Continuous Quality Improvement - PowerPoint PPT Presentation

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Continuous Quality Improvement

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Side effects/ adverse reactions/ contraindications and how were they resolved? ... allergy/drug-drug interactions/ drug-food interactions ... – PowerPoint PPT presentation

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Title: Continuous Quality Improvement


1
Continuous Quality Improvement
  • Drug Utilization Evaluation

2
Quality in Health Care
  • What impacts the level of quality?
  • Differences in diseases
  • Differences in treatments
  • Differences in health providers
  • Differences in patients responses to therapy
  • Differences in patients expectations
  • Differences in patients perception of quality

3
Problems with Quality in Health Care
  • Overuse (service provided but not needed)
  • Under-use (service is needed but not available or
    provided)
  • Misuse (correct services provided so poorly that
    benefit not seen)

4
Quality Assurance
  • Older term process to ensure that something is
    done or made well enough.
  • Usually retrospective
  • Focuses on a particular component of health care
    problem, not total health care of patient

5
Continuous Quality Improvement, Total Quality
Management(CQI, TQM)
  • Newer term encompass all persons involved in the
    entire process of health care
  • More statistical, data driven
  • More prospective in nature

6
Who Sets Standards for TQM/CQI in U.S.?
  • JCAHO accredits
  • hospitals
  • laboratories
  • home-care organizations
  • long-term care organizations
  • mental health organizations
  • integrated health systems

7
Who Sets Up and Oversees TQM/CQI?
  • Hospital PT committee provides DUE/MUEs
  • LTCF DRR mandated by HCFA
  • Ambulatory Services DUR mandated by OBRA90, set
    up by state Medicaid programs.
  • Prospective Patient counseling
  • Retrospective Use Rx records, claim forms

8
Drug Usage Evaluation (DUE)Medication Usage
Evaluation (MUE)
  • Authorized, structured ongoing review of MDs
    prescribing, RPh dispensing, and patient use of
    medication
  • Prospective, Concurrent or retrospective

9
Prospective/Concurrent DUE
  • Evaluation before med is dispensed.
  • RPh can review meds dosage, directions, patient
    information, drug interactions or duplicate
    therapy.
  • Issues addressed Drug disease contraindications,
    Therapeutic interchange, Generic substitution,
    Incorrect drug dosage, Inappropriate duration of
    drug treatment, Drug-allergy interaction,
    clinical abuse/misuse of drugs

10
Retrospective DUE
  • Drug therapy is reviewed after med is dispensed.
  • Simplest to perform
  • Uses patients medical charts, computerized
    records, insurance claims, etc
  • Similar steps to performing DRR, DUR
  • Issues addressed Appropriateness, over/under
    utilization, generic use, therapeutic
    duplication, drug-disease contraindication,
    incorrect drug dosage, inappropriate duration of
    treatment, clinical abuse/misuse

11
Steps in Conducting and DUE
  • 1. Identify Criteria (optimal indicators)for
    evaluation.
  • Based on current standards of practice
  • supported by the literature
  • clear concise, complete
  • accurate
  • objective

12
Sample Indicators
  • Used for appropriate indication?
  • Correct dose/ route/ dosage time (time of day, w/
    or w/o meals, dose spacing etc)
  • Side effects/ adverse reactions/
    contraindications and how were they resolved?
  • Appropriate duration of treatment?
  • allergy/drug-drug interactions/ drug-food
    interactions
  • therapeutic duplication with other drugs (too
    many nausea or pain meds on board already-is this
    needed?)
  • proper monitoring done? (lab tests/ pain scale
    issues etc)
  • Did drug work? Within reasonable time frame?
    Optimal outcome?

13
Steps in Conducting a DUE
  • 2. Measure actual use
  • data collection
  • Retrospective use medical and Rx records or
    claim forms
  • Prospective prior to or as patent is receiving
    drug/therapy.

14
Steps in Conducting a DUE
  • 3. Compare between optimal and actual use
  • Determine causes for discrepancies.
  • 4. Intervene
  • take corrective action if necessary
  • look at prescribing patterns, medication
    misadventures, quality of drug therapy, economics

15
Intervention Steps
  • Conduct educational programs for target groups
  • Changing policies and procedures
  • Correct or improve communication
  • Provide more information
  • Change indicators and or thresholds
  • Restrict or revoke physician privileges
  • Change the drugs available on formulary

16
5. Evaluate the DUE
  • Assess the effectiveness
  • Evaluate outcomes
  • Document reasons for positive and negative
    results
  • Implement appropriate changes
  • Continue observation

17
Example DUE Ondansetron
  • Criteria (indicators)
  • Is drug used for proper indication?
  • Post-op nausea/vomiting
  • Pre/post chemotherapy
  • Is drug prescribed in correct route/dose?
  • 0.15 mg/kg IV 30 min pre-chemotherapy and at
    48hrs
  • 32 mg IV 30 min pre-chemo (one time use)
  • 4mg IV q6h prn pre/post anesthesia or surgery

18
DUE Criteria (Indicators) cont...
  • Did patient receive optimal outcome?
  • Was drug efficacious?
  • Was nausea/vomiting controlled w/in certain time
    frame or certain number of doses?
  • Were there adverse effects?
  • HA, diarrhea, constipation, sedation, rash, lab
    abnormalities?
  • Did they resolve spontaneously, or upon DC of
    drug?
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