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Safety Quality and PPMI

This document discusses engaging C-suite executives to advance pharmacy practice and improve patient care and outcomes. It provides an update on initiatives to align pharmacy services with goals of the Affordable Care Act to increase access, improve quality, and decrease costs. Specifically, it describes how one hospital implemented targeted medication counseling and education, bedside delivery of discharge prescriptions, and pharmacy-led heart failure education to improve HCAHPS scores and reduce readmissions. Moving forward, the document suggests expanding these programs to additional high-risk patients and conditions while continuing to monitor metrics like readmissions, infections, and patient experience.

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o cindy glaudia
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35 views18 pages

Safety Quality and PPMI

This document discusses engaging C-suite executives to advance pharmacy practice and improve patient care and outcomes. It provides an update on initiatives to align pharmacy services with goals of the Affordable Care Act to increase access, improve quality, and decrease costs. Specifically, it describes how one hospital implemented targeted medication counseling and education, bedside delivery of discharge prescriptions, and pharmacy-led heart failure education to improve HCAHPS scores and reduce readmissions. Moving forward, the document suggests expanding these programs to additional high-risk patients and conditions while continuing to monitor metrics like readmissions, infections, and patient experience.

Uploaded by

o cindy glaudia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Engaging the C-suite to Advance

Pharmacy Practice
Providing quality patient care through
progressive pharmacy practice

Safety, Quality, and the Pharmacy Practice


Model Initiative: Aligning for Success
Erick Sokn, Pharm.D., M.S., BCPS
Manager, Transitions of Care/ED
Cleveland Clinic
Objectives

• Provide update since original C Suite


series
• Describe metrics and a process that can
be used to measure the quality of change
that occurred and ensure that a positive
change has taken place
• Describe how organizations have
implemented safety and quality principles
in daily practice
Projected Impact of Healthcare
Reform

• Affordable Care Act


– Increase Access
– Improve Quality
– Decrease Cost
Early Measures of Interest

• CMS Readmission Reduction


• CMS Hospital Value-Based Purchasing
– HCAHPS
– Clinical processes of care
– Outcome measures
– Efficiency
Hospital Value-Based Purchasing. Centers for Medicare and Medicaid Services. http://www.cms.gov. Accessed
2014 Oct 20.
Readmissions Reduction Program. Centers for Medicare and Medicaid Services. http://www.cms.gov. Accessed
2014 Oct 20.

CMS=Centers for Medicare & Medicaid Services


HCAHPS=Hospital Consumer Assessment of Healthcare Providers and Systems
Readmissions

• Impact from CHF, AMI, pneumonia:


– Year 1 – 2,217 hospitals penalized for ~$280
million
– Year 2 – 2,225 hospitals penalized for ~$227
million
– Year 3 – 2,610 hospitals penalized for ~$428
million
• October 2014, added total hip/knee and
COPD
Value-Based Purchasing

Fiscal Year Potential Payment Domains


Reduction
2013 1% Processes of Care
HCAHPS
2014 1.25% Processes of Care
HCAHPS
Outcomes
2015 1.5% Processes of Care
HCAHPS
Outcomes
Efficiency
Reduction increases by 0.25% annually, to
maximum of 2% in FY17
HCAHPS Medication Domain Questions

• Purpose of new medications explained


• Side effects described
• Medication Communication
– Composite score based on the percent of
patients responding ‘Always’
• NEW Transitions of Care domain
– Purpose for taking medications at discharge
PPMI Alignment

• B11 and B12 – Prioritize pharmacist


interventions (high risk patients)
• B20 – Medication continuity of care
• Advancing role of the pharmacy
technician
• Expanded ownership and accountability
for quality and access

Am J Health Syst Pharm. 2011; 68: 1148-52.


Ongoing Efforts at
Cleveland Clinic
• Initiatives align with goals and metrics
from Affordable Care Act
– Patient experience / HCAHPS
– Access to care
– Readmissions
• What’s next?
Targeted Counseling
Targeted Counseling

Med Rec • For home-going patients:


• Review discharge prescriptions
Target: • Ensure clear medication list and instructions for
discharge
Discrepancies • Use electronic health record to prioritize work

Discharge • For home-going patients:


• Education on medication purpose and side effects
Counseling • Reinforce after-hospital medication-related follow up
plans
Target: HCAHPS • Use electronic health record to prioritize work

• For all neurology patients, educate on:


First Dose • Anticonvulsants
Teaching • Antidepressants
• Antipsychotics
• Use electronic health record to identify inpatient
Target: HCAHPS orders
Impact - HCAHPS
• Counseling 4-6 patients per day
- ~66% capture rate of home discharges
Highest-ever
98th percentile
Bedside Delivery of Medications

• Bedside delivery option for discharge


prescriptions
– Program targets discharging patients to
improve access to medications and increase
compliance
– Assures patient has tools necessary to
continue medication therapy plan after
discharge
Bedside Delivery Win-Win

• Large increases in revenue for pharmacy


department
– 13% return on investment
• Large patient satisfier
– 98% would recommend
Pharmacy Heart Failure Education

• Patients with actively managed heart


failure (HF)
– Multi-disciplinary discharge checklist
– Pharmacy education as required element
• Hard stop in electronic health record if
pharmacist education not documented
What’s Next?

• HCAHPS remains a high focus of the


enterprise
– COPD education
– Targeted expansion to high-risk patients
using complexity score
• Medication reconciliation
• Patient counseling
• Messaging: No quick fix – follow the data,
adjust the focus
What’s Next?

• Patient safety indicators


• Readmissions
• Increasing emphasis on hospital acquired
infections
– Pharmacist role?
Questions???

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