Quality Assurance Exam 2

Exam 2 Tuesday, November 05, 2024 11:23 PM Quality Assurance • What is quality (Slide 4) ○ Quality is defined as a “degree of excellence.” ▪ This can be quite subjective ○ Quality Medical Care can be defined as: ▪ An evaluation of the degree to which the care given increases the probability of outcomes desired and reduces the probability of undesired outcomes while remaining consistent with medical knowledge ▪ Gives patients what they want and need ▪ Do patients always know what they need from the medical care they receive? • Quality in pharmacy practice (Slide 5) a. Represent a degree of excellence b. Increase the probability of positive outcomes c. Decrease the probability of negative outcomes d. Correspond with current Medical knowledge e. Offer patients what they want and need As quality improves, a corresponding improvement in productivity is seen. • QA vs QC vs CQI (Slides 9 & 10) QA (Quality Assurance) ○ QC (Quality Control) • Systematic monitoring and • An aggregate of activities, evaluation of various aspects of a defect prevention project or service to ensure • Final pharmacist check standards are being met. • Required by BOP • Retrospective review of what went wrong. After an error has been made.....Peer review. • Required by BOP CQI (Continuous Quality Improvement) • • • • • Philosophy of continual improvement of the process. Transcends QA and QC. All workers within the systems are interconnected. Focus is on identification of the root cause via scientific methodology. CQI is continuous and never ending. • CQI is a more positive process than QA and QC • Constantly striving for improvement in every facet • Many Models of CQI exist • Examples include: PDCA, FOCUS –PDCA, Six sigma... • Key concepts: Plan, design, measure, assess, improve Reimbursements and 3rd Party Payers • How we get paid (Slide 2) ○ Patients (Cash or Private pay) ▪ Can pay for the complete cost of the Rx ▪ Up to the Pharmacy to decide how much to charge ○ 3rd Party Payers (Insurance Co/Gov.) ▪ Pay for all or a large portion of the cost of a prescription possibly leaving a patient with copay ▪ Payment is based on a contracted rate • Know WAC ○ Reimbursement Formula Using WAC (weighted average cost) ▪ WAC + 2% + $2.00 dispensing fee • KNOW PSAO (slide 6) ○ PSAO (Pharmacy Services Administrative Organization) ▪ Responsible for broad 3rd party contracting with PBMs on behalf of its members. Usually tied to an individual wholesaler. Regulatory Compliance • Federal Agencies (slide 5) ○ FDA (Food and Drug Administration) ○ DEA (Drug Enforcement Agency) ○ DHHS (Department of Health and Human Services) ○ IRS (Internal Revenue Service) • California Agencies (slide 7) ○ Board of Equalization (Property Tax) ○ Secretary of State (Register Business) ○ California Department of Fair Employment and Housing (DFEH) ○ CURES ○ Board of Pharmacy ○ Department of Public Health • Local Laws (slide 8) ○ City Business License ○ City Business Tax ○ City Construction Permits ○ Minimum Wage Law ○ County Property Taxes ○ NOTE: If business in unincorporated area of county, then county laws apply • PIC Duties (slide 11) ○ Pharmacist-in-Charge: Notification to Board; Responsibilities ▪ (a) Every pharmacy shall designate a pharmacist-in-charge and, within 30 days thereof, shall notify the board in writing of the identity and license number of that pharmacist and the date he or she was designated. ▪ (b) The proposed pharmacist-in-charge shall be subject to approval by the board. The board shall not issue or renew a pharmacy license without identification of an approved pharmacist-in-charge for the pharmacy. • Designation of PIC (slide 14) ○ (a) The pharmacist-in-charge of a pharmacy shall be employed at that location and shall have responsibility for the daily operation of the pharmacy. ○ (b) The pharmacy owner shall vest the pharmacist-in-charge with adequate authority to assure compliance with the laws governing the operation of a pharmacy. ○ (c) No pharmacist shall be the pharmacist-in-charge of more than two pharmacies. If a pharmacist serves as pharmacist-in- charge at two pharmacies, those pharmacies shall not be separated by a driving distance of more than 50 miles. ○ (d) No pharmacist shall be the pharmacist-in-charge of a pharmacy while concurrently serving as the designated representative-in-charge for a wholesaler or a veterinary food-animal drug retailer. Reducing Medication Errors • Purpose of a Quality Assurance Program (slide 3) ○ The purpose of the quality assurance program shall be to assess errors that occur in the pharmacy in dispensing or furnishing prescription medications so that the pharmacy may take appropriate action to prevent a recurrence. • QA Programs (slide 4) ○ Each quality assurance program shall be managed in accordance with written policies and procedures maintained in the pharmacy in an immediately retrievable form ○ When a pharmacist determines that a medication error has occurred, a pharmacist shall as soon as possible: ▪ Communicate to the patient or the patient’s agent the fact that a medication error has occurred and the steps required to avoid injury or mitigate the error. ▪ Communicate to the prescriber the fact that a medication error has occurred. • How to address errors (slide 5) ○ Keep accurate records: ▪ Date, location, and participants in the quality assurance review ▪ Pertinent data and other information related to the medication error(s) reviewed ▪ Findings and determinations; and ▪ Recommended changes to pharmacy policy, procedure, systems or processes, if any. ○ Have Policies and Procedures regarding the Quality Assurance process • Role of a Pharmacist (slide 8) ○ Assessment: ▪ Examine/evaluate causes ▪ Analyze data to determine trends, significance and frequency ○ Prevention strategies: ▪ Develop interventions towards med error reduction ▪ Establish goals and measurable standards ▪ Monitor interventions and make changes ○ Reporting ▪ Communicate results to all health care providers, patients and caregivers ▪ Promote reporting of med errors to national system for review and analysis • ISMP (slide 9) ○ ISMP (Institute for Safe Medication Practices) ▪ While ISMP widely disseminates case studies of events and what has been learned about the causes and prevention of medication and vaccine errors, identifiable details regarding individual events, where they occurred, and the identity of patients, involved staff, and reporters remains strictly confidential. Your identity, affiliation, and location will NOT be revealed in any ISMP publications. Evaluating Outcomes • Assessing data (slide 19) ○ Compare before and after results ○ Look for areas that still need improvement ○ Create a new plan for improvement ○ Implement and re-assess • Establishing “Framework” (slide 12) ○ Create a plan ▪ Design interventions ▪ Determine the outcomes to be measured ▪ Develop a timeline for implementation, data collection, analysis, and follow-up Human Resources Management • Recruitment guidelines (Slide 7) ○ Recruiting ▪ Key • (1) continually recruit & network • (2) maintain a pleasant work environment • (3) establish a positive image in the minds of potential recruits ▪ Benefits of a desirable work environment – employees feel rewarded and recognized, fewer job turnover, job vacancies are filled quickly and with less effort, want ads become unnecessary ▪ Employers of choice have a positive image in the community and can pick and choose among the best candidates ▪ Advertisement ▪ (1) local – hometown newspaper or professional local chapter journals ▪ (2) regional – CPhA ▪ (3) national – APhA ▪ (4) internet ▪ (5) don’t forget employees’ referral!! • Components of training (Slide 14&15) ○ Training ▪ Improve current tasks and jobs, essential for meeting current needs ▪ Orientation • Purpose – welcome new associates, present a positive first impression, help them settle into their new responsibilities, establish early expectations of performance and behavior, introduce mission, goals, culture & expectations • Examples – coworker introductions, tour of facilities, benefits, policies & procedures, performance objectives, computer systems, special organizational/departmental training (HIPAA, sexual harassment and discrimination) ▪ Job training • Need ongoing job training because of changing nature of medical and business model • Can be: ○ (1) continuing education, ○ (2) on-the-job training or (3) short courses • Cross-training – help staffing, improve self-esteem & sense of contribution to organization ○ Development ▪ Prepares employees for new responsibilities and positions; is an investment in future needs ▪ Factors to consider: • (1) Where am I now? • (2) Where do I want to be? • (3) What skills, knowledge and training do I need to get there? ▪ Requires a greater intensity of education and instruction • e.g. formal education, structured experiences such as college courses, multiday seminars & certificate programs, residencies or fellowships