Healthcare Systems and Population Health Flashcards
Principles of quality improvement
- Focus on system and team as large contributors to errors
- Recognize humans are human
- Errors = opportunity to learn
- Checks and balances to support individuals and prevent errors
- Peer-review errors to identify contributors to the occurrence so change can be adopted
Plan-Do-Study-Act
Cycle for quality improvement
Changes can be evaluated for effectiveness and issues before being adopted by entire organization
Tests for change
Quality improvement frameworks
Six Sigma
Lean
Lean Six Sigma
Focus = removing waste, duplication, and non-value-added steps in a process
Failure Modes and Effects Analysis (FMEA)
Quality Improvement tool
Look at OUTCOME and predict where, how, and to what extended a system failure could occur
Flowchart
Quality improvement tool
look at OUTCOME and IDENTIFY contributing factors, variations and create a visual map showing steps in a process
Cause-and-Effect diagram (Ishikawa, fishbone)
Quality improvement tool
look at OUTCOME and graphically display relationship of many causes contributing to the outcome
Driver diagram
Quality improvement tool
Look at OUTCOME and visually display the primary and secondary items contributing to achievement of an aim
Histogram
Quality improvement tool
identifies factors & Variation, displays continuous data over time to show variation
Pareto chart (80/20 rule)
Quality improvement tool
Identify contributing factor and create a bar chart in order from largest contributing factor to smallest
Run chart
Quality improvement tool
Identify contributing factor and graph data over time.
Can add upper and lower control limits to distinguish causes of variation -(control chart)
Scatter diagram
Quality improvement tool
Identify contributing factor and create scatter plot to identify cause-and-effect relationship between two variables
Project planning
Quality improvement tool
Systematically plan for testing a change
Formulary
Standardized list of medications for use to reduce variability and improve efficiency
TJC Standard: must develop and approve criteria for identifying formulary medications (indication for use, interactions, ADE, potential for error/sentinel event, cost)
Formulary management tools by P&T
-Preference for generics
-Restricted use for specific drugs
-Policy/procedure for non-forms
-Therapeutic interchange according to protocol
-Medication use criteria
Medication Use Evaluations (MUE)
Interprofessional quality improvement program, with responsibility falling on P&T
-Goal: improve safety, efficacy, cost
May evaluate any OR all steps of med use process (prescribing, dispensing, administration, monitoring, system management)
Antibiotic Stewardship
TJC Requirement for hospitals, critical access hospital, and nursing care centers
-Identify patients with redundant antimicrobial coverage
-Review antibiotic use quarterly
-Daily review of antibiotics from proposed list of restricted-use agents
-Daily escalation/de-escalation, IV-to-PO, PK monitoring, renal dose adjustments
CDC Core Elements of Antibiotic Stewardship
Hospital Leadership Commitment
Accountability (leader needed)
Pharmacy Expertise (pharmacist as co-leader)
Action (interventions)
Tracking (monitoring prescribing, monitor Cdiff infections, etc.)
Reporting
Education
IDSA role in Antibiotic Stewardship
-Describe purpose for the program
-Requires pharmacist trained in ID with a physician, microbiologist, infection control expert
Adverse Drug Reaction (ADR)
Any response to a drug at doses normally used in humans
ALL ADRS ARE ADE, BUT NOT ALL ADE ARE ADR*
Programs that assess causality in ADRs
Naranjo Algorithm and WHO Uppsala Monitoring Centre Scale
Adverse Drug Event (ADE)
An injury resulting from a medical intervention related to a drug
National Action Plan for ADE Prevention
Outlines goals to identify significant ADDEs and align efforts to reduce ADEs
Medication error
any preventable event that may cause or lead to inappropriate medication use or patient harm while medication is in control of healthcare professional, patient or consumer
Most do not lead to significant patient harm
If significant patient harm, then also ADR or ADE.
Where to report med ADRs
MedWatch
Where to report vaccine ADRs
VAERS
What medication use process do medication errors occur in?
Can occur in dispensing, administering, prescribing, monitoring
Naranjo algorithm
10 questions to standardize assessment of ADE
Helps determine if a drug caused the clinical event
Root cause analysis
Tool for ADE monitoring
Reconstruct occurrence of event that resulted in undesired outcome, and multidisciplinary analysis of how and why that happened
Use quality improvement tools
ADE review key components
Start within 72 hours by a team of 4-6 people
(provided time during normal work hours for meetings/data collection)
Opioid Stewardship
Effective way to ensure facility meeting TJC requirement of surveillance over pain assessment & management
When is medication reconciliation required
Transitions of care
-hospital admission
-between settings in hospital
-discharge
Who benefits most from med recs
-older adults
-pts taking >=5 meds
-pts taking high risk meds
-pts with renal impairment
-pts in critical care settings
-transplant recipients
-pts with low health literacy
TJC 5 steps for med rec
- develop list of current meds
- develop list of meds to be prescribed
- compare the two lists
- make clinical decisions according to the comparison
- communicate new list to caregiver/patient
CMS Part D MTM 5 core elements
- Medication therapy review
- Personal medication record
- Medication-related action plan
- intervention and referral
- documentation and follow up
Comprehensive Medication Management
Part of MTM = holistic strategy including goals of care and patient shared decision-making
improves outcomes, access to care, reductions in cost esp in diabetes, bp management, and copd
Population Health Management Cornerstones
Disease surveillance
Disease prevention (immunizations, screenings)
Preventative medication
Emergency preparedness
Disease surveillance
Cornerstone of population health management
ongoing systematic collection, analysis, and interpretation of health-related data essential to planning, implementing, and evaluation public health practice
COVID
APhA role in vaccinations
Maintains vital information on storage and administration of vaccines
Immunization Action Coalition
www.immunize.org
provides info for healthcare providers, the public, and immunization coalitions
USPSTF
Independent, volunteer panel of experts that develop evidence-based recommendations for health screenings
Primary disease prevention
focus on general population for reduction to exposure of risk factors
immunizations, awareness campaigns
Secondary disease prevention
focus on individuals with early disease before morbidity occurs to provide postexposure prophylaxis
ex: antivirals for nursing home in flu outbreak; colonoscopy after age 45
Tertiary disease prevention
focus on pts with disease causing morbidity to reduce mortality and get back to health
ex: support groups to improve diabetes adherence, prevent blindness; antivirals for influenza to prevent pneumonia, hosp, death
Ready or Not 2022
Trust for America’s Health report that evaluated 10 indicators of emergency preparedness to rank states’ level of preparedness
Pharmacist role in emergency plans
procurement and distribution of medications
mass immunization
antibiotic dispensing
mobilization
key consideration: pharmacists need to get supplies & materials to where the population experiencing disaster is located
Bloom’s taxonomy
Way to design, assess, and diagnose student learning
Defined levels of learning for 3 different learning paradigms: cognitive, psychomotor, affective
Cognitive learning (blooms taxonomy)
Surface > deep
remembering > understanding > applying > analyzing > evaluating > creating
**most widely used domain in education
Psychomotor learning (blooms taxonomy)
Surface > deep
observing > modeling > developing standards > applying > coaching
Affective learning (blooms taxonomy)
surface > deep
receiving > responding > valuing > organizing >characterizing
Kirkpatick’s four levels of evidence
perception, knowledge, behavior, results
Perception/Reaction
One of kirkpatricks four levels of evidence
includes course evaluation, perceptions/confidence, self-assessment
Knowledge
one of kirkpatricks four levels of evidence
includes quizzes, exams, case questions
Behavior
one of kirkpatricks four levels of evidence
includes observed standardized clinical encounter (OSCE) and experiential learning
APPEs
Results
one of kirkpatricks four levels of evidence
includes entrustable professional activities (EPA), NAPLEX/MPJE, performance in practice
low health literacy associations
increased visits to hospital/ER
decreased mammography
decreased influenza vaccination
**increasing health literacy is a Healthy People 2030 goal
Objectives related to health literacy
- Increase providers who check pt understanding
- Decrease providers with poor communication
- Increase providers who involve pts in decision-making (as much as they want)
- Increase people who understand online medical record
- Increase adults with limited English to say their providers explain things clearly
Office of Minority HEalath
within health & human services
published standards for providing services that are culturally and linguistically appropriate (CLAS)
ETHNICS Frame work
Handy tool to honor a patient’s culture during encounter
Explanation
Treatment
Healers
Negotiation
Intervention
Collaboration
Spirituality
Teach-Back
Useful tools to ensure patients understand info they have been given – useful for all patients, regardless of health literacy level
promotes adherence, quality, pt safety
Motivational interviewing
Useful tools to ensure patients understand info they have been given – useful for all patients, regardless of health literacy level
Evidence-based, pt-centered method of communicating
increases likelihood of change in behavior
Motivational Interviewing Principles
Express Empathy
Develop Discrepancy
Supporting Self-Efficacy
Rolling with Resistance
Avoiding Argumentation
