Exam 3 Flashcards
Four objectives for Pharmacy Service Development 2
(1) discuss IMPLEMENTING pharmacy services (2) describe existing successful/sustainable services (3) promote idea generation for future services
Four types of implementation issues
(1) action plan (2) start-up coordination (3) monitoring performance and adjusting as needed (4) commitment to refining and sustaining
Define an action plan
(1) listing of tasks needed to be performed for start-up, (2) when they should be completed, (3) and who is responsible for doing them.
What are 4 issues regarding start-up coordination
(1) operational readiness 2) cash flow (3) awareness of service (4) staying informed on performance, i.e. feedback
What are three issues regarding monitoring rollout
(1) during first weeks and months monitor closely (2) debrief staff after each service encounter - areas for improvement (3) call back or survey patients to ask about their experience with service
What are five issues in refining and sustaining service/ monitoring performance
(1) promotional activites (2) number of patients using service/# of service episodes (3) revenue from services (4) expenses and accounts receivable (5) workflow - what needs to be addressed
How to achieve patient loyalty?
(1) identification by consumer (2) and faithfulness demonstrated by repeated use
Two issues in achieving sustainability
(1) track performance - service uptake, quality of care, profitability (2) positive profit expected - adjust costs over time, change marketing mix.
Two examples of sustainable pharmacy services
(1) pharmacy-based immunization programs (flu, travel) (2) disease state management
Five learning objectives for implementation science
(1) dissemination research vs. implementation research (2) describe principles of Designing for Dissemination - how they may improve your work (3) list and define attributes influencing implementation (4) describe intervention mapping and the RE-AIM framework (5) describe pragmatic clinic trials and mixed methods designs
Define implementation research
“Scientific study of the use of strategies to adopt and integrate evidence-based interventions into practice”
Define dissemination research
“Scientific study of targeted distribution of information to best spread and sustain knowledge of evidence-based interventions”
Describe 4 principles of designing for dissemination (D4D)
(1) set of activities performed through intervention planning, development and evaluation to increase likelihood of dissemination, implementation and sustainability (2) start early (3) donabedian model (4) intervention mapping
describe 3 aspects of the donabedian model
(1) structures (2) processes (3) outcomes
define intervention mapping
a protocol for developing theory-based and evidence-based health promotion intervention
List six (6) steps of intervention mapping
(1) needs assessment (2) performance and change OBJECTIVES (3) selection of theory-based intervention methods and practical applications to change (DESIGN) (4) PRODUCTION of program components, design and production (5) program PLAN: adoption, implementation and sustainability (6) process and effect EVALUATION
List four (4) components of a needs assessment
(1) systematic process for determining and addressing needs (2) should be interdisciplinary (3) provides justification for why decisions were made (4) the discrepancy between the current condition and the wanted condition must be measured to appropriate identify the need
List five (5) components of the RE-AIM framework
(1) reach (2) effectiveness (3) adoption (4) implementation (5) maintenance
Define pragmatic trials
“A randomized controlled trial in which the research question focuses on EFFECTIVENESS in a normal practice setting with the full range of study participants.”
Define mixed methods (2 components)
(1) uses qualitative and quantitative methods of data collection (2) provides practical way to understand multiple perspectives, different causal pathways, and multiple types of outcomes
Four (4) learning objectives for Quality Improvement
(1) recognize the six domains of healthcare quality (2) differentiate quality-related vocabulary (3) describe the IHI’s Model for Improvement (4) describe root cause analyses, fishbone diagrams, PDSA cycles and how these tools can be used to improve healthcare quality.
List six (6) domains of healthcare quality
(1) safe (2) effective (3) patient-centered (4) timely (5) efficient (6) equitable
Define quality assurance, quality control, and continuous quality improvement
QA: conforming processes to standards, QC: catch failures in QA; stop defective products, CQI: continous process of improving systems (incorporates QA and QC)
Describe IHI Model for Improvement (4 components)
(1) heart is the Plan-Do-Study-Act cycle (2) Three key questions answered by root-cause analysis: what are we trying to accomplish? (AIM) (3) How will we know that a change is an improvement? (MEASURES) (4) What change can we make that will result in an improvement? (Changes)
List three (3) components of root cause analysis
(1) a process for identifying causal factors underlying variation in performance (2) variation in performance produce undesired outcomes, including risk of sentinel event
List six (6) most likely areas for causes in a root cause analysis
(1) communication (2) training (3) fatigue/scheduling (4) environment/equipment (5) rule/policies/procedures (6) barriers
Two methods for a Root Cause Analysis
(1) 5 Whys (2) Fishbone diagram
List five objectives for Medication Safety 1
(1) medication safety terminology (2) link between medication error and adverse drug events (3) types of medication errors in U.S. (4) common causes of pharmacist-related medication errors (5) examples of medication error incidents
Define adverse drug event, medication error and adverse drug reaction
ADE: unintended, medication-induced injury; medication error: preventable event, adverse drug reaction: mostly non-preventable, medication related ahrm
Describe link between Medication Error and Adverse Drug events (3 components)
(1) adverse drug events may be due to medication error (2) medication error is preventable (3) often a series of mistakes.
List 4 types of medication errors
(1) prescribing error (2) administration error: wrong time error, improper dose error, wrong route/technique error (3) dispensing error (4) deteriorated drug error
Define skill-based errors and list causes.
In-attentional blindness (knows the right action but fails to conduct as such)
causes: distractions, interruptions, fatigue, stress, inadequate lighting
List three kinds of rule-based errors
Learned the wrong rule, applied the wrong rule, bypassed the rule.
Define knowledge-based errors
Work outside of expertise
List three (3) objectives of medication safety 2
(1) describe the Systems Engineering Initiative for Patient Safety (SEIPS) model of work system and its applications to improve medication safety and health outcomes (2) discuss a study applied the SEIPS model to ADEs in NHs (3) applying SEIPS work system to pharmacy practice
Describe SEIPS model (four components)
(1) explains influence of work system, represented by a person and work environment, on health outcomes (2) a work system is composed of: person, organization, technologies&tools, tasks, and environment (3) in a work system, a person performs range of tasks using tools and technologies (4) performance of tasks occurs within physical environment under specific organization condition.
List four (4) objectives of team-based care 1
(1) recognize and define main domains of the Chronic Care Model (2) recognize the main principles of the Collaborative Care model (3) define a patient-centered medical home (PCMH) (4) discuss pharmacy’s role in PCMH)
List six (6) elements of the Chronic Care Model
- health system leadership and support
- community resources
- self-management support
- delivery system design
- decision support
- clinical information systems
Describe the Collaborative Care Model (2 components)
- Co-location of primary care providers and mental health specialists PLUS
- Collaboration to develop and adjust treatment plans based on measurement of symptom-related outcomes.
Define the medical Home
- Approach to primary care that is:
(1) person centered, (2) comprehensive (3) committed to quality and safety (4) coordinated (5) accessible.
List 5 roles of pharmacist in patient-centered medical home (PCMH)
- comprehensive therapy reviews
- resolve medication-related problems
- optimize complex regimens
- design adherence programs
- recommend cost-effective therapies
List four (4) learning objectives for Team-based Care 2
- Define transitional care
- Define patient-centered care
- Identify and define the four pillars of transitional care
- Describe different current team-based care models in primary care
Define transitional care
- Set of actions
- Designed to ensure coordination and continuity.
- at all stages of care.
define patient-centered care
- care that is responsive
- to patient preferences, needs and values
- and ensures patient values guide all clinical decisions.
List four (4) pillars of transitional care
- medication self-management
- use of dynamic patient-centered record
- primary care and/or specialist follow-up
- knowledge of red flags
