Rick Burnett Chief Operating Officer Kenneth Maxik Director, Patient Safety & Pharmacy Compliance Improving the Patient Experience Through Pharmacy August 19, 2015
Speakers Rick Burnett, PharmD, FACHE Chief Operating Officer Kenneth Maxik, MBB, MBA, FACHE Director, Patient Safety & Pharmacy Compliance
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
Poll Question Which best describes who Pharmacy reports to at your facility?
Evolving Healthcare Delivery System Past Current Treating sickness Inpatient care Silos Fee per service Dispensing Wellness Ambulatory care Integrated Team Value?
Pharmacy Touches Everything Select/ Prescribe Dispense Administer Procure/ Store Outcomes Monitor
Dispense Human Resources Information Technology Finance Environmental Services Bio-engineering
Administer Nursing Anesthesia Respiratory Therapy
Monitor Laboratory Microbiology Nursing
Outcomes
Procure/Store Proper Storage & Security Materials Management Facilities Management
Select/Prescribe Medical Staff Formulary Medication Protocols
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
PATIENT Pre-Admission Admitting Patient Stay Discharge Planning Post Discharge Pharmacy touches the entire patient experience
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.
Sterile The Case Compounding For Medication Safety
The Case for Sterile Compounding
CMS Conditions of Participation The regulations at 482.23(c) and 482.23(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, 04-01-15)
High Reliability Organizations
Poll Question How confident are you that your medication error reporting system is capturing all reportable events?
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
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 100 95.0% C I Percent 100 95.0% C I Percent 80 80 Percent 60 Percent 60 40 40 20 20 1 2 3 4 Appraiser 5 1 2 3 4 Appraiser 5
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
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
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
Sterile Compounding Who Compounds? Training and Competency Environmental Control
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 797-800 SUPPLY CHAIN 340B HCAHPS FORMULARY MANAGEMENT CLINICAL BIOSIMILARS MED THERAPY MGMT RETAIL PHARMACY QUALITY IMPROVEMENT
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
Questions? Knowledgeseries@completerx.com www.completerx.com