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Safe Practice 18 Pharmacist Leadership Structures and Systems

NQF-endorsed™ Safe Practices for Better Healthcare. Safe Practice 18 Pharmacist Leadership Structures and Systems. Chapter 6: Improving Patient Safety Through Medication Management. Slide Deck Overview. Slide Set Includes:

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Safe Practice 18 Pharmacist Leadership Structures and Systems

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  1. NQF-endorsed™ Safe Practices for Better Healthcare Safe Practice 18 Pharmacist Leadership Structures and Systems Chapter 6: Improving Patient Safety Through Medication Management

  2. Slide Deck Overview Slide Set Includes: • Section 1: NQF-endorsed™ Safe Practices for Better Healthcare Overview • Section 2: Harmonization Partners • Section 3: The Problem • Section 4: Practice Specifications • Section 5: Example Implementation Approaches • Section 6: Front-line Success Stories

  3. NQF-endorsed™ Safe Practices for Better Healthcare Overview Safe Practice 18 Pharmacist Leadership Structures and Systems Chapter 6: Improving Patient Safety Through Medication Management

  4. 2010 NQF Safe Practices for Better Healthcare: A Consensus Report • 34 Safe Practices • Criteria for Inclusion • Specificity • Benefit • Evidence of Effectiveness • Generalization • Readiness

  5. Culture SP 1 2010 NQF Report

  6. Culture • CHAPTER 2: Creating and Sustaining a Culture of Patient Safety (Separated into Practices] • Leadership Structures and Systems • Culture Measurement, Feedback, and Interventions • Teamwork Training and Team Interventions • Identification and Mitigation of Risks and Hazards Structures and Systems Culture Meas., FB., and Interv. Team Training and Team Interv. ID and Mitigation Risk and Hazards Consent & Disclosure Consent and Disclosure • CHAPTER 3: Informed Consent and Disclosure • Informed Consent • Life-Sustaining Treatment • Disclosure • Care of the Caregiver Informed Consent Life-Sustaining Treatment Disclosure Care of Caregiver Workforce • CHAPTER 4: Workforce • Nursing Workforce • Direct Caregivers • ICU Care Nursing Workforce Direct Caregivers ICU Care • CHAPTER 5: Information Management and Continuity of Care • Patient Care Information • Order Read-Back and Abbreviations • Labeling Studies • Discharge Systems • Safe Adoption of Integrated Clinical Systems including CPOE Information Management and Continuity of Care Patient Care Info. Read-Back & Abbrev. Labeling Studies Discharge System CPOE Medication Management • CHAPTER 6: Medication Management • Medication Reconciliation • Pharmacist Leadership Role Including: High-Alert Med. and Unit-Dose Standardized Medication Labeling and Packaging Med. Recon. Pharmacist Systems Leadership: High-Alert, Std. Labeling/Pkg., and Unit-Dose • CHAPTER 7: Hospital-Associated Infections • Hand Hygiene • Influenza Prevention • Central Venous Catheter-Related Blood Stream Infection Prevention • Surgical-Site Infection Prevention • Care of the Ventilated Patient and VAP • MDRO Prevention • UTI Prevention Healthcare-Associated Infections Hand Hygiene Influenza Prevention Central V. Cath. BSI Prevention Sx-Site Inf. Prevention VAP Prevention MDRO Prevention UTI Prevention • CHAPTER 8: • Wrong-Site, Wrong-Procedure, Wrong-Person Surgery Prevention • Pressure Ulcer Prevention • DVT/VTE Prevention • Anticoagulation Therapy • Contrast Media-Induced Renal Failure Prevention • Organ Donation • Glycemic Control • Falls Prevention • Pediatric Imaging Condition-, Site-, and Risk-Specific Practices Wrong-site Sx Prevention Press. Ulcer Prevention DVT/VTE Prevention Anticoag. Therapy Contrast Media Use Organ Donation Glycemic Control Falls Prevention Pediatric Imaging

  7. Harmonization Partners Safe Practice 18 Pharmacist Leadership Structures and Systems Chapter 6: Improving Patient Safety Through Medication Management

  8. Harmonization – The Quality Choir

  9. The Patient – Our Conductor

  10. The Objective Pharmacist Leadership Structures and Systems • Pharmacy leadership is the core of a successful medication safety program. Pharmacy leadership structures and systems ensure a multidisciplinary focus and a streamlined operational approach to achieve organization-wide safe medication use.

  11. The Problem Safe Practice 18 Pharmacist Leadership Structures and Systems Chapter 6: Improving Patient Safety Through Medication Management

  12. The Problem

  13. [http://www.cnn.com/2008/HEALTH/07/10/heparin/]

  14. The Problem Frequency • Adverse drug events, or ADEs, are the most frequently cited significant cause of injury and death among hospital patients • 40% of Americans take prescription drugs • 16% take three or more prescriptions • One study showed that 10.4% of patients experience an ADE [Bedell, Arch Intern Med 2000 Jul 24;160(14):2129-34; Bates, Saving Money: The Imperative for Computerized Physician Order Entry in Massachusetts, 2008]

  15. The Problem Severity • Mortality rate of 1.0% to 2.45% attributed to ADEs • ADEs contribute to: • 2.5% of emergency department visits for unintentional injuries • 0.6% of all medical visits • 22% of hospitalizations have been attributed to patient medication non-adherence [Bates, JAMA 1995 Jul 5;274(1):29-34; Classen, JAMA 1997 Jan 22-29; 277(4):301-6; Stagnitti, Statistical Brief #21: Trends in Outpatient Prescription Drug Utilization and Expenditures: 1997-2000, 2003; Budnitz, JAMA 2006 Oct 18;296(15):1858-66; Levinson, ADEs in hospitals: overview of key issues, 2008 Dec]

  16. The Problem Preventability • 1.5 million preventable ADEs occur each year in the United States • Implementing computerized monitoring systems can greatly reduce medication errors • Pharmacist review of medication orders may decrease preventable ADEs [Agency for Healthcare Research and Quality, A Critical Analysis of Patient Safety Practices: AHRQ Publication No. 01-E058, 2001; Nester, Am J Health Syst Pharm 2002 Nov 15;59(22):2221-5; Slee, Pharm J 2002 Mar 30;268(7191):437-8; Gleason, Am J Health Syst Pharm 2004 Aug 15;61(16):1689-95; Aspden, Preventing Medication Errors: Quality Chasm Series, 2007; Denham, J Patient Saf 2008 Dec;4(4):253-60]

  17. The Problem Cost Impact • ADEs account for $3.5 billion (2006 dollars) of additional costs • Average cost of ADE is $2K-$7K • National drug expenditures in 2005 were $200.7 billion and expected to grow at double-digit rates [Bates, JAMA 1997 Jan 2229;277(4):307-11; Senst, Am J Health Syst Pharm 2001 Jun 15;58(12):1126-32; Kaiser, Prescription Drug Trends, 2007]

  18. Practice Specifications Safe Practice 18 Pharmacist Leadership Structures and Systems Chapter 6: Improving Patient Safety Through Medication Management

  19. Safe Practice Statement Pharmacist Leadership Structures and Systems • Pharmacy leaders should have an active role on the administrative leadership team that reflects their authority and accountability for medication management systems performance across the organization.

  20. Additional Specifications

  21. Additional Specifications Leadership and Culture Safety • Pharmacy leaders should engage in regular, direct communication with administrative leaders • Pharmacists should actively participate in medication management processes, structures, and systems [American Society of Health-System Pharmacists, 2015 ASHP Health-System Pharmacy Initiative, 2003; National Quality Forum, National Voluntary Consensus Standards for the Reporting of Therapeutic Drug Management Quality, 2006]

  22. Additional Specifications Selection and Procurement • Pharmacists work with physicians to select and maintain a formulary of medications chosen for safety, effectiveness, and cost • Medication selection should be informed by the best scientific evidence and clinical guidelines • Pharmacists are actively involved in the development and implementation of evidence-based drug therapy protocols [Pederson, Am J Health Syst Pharm 2001 Dec 1;58(23):2251-66; American Society of Health-System Pharmacists, 2015 ASHP Health-System Pharmacy Initiative, 2003; National Quality Forum, National Voluntary Consensus Standards for the Reporting of Therapeutic Drug Management Quality, 2006; Am J Health Syst Pharm 2007 May 15;64(10 Suppl 6):S15-20; quiz S21-3; Pederson, Am J Health Syst Pharm 2008 May 1;65(9):827-43]

  23. Additional Specifications Storage • Identify and review a list of look-alike/sound-alike drugs used in the organization, and take action to prevent errors involving the interchange of these drugs • Ensure that the written medication storage policy is implemented • Certify that all medications are available in unit-dose (single unit), age- and/or weight-appropriate, and ready-to-administer forms [Rich, Am J Health Syst Pharm 2004 Jul 1;61(13):1349-58; AHA, Hosp Health Netw 2005 Oct;79(10):57-8; McCoy, Jt Comm J Qual Patient Saf 2005 Jan;31(1):47-53; Joint Commission Resources, 2010 Comprehensive Accreditation Manual: CAMH for Hospitals: The Official Handbook, 2010]

  24. Additional Specifications Ordering and Transcribing • Ensure with the healthcare team that only the medications needed to treat the patient’s condition are ordered, provided, and administered [The Joint Commission, Preventing pediatric medication errors, Sentinel Event Alert, 2008; Gardner, Jt Comm J Qual Patient Saf 2009 May;35(5):278-82]

  25. Additional Specifications Preparing and Dispensing • Pharmacists should review all medication orders and the patient medication profile for appropriateness and completeness • Pharmacists should oversee the preparation of medications • Medications should be labeled in a standardized manner [Kastango, Am J Health Syst Pharm 2005 Jun 15;62(12):1271-88; Jennings, AORN J 2007 Oct;86(4):618-25; Shrank, Arch Intern Med 2007 Sep 10;167(16):1760-5; Institute for Safe Medication Practices, ISMP's List of High-Alert Medications, 2008; Momtaha, Healthc Q 2008;11(3 Spec No.):122-8; Westerlund, J Clin Pharm Ther 2009 Jun;34(3):319-27; Joint Commission Resources, 2010 Comprehensive Accreditation Manual: CAMH for Hospitals: The Official Handbook, 2010]

  26. Additional Specifications Preparing and Dispensing Cont’d • Every unit-dose package label should contain a machine-readable code identifying the product name, strength, and manufacturer • Ensure that a pharmacist is available on-site or by telephone 24 hours a day [Woodall, Jt Comm J Qual Saf 2004 Aug;30(8):442-7; Department of Veteran Affairs, Quality directive for unit-dose packaging and barcode labeling, 2006; Pederson, Am J Health Syst Pharm 2008 May 1;65(9):827-43; ASHP, Am J Health Syst Pharm 2009 Mar 15;66(6):588-90; Joint Commission Resources, 2010 Comprehensive Accreditation Manual: CAMH for Hospitals: The Official Handbook, 2010]

  27. Additional Specifications Medication Administration • Organizations should prepare for the use of medication administration technologies • The five rights for medication administration do not address all pertinent organizational systems, human factors performance, and human-technology interface issues • Practitioner’s duty is to follow the procedural rules designed by the organization to produce optimal outcomes [Bechtel, J Nurs Care Qual 1993 Apr;7(3):28-34; Cohen, Effective approaches to standardization and implementation of smart pump technology: a continuing education program for pharmacists and nurses, 2007; Fanikos, Am J Cardiol 2007 Apr 1;99(7):1002-5; Institute for Safe Medication Practices, The Five Rights: A Destination Without a Map, 2007; Paoletti, Am J Health Syst Pharm 2007 Mar 1;64(5):536-43]

  28. Additional Specifications Monitoring • Pharmacists should monitor patient medication therapy regularly, based on patient needs and best evidence, for effectiveness, adherence, persistence, and avoidance of adverse events • Medication errors and near-miss internal reports should be shared with organizational safety, risk, and senior leadership through the pharmacy leader [Cohen, BMJ 2000 Mar 18;320(7237):728-9; Bond, Pharmacotherapy 2006 Jun;26(6):735-47; Bond, Pharmacotherapy 2007 Apr;27(4):481-93; Lehmann, Jt Comm J Qual Patient Saf 2007 Jul;33(7):401-7; Montesi, Br J Clin Pharmacol 2009 Jun;67(6):651-5]

  29. Additional Specifications Monitoring Cont’d • Medication error and near-miss information is reported through external sources • Proactive risk mitigation strategies should be demonstrated to prevent errors in the organization [Cohen, BMJ 2000 Mar 18;320(7237):728-9; MCPME, When Things Go Wrong: Responding to Adverse Events, 2006; Institute for Safe Medication Practices, Quarterly Action Agenda: Free CE for nurses, 2009]

  30. Additional Specifications High-Alert Medications • Identify high-alert medications within the organization • Implement institutional processes for high-alert medications, such as: • procuring • storing • ordering • transcribing • preparing • dispensing [Cohen, Nursing 2007 Sep;37(9):49-55; quiz 1 p following 55; Federico, Jt Comm J Qual Patient Saf 2007 Sep;33(9):537-42; Institute for Safe Medication Practices, ISMP's List of High-Alert Medications, 2008; Joint Commission Resources, 2010 Comprehensive Accreditation Manual: CAMH for Hospitals, 2010]

  31. Additional Specifications Evaluation • Perform medication safety self-assessments to identify organizational structure, system, and communication opportunities to target harm reduction • Evaluate the ability of the patient to understand and adhere to medication regimens when in the community setting [Institute for Safe Medication Practices, ISMP Medication Errors Reporting Program (MERP), N.D.; Smetzer, Jt Comm J Qual Saf 2003 Nov;29(11):586-97; National Quality Forum, National Voluntary Consensus Standards for the Reporting of Therapeutic Drug Management Quality, 2006; Davis, Ann Intern Med 2006 Dec 19;145(12):887-94; Davis, J Gen Intern Med 2006 Aug;21(8):847-51; Joint Commission Resources, 2010 Comprehensive Accreditation Manual: CAMH for Hospitals: The Official Handbook, 2010]

  32. Example Implementation Approaches Safe Practice 18 Pharmacist Leadership Structures and Systems Chapter 6: Improving Patient Safety Through Medication Management

  33. Example Implementation Approaches

  34. Example Implementation Approaches • Seek pharmacists with experience, expertise, and training in management and clinical services to lead and oversee clinical pharmacy operations • Ensure that pharmacy director or leader regularly represents the pharmacy at senior leadership • Enable pharmacy staff collaboration with medical, nursing, and direct workforce staff in clinical areas to optimize knowledge transfer • Prepare patient-specific doses by the pharmacy to eliminate final preparation of the dose by nurses [Garrelts, Am J Health Syst Pharm 2001 Dec 1;58(23):2267-72]

  35. Example Implementation Approaches • Provide resources to pharmacists in order to: • maintain awareness of safe practices literature • provide the opportunity to attend professional conferences • Require pharmacists to complete credentialing consistent with their scope of practice • Encourage professional development, and implement a reward system for those pharmacists who seek further education

  36. Example Implementation Approaches • Provide resources to ensure sufficient space and equipment allocated for pharmacy activities • Supply an organized, well-lit workspace to decrease errors and distractions • Grant organizational training programs that include extensive education about patient populations with special needs and treatment considerations [Flynn, Am J Health Syst Pharm 1999 Jul 1;56(13):1319-25; Kaushal, JAMA 2001 Apr 25;285(16):2114-20; Simmons, Crit Care Nurs Q 2009 Apr-Jun;32(2):71-4; quiz 75-6]

  37. Example Implementation Approaches Strategies of Progressive Organizations • Create a Chief Pharmacy Officer post as a senior administrative position • Develop 24/7/365 pharmacist coverage • Establish conflict resolution guidelines for when questions arise about medication orders • Implement real-time electronic alert triggers for potential ADEs [Young, Am J Health Syst Pharm 2001 Dec 15;58(24):2362, 2365; Clifton, Am J Health Syst Pharm 2003 Dec 15;60(24):2577-82; Ivey, Am J Health Syst Pharm 2005 May 1;62(9):975-8; Humphries, Ann Pharmacother 2007 Dec;41(12):1979-85; Paré, J Am Med Inform Assoc 2007 May-Jun;14(3):269-77; Institute for Safe Medication Practices, Resolving human conflicts when questions about the safety of medical orders arise, 2008; Stratton, Am J Health Syst Pharm 2008 Sep 15;65(18):1727-34]

  38. Example Implementation Approaches Strategies of Progressive Organizations Cont’d • Senior leadership enables pharmacist staffing levels to sustain pharmacy operations and improvement activities • Pharmacy interventions are documented and analyzed for organization-wide improvement • Pharmacy models where pharmacists are best able to promote safe use of medications [Nesbit, Am J Health Syst Pharm 2001 May 1;58(9):784-90; Bond, Pharmacotherapy 2002 Feb;22(2):134-47; Kopp, Am J Health Syst Pharm 2007 Dec 1;64(23):2483-7; Lyons, Am J Health Syst Pharm 2007 Jul 15;64(14):1467-8; Malone, Med Care 2007 May;45(5):456-62; ASHP PITEComm, Am J Health Syst Pharm 2009 Sep 1;66(17):1573-7; Abramowitz, Am J Health Syst Pharm 2009 Aug 15;66(16):1437-46]

  39. Example Implementation Approaches Strategies of Progressive Organizations Cont’d • Continually reevaluate and redesign medication-use systems to improve error-prone steps through technology • Utilize pharmacy technicians to improve efficiency • High-performing organizations understand that: • Execution is integral to strategy • Leaders must be engaged • Leaders have a direct impact on employees [Bossidy, Execution: The Discipline of Getting Things Done, 2002; Desselle, Am J Health Syst Pharm 2005 Oct 1;62(19):1992-7; Desselle, J Am Pharm Assoc (2003) 2005 Jul-Aug;45(4):458-65; Covey, The SPEED of Trust: The One Thing That Changes Everything, 2006; Gladwell, Outliers: The Story of Success, 2008; Neuenschwander, Improving medication safety in health systems through innovations in automation technology. Proceedings of educational symposia and educational sessions, 2009]

  40. Front-line Success Stories Safe Practice 18 Pharmacist Leadership Structures and Systems Chapter 6: Improving Patient Safety Through Medication Management

  41. Title of Video Insert Video this size

  42. The 3 Ts of Leadership Engagement: Truth, Trust, and Teamwork Charles Denham

  43. TMIT High Performer Webinar Leadership Lessons for Pharmacy, Nursing, and Hospital Leaders • TMIT is launching a Leadership Collaborative with heavy focus on Pharmacy, Nursing, and Hospital Leadership Development. • Bill George, one of our nation’s greatest business leaders, will address critical lessons that such leaders can apply from his soon-to-be-released book. • Go to: http://www.safetyleaders.org/pages/idPage.jsp?ID=4945

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