Pharmacy Practice and Technology Study Notes
History and Technology in Pharmacy Practice
Objectives of Pharmacy Practice and Education
Identify major milestones in pharmacy practice and education during the 20th century and the principal forces that shaped the profession.
Describe the future VISION of Pharmacy Practice by the Joint Commission of Pharmacy Practitioners (JCPP) and the 5 goals of JCPP's strategic plan.
Collect, assess, plan, implement, follow-up/monitor.
Write a reflection describing ways in which pharmacists’ professional roles have changed over the years and the barriers which need to be overcome for pharmacists’ role expansion.
Technology in Pharmacy Practice
Automation in Pharmacy
Definition: Automation involves technology, machines, and devices linked to or controlled by a computer, facilitating various pharmacy functions.
Areas of Automation
Purchasing/Inventory Management
Streamlines procurement and management of inventory.
Prescribing/Medication Decisions
Utilizes technology to aid in prescribing decisions.
Medication Preparation and Dispensing
Automation assists in preparing medications accurately and efficiently.
Medication Administration
Ensures proper administration protocols are followed.
Patient Monitoring/Assessment
Supports ongoing patient assessments to improve outcomes.
Drug Acquisition and Storage
Automation Devices
Carousel Automation: Storage cabinet with rotating shelves and computer interfaces for efficient inventory management.
Pyxis Cabinets: Automated dispensing units that help manage medication storage and access.
C-II Safes: Secure storage for controlled substances.
Drug Prescribing Technology
Medication Order Scanning
Methods: Fax machines, Pyxis connect technology.
Computerized Prescriber Order Entry (CPOE)
Advantages:
Decreases delay in order completion.
Eliminates pharmacist transcription, reducing transcription errors.
Computerized decision support checks for errors; provides prospective advice and protocols.
Allows for off-site order entry and eliminates abbreviation use.
Combined with dispensing technology enables efficient pharmacist deployment.
Disadvantages:
Deterioration of communication between physician and nurse.
Creates a false sense of security in decision-making.
Possible orders for wrong patients or drugs resulting in missed picks and log-in security risks.
Decision Support Technology
Pros:
Provides clinical warnings regarding dosage, interactions, and duplications.
Interfaces with laboratory systems and produces reports through database programs.
Includes pre-set protocols, enhancing clinical decision-making.
Cons:
Excessive insignificant warnings leading to alert fatigue.
Risk of false sense of security in clinical settings.
Medication Dispensing and Compounding
Decentralized Point-of-Care Cabinets
Examples: Pyxis, Omnicell.
Advantages:
Provides unit-dose medications and bulk medications efficiently.
Offers real-time interface to computer systems, reducing manual cart fill tasks.
Improves accountability for controlled substances.
Disadvantages:
Risks of incorrect medication selections from open matrix drawers.
Possibility of drugs being stocked in the wrong compartments.
Expanded drug inventories and issues with medication overrides.
Potential for nurses to queue medications or return medications to incorrect pockets.
Centralized Dispensing Technology
Example: McKesson Robot, Baxter ATC 212.
Advantages:
Reduces pharmacy labor costs associated with manual dispensing.
Eliminates cart fill checking tasks for pharmacists, enhancing accuracy in medication dispensing.
Aims to support Barcode Medication Administration (BCMA) processes.
Disadvantages:
Improved accuracy in dispensing has not been conclusively linked to enhanced patient safety.
Does not address nurse errors during administration.
High capital costs are associated with installation and maintenance.
Requires barcode compliance; issues arise if medications are not sourced from manufacturers in barcoded packaging.
Centralized Outpatient Dispensing Technology
Example: Script-pro.
Benefit: Expedites filling processes, prioritizing patients and freeing technician time, which enhances patient care efficiency.
Medication Administration
Bar Code Medication Administration (BCMA)
Process: Incorporates a 3-point check system involving the nurse's badge, medication and dose, and the patient’s ID band.
Five Rights of Medication Administration: Ensures correct patient, medication, dose, time, and route are adhered to during administration.
Documentation Requirements: Includes product name, dose, dosage form, route, expiration date, and lot number.
Smart Pumps
Mechanisms for precise medication delivery ensuring medication safety.
Professional Communication
Objectives of Motivational Interviewing
Recall and apply principles of motivational interviewing:
Open-Ended Questions: Facilitate dialogue and extraction of details from patients.
Affirmations: Recognize and support patient efforts.
Reflection: Clarify patient comments, enhancing understanding.
Summary: Provide a summary of the discussion, reinforcing patient engagement.
Accreditation, Credentialing, Certification, and Healthcare Quality Measures
Objectives
Differentiate between accreditation, credentialing, certification, and regulation.
Describe the role of the Joint Commission in the US healthcare system.
Identify major accreditation standards, initiatives, and goals of the Joint Commission.
Recognize different quality performance measures in US healthcare and their impacts on pharmacy practice:
ORYX for Hospitals: CORE Measure Sets in collaboration with the Joint Commission and/or CMS targeting hospitals.
HCAPHS: Hospital Consumer Assessment of Healthcare Providers and Systems coordinated by CMS focusing on patient feedback.
HEDIS Measures: Healthcare effectiveness data focusing on health plans and physicians, structured by the National Committee for Quality Assurance.
Part D STAR Measures: Measures coordinated by the Center for Medicare/Medicaid Services addressing quality in health plans and pharmacies.
Credentials in Healthcare
Definition: Any documented evidence of professional qualifications (e.g., degrees, licenses, certificates).
Credentialing: The process by which organizations verify and assess individuals’ qualifications to provide patient care.
Certification: A non-governmental, volunteer process recognizing individuals who fulfill specific qualifications; requires periodic renewal and assessment.
Privileging: Authorization process granting healthcare providers specific scopes of patient care services after satisfactory review of credentials.
Programs and Outcomes Assessment
Accreditation Process
Definition: The process by which organizations receive recognition for meeting established criteria through evaluations.
Examples:
Accreditation Council for Pharmacy Education (ACPE): Governing accreditation for pharmacy education.
The Joint Commission (TJC): Provides voluntary accreditation for hospitals, emphasizing national standards set by healthcare professionals.
Benefits of Accreditation:
Enhances public confidence as a report card for organizational performance.
Encourages continuous quality improvement (CQI) efforts.
Helps meet Medicare certification and managed care requirements.
Standards for Hospitals:
Focused on the entire medication use process including acquisition, storage, ordering, dispensing, compounding, administration, and monitoring.
Committed to an interdisciplinary and systems approach to care.
Necessitates medication reconciliation to ensure continuity of care during transitions, avoiding errors such as omissions, duplications, and drug interactions.
Quality improvement initiatives assess workforce competency and patient safety and integrate unannounced surveys every three years focusing on medication safety.
Medication Reconciliation Process
Five Steps:
Develop a list of previous medications.
List newly prescribed medications.
Compare the two lists for discrepancies.
Respond to any differences noted.
Finalize the new list and share with caregivers and patients.
Patient Safety Goals
Focus on establishing protocols to correctly identify patients, improve staff communication on test results, ensure medication safety, prevent infections, and identify surgical risks.
Performance Measures:
Includes various organizations measuring quality care in hospitals and health plans. Specific focus on investigating patient outcomes and satisfaction perceptions through multiple surveys and data evaluations.
Centers for Medicare and Medicaid Services (CMS)
Definition and Components of Medicare
Overview: A federal health insurance program covering medical care for the elderly and specific disabled individuals.
Part A: Provides hospital insurance for inpatient care, skilled nursing facilities, home health care, and hospice care.
Part B: Covers medical insurance for outpatient visits and supplies.
Part C (Medicare Advantage): Customized plans meeting specific medical needs.
Part D: Represents options for prescription medication coverage either within a Medicare Advantage plan or as an add-on to Part B.
Medicaid Overview
A state-level program providing healthcare coverage for low-income families, often referred to as public assistance or welfare.
Medication Use Systems and Medication Safety
Key Organizations for Patient Safety
Role in Medication Safety Improvement
Access various organizations that advocate for patient safety and medication error prevention.
Adverse Drug Reactions (ADRs) and Medication Errors
Definitions and Classification
Adverse Event: Injury caused by medical management rather than an underlying condition.
Medication Error: Any preventable event that may cause inappropriate medication use or patient harm.
Preventable Adverse Event: An adverse event associated with an error.
Adverse Drug Reaction: An unintended reaction occurring at normal doses used to prophylax, diagnose, or treat disease.
Preventable Adverse Drug Event: An adverse drug event linked to a medication error.
Reporting Systems for Medication Errors and ADRs
Utilize the FDA MedWatch voluntary reporting system for ADRs and the ISMP Medication Error Reporting Program (MERP) for suspected medication errors.
Just Culture Principles
Overview
Understand and embrace a just culture that promotes openness about errors, focusing on systems approach for prevention rather than punishment.
Medication Order Writing
Focus on clear and concise prescription writing avoiding dangerous abbreviations to mitigate risk of errors
Incident Analysis and Reporting Systems
Sentinel Events and Root Cause Analysis
Review and comprehend Sentinel Event reporting systems implemented by organizations to track serious incidents leading to patient harm and develop strategies for improvement.
Case Studies in Medication Errors
Examples of Medication Errors in Clinical Practice
Situation Involving Digoxin: A patient developing toxicity due to being administered both prescribed and personal medications mistakenly.
Metformin in Renal Failure: Demonstrates the potential adverse effects of unmonitored therapy leading to lactic acidosis.
Dispensing Errors: Instances of tech errors in filling prescriptions leading to patient counseling confusion and safety risks.
Emergency Incident with Epi-pen: Involving malfunctioning devices during critical patient situations exemplifying the need for various monitoring systems in place in clinical settings.
Optimizing Medication Use
Medication Systems Principles
Implement the 5 rights approach to minimize errors: drug, patient, time, dose, route.
Exercise accountability among professionals to ensure compliance with established protocols.
Provide continuous access to information for healthcare professionals regarding safe medication use, and educate patients about self-care and recognizing adverse reactions.
Important Definitions in Safety Practices
Adverse Drug Reaction (ADR): Any unintended, noxious response to a drug, occurring at normal therapeutic doses.
Preventable Adverse Drug Event: An ADR that is attributable to an error.
Reporting Mechanisms and Requirements
Adequate reporting of adverse reactions and medication errors is facilitated through established FDA and ISMP protocols, ensuring attention to ongoing education and safety enhancements in pharmacy practice.
Culture of Safety
Emphasis
Foster a non-punitive environment that encourages incident reporting and continuous quality improvement in pharmacy practice, utilizing comprehensive data analysis and technology to enhance medication safety protocols.
Pharmacy Operations and Medication Processes
Operations CQI (Continuous Quality Improvement)
Overview
Implement continuous quality assurance measures to monitor and enhance pharmacy operations focusing on medication safety and error reduction.
Common Goals in PTC (Pharmacy and Therapeutics Committee)
Guiding the selection and usage of medications within healthcare systems, managing medications and improving patient safety through regulatory compliance and evidence-based practices.
Key Responsibilities
Establish policies and guidelines affecting medication therapy management while integrating formulary systems that prioritize patient safety and cost-effectiveness in practice.
Pharmacy and Therapeutics Committee (PTC) and Formulary Systems
Composition and Function
Comprised of interprofessional members, including physicians, pharmacists, nurses, and representatives from laboratory medicine and clinical nutrition.
Act as an advisory group regarding drug therapy decisions within hospital systems and managed care organizations.
Formulary Management and Impact
Ongoing processes involving the establishment of a comprehensive list of medications outlining their usage policies, ensuring formulary management benefits both clinical outcomes and financial sustainability in healthcare organizations.
Typical Agenda Items
Address safety protocols with ongoing needs for pertinent discussions on medication evaluation and monitoring, advancing safe and effective medication use across healthcare settings.
Outcomes from Strengthening Formulary Systems
Enhanced medication use leading to reduced risks of errors and adverse events, contributing to improved patient health outcomes and reduced healthcare costs.
Clinical Outcomes and Final Review
Summary of Contributions to Pharmacy Practice Outcomes
Review changes in pharmacy practices, new technology implementations, and ongoing initiatives addressing patient safety and healthcare quality benchmarks.
Emphasize the pharmacist's evolving role within interdisciplinary teams collaborating for improved healthcare delivery
Preparation for Exam Evaluation
Focus on understanding all relevant components covered, including medication error examples, accreditation standards, and accreditation definitions to ensure comprehensive readiness for examinations in pharmacy practice and healthcare quality.