Operation powerpoint 8- Quality and Risk Management – Flashcards
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What Is Quality?
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â¢Represents a "degree or grade of excellence" â¢Increases the probability of positive outcomes â¢Decreases the probability of negative outcomes â¢Corresponds with current medical knowledge â¢May offer the patient what he or she wants â¢Provides the patient with what he or she needs
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Quality measures: -Structure -Process -Outcomes
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Structure Quality Measures â¢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 â¢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 â¢Question asked: "How" -Examines the steps in providing quality care -Many include professional guidelines and practice standards â¢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 â¢Question asked: "Results?" -Did the service achieve its intended goal(s)? -May include: â¢Clinical measures -Efficacy, safety â¢Humanistic -Quality of life , patient satisfaction â¢Economic -Medical and non-medical direct and indirect costs and intangible costs â¢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
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Quality Assurance (QA):
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-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: â¢A standard procedure for preparing a sterile IV product â¢A procedure for checking a prescription before it is dispensed to a patient
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Quality Control (QC):
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-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: â¢Pharmacist check of a medication cart before delivery â¢Bar-coding a medication before administration to a patient â¢Sterility testing of an IV product before delivery to a patient
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Continuous Quality Improvement (CQI):
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-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
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CQI Measurement Cycle
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Background: Focus Selection Focus Description Focus Importance Literature Review Goals Methods: Intervention Process & Outcomes Measured Data-Collection Procedure Data-Analysis Plan Results: â¢Data collection -What data should be collected? â¢Analyze the data -Utilize descriptive statistics -Charts , graphs -Look for patterns and trends -Compare to baseline data Conclusions & Recommendations â¢Generate possible conclusions from the data collected and analyzed â¢Implications of the results collected â¢Make recommendations for additional study and/or solutions â¢Cycle starts again
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Benchmarking
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â¢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)
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CAHPS (patient satisfaction)Consumer Assessment of Healthcare Providers & Systems
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â¢An on-going assessment of consumers' experiences with healthcare â¢Developed by the Agency for Healthcare Research & Quality (AHRQ) in 1995 â¢Provides comparative information on healthcare providers in various ambulatory and institutional settings â¢Publically reported data â¢Financial implications â¢Hospital Value-Based Purchasing (VBP) -Pay for performance -Take from lower performing hospitals and give to higher performing hospitals
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HCAHPS
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â¢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 â¢Survey 48 hours to 42 days post discharge via telephone or mail -Survey vendors or self-administering -8400 patients complete the survey daily
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HCAHPS Content: Composites
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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
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The EQuIPPTM Initiative
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â¢Originated through collaboration of Highmark BC/BS & Rite-Aid Pharmacy â¢Data on the Part D performance measures from community pharmacies â¢Star ratings for community pharmacies â¢Provided to pharmacies and health plans â¢Pharmacists can compare their practice to similar ones
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What is Risk?
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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)
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Criteria for Insurable Risks
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â¢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
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The Risk Management Process
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Step 1: Establish the Context â¢What are the potential vulnerabilities of the pharmacy? â¢Do employees or patients risk injuries? â¢How might the reputation of the pharmacy be affected by someone being injured? â¢Could costly claims be avoided by not providing goods or services? Step 2: Identify and Analyze â¢Non-criminal risks -Fire, tornadoes, floods, economic recessions, death, injury, etc. -Natural disasters will depend on geographic location â¢Criminal risks -Burglaries, robberies, shoplifters, computer hackers, embezzlement, etc. â¢Pharmacy practice risks -Malpractice, privacy breaches, sterile products, improper record keeping, inadequate patient counseling, etc. Step 3: Evaluate and Prioritize â¢Not every risk can be addressed at the same time â¢Not all risks are equal â¢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 â¢Possible techniques include: 1.Risk elimination/avoidance 2.Risk transfer 3.Risk reduction 4.Risk absorption â¢Each technique has an associated cost â¢The two surest ways to control risk is to eliminate or avoid it Step 5: Monitor Decisions â¢Plans implemented to manage risk are never perfect â¢Monitor and update risk management strategies as needed -Meet new challenges -Identify new threats -Employ new opportunities
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Risk Elimination/Avoidance
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â¢Elimination/Avoidance -Total removal of an identified risk â¢Ex. Not participating in sterile compounding -May not be practical for many of the risks a pharmacy faces
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Risk Transfer
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â¢Shifting the risk to another party â¢Two main ways to transfer risk: 1.Indemnification/hold harmless agreements â¢Independent contractors â¢Hiring an outside company for prescription delivery 2.Insurance â¢States the circumstances the policy will cover â¢States exclusions that will not be covered â¢No insurance company covers all risks
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Risk Reduction
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â¢Minimize the likelihood of a risk occurring â¢Implement policies and procedures to prevent and reduce pharmacy errors -Continuous quality improvement (CQI) programs -Analyze workflow â¢Utilize technology to reduce non-criminal and criminal risks -Sprinklers, security cameras, background checks
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Risk Absorption
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â¢Acceptance of a loss â¢Usually involves smaller risks with less cost: -Shoplifting -Employee theft -Product expiration â¢Costs may be passed onto consumers by charging higher prices for products
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Insurance for a Pharmacy
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â¢Property Insurance -Protects property and physical assets â¢Liability Insurance (Casualty Insurance) -Protects against customers suing for damage or injuries caused by negligence â¢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 â¢Key Person Insurance -Protects against financial loss if a key individual were to die, become disabled, or leave â¢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 â¢Fidelity and Surety Bonds -Protects the pharmacy from dishonest employees -Internal crimes: theft, embezzlement â¢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