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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?