Management Exam II
What is quality?
- A valued product
- An increase of positive outcomes
- A decrease of negative outcomes
- Represents current medical knowledge
- Increases patient’s quality of life
- Increases patient satisfaction
How is Quality Measured?
- Outcomes (Economic, Humanistic, Clinical)
What are the Human Factors principles?
- Reducing reliance on memory
- Simplifying and standardizing
- Using protocols and checklists
- Using mechanisms to physically stop errors from happening
- Improving access to information
- Decreasing reliance on vigilance
- Implementing automation
Describe Quality Assurance (QA)
A check is performed to ensure a certain quality standard has been met
Describe Quality Control (QC)
Improves design to improve level of quality
Describe Continuous quality improvement (CQI)
- A total systems perspective
- Demands that quality improvement process is continuous
There are six domains of the medication use process. Which domain has the lowest rate of error interception in the medication use process?
Regarding HIT, the functions of CPOE and CDS include ___________ (2)
1. Real-time patient information at point of care
2. Legibility improvement
From the list below, which is the most important element in time management?
- Making a to-do list
- Minimizing external time wasters
- Taking a time inventory
- Setting and Scheduling priorities first
4. Setting and scheduling priorities first
What are symptoms of poor time management?
- Feel rushed constantly
- Feel fatigued or overwhelmed
- Misses deadlines
- Have little time for rest or personal relationships
- Feel like they can’t do what they want most of the time
What are the two mistakes that people new to management often make?
- Don’t allow adequate time for planning
- Underestimate the importance of a daily plan
The pharmacist spot checks the unit dose medication carts after the technician fills them. Which of the following best describes this situation?
The pharmacist develops a standard procedure for error prevention for technicians to use when filling medication carts. Which of the following best describes this situation?
Which type(s) of patient identifiable health information is(are) covered by HIPAA requirements?
- A written prescription
- Verbal communication in the pharmacy
- Conversations with the physician in the elevator
- Electronic prescription records
The federal law that established requirements for both safety and proof of efficacy of drug products is:
The 1962 Kefauver-Harris Amendments to hte Food, Drug, and Cosmetic ACT of 1938
A pharmacy manager's strategy for reducing the likelihood of an error that harms a patient and results in a lawsuit is most likely to be successful if:
Performance Improvement policies and procedures are in place
Which of the following are key drivers for automation and technology in pharmacy practice?
- Limited resources
- Streamlining of processes and costs
- Improving customer satisfaction
- Improving scheduling
- Limited resources
- Streamlining of processes and costs
- Improving customer satisfaction
Which of the following are the goals of best practices in Health Information Technology?
- To improve the quality of care rendered
- To enhance business function
- To ensure timely payment of claims
- To improve patient satisfaction
- To improve the quality of care rendered
- To enhance business function
What is the primary goal of a Closed-Loop Medication Management system?
It reduces the number of steps in a complex process, reducing the number of opportunities for errors to occur.
Please select the essential element(s) that a pharmacist should review when working with a vendor in the selection of a health information technology system.
There are six domains of the medication use process. Which domain has the highest rate of error interception in the medication use process?
What is the definition of time management?
The predictable control an individual can exercise over a series of events
What is the purpose of time management?
To improve productivity and effectiveness, thus reducing stress and reactive management of tasks
In the time matrix, what is both important and urgent?
Firefighting (Crises, pressing problems, deadline-driven projects)
In the time matrix, what is both important and NOT urgent?
Quality Time (Prevention, capability improvement, relationship building, recognizing new opportunities, planning, recreation)
In the time matrix, what is both NOT important and NOT urgent?
Time wasting (Trivia, busy work, some mail, some phone calls, time wasters, pleasant activities)
In the time matrix, what is both NOT important and urgent?
Distractions (Interruptions, some callers, some mail, some reports, some meetings, proximate pressing matters, popular activities)
T/F: It is rare to apply different principles at how we manage time in different settings
T/F: The ability to multi-task is not an absolute necessity
Is delegation avoidance an example of an internal or external time waster?
Is haste an example of an internal or external time waster?
Is incompetent or non-participating colleagues an example of an internal or external time waster?
Are interruptions (Phone and drop-ins) an example of an internal or external time waster?
Is the inability to say no an example of an internal or external time waster?
Is Lack of feedback/information an example of an internal or external time waster?
Is Indecisiveness an example of an internal or external time waster?
Is Open door policy an example of an internal or external time waster?
Is Poorly planned or unnecessary meetings an example of an internal or external time waster?
Is Poor filing system an example of an internal or external time waster?
Is Poor planning an example of an internal or external time waster?
Are Superfluous emails an example of an internal or external time waster?
Is Procrastination an example of an internal or external time waster?
Is Management by crisis an example of an internal or external time waster?
Are Unimportant tasks an example of an internal or external time waster?
While you cannot control some of the external time wasters, what can you develop to mitigate them?
Strategies and feedback
For internal time wasters, identify and remediate your areas of ______________
This author has a series of books on time management and organization
This author is on "The 5 choices of Extraordinary Productivity"
Examples of basic time management smartphone apps
Clear, 2Do, aTimeLogger
Examples of comprehensive time management smartphone apps
Remember the Milk, Got 2 Do, OmniFocus
What are the common themes of all time management systems?
- Recognize the need for improvement
- Conduct an honest analysis of how you currently use your time
- Establish your mission and set goals
- Get organized (sort through your tasks, create a master list, schedule tasks, use a system) and prioritize
- Take action
Review, revise, modify
What is the first step in developing your time management skills?
Perform a time inventory
What are the 5 choices of extraordinary productivity?
- Act on the important -- don't react to the urgent
- Go for extraordinary -- don't settle for ordinary
- Schedule the big rocks -- Don't sort gravel
- Rule your technology -- don't let it rule you
- Fuel your fire -- don't burn out
Of the 5 choices of extraordinary productivity, which 2 choices are involved with your decision management?
- Act on the important (Pause, clarify, decide)
- Go for the extraordinary
Of the 5 choices of extraordinary productivity, which 2 choices are involved with your attention management
- Schedule the Big Rocks
- Rule Your Technology
Of the 5 choices of extraordinary productivity, what choice are involved with your energy management
- Fuel your fire
Imbalance of management in the 5 areas (of extraordinary productivity) causes a shift from use of the __________ __________ to the ____________ __________ of the brain
Prefrontal cortex; limbic portion
A shift from use of the prefrontal cortex to the limbic portion of the brain shift your thinking from a controlled planning process to a more ___________ __________
A shift from use of the prefrontal cortex to the limbic portion of the brain leads to a more ______________/_________________ feelings about events in your life
What are the key drivers of adoption of technology in pharmacy?
- Limited resources
- Regulatory and legal requirements
- Customer satisfaction
- The need to streamline operational processes and costs
- Point of sale prescription adjudication and financial reimbursement
The FDA report made it clear that to improve medication safety, pharmacies must 'implement proven safety practices' to:
Reduce reliance on memory, standardize terminology, minimize data handoffs, and utilize constraints and forcing functions, protocols and checklists
What were all allied health professionals tasked with
- Automating patient-specific clinical information in the context of an electronic health record (EHR) and to integrate with computerized prescription order entry (CPOE) systems, drug distribution and medical administration
- The desire was these systems would work together and across organizational boundaries to share (in real time) patient specific clinical information
What must be met to be eligible for reimbursement as a driver?
Hospitals and physicians must demonstrate meaningful use of HIT, exchange of electronic health information, and report on key quality measures
What did the American Recovery and Reinvestment Act (AARA) of 2009 and the Health Information Technology for Economic and Clinical Health (HITECH) act provide?
Financial subsidies for those using HIT and required those participating in medicare to use it by a specific date or pay a penalty
What is the role of the pharmacist in HIT?
- Leads medication management supporting system deployments, maintenance, and optimization efforts.
- Serves in project management leadership (Planning, Initiation, Execution, Analysis, and Closure)
- Collaborates with stakeholders to assist with system analysis and identification of opportunities for optimization
- Perform quality improvement activities to enhance systems
What are 4 ways the pharmacist can make change using HIT?
- Data, Information, and Knowledge Management
- System Selection, Development, and Design
- Implementation, Maintenance, and Optimization
- Education and Research
In HIT - related change management, _______________ and ______________ are crucial
In HIT - related change management, is change avoidable or unavoidable?
In HIT - related change management, _______________ should be expected
In HIT - related change management, _________________ impacts the way someone does their job
In HIT - related change management, _______ __________ should be involved
What are at the 6 domains of MUP (Medication Use Process)?
- Selection and Procurement
- Ordering and Transcribing
- Monitoring and Assessment
- Preparation and Dispensing
What technologies are used in the Prescribing step of MUP?
- CPOE (Computerized prescriber order entry systems)
- CDS (Clinical decision support systems)
What technologies are used in the Transcribing step of MUP?
- Order management systems
- PIMS (Pharmacy Information Management systems)
What technologies are used in the Administration step of MUP?
- Electronic medication administration record (eMAR)
- Bar code medication administration systems
- Smart pumps
What technologies are used in the Preparation and Dispensing step of MUP?
- Solid dosage form robotics
- Workflow management systems
- Inventory management systems
- Automated dispensing devices
- Tablet counters
- Bar code packagers
- Sterile compounding robotics
What are the core MUP supporting technologies?
- CPOE and CDS
- Preparation and Dispensing systems
- Medication Administration systems
Describe CPOE systems
- Clinicians create orders electronically
- Secure and safe way to transport and share data across the health system and community pharmacy environment
- Although considered costly and cumbersome to use, CPOE is considered one of the most important HIT investments to improve safety and quality
Describe CDS systems
- Guides decisions based on information in the patients EMR
- Pharmacy Information Management Systems
- This system has been in place for more than two decades and is considered the backbone of the MUP technologies
- Can function as independent ordering systems, or ideally, an be tightly integrated with the CPOE system to reduce the potential errors for verification and transcription
- Can be used for inventory management and point-of-sale prescription benefit reimbursement
What are the functions of CPOE and CDS?
- Legibility improvement
- Structure menu-driven orders
- Real-time patient information at the point of care
- Embedded drug information, including dose checking, drug-drug interactions, and allergy alerts
What are the functions of PIMS?
- Verification of prescribed orders
- Structured ordering
- Online drug information support (dose checking, drug interactions, allergy alerts)
What are the functions of preparation & dispensing systems?
- Drug purchasing and supply chain management systems
- Automated distribution (hospital and community)
(Automated dispensing cabinets, robot cart filing systems, automated medication storage systems)
- Preparation systems
(Sterile compounding devices, unit dose and bar code packaging, medication counting and labeling devices)
What do our medication management systems accomplish?
- Drug-drug interaction checking
- Drug-disease alerts
- Duplicate therapy alerts
- Dose range checking
- Documented administration of medicaiton
- Using the bar code system to administer medications ensures the five rights
What are the 5 rights
- Right patient
- Right medication
- Right dose
- Right time
- Right route
Define the closed-loop medication management system
A fully electronic, connected medication management system that feeds a one-step of medication use process sequentially from one step (such as order entry) to the next (such as validation)
A closed-loop medication management system feeds outcomes from the medication process back into the system to:
Enable deployment and development of improved practices to effectively monitor patient care
Through automation of all medication related processes, a closed loop can reduce the number of steps in a complex process, which , in turn can do what?
Significantly reduce the number of opportunities for errors to occur (PRIMARY GOAL)
What is the primary goal of a closed-loop medication management system?
To significantly reduce the number of opportunities for errors to occur
What are the objectives of closed-loop medication management?
- An accurate electronic patient health record
- Provider order entry process
- CDS system to evaluate orders as they are entered as well as changes that a patient condition may demand
- A preparation and distribution automation infrastructure that uses automatic identification and other technologies to verify that medications are selected and/or prepared in response to specific orders appropriately selected for change
- Computer-based bedside verification of medications at the time of administration that is tolerant of a variety of products and dose forms
Vendor selection for HIT requires what kind of team?
Multidisciplinary (IT experts, nurses, physicians and pharmacists)
T/F: Because of the pharmacist's expertise in best medication management processes, the pharmacist should participate in all vendor selections processes for all medication management related systems
T/F: The pharmacists is most qualified to assess the potential clinical, operational, and safety features available in a system which are essential components that align the system requirements to the institutional goals and ideal HIT
As the most qualified to assess the potential clinical, operational, and safety features available in a system, what should pharmacist do?
- Serve in a project leadership role throughout the process
- Take responsibility for all aspects of the process
- Collaborate with stakeholders
What is downtime?
A temporary outage of computing systems
What is data loss?
The permanent inability to access data
What are causes of downtime in HIT?
- Scheduled system backup
What are the two main types of backup procedures?
- Offsite backup-stored internally
- Data stored and backed up externally
When is using 'offsite backup-stored internally' useful?
When the pharmacy system is nonfunctional. Data stored and backed up externally
When is using 'data stored and back up externally' advantageous?
The pharmacy bears little responsibility for computing hardware and software because it is maintained by the vendor
What 5 questions need to be asked on backup procedures?
- How are patient data secured?
- How often do backups occur? Can that be changed by pharmacy management?
- Where are data backed up? Offsite in multiple locations with 24/7 security
- How quickly can data be backed up in the event of an outage?
- Are automated notifications sent to key personnel when backups occur or when they don't?
In summary, what are best practices in HIT?
- Minimize the impact of downtime or the loss of data due to the absence of an adequate backup
- Apply to both prescribers and pharmacies
- Focus on processes related to workflow, system design, and usage
In summary, what are the goals of best practices in HIT?
- Improve quality of care
- Enhance business function
In community pharmacy practice, suggested best practices for e-prescriptions would include workflow improvements for which areas?
- Physician entry of electronic prescriptions or close review if done by other providers
- Use of CDS by prescribers
- Receipt of electronic prescription should trigger an obvious notification in the pharmacy PIMS system
- Capacity of the pharmacist to request additional information from prescribers and the responses electronically
What are some suggested sources for best practices in HIT
- American Pharmacists Association
- American Society of Health-System Pharmacists
- Leapfrog Group
- Markle Foundation
- National Governor’s Best Practices
- The Joint Commission
- The Office of the National Coordinator for Health Information Technology
- American Medical Informatics Association
T/F: HIT already serves a number of roles in pharmacy and will only continue to grow
Briefly describe the future of pharmacy and HIT
- Electronic medical records
- Telemedicine and telepharmacy
- On-site, walk-in clinics