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Ensuring Quality in Pharmacy Operations


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Importance of Quality in Pharmacy
-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
How is quality measured in pharmacy practice?
By assessing:
1. Structure (RPh, meds in stock)
2. Process (prescribing, dispensing, monitoring)
3. Outcomes (what we are trying to accomplish)
Describe the ECHO model
-assesses types of outcomes:
1. economic
2. clinical
3. humnistic
Economic Outcomes
Direct, indirect, & intangible costs compared to consequences of medical treatment
Costs: value of resources consumed
Consequences: effects, outputs, & outcomes of program/treatment alternative
Types of Economic Evaluations
1. Cost minimization - $ vs. assumed equal
2. Cost-benefit - $ vs. $
3. Cost-effectiveness - $ vs. therapeutic objective
4. Cost-utility - $ vs. humanistic outcome
Clinical Outcomes
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
Humanistic Outcomes
Consequences of disease or treatment on patient functional status or QOL
Health-Related Quality of Life
Encompasses those aspects of life which are influenced significantly by activities performed to maintain or improve health
Quality Assurance
"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
Quality Control
"an aggregate of activities designed to ensure adequate quality" - ch9 D&DrZ
Improved Design = Improved Qualtiy
Continuous Quality Improvement (CQI)
"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
Name two important aspects of CQI:
1. Systems perspective
2. Continuous
List 3 other names for CQI:
1. Quality Improvement Process
2. Total Quality Management
3. Total Quality Control
CQI is a practical application of the ________ _________. (Process)
Scientific Method
-Conclusions & Recommendations
-Select a focus
-Describe the focus
-Sate focus importance
-Relate focus to literature
-Select global and specific goals
Overall Goal (types)
1. Discovery
2. Frequency estimation
3. Measurea a change
-combination of above/other
Clearly Stating a Specific Goal:
An X% reduction in Y over Z

where: x = number, y = process/outcome, z = time
Methods (process of)
-Select intervention
-Select process & outcome measures
-Describe data collection procedure
-Describe analysis
Possible Problems
-Causes of errors in health care:
1. Design failure - process design/equipment design
2. Organizational failure - lack of training/schedules
Possible Interventions - Design Change Examples
-Reduce reliance on memory
-Use checklists
-Improve access to information
-Reduce handoffs
-Differentiate: look-alike/sound-alike
-Automate carefully
Possible Interventions - Organizational Changes
-Optimize work environment
-Increase feedback
-Train for teamwork
-Improve direct communication
How do you measure progress?
1. Process measures- ex: decrease in % of inappropriate ptoassium doses prescribed
2. Outcome measures - ex: decrease in error rate
Data Collection Methods
1. Inspection points
2. Focus groups
3. Monitoring error markers
4. Chart review
5. Observation
6. Spontaneous reporting
A CQI program will eliminate errors as long as human beings are involved in the process of filling prescriptions
FALSE: it will NOT eliminate errors as long as human beings are involved
Why is a CQI so important to a successful pharmacy?
-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
Does a mistake = an error?
-Mistake is caught
-Error = mistake is given to patient
Why do we need Pharmacy Quality Commitment (PQC)?
Professional Need
Legal Need
Business Need
Professional Need for PQC
Enhance processes to improve quality of care provided
Legal Need for PQC
-State legislation
-Federal legislation
-Third Party Contracts
Business Need for PQC
Lower risk/insurance rates & requirements
Purpose of Risk Management (PQC)
To develop a system of pharmacy practice in which pharmacists & support personnel can be as error free as possible
Philosophy of Risk Management (PQC)
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.
Risk Management
1. Identify the risk
2. Select the technique
3. Implement a standard workflow
4. Monitor & make necessary changes
Over __________ deaths a year from medical errors
Two Parts of PQC
Sentinel System
Quality Manager
Sentinel System
-Standardized workflow process of filling an prescription
-Assembly line-like
-Reduces confusion
-Problems & errors become less frequent
Seven Workflow Processes/Stations of PQC
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
Key Issue of PQC System
A standardized workflow should be followed in each pharmacy on every prescription in order to minimize problems of pharmacists working in multiple locations
Pharmacy "Best Practices"
1. Take "5"
2. "Mark it!"
3. Triple Check
4. <6-60>
5. 60 Second Consult
6. Echo, Verify, & Document
Take "5"
Take 5 seconds & review what was done at the previous station
Mark It
Mark drugs for special attention where potential errors may occur
Triple Check
Check the name 3 times in Rx assembly station
Pay special attention to patients in these age groups
60 Second Consult
When a mistake is discovered, take 60 seconds w/ team and discuss to prevent reocurrence
Echo, Verify, and Document should be used for...
Telephone prescriptions
Indian Health System Counseling
-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?

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