Ensuring Quality In Pharmacy Operations

Front 1

Importance of Quality in Pharmacy

Back 1

-represents degree of excellence
-increases probability of + outcomes
-decreases probability of (-) outcomes
-corresponds w/ current medical knowledge
-offers patient what he wants
-provides patient what he needs

Front 2

How is quality measured in pharmacy practice?

Back 2

By assessing:
1. Structure (RPh, meds in stock)
2. Process (prescribing, dispensing, monitoring)
3. Outcomes (what we are trying to accomplish)

Front 3

Describe the ECHO model

Back 3

-assesses types of outcomes:
1. economic
2. clinical
3. humnistic

Front 4

Economic Outcomes

Back 4

Direct, indirect, & intangible costs compared to consequences of medical treatment
Costs: value of resources consumed
Consequences: effects, outputs, & outcomes of program/treatment alternative

Front 5

Types of Economic Evaluations

Back 5

1. Cost minimization - $ vs. assumed equal
2. Cost-benefit - $ vs. $
3. Cost-effectiveness - $ vs. therapeutic objective
4. Cost-utility - $ vs. humanistic outcome

Front 6

Clinical Outcomes

Back 6

Medical events that occur as a result of disease or treatment.
Vary w/ disease state
Usually include: medication, side & adverse effects, lab values, documented physical state

Front 7

Humanistic Outcomes

Back 7

Consequences of disease or treatment on patient functional status or QOL

Front 8

Health-Related Quality of Life

Back 8

Encompasses those aspects of life which are influenced significantly by activities performed to maintain or improve health

Front 9

Quality Assurance

Back 9

"the systemic monitoring & evaluation of varoius aspects of a project, service, or facility to ensure that standards of quality are met"
-ch9 Desselle & Dr. Z

Front 10

Quality Control

Back 10

"an aggregate of activities designed to ensure adequate quality" - ch9 D&DrZ
Improved Design = Improved Qualtiy

Front 11

Continuous Quality Improvement (CQI)

Back 11

"Philosophy of continual improvement of the process associated w/ providing a good or service that meets or exceeds customer expectations" (Shortell)
aka: total quality management

Front 12

Name two important aspects of CQI:

Back 12

1. Systems perspective
2. Continuous

Front 13

List 3 other names for CQI:

Back 13

1. Quality Improvement Process
2. Total Quality Management
3. Total Quality Control

Front 14

CQI is a practical application of the ________ _________. (Process)

Back 14

Scientific Method
-Background
-Methods
-Results
-Conclusions & Recommendations

Front 15

Background

Back 15

-Select a focus
-Describe the focus
-Sate focus importance
-Relate focus to literature
-Select global and specific goals

Front 16

Overall Goal (types)

Back 16

1. Discovery
2. Frequency estimation
3. Measurea a change
-combination of above/other

Front 17

Clearly Stating a Specific Goal:

Back 17

An X% reduction in Y over Z

where: x = number, y = process/outcome, z = time

Front 18

Methods (process of)

Back 18

-Select intervention
-Select process & outcome measures
-Describe data collection procedure
-Describe analysis

Front 19

Possible Problems

Back 19

-Causes of errors in health care:
1. Design failure - process design/equipment design
2. Organizational failure - lack of training/schedules

Front 20

Possible Interventions - Design Change Examples

Back 20

-Reduce reliance on memory
-Simplify
-Standardize
-Use checklists
-Improve access to information
-Reduce handoffs
-Differentiate: look-alike/sound-alike
-Automate carefully

Front 21

Possible Interventions - Organizational Changes

Back 21

-Optimize work environment
-Increase feedback
-Train for teamwork
-Improve direct communication

Front 22

How do you measure progress?

Back 22

1. Process measures- ex: decrease in % of inappropriate ptoassium doses prescribed
2. Outcome measures - ex: decrease in error rate

Front 23

Data Collection Methods

Back 23

1. Inspection points
2. Focus groups
3. Monitoring error markers
4. Chart review
5. Observation
6. Spontaneous reporting

Front 24

TRUE/FALSE:
A CQI program will eliminate errors as long as human beings are involved in the process of filling prescriptions

Back 24

FALSE: it will NOT eliminate errors as long as human beings are involved

Front 25

Why is a CQI so important to a successful pharmacy?

Back 25

-Every one in the pharmacy wants to deliver safe & secure products for their patients
-Pharmacists want to sleep at night
-Reputations of businesses & individuals are at stake
-Errors reaching patients can affect loss of revenue

Front 26

Does a mistake = an error?

Back 26

NO
-Mistake is caught
-Error = mistake is given to patient

Front 27

Why do we need Pharmacy Quality Commitment (PQC)?

Back 27

Professional Need
Legal Need
Business Need

Front 28

Professional Need for PQC

Back 28

Enhance processes to improve quality of care provided

Front 29

Legal Need for PQC

Back 29

-State legislation
-Federal legislation
-Medicare
-Third Party Contracts

Front 30

Business Need for PQC

Back 30

Lower risk/insurance rates & requirements

Front 31

Purpose of Risk Management (PQC)

Back 31

To develop a system of pharmacy practice in which pharmacists & support personnel can be as error free as possible

Front 32

Philosophy of Risk Management (PQC)

Back 32

Pharmacists who participate as team members in an organized effort to evaluate past failures of quality, and commit to policies that have been developed to prevent future failures of quality, will reduce the incidence of error in their practice.

Front 33

Risk Management

Back 33

1. Identify the risk
2. Select the technique
3. Implement a standard workflow
4. Monitor & make necessary changes

Front 34

Over __________ deaths a year from medical errors

Back 34

44,000

Front 35

Two Parts of PQC

Back 35

Sentinel System
Quality Manager

Front 36

Sentinel System

Back 36

-Standardized workflow process of filling an prescription
-Assembly line-like
-Reduces confusion
-Problems & errors become less frequent

Front 37

Seven Workflow Processes/Stations of PQC

Back 37

1. Receiving Rx
2. Data entry
3. Assembly (filling) Rx
4. Pharmacist's Final Check
5. Drug Utilization Review
6. Counseling
7. Delivery of Rx to patient & receipt of payment

Front 38

Key Issue of PQC System

Back 38

A standardized workflow should be followed in each pharmacy on every prescription in order to minimize problems of pharmacists working in multiple locations

Front 39

Pharmacy "Best Practices"

Back 39

1. Take "5"
2. "Mark it!"
3. Triple Check
4. <6-60>
5. 60 Second Consult
6. Echo, Verify, & Document

Front 40

Take "5"

Back 40

Take 5 seconds & review what was done at the previous station

Front 41

Mark It

Back 41

Mark drugs for special attention where potential errors may occur

Front 42

Triple Check

Back 42

Check the name 3 times in Rx assembly station

Front 43

<6-60>

Back 43

Pay special attention to patients in these age groups

Front 44

60 Second Consult

Back 44

When a mistake is discovered, take 60 seconds w/ team and discuss to prevent reocurrence

Front 45

Echo, Verify, and Document should be used for...

Back 45

Telephone prescriptions

Front 46

Indian Health System Counseling

Back 46

-What did your doctor tell you this is for?
-How did your doctor tell you to take this?
-What did your doctor tell you to expect?