1 Quality Assurance PHAR 841 2 “Quality is never an accident. It is always the result of intelligent effort.” John Ruskin Learning Objectives  Define “quality” in health care and in terms of pharmacy practice  Describe how quality is measured  Describe the difference between quality assurance , quality control, and CQI  Describe Continuous quality improvement and the steps in the CQI method  List methods for ensuring quality in pharmacy practice 3 Quality Defined B  Quality is defined as a “degree of excellence.” This can be quite subjective  Quality Medical Care can be defined as In  aAn 2 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? 4 Quality In Pharmacy Practice Quality in Pharmacy practice must therefore…. a. 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. 5 DTIC How is Quality Measured? By Assessing …… a) Structure (raw materials)  b) Process (methods used)  c) #s of pharmacists, counterpace, square footage, inventory Percent of DURs appropriately addressed, percent of patients counseled, percent of scripts correctly typed… Outcomes (results….What are we trying to accomplish?)  Economic, clinical, and humanistic = ECHO model 6 Driving Quality  Applying systems theories to pharmacy Practice is the best way to ensure and improve quality.  Systems approach  Defines the purpose and performance expectations of the system  Examines characteristics of inputs  Considers alternative mechanisms for achieving goals  Implements the system  Adjusts system based on feedback 7 Driving Quality  Human Factors Principles – a specific systems view of quality improvement which focuses on the designing a system to take advantage of the strengths of the human mind and compensate for its limitations. Key principles include……  Reducing reliance on memory (DUR)  Simplifying and standardizing**  Using protocols and checklists  Constraints and forcing functions (hard stops)  Improving access to information  Implementing automation 8 Methods For Ensuring Quality  Quality Assurance (QA)— Systematic monitoring and evaluation of various aspects of a project or service to ensure standards are being met. IF  Retrospective review of what went wrong. After an error has been made…..Peer review.   Required by BOP Quality Control (QC)– An aggregate of activities, defect prevention  Final pharmacist check  Required by BOP E 9 Methods for Improving Quality  GI  10 SIT Continuous Quality Improvement (CQI)—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 PDMAl MDIPA Questions…. 11

Quality Assurance Learning Objectives

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