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    Pharmacy CQI in Florida

    Uploaded by

    asgbalaji
    This document discusses approaches to improving patient safety in pharmacy practices through continuous quality improvement programs. It provides examples of quality-related events that should be recorded and reviewed, such as dispensing the wrong drug, strength, or dosage. The document also outlines components of an effective CQI program, such as having standard operating procedures, a CQI committee, and regularly reviewing quality records to improve practices. Finally, it notes that regulators inspect for evidence of a CQI program and aim to prevent errors by enabling improvement, rather than solely punishing mistakes.

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    Pharmacy CQI in Florida

    Uploaded by

    asgbalaji
    75 views21 pages
    This document discusses approaches to improving patient safety in pharmacy practices through continuous quality improvement programs. It provides examples of quality-related events that should be recorded and reviewed, such as dispensing the wrong drug, strength, or dosage. The document also outlines components of an effective CQI program, such as having standard operating procedures, a CQI committee, and regularly reviewing quality records to improve practices. Finally, it notes that regulators inspect for evidence of a CQI program and aim to prevent errors by enabling improvement, rather than solely punishing mistakes.

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    Brushwood 091203

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    This document discusses approaches to improving patient safety in pharmacy practices through continuous quality improvement programs. It provides examples of quality-related events that should be recorded and reviewed, such as dispensing the wrong drug, strength, or dosage. The document also outlines components of an effective CQI program, such as having standard operating procedures, a CQI committee, and regularly reviewing quality records to improve practices. Finally, it notes that regulators inspect for evidence of a CQI program and aim to prevent errors by enabling improvement, rather than solely punishing mistakes.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    75 views21 pages

    Pharmacy CQI in Florida

    Uploaded by

    asgbalaji
    This document discusses approaches to improving patient safety in pharmacy practices through continuous quality improvement programs. It provides examples of quality-related events that should be recorded and reviewed, such as dispensing the wrong drug, strength, or dosage. The document also outlines components of an effective CQI program, such as having standard operating procedures, a CQI committee, and regularly reviewing quality records to improve practices. Finally, it notes that regulators inspect for evidence of a CQI program and aim to prevent errors by enabling improvement, rather than solely punishing mistakes.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 21

    Is Knowledge Power?

    Developing An Infrastructure That


    Enhances Patient Safety
    Pharmacy CQI In Florida
    David B. Brushwood, R.Ph., J.D.
    Professor of Pharmacy Health Care
    Administration
    The University of Florida
    College of Pharmacy

    Who says the system is broken?

    The media
    Television programs
    Magazines
    Newspapers

    State regulators
    The courts
    The IOM Report
    But
    No pharmacist wants to make a mistake
    No pharmacy manager wants pharmacists to
    make a mistake
    Maybe the system just needs to be organized better.

    Harco Drugs v. Holloway


    669 So.2d 878 (Ala. 1995).

    We note that the jury was also informed of 233 incident


    reports that had been prepared by Harco employees
    during the three years preceding the incident. This
    evidence, in addition to evidence of complaints filed
    with the State Board of Pharmacy and the evidence of
    lawsuits filed alleging misfilled prescriptions, was
    relevant to show Harcos knowledge of problems, and
    Harcos having failed to initiate sufficient
    institutional controls over the manner in which
    prescriptions were filled.

    Alternative Responses
    Do Nothing.
    Punishment.
    Advantages
    Practical Appeal.
    Political Appeal.
    Emotional Appeal.

    Disadvantages
    Ineffective
    Too little
    Too much

    Unreliable
    Unfair

    Centralized Data Reporting


    and Feedback
    Centralized QA Program
    Error Prevention Clinic
    Mandatory or Recommended
    CQI
    Regulating for Outcomes
    (Responsive Regulation) Brennan
    and Berwick, New Rules (1996).

    Ten (Possible) Approaches


    Continuous Quality
    Improvement Program
    Professional
    Performance Evaluation
    Consumer Surveys
    Criteria and Standards
    Localized Minimum
    Data Set

    Periodic Self Audit


    Centralized
    Performance Database
    Practice Accountability
    Audit
    Initial Licensure by
    Portfolio
    Relicensure by
    Portfolio

    Continuous Quality Improvement


    Identify and record
    failures of quality.
    Take a systems view.
    Involve all personnel.
    Learn from past and
    plan for improved
    future.
    Records available for
    inspection.

    CQI Program
    Significant
    42%

    Essential
    12%

    Useful
    40%

    Not
    Necessary
    6%

    Not Necessary
    Useful
    Significant
    Essential

    Consumer Surveys
    Conducted at least once per
    year.
    Pertinent Questions
    Is the pharmacist accessible?
    Can you read your
    prescription label?
    Is your drug therapy helping
    you get better?

    Evidence of completion
    available for inspection.

    Consumer Surveys
    Significant
    30%

    Essential
    5%

    Useful
    51%

    Not
    Necessary
    14%

    Not Necessary
    Useful
    Significant
    Essential

    Criteria and Standards


    Criterion: Predetermined
    elements with which
    comparison can be made.
    Example: No refills more
    frequently than days
    supply indicates.

    Standard: Acceptable
    variation from criterion.
    Example: Within 20% (6
    days for 30 day period) ok.

    Criteria and Standards


    Essential
    15%

    Not
    Necessary
    8%

    Significant
    47%

    Useful
    30%

    Not Necessary
    Useful
    Significant
    Essential

    Periodic Self Audit


    Have criteria and
    standards been met?
    Drug-drug interaction
    overrides.
    Duplicative drug therapy.
    Absence of documented
    patient education.

    Benchmark over time.

    Periodic Self Audit


    Essential
    10%

    Significant
    38%

    Useful
    40%

    Not
    Necessary
    12%

    Not Necessary
    Useful
    Significant
    Essential

    Centralized Performance Database


    Aggregate data from a
    large number of
    practice sites.
    Uploaded to board.
    Purchased from payer.

    Picture of quality
    throughout state.
    Compare practice
    sites.

    Centralized Performance Database


    Significant
    30%

    Essential
    5%

    Useful
    51%

    Not
    Necessary
    14%

    Not Necessary
    Useful
    Significant
    Essential

    Practice Accountability Audit


    Evaluates Performance
    Database
    Triggered by violation
    of criteria/standards
    Request explanation of
    violation.
    Done by board or by
    profession.

    Practice Accountability Audit


    Significant
    30%

    Useful
    38%

    Essential
    12%
    Not
    Necessary
    20%

    Not Necessary
    Useful
    Significant
    Essential

    CQI as a Risk Management System


    RPh. & P.T. dispense according to established
    Procedures
    Quality related event
    occurs
    Quality
    Consult
    held

    Telephone Reports and


    in-store documentation

    Quality Supervisor
    Reviews

    Quality Supervisor
    Reviews
    Management Kept
    Informed of Progress

    Quality Inservice
    Developed

    Management Reviews Policies and


    Adjusts PRN

    CQI and the Florida BOP


    64B1627.300 Standards of Practice Continuous Quality Improvement Program.
    (1) "Continuous Quality Improvement Program" means a system of standards and
    procedures to identify and evaluate qualityrelated events and improve patient care.
    (2) "QualityRelated Event" means the
    inappropriate dispensing of a prescribed
    medication including:
    (a) a variation from the prescriber's
    prescription order, including, but not
    limited to:
    1. dispensing an incorrect drug;
    2. dispensing an incorrect drug strength;
    3. dispensing an incorrect dosage form;
    4. dispensing the drug to the wrong
    patient; or
    5. providing inadequate or incorrect
    packaging, labeling, or directions.

    (b) a failure to identify and manage:


    1. overutilization or
    underutilization;
    2. therapeutic duplication;
    3. drugdisease contraindications;
    4. drugdrug interactions;
    5. incorrect drug dosage or
    duration of drug treatment;
    6. drugallergy interactions; or
    7. clinical abuse/misuse.

    CQI Components

    P&P Manual
    CQI Committee
    Record QREs
    Review Record at least once every 3 months
    staffing levels
    workflow
    technological support

    Summarization Document (no identifiers)


    Protection from Discovery (766.101 FS)

    RESULTS
    Inspector looks for evidence of CQI
    program and compliance.
    Inspector is educator and enabler, to prevent
    errors not react to them.
    Punishment for failure to conduct CQI, not
    for failure to be perfect.
    Commercial product available.

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