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Use guidelines to improve pharmacy's performance
Expert points to 8 domains
Hospital pharmacies continually search for ways to improve quality, safety, and develop best practices. But they might not be going about this as efficiently and effectively as they can.
A first step is to establish your institution's priorities, an expert advises.
"We look at the industry as a whole and decide from our perspective what is the best practice," says Robert Sobolik, RPh, quality advisor for McKesson Health Systems of Great Falls, MT.
The first step in developing your own best practices is to decide how big your focus will be, Sobolik says.
"If you're talking about best practices with medication safety, then you have to decide whether you'll focus on medication administration only," Sobolik says.
"But we think medication safety best practices are a whole lot more than that," he notes.
A more effective focus might be to work toward becoming a high performance pharmacy, Sobolik says.
High performance pharmacies focus on how to maximize what's spent on drugs and quality outcomes, he says.
As part of the quality outcomes focus, McKesson Health Systems does an assessment of hospitals' medication safety, how the system works, and how it can be improved, Sobolik says.
"Everything the pharmacy does can reflect on the leadership," Sobolik says. "That's one of the hardest ones to quantify and get your arms around."
So it's a good idea to create a reference document, which can run more than 30 pages, to show to what Sobolik calls the C-fleet: the CEO, CFO, etc.
"You can set it up in sections so they don't have to read it all at once," he explains. "It breaks up the information so someone doesn't have to spend an hour or so to read everything at one time."
Next, develop an assessment tool, using Excel spreadsheet software, to create a spreadsheet for each area or domain. The last area is an action plan. Each spreadsheet has columns for when a pharmacy is in full compliance or whether this compliance is occasional, never, or not addressed, Sobolik says.
Sometimes a particular area of compliance is not addressed because no one has thought about that issue, he adds.
"Then, if the compliance is sometimes or never, you move it to an action plan page along with a comment," Sobolik explains. "And you create a macro to collapse the blank lines so that all you have is the action plan there."
The action plan includes priorities.
"I recommend that you look at that action plan for potential sentinel events and other major areas that would strongly impact patient safety, and those become your high-priority items," Sobolik says. "Then you share the action plan with the C-fleet because a lot of those things are high-ticket budget items, and you can gauge where their priorities are, too."
Once the hospital's top leaders buy in to the plan, then implementation can begin.
Keep in mind that it's wise to shoot for the low-hanging fruit first because these early successes will foster an attitude among staff that the organization is moving in the right direction, and it can create momentum for future successes, Sobolik advises.
"Then work through the plan," he says. "Nothing in the world is stagnant, so you'll have to look at this regularly — we look at our documents every year — to see what new technologies are out there and what other hospitals have reported that they're doing."
Pharmacy directors should look at peers' best practices as reported in management studies and at sessions held during mid-year meetings.
And they need to keep in mind that their job is only half done if they research all of the regulatory and accreditation standards, implement those, and stop there.
"Our belief is that because these are either regulations or used as regulations, those are not best practices," Sobolik says. "Those become the minimum standard if they're regulations because you have to do that at the very least."
Best practices are when organizations go beyond what's required.
For example, hospitals are recommended to vent their chemotherapy hoods outside, but it's not a requirement, Sobolik says.
"So that's a best practice because you have to vent that hood somewhere, and the best practice is to vent it outside," he adds. "This is above and beyond."
Although it's common these days to hear that hospitals do not have the financial resources to spend on practices and items that are not absolutely necessary, it's still important to focus on providing patients with the best care possible, Sobolik adds.
"I still think the best care we can provide our patients is the only way to go," he says.