Operation powerpoint 8- Quality and Risk Management – Flashcards

•Represents a "degree or grade of excellence" •Increases the probability of positive outcomes •Decreases the probability of negative outcomes •Corresponds with current medical knowledge •May offer the patient what he or she wants •Provides the patient with what he or she needs

Structure Quality Measures •Question asked: What? -What are the characteristics of the people, materials, environment that set the stage for quality patient care? -May include legal & regulatory requirements •Examples: -Pharmacy has a private patient counseling area -Required drug information references available -Pharmacy technicians are all certified -Sterile compounding area meets USP 797 standards Process Quality Measures •Question asked: "How" -Examines the steps in providing quality care -Many include professional guidelines and practice standards •Examples: -Staff wash their hands before compounding sterile products in the IV hood -INR is maintained in a range of 2-3 while receiving warfarin for treating an acute DVT -Every nursing home patient is evaluated upon admission to confirm he or she has received the influenzaeand pneumococcal vaccines and immunization is provided if needed Outcome Quality measures •Question asked: "Results?" -Did the service achieve its intended goal(s)? -May include: •Clinical measures -Efficacy, safety •Humanistic -Quality of life , patient satisfaction •Economic -Medical and non-medical direct and indirect costs and intangible costs •Examples: -Patient satisfaction at the 97th percentile -QOL measure rated high -Reduction in thromboembolic events -Reduction in costs of using IV antibiotics when patients were switched to oral therapy

-Improving & stabilizing processes to avoid or minimize problems leading to defect (error) -Objective is to prevent errorsin products and services -Everyone involved in the product or service is responsible -Examples: •A standard procedure for preparing a sterile IV product •A procedure for checking a prescription before it is dispensed to a patient

-a set of testing activities used to confirm the final product meets predetermined requirements and emphasizes blocking the release on defective products -Defect identification -Examples: •Pharmacist check of a medication cart before delivery •Bar-coding a medication before administration to a patient •Sterility testing of an IV product before delivery to a patient

-A philosophy of continual improvement of the processes associated with providing a product or service that meets or exceeds customer expectations -Ongoing repeated enhancements -Systems approach to quality -Multidisciplinary team approach -Not focused on correcting individual mistakes -Identifies the cause of the problem -Other terms: Total Quality Management (TQM) -Examples: Six Sigma

Background: Focus Selection Focus Description Focus Importance Literature Review Goals Methods: Intervention Process & Outcomes Measured Data-Collection Procedure Data-Analysis Plan Results: •Data collection -What data should be collected? •Analyze the data -Utilize descriptive statistics -Charts , graphs -Look for patterns and trends -Compare to baseline data Conclusions & Recommendations •Generate possible conclusions from the data collected and analyzed •Implications of the results collected •Make recommendations for additional study and/or solutions •Cycle starts again

•Process of measuring one's organization's products or service according to specified standards so as to compare it with a similar organization -Internal benchmarking (amongst stores in chain) -External benchmarking (similar organizations) -Functional benchmarking (other industries)

•An on-going assessment of consumers' experiences with healthcare •Developed by the Agency for Healthcare Research & Quality (AHRQ) in 1995 •Provides comparative information on healthcare providers in various ambulatory and institutional settings •Publically reported data •Financial implications •Hospital Value-Based Purchasing (VBP) -Pay for performance -Take from lower performing hospitals and give to higher performing hospitals

•Eligible Patients: -Adult (18+) -Medical, surgical, or maternity care -Overnight stay or longer -Alive at discharge -Excludes: hospice discharge, prisoner, foreign address, "no publicity" patients, patients discharged to nursing homes •Survey 48 hours to 42 days post discharge via telephone or mail -Survey vendors or self-administering -8400 patients complete the survey daily

1.Communication with nurses 2.Communication with doctors 3.Responsivenessof hospital staff 4.Pain Management 5.Communication about medications 6.Discharge information 7.Care transition 8.Cleaniness& Quietness of hospital 9.Overall rating of hospital

•Originated through collaboration of Highmark BC/BS & Rite-Aid Pharmacy •Data on the Part D performance measures from community pharmacies •Star ratings for community pharmacies •Provided to pharmacies and health plans •Pharmacists can compare their practice to similar ones

Risk -Anything that threatens the ability of a person or organization to accomplish its mission -A hazard will result in a negative outcome -Two basic types of risk: 1.Speculative Risk 2.Pure Risk (sometimes referred to as insurable risk)

•Pure risk must meet certain requirements to be insurable: 1.The loss must be measurable in dollars 2.The loss must have a defined time and place 3.The loss must be accidental 4.The probability of the event can be calculated in a population 5.The insured must have an insurable interest 6.The premium must be for a reasonable cost

Step 1: Establish the Context •What are the potential vulnerabilities of the pharmacy? •Do employees or patients risk injuries? •How might the reputation of the pharmacy be affected by someone being injured? •Could costly claims be avoided by not providing goods or services? Step 2: Identify and Analyze •Non-criminal risks -Fire, tornadoes, floods, economic recessions, death, injury, etc. -Natural disasters will depend on geographic location •Criminal risks -Burglaries, robberies, shoplifters, computer hackers, embezzlement, etc. •Pharmacy practice risks -Malpractice, privacy breaches, sterile products, improper record keeping, inadequate patient counseling, etc. Step 3: Evaluate and Prioritize •Not every risk can be addressed at the same time •Not all risks are equal •Each risk can be classified by frequency, severity, and time to probable impact -Some risks are common, but are not associated with a substantial loss -Other risks are less common, but result in a significant loss Step 4: Select a Technique •Possible techniques include: 1.Risk elimination/avoidance 2.Risk transfer 3.Risk reduction 4.Risk absorption •Each technique has an associated cost •The two surest ways to control risk is to eliminate or avoid it Step 5: Monitor Decisions •Plans implemented to manage risk are never perfect •Monitor and update risk management strategies as needed -Meet new challenges -Identify new threats -Employ new opportunities

•Elimination/Avoidance -Total removal of an identified risk •Ex. Not participating in sterile compounding -May not be practical for many of the risks a pharmacy faces

•Shifting the risk to another party •Two main ways to transfer risk: 1.Indemnification/hold harmless agreements •Independent contractors •Hiring an outside company for prescription delivery 2.Insurance •States the circumstances the policy will cover •States exclusions that will not be covered •No insurance company covers all risks

•Minimize the likelihood of a risk occurring •Implement policies and procedures to prevent and reduce pharmacy errors -Continuous quality improvement (CQI) programs -Analyze workflow •Utilize technology to reduce non-criminal and criminal risks -Sprinklers, security cameras, background checks

•Acceptance of a loss •Usually involves smaller risks with less cost: -Shoplifting -Employee theft -Product expiration •Costs may be passed onto consumers by charging higher prices for products

•Property Insurance -Protects property and physical assets •Liability Insurance (Casualty Insurance) -Protects against customers suing for damage or injuries caused by negligence •Individual Professional Liability Insurance -Protects the individual against claims, including negligence, in the course of professional duties -An addition to the insurance offered by the company -Malpractice insurance •Key Person Insurance -Protects against financial loss if a key individual were to die, become disabled, or leave •Worker's Compensation -Occupational Safety and Health Act (OSHA) regulations -Covers medical expenses, disability income, and death benefits to dependents of an employee whose accident, illness, or death is job related •Fidelity and Surety Bonds -Protects the pharmacy from dishonest employees -Internal crimes: theft, embezzlement •Business Interruptions -Covers losses from a disruption in business due to fire or other disasters -Property insurance only covers the physical damage, not losses from lack of business