion 4.1.1: Occupational health and safety (OH&S)Indicator Met Not Partially Not Applicable Comment

A      

B      

C      

D      

E      

Criterion 4.1.2: Management of clinical appointmentsIndicator Met Not Partially Not Applicable Comment

A      

B      

C      

D      

E      

F      

G      

H      

Standard 4.2 Records ManagementCriterion 4.2.1: Business recordsIndicator Met Not Partially Not Applicable Comment

A      

B      

C      

Criterion 4.2.2: Clinical records and consumer informationIndicator Met Not Partially Not Applicable Comment

A      

B      

C      

D      

E      

F      

G      

H      

Criterion 4.2.3: Flagging of abnormal resultsIndicator Met Not Partially Not Applicable Comment

A      

B      

Standard 4.3 Service Maintenance

Criterion 4.3.1: Cleaning and MaintenanceIndicator Met Not Partially Not Applicable Comment

A      

B      

C      

D      

Criterion 4.3.2: Service and replacement of equipmentIndicator Met Not Partially Not Applicable Comment

A      

B      

C      

D      

E      

F      

CONCLUDING FEEDBACK

1. Did you find the NADC accreditation process beneficial to you and your service – why/why not?

     

2. Was the accreditation process easy to understand and were you able to fill out the criteria easily?

     

3. What improvements would you like to see included in future versions of the NADC pharmacy accreditation standards?

     

4. Other comments.

     

Thank you