Pharmacy & Therapeutics Society: The P&T Society Working Group Findings

In: Health

19 May 2010

Therapeutics SocietySpeaker: Burton Orland, RPh, Vice President of Pharmacy, Oxford Health Plans, Inc.

There is an opportunity for improving health care for patients with the following chronic diseases: asthma, diabetes, and dyslipidemia. In keeping with the PTS report, the “practice of excellence” in patient care would involve selecting the appropriate medication and developing and implementing programs aimed at ensuring the appropriate use of medications to improve quality of life.

The PTS response to the Working Group’s findings was positive. The PTS envisions an important and vital role for P&T committees in developing oversight programs for effective management of chronic diseases.
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The risk of drug-drug interactions in patients receiving two or more drugs or herbal supplements is very significant, and there is a need to improve communication among the patients, the health care team, the family, and support groups, especially in the case of elderly patients. The practice of excellence would be to use the findings from P&T committee meetings as a resource for drug information and drug-drug interactions in products selected for the formulary.

P&T committees can provide the basis for assembling useful information about particular drugs. Together with medical and pharmacy leaders, they might plan to maintain and develop patient and family educational materials to facilitate communication between providers and patients. The PTS recommends a variety of measures to improve patient care, such as:

  • providing education to patients.
  • anticipating questions that patients might ask about their medications.
  • developing a data-based system that collects, stores, and retrieves the medication history of each patient.

Patients sometimes receive the wrong medication or an incorrect dose when drug-dispensing protocols are not in place. One problem is that there is a lack of pharmacist interaction with the patient. The practice of excellence would be to avoid lapses in adhering to dispensing protocols. Efforts have focused on familiarizing staff members with the existing drug-distribution system, including its built-in safeguards, and educating patients about the benefits of following protocols.
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The PTS suggests that standardized procedures be used to evaluate the effectiveness of dispensing protocols. It recognizes the importance of the development and use of technology-based information systems and urges further examination of these systems in both inpatient and outpatient settings. Additional training of staff members may be required.

Illegible writing occurs in both inpatient and outpatient settings and often leads to medication errors. The practice of excellence would be to implement a computerized physician order-entry (CPOE) program. The PTS believes that technology-based solutions have the potential to eliminate many medication errors that result from poor handwriting. Computer-based approaches would need to adhere to pharmacy data-management standards.

Patients sometimes receive the wrong drugs because of confusion surrounding drug product nomenclature or packaging that results in a look-alike/sound-alike mistake. The practice of excellence is to reshelve medications according to therapeutic class, grouping liquids and solids, and arranging the products alphabetically within their therapeutic class.

All dispensed drugs require a two-person read-back system. The PTS believes that this practice illustrates ways in which “low-tech,” cost-effective solutions can be used to address challenges faced by both outpatient and institutional health care providers. With nurses, pharmacy technicians, and others, this approach can also help to empower all members of the health care team in the goal of reducing errors.
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The PTS Working Group believes that communication between pharmacists and physicians in critical-care settings represents an opportunity for improvement. The practice of excellence should include clinical pharmacists as participants on the health care team. There should be ongoing consultations with the clinical pharmacists, who would maintain communication with the nursing staff to assist in drug administration. When it is warranted and feasible, increased involvement of the clinical pharmacist in the critical-care setting would improve communication among members of health care teams in both inpatient and outpatient settings.

Managing medications in assisted-living facilities is problematic because:

  • residents are free to select the pharmacy of their choice, so that a single assisted-living facility might have to keep track of any number of pharmacies.
  • medication packaging and dispensing systems may vary.
  • patients like to maintain control of their medications.
  • multiple health care providers are involved with the residents’ care.
  • usually, only a limited skilled nursing staff is available.

The practice of excellence notes that Max Well Medical and other assisted-living facilities have developed a system designed to improve the quality and safety of medication management. The PTS believes that standards and systems should be developed at the highest level within health care chains and networks. It is necessary to establish guidelines and expectations for the development of corporate-level P&T committees, to issue guidance regarding medication processes used at each facility, and to implement chain- and facility-specific therapeutic product lists and related educational materials.
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The PTS Working Group observed a lack of uniform standards for medication management and pharmaceutical care among practice settings. The practice of excellence expressed by the group identified a mock survey of a hospital to evaluate its compliance with the current Joint Commission on Accreditation of Healthcare Organizations (JCAHO) guidelines and the hospital has launched an institution-wide educational campaign to train its staff in practices that will reduce the potential for medical errors. The hospital’s P&T committee has also instituted changes in its procedures and practices. The PTS recognizes the value of the JCAHO guidelines as a means of standardizing care and encourages P&T committees to implement initiatives, similar to those discussed, to help institutions to move toward compliance with national safety and medical management standard goals.

Leveraging Dramatic Improvements in Safety, Quality, and Overall Value of Health Care

Speaker: Gregory Belden, MBA, Senior Program Associate, The Leapfrog Group.

The Leapfrog Group is a consortium of more than 150 large health care purchasers. One recommendation in the 2001 IOM report, Crossing the Quality Chasm, was that large health care purchasers, namely employers, take a leadership role in creating incentives that foster quality improvement. The Leapfrog Group has risen to the IOM’s challenge and, along with other Leapfrog employers and its various stakeholders, will follow the IOM’s recommendations.

The message of Leapfrog and the PTS is to improve patient safety and quality of care through standardization, transparency, education, and collaboration. Leapfrog supports the IOM’s improvement initiative in chronic disease management by rewarding results through “bridges to excellence.”

Leapfrog employs a strategy of using its market influence to affect dramatic improvements in the safety, quality, afford-ability, and overall value of health care by educating consumers to seek better performing providers and by motivating and rewarding providers for quality and efficiency-of-care improvements.
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Leapfrog is a national movement that uses 22 targeted regions to develop “best practices,” creating early successes and learning from its stakeholders. It collects hospital-level data. For instance, 5% of the participating hospitals have fully implemented CPOE, and another 17% will have implemented it by 2005; 24% of responding hospitals have fully implemented intensive-care unit intensivist staffing.

The “leap” over the gridlock has begun with the rapid increase in purchasers signing on to Leapfrog’s approach, the rapid growth in the number of hospitals disclosing their status to their communities, active health plan support, massive education of consumers through purchasers, and market reinforcement through different channels.

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