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At the end of the chapter, the reader will be able to:

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  1. Describe the importance of measurement of quality in health care and pharmacy.

  2. Provide three examples of measures that can be used to assess pharmacy quality measures in pharmacy.

  3. Propose a quality measure for pharmacy.

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During the 1990s, significant emphasis was placed on defining and evaluating medication errors and adverse drug events (ADEs). Researchers were published on the definition, incidence, and severity of these events.1 The incidence and severity of medication errors discovered by these researchers prompted a federal review of errors as published in the first Institute of Medicine (IOM) report.2 This report clearly showed the causes of medication errors and adverse events to be the result of faulty systems; it was also a call to action to implement systems to improve quality by reducing medication errors. Inherent to implementing systems to improve patient safety was to also develop a system for measuring the effectiveness of these system process and outcome measures.

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At the beginning of the new millennium, the Agency for Healthcare Research and Quality (AHRQ) began funding research that measured the impact of patient safety interventions on the occurrence of medication errors and adverse events.3 These research studies focused on equipment such as computerized physician order entry (CPOE). In addition, the Joint Commission on Accreditation and Health Care Organizations [now, The Joint Commission® (TJC)] placed a greater emphasis on organizations developing and implementing interventions to improve quality and safety, with the advent of national core quality measures and National Patient Safety Goals. Further, the second IOM report published in 2006 described ways to prevent medication errors, and stressed the importance of developing surveillance and reporting systems to track the effectiveness of patient safety interventions.4 As the second IOM report gained more publicity, measuring quality and safety in health care became more important.

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Organizations such as TJC required a specific quality organization improvement plan that measures the quality and safety of their patient care processes. As a result, most hospitals and health care organizations implemented quality improvement programs and applied them to medication-use processes. Many hospitals and health systems dedicated significant resources to quality improvement departments, and appointed Chief Quality Officers and/or Patient Safety Officers to assume responsibility and oversight for process improvements. Within the last 5 years, health care payors and the federal government are offering pay-for-performance programs for quality, with significant financial incentives attached to measuring and demonstrating improvement in patient care processes. In 2004, the national core quality measures of TJC and the Centers for Medicare and Medicaid Service became the same, helping to further focus hospital quality improvement efforts. Finally, continuous quality improvement (CQI) has been incorporated into most of TJC standards, particularly those related to medication management. Most of the current TJC standards for clinical departments require a comprehensive quality improvement plan.

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CQI is defined as a systematic, organizational ...

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