slide1 n.
Download
Skip this Video
Download Presentation
Craig A. Pedersen, R.Ph., Ph.D., FAPhA Associate Professor

Loading in 2 Seconds...

play fullscreen
1 / 47

Craig A. Pedersen, R.Ph., Ph.D., FAPhA Associate Professor - PowerPoint PPT Presentation


  • 106 Views
  • Uploaded on

Comparing Pharmacy Practice in VA Hospitals to General Medical-Surgical Hospitals: Results from the 2004-2006 ASHP National Hospital Pharmacy Surveys. Craig A. Pedersen, R.Ph., Ph.D., FAPhA Associate Professor The Ohio State University College of Pharmacy 614.292.3011 Pedersen.18@osu.edu.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Craig A. Pedersen, R.Ph., Ph.D., FAPhA Associate Professor' - lisandra-bradford


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

Comparing Pharmacy Practice in VA Hospitals to General Medical-Surgical Hospitals: Results from the 2004-2006 ASHP National Hospital Pharmacy Surveys

Craig A. Pedersen, R.Ph., Ph.D., FAPhA

Associate Professor

The Ohio State University College of Pharmacy

614.292.3011

Pedersen.18@osu.edu

acknowledgements
Acknowledgements
  • William Jones, M.S., R.Ph. (Southwest CMOP)
  • ASHP
  • Philip J. Schneider, M.S., FASHP (OSU)
  • Douglas J. Scheckelhoff, M.S., FASHP (ASHP)
  • Elizabeth H. Chang (OSU)
  • Virginia S. Torrise, Pharm.D. (Dept of VA)
  • Merck & Co, Inc. for funding of the survey
history of the ashp national survey
History of the ASHP National Survey
  • ASHP has a long and distinguished history of support for examining hospital pharmacy practice
  • First examination by Don Francke and Clifton Latiolais, “Mirror to Hospital Pharmacy” published in 1964
    • Study took 8 years to complete (1956-1963)
    • Objective: “to determine what constitutes good pharmacy services for patients in hospitals and to study methods of improving the quality and expanding the scope of these services in the interest of better patient care”
history of the ashp national survey1
History of the ASHP National Survey
  • That vision has remained throughout the years
  • ASHP continued to biannually surveyed hospital practice from mid-1970s through 1996
  • Beginning in 1998 survey redesigned to capture the role pharmacists play in managing and improving the six steps of the medication-use process:
    • Year 1: Prescribing and Transcribing
    • Year 2: Dispensing and Administration
    • Year 3: Monitoring and Patient Education
the swiss cheese model weaknesses in the medication use system
The “Swiss Cheese” Model: Weaknesses in the Medication Use System

Reason, J. BMJ. 2000;320:768-770.

what does the va inpatient medication use system look like
What does the VA Inpatient Medication Use System Look Like?
  • VA hospitals are widely thought the lead the way in pharmacy practice
    • Technology (BCMA, CPOE, eMAR)
    • Pharmacists’ roles and responsibilities in ambulatory care (Knapp 2005)
  • Last examination was from 1993 (Crawford)
  • No broad-based comparison data exist

Knapp KK, Okamoto MP, Black BL. ASHP survey of ambulatory care pharmacy practice in health systems – 2004. Am J Hosp Pharm. 2005;62: 274-84.

Crawford SY, Santell JP. ASHP national survey of pharmaceutical services in federal hospitals – 1993. Am J Hosp Pharm. 1994;51:2377-93.

objective
Objective
  • To compare the pharmacy practice between Veterans Affairs hospitals, and general and children’s medical-surgical hospitals.
    • 6 steps in the medication-use process
    • Technology
  • 2004-2006 surveys
caveats
Caveats
  • Results are from pharmacy director responses to survey questions
  • Respondents may be different from non-respondents (response rates were low for VA hospitals)
  • Your feedback on the results is critical
  • Don’t shoot the messenger!
prescribing and transcribing

Prescribing and Transcribing

2004 ASHP National Survey

transcribing
Transcribing
  • Without CPOE / eMAR (Gen-med-surg hospitals)
    • Standard physician order forms
    • Any illegible order is clarified before transcription / entry onto MARs
    • Reconcile MARs and pharmacy patient profiles daily
    • Special transcribing procedures are used for high-risk medications
    • If computerized prescriber order entry (CPOE) not available, physicians must print / type all medication orders
    • Countersign verbal orders
  • Read back all verbal orders (including spelling the drug name, dose, dosage form, and name of patient)
    • VA = 81.6% , GenMedSurg=81.9%, 400+=94.2%
dispensing and administration

Dispensing and Administration

2005 ASHP National Survey

ways to build safety into drug preparation and dispensing
Ways to Build Safety Into Drug Preparation and Dispensing
  • Using true “unit dose” (93% orals*, 65% injectables)
    • No manipulations at the bedside
    • No “note strength” labels
  • Two pharmacist check before dispensing high-risk drug therapies, e.g. chemo (67%)*
  • TPN
    • Large volume base compounder (37%)
    • Additive compounder (19%)
pharmacists review of orders in the traditional black holes of the hospital
Pharmacists Review of Orders in the Traditional “Black Holes” of the Hospital

Better than others, but opportunity exists here

system failures and interceptions
System Failures and Interceptions

39% 12% 11% 38%

System Failures (Where errors occur)

48% 33% 34% 2%

Interceptions of Potential ADE’s

(How often errors are detected)

Prescribing

Transcribing

Dispensing

Administration

Source: Leape et al. JAMA. 1995;274:35-43

smart infusion pumps
Smart Infusion Pumps
  • IV errors have greatest opportunity for adverse events
  • Nurses value assistance with calculations
  • Extensive library (65%*less)
    • Library composition
  • Used throughout the hospital (88%)
  • Drug library automatically on
  • Avoid rate-set-go
monitoring and patient education

Monitoring and Patient Education

2006 ASHP National Survey

pharmacists spend more time monitoring and monitor more patients in va s
Pharmacists Spend More Time Monitoring and Monitor More Patients in VA’s
  • Greater proportion of pharmacist time spent in medication therapy monitoring activities
    • 30% or more of time
      • 49% VA : 24% Gen-med-surg : 35% 400+
  • Greater proportion of patients monitored by pharmacists
    • 75% or more of patients
      • 35% VA : 24% Gen-med-surg : 28% 400+
  • Mechanisms implemented to improve medication therapy monitoring (top 2)
    • VA: 61% report increased hiring of clinical staff, and 43% report marketing impact of clinical pharmacy services
    • Gen-Med-Surg: 46% report expanding technicians responsibilities, and 45% increasing access to patient-data
pharmacist authority to manage medication therapy
Pharmacist Authority to Manage Medication Therapy
  • Monitor Medication Levels (88%)
  • Order Serum Medication Level (74%)
  • Adjust Dosages (67%)
  • Notification when Levels are Outside Therapeutic Range
    • 63% VA
    • ~45% Gen-med-surg and 400+
  • Pharmacists document in medical record
    • 95% VA
    • ~65% Gen-med-surg and 400+
more patients receive medication education by pharmacists
More Patients Receive Medication Education by Pharmacists
  • More than 25% of patients at discharge
    • 71% of VA hospitals
    • <10% of gen-med-surg and 400+
  • More than 25% of patients during inpatient stay
    • 40% of VA hospitals
    • <10% of gen-med-surg and 400+
summary
Summary
  • VA has adopted technology at a much higher rate
  • Technology appears to be a strategic focus of the organization
  • P&T and formulary process is more active (e.g., CPG’s) because local/regional/national all take on some aspects of drug policy and evaluation
  • Philosophy of drug distribution is of more centralization, a robot, patient specific medications, and ADC’s in procedure areas and not the whole hospital
summary1
Summary
  • VA has more QI activities associated with medication preparation and dispensing activities
  • There is increased control of medication use
  • Better use of MAR because of eMAR
  • More time on medication therapy monitoring and more patients monitored
  • Monitoring is baked in the cake
summary2
Summary
  • ADE monitoring and reporting occurs much more frequently through pharmacist contact with patients and rounding with physicians
  • Share more ADE reports externally to learn and not make mistake again
  • Centralized VA control over system has led to rapid advancements and faster adoption than highly fragmented systems
summary3
Summary
  • Patient teaching is much more prevalent
  • More patients are counseled, more documentation, more routine education of patient on high-risk medications
  • More physician collaboration through pharmacist consultations
  • Opportunities exist to get even better!
where are the opportunities for va pharmacy
Where are the Opportunities for VA Pharmacy?
  • Biggest gaps: Self assessment
  • Speed to impact: What can you do by next Tuesday?
  • Magnitude of impact: What errors are most common?
  • External factors: TJC, USP, National VA initiatives
  • Local factors: Politics, need, resources
  • Change requires: Leadership, infrastructure, competence, and will
the swiss cheese model weaknesses in the medication use system1
The “Swiss Cheese” Model: Weaknesses in the Medication Use System

Reason, J. BMJ. 2000;320:768-770.

2004 2006 surveys
2004-2006 Surveys
  • Pedersen CA, Schneider PJ, Scheckelhoff DJ. “ASHP National Survey of Pharmacy Practice in Hospital Settings: Prescribing and Ttranscribing—2004.” American Journal of Health-System Pharmacy 2005; 62:378-90.
  • Pedersen CA, Schneider PJ, Scheckelhoff DJ. "ASHP National Survey of Pharmacy Practice in Hospital Settings: Dispensing and Administration—2005." American Journal of Health-System Pharmacy 2006; 63:327-45.
  • Pedersen CA, Schneider PJ, Scheckelhoff DJ. "ASHP National Survey of Pharmacy Practice in Hospital Settings: Monitoring and Patient Education—2006." American Journal of Health-System Pharmacy 2007; 64:507-20.
slide47

Comparing Pharmacy Practice in VA Hospitals to General Medical-Surgical Hospitals: Results from the 2004-2006 ASHP National Hospital Pharmacy Surveys

Craig A. Pedersen, R.Ph., Ph.D., FAPhA

Associate Professor

The Ohio State University College of Pharmacy

614.292.3011

Pedersen.18@osu.edu