Pharmacists to assess their safety processes

Aggregate survey data available soon

The Institute for Safe Medication Practices (ISMP) in Huntingdon Valley, PA, is encouraging pharmacists to help conduct a self-assessment of their hospitals’ medication safety processes. Data from the surveys then will be compiled and analyzed so that participating hospitals can compare their results against demographically similar institutions.

The 2004 ISMP Medication Safety Self-Assess-ment has recently been distributed to hospitals across the county. ISMP launched the self-assessment in partnership with the Health Research and Educational Trust and the American Hospital Association (AHA), both based in Chicago. The Commonwealth Fund in New York City provided funding for the project.

The self-assessment is an opportunity for hospitals to take a look at their medication practices, says Allen J. Vaida, PharmD, FASHP, ISMP executive director. The first self-assessment, which had 194 survey items, was conducted in 2000. The current self-assessment has 231 items. "We added items over the last four years from new things that we have learned," he says.

Hospitals are being asked to convene multidisciplinary teams to respond to the survey and to provide a wide range of perspectives so the data can be as complete as possible. The teams often include representatives from pharmacy, nursing, information technology, administration, and front-line medical staff. The assessments were mailed to the director of pharmacy at each hospital, and pharmacists often spearhead the project, Vaida says.

The self-assessment process runs at least two to three hours over several meetings, he notes.

Members of the team go through the assessment and come to a consensus on the answers. In some instances, members of the team may not be able to answer a question completely. Someone may be asked to find out the information and report it back to the team at the next meeting.

Questions based on experience

More than 1,400 hospitals submitted their survey data to ISMP in 2000, Vaida says. The time seemed right to launch a self-assessment then. The Institute of Medicine had issued its groundbreaking report on the prevalence of medical errors in late 1999, and the self-assessment came out the next spring. Vaida, however, found that he spent much of his time explaining terms and concepts. "People weren’t really into the self-assessing even though we gave it some press."

The climate has since undergone a tremendous change. "Now there is so much more awareness of the importance of self-assessment," he says. The Joint Commission on the Accreditation of Healthcare Organizations, for example, has added goals regarding medication safety. Accounting for this and AHA’s promotion of the current assessment, ISMP expects many more hospitals to participate this year.

The self-assessment also should not be viewed as just ISMP’s view of good practices, Vaida says. "The assessment itself is based on ISMP’s 30 years of experience in trying to safeguard against medication errors."

ISMP receives information from its national Medication Errors Reporting Program, and from its hospital consults, lectures, and work with groups. "[The assessment] is based on solid information of what we consider are safe characteristics. It’s not just someone sitting down and saying, This is what I think,’" he says. ISMP also relies on the advice of a national advisory board.

Hospitals who have taken the self-assessment have often found their medication practices weren’t quite what they thought before they took the survey. "When [team members] talk about how they share information and what information is obtained on patients, they say, Are you telling me that pharmacy doesn’t have that information? I never knew that. Why don’t they have that?’ It might be an IT problem," Vaida says. "When you sit down as a multidisciplinary group, many things may open your eyes that you had taken for granted was done everywhere."

The self-assessment also was meant to set some goals for the hospitals. "As you are going through it, you realize some of your shortcomings and what goals you should work on," he says.

Once the survey has been completed, hospitals can then enter their results on-line at the secure ISMP web site, Vaida explains. The assessments have a password, which a hospital representative enters before submitting the data. The password is not identified with any hospital; it exists only for the integrity of the data.

"I can’t tell you what the password is from St. Joe’s in Atlanta or what their data are in the database. It is completely de-identified," he says.

Hospitals can enter their data through about the third week in September. Then ISMP will compile and analyze the data, after which participants will get the opportunity to compare the aggregate data against their own results.

For example, each question has a weighted score. The weighted scores that hospitals received from ISMP help for comparison purposes, reports Vaida. "The assessment is broken up into about 20 sections. A hospital could look at it and say, How did I score in the section that asks about formulary safety? Also, how did the rest of the nation score in that? Was I higher or lower?’"

ISMP will break down the information by demographics so hospitals can compare their data to similar institutions. Hospitals will be able to compare by factors such as the number of inpatient beds, type of organization (for-profit, not-for-profit), location (urban, rural), and teaching or nonteaching. ISMP also has the baseline 2000 data.

Some multihospital systems and state quality collaboratives also are interested in finding out how they score as a group, he adds. "[They’ll say], let’s look at the range. Some of us are doing it well, some not as well in certain categories. Let’s start trying to share some best practices."

For the survey to adequately help improve medication safety practices, hospitals must participate, Vaida says. "The important thing is that we are looking for a solid response to this. If we don’t know what people need help with, and what some of the issues are, we can’t help."

After the first self-assessment, ISMP developed education programs, one of which was the Path-ways for Medication Safety. The three tools in the pathways were designed specifically from the results of the first self-assessment, Vaida says. "It was done in collaboration with the Health Research and Educational Trust of AHA and ISMP."

ISMP also had a large advisory group and received funding that allowed it to offer the tools completely free (see "We put that together looking at where the hospitals had their shortcomings," Vaida says. "We hope we can do something like that this time, too."

Here’s a look at the ISMP 2004 Self-Assessment

Here are some of the items included in the Institute for Safe Medication Practices (ISMP)’s 2004 Medication Safety Self Assessment. This section is listed under Core Characteristic #1: "Essential patient information is obtained, readily available in useful form, and considered when prescribing, dispensing, and administering medications." Hospitals need to use this scoring system to respond to the items below:

A - There has been no activity to implement this item.
B - This item has been formally discussed and considered, but it has not been implemented.
C - This item has been partially implemented in some or all areas of the organization.
D - This item is fully implemented in some areas of the organization.
E - This item is fully implemented throughout the organization.

1(1). Prescribers and nurses can easily and electronically access inpatient laboratory values while working in their respective inpatient locations.

1(2). Pharmacists can easily and electronically access inpatient laboratory values while working in their respective inpatient locations.

2(1). Prescribers and nurses can easily and electronically access outpatient laboratory values while working in their respective outpatient locations.

2(2). Pharmacists can easily and electronically access outpatient laboratory values while working in their respective outpatient locations.

3(1). Prescribers and nurses can easily and electronically access both inpatient and outpatient laboratory values while working in their respective inpatient and outpatient locations.

3(2). Pharmacists can easily and electronically access both inpatient and outpatient laboratory values while working in their respective inpatient and outpatient locations.

4. A pharmacist or prescriber routinely adjusts doses of medications that may be toxic in patients with renal or liver impairment.