Improving the Patient Experience Through Pharmacy

Transcription

1 Rick Burnett Chief Operating Officer Kenneth Maxik Director, Patient Safety & Pharmacy Compliance Improving the Patient Experience Through Pharmacy August 19, 2015

2 Speakers Rick Burnett, PharmD, FACHE Chief Operating Officer Kenneth Maxik, MBB, MBA, FACHE Director, Patient Safety & Pharmacy Compliance

3 Today's Objectives 1. How pharmacy impacts the patient experience 2. Key patient safety and pharmacy compliance techniques 3. Evidence for creating a medication safety program 4. Impact of CMS proposed changes

4 Poll Question Which best describes who Pharmacy reports to at your facility?

5 Evolving Healthcare Delivery System Past Current Treating sickness Inpatient care Silos Fee per service Dispensing Wellness Ambulatory care Integrated Team Value?

6 Pharmacy Touches Everything Select/ Prescribe Dispense Administer Procure/ Store Outcomes Monitor

7 Dispense Human Resources Information Technology Finance Environmental Services Bio-engineering

8 Administer Nursing Anesthesia Respiratory Therapy

9 Monitor Laboratory Microbiology Nursing

10 Outcomes

11 Procure/Store Proper Storage & Security Materials Management Facilities Management

12 Select/Prescribe Medical Staff Formulary Medication Protocols

13 Pharmacy Touches Everything Select/ Prescribe Medical Staff Procure/ Store Materials Management Facilities Management Dispense Human Resources Information Technology Finance Environmental Services Bio-engineering Outcomes Quality Assurance Risk Management Administer Nursing Anesthesia Respiratory Therapy Monitor Laboratory Microbiology

14 PATIENT Pre-Admission Admitting Patient Stay Discharge Planning Post Discharge Pharmacy touches the entire patient experience

15 There are approximately 7,000 deaths annually associated with medication errors. If two out of 100 admissions have a medication error, the cost to the system is $2 billion annually.

16 Sterile The Case Compounding For Medication Safety

17 The Case for Sterile Compounding

18 CMS Conditions of Participation The regulations at (c) and (c)(1) promote safety in the preparation and administration of drugs and biologicals to hospital patients by requiring preparation and administration in accordance with: Federal and State law Accepted standards of practice (Rev. 137, )

19 High Reliability Organizations

20 Poll Question How confident are you that your medication error reporting system is capturing all reportable events?

21 How Good Are We Measuring? Voluntary Reporting System Reported Events 50 per Month 28 Average number of errors per day Observation and Chart Review Single Unit (CCU) 0.86 errors per Patient Day

22 How Good Are We Measuring? Assessment Agreement Date of study: April 2010 Reported by: Name of product: Phy sician Order Rev iew Misc: Within Appraisers Appraiser vs Standard % C I Percent % C I Percent Percent 60 Percent Appraiser Appraiser 5

23 Taxonomy of Medication Errors Suppliers Inputs Medication Management Process Outputs Customer Patient GPO Wholesaler Direct Purchase Medical Staff Medications Disease State Drug Information Contract Pricing Five Rights Regulatory documentation QA Information Patient Medical Staff Regulatory Agency Procure/ Store Select/ Prescribe Ordering and Transcribing Preparing and Dispensing Administration Monitoring and Evaluation

24 Risk Mitigation Strategy Medication Name/Class Selection & Procurement Process Select medications based on the dependability and reliability of the manufacturer Address the potential for adverse medication events when medications are frequently changed Consider whether product is labeled correctly Develop policies and processes for handling drug outages Storage Physically separate look-alike/sound-alike medications Build in system alerts and use warning labels regarding problematic drug names, packaging, and labeling Consider labeling medications with both the generic and brand name Handle boxes that contain chemotherapy agents with chemotherapy-protective gloves; store in negative pressure room Develop policies and procedures for inspecting all storage areas

25 Assessment At-Risk Identification Performance Criteria Behavior Identified Patient Information A. Preparing more than one patient s medications/more than one medication at one time B. Not checking patient identification using two identifiers (e.g., name, medical record number, birth date) C. Using an estimated patient weight compared to an actual weight D. Prescribing/dispensing/administering medications without checking patients laboratory values and vital signs E. Not checking a patient s allergies before prescribing/dispensing/administering medications F. Not waking the patient for assessments/medications G. Not viewing/checking the patient s complete medication profile (or medication administration record [MAR]) prior to prescribing/dispensing/administering medications

26 Sterile Compounding Who Compounds? Training and Competency Environmental Control

27 Traditional Skill Requirements SUPPLY CHAIN P&L MANAGEMENT STAFF SUPERVISION Current Skill Requirements PATIENT SAFETY EMAR ISMP STANDARDS ACCOUNTABILITY AND EXECUTION CPOE STRATEGIC PLANNING P&L MANAGEMENT LEADERSHIP PERSONNEL DEVELOPMENT INFORMATION TECHNOLOGY SMART PUMPS REVENUE CYCLE CDM MANAGEMENT PATIENT ASSISTANCE PROGRAM MGMT REGULATORY AND ACCREDITATION FORMULARY MANAGEMENT QUALITY IMPROVEMENT REGULATORY AND ACCREDITATION USP SUPPLY CHAIN 340B HCAHPS FORMULARY MANAGEMENT CLINICAL BIOSIMILARS MED THERAPY MGMT RETAIL PHARMACY QUALITY IMPROVEMENT

28 Pharmacy: A Powerful Piece of the Patient Experience Patient Hospital R x Quality of Care Patient Safety Medication Safety Wellness Patient Satisfaction Education Risk Management Cost HCAHPS VBP Reimbursement Readmissions

29 Questions?