Download Part II

Hospital part II OCT 4- oct 25
*****INSERT: Health Services Restructuring
Commission.,Regional Pharmacy Models in CanadaOverviews of Findings handout, Table II Comparative key
indicators across existing regions. Facilities, People and Drugs
handout. Hospital Systems – Medications Errors article
**********************Sept. 27/2002
HOSPITAL PHARMACY RESIDENCY PROGRAMS
Oct. 4/2002
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CHPRB:
- role of the board
- role of CSHP
- membership
- Accreditations Survey process
- Preceptor Training
Role of the CHPRB Board
 Establish and maintain standards of practice for residency programs
 Carry out accreditation surveys
 Provide opportunities for Preceptor Training
 Communications Board activities to CSHP members etc.
 Adhere to budgetary guidelines
Role of CSHP
 CSHP council appoints chair of CHPRB
 CSHP council confirms members of the board
 CSHP provides office support for the board
 CHPRB chair reports to CSHP council twice yearly
CHPRB Membership
 Chairperson – elected by board 2 year term
 Vice Chairperson – elected by board – 2 year term
 5 board members
 Each has 2 year terms renewable 2 times (max 6 years)
 Members represent residency directors, residency coordinators and full time
academic staff from the participating faculties
 Total of 7 members
 Can serve 6 years maximum
Pharmacy Residency Forum of Ontario
 Coordinates program s in Ontario
 Membership includes residency directors, residency coordinators,
representative from OPRA, faculty liaison and Residency selection
coordinator
 Activities include coordination of residency activities including selection
process
Ontario Pharmacy Residents Association
 Represents the residents enrolled in programs
 Includes hospital, community and industrial
 Communicate with members
 Organize educational events
 Attempt at national membership bid failed because difficulty to organize
CHPRB Standards
 Residency program requirements
o General education approach
o Assessment of residents learning
o Pharmacy practice rotations
o Communication and research skills
o Program completion
 Purpose of residency programs
o To provide an experiential learning environment using pharmacy
practitioner role models so the necessary skills, knowledge and values
can be acquired and applied by the resident in the provision of
exemplary patient care
o To develop competent and progressive pharmacy practitioners in
health care organizations and encourage future leaders for the
profession
 Qualifications
o Health care organization
o Program direction
o Preceptors
o Residents
o Also used as a recruitment tool
o Most residents are offered jobs at least 6 months into the program
Pharmacy practice rotations
 Direct patient care (focus of all rotations)
 Drug distribution and intravenous admixtures
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Drug information and literature evaluation
Practice management and drug use control
Research project
Aka administrative rotations
Accreditation Survey Process
 Each program is survey every 4 years or sooner if deemed necessary
 Two members of board conduct an on-site visit to evaluate the program
against the standard
 A verbal report is provided at the time of the visit but no recommendations
are given
 A written report is provided ot the program within 30 days which will
contain any recommendations
 The program is given 60 days to respond to any recommendations
 Report and response are discussed at next CHPRB meeting and an
accreditation award is given
 Recommendations
o Recommendations based on standards
 Accreditation award is directly related to the number and
seriousness of the concerns
o Consultative recommendations
 Recommendations about some factors that may help to
improve the delivery of the program but are not directly
related to the standards
 Do not affect the accreditation status
 Ie. Phmt shortage (no DI phmt)
 Too many recommendations and the hospital won’t get accredited
 Accreditation Awards
o Accreditation
o Accreditation with progress report at 2 years
o Accreditation with progress report at 1 year
o Not a good report  at risk of getting pulled
o Accreditation is time to fix mistakes
o Status is based upon how the program meets the standards
o Not dependant on whether meet recommendations
o Standards  not consultative recommendations
Structure of Residency Programs
 Program Director – usually the director of pharmacy
 Program coordinator
 Individual resident coordinator (optional)
 Preceptors
 Residency advisory committee
Residency Advisory Committee
 Oversees the program to ensure effective operation
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Provides guidance to the program and to the residents
Act as as a source for quality improvement ideas
Support for project
Membership (variable)
o Program director and coordinator
o Hospital administrator
o Nurse
o Physician
o Faculty liaison
o Preceptors
Preceptor Training
 CHPRB seminars q2yr
 On the job by residency coordinators
 Preceptor guide
 Qualifications and requirements of a preceptor
 Assessment, feedback and evaluation
 Mentoring and motivating residents
 Challenges to preceptor
 Dealing with residents in difficulty
Qualifications
 Broad knowledge base
 Desire to learn and teach
 Challenge resident to think logically and critically
Assessment Feedback and Evaluation
 Learning portfolio
 Self-assessment
 Providing feedback
 Evaluating the resident
Mentoring and Motivating
 Mentor is a person who unselfishly serves as a wise and trusted counselor
 Motivating the resident
o Motivation comes from within
o Preceptor can maximize motivation by guiding and challenging
resident but not by overloading and overwhelming them
 Leaders are learners who are willing to take risks and learn from their
mistakes
Challenges to Precepting
 Interpersonal conflicts between the preceptor and the residents
 Attitude
 Behavior
 Competency
Dealing with Residents in Difficulty
 When preceptor recognizes the problem they should deal with the problem
quickly with the help of the coordinator
 Timing of the evaluation is crucial
 Develop a plan of action
 Follow up
************INSERT: Oct 04.02 accreditation standards Introduction handout ,
Assessment, feedback and evaluation handout too***************************
HOSPITAL ACCREDIATION OCT 11, 2002
Overview
 Why have accreditation
 Voluntary (unlike OCP regulation)
 Does pharmacy have anything comparable
 CCHSA as a process model
o Theory and process
o Elements for evaluation
o Self assessment tool
o Standard 15 (medication)
o Strengths/weaknesses
What evaluation tools are available to the profession of pharmacy?
 OCP
 Regulatory, mandatory
 Standards of practice
 Community pharmacy accreditation
 Backed up by inspection and enforcement
 QA program for pharmacists
 CSHP
 Voluntary standards
 No enforcement
 Other
 Faculty and residency accreditation
 Specialty organizations
 Consultants
 Networks
MOTIVATION = Desire to know we are doing the right thing PLUS Desire to keep
improving
Accountability through
 Self examination and reflection
 Peer review
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External expert review
Benchmarking against standards
Use of CQI strategies
CCHSA process provides a model for this
CCHSA Mission
 The mission of CCHSA is to promote excellence in the provision of health
care and
 The efficient use of resources
 In health organizations throughout Canada
 For the benefit of Canadians
CCHSA AIM: “ACHIEVING IPORVED MEASUREMENT”
Quality Dimensions and Descriptors
1.Client and community
 Responsiveness
 Confidentiality
 Participation and partnership
 Respect and caring
 Involvement in the community
2.Work Life
 Open communication
 Role clarity
 Participation in decision-making
 Learning environment
 Well being
3.Responsiveness
 Availability
 Accessibility
 Timeliness
 Continuity
 Equity
4.System competency
 Appropriatness
 Competence
 Effectiveness
 Safety
 Efficiency
 Alignment between organization and programs
Elements of a CCHSA survey
 Pre-survey documents
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On-site documents
Quality indicator data
Self-assessment
Team interviews
Client interviews
Focus groups
Tours
Teams
 Leadership and partnership
 Environment
 Human resources
 Information management
 Patient care
Patient Care Standards
 Individual and population
 Assessment
 Diagnostic servies
 Providing information
 Consent
 Ethics
 Rights and responsibilities
 Cycle of planning and providing
Standard 15: Medication
The use of medication is safe, efficient, effective and promotes the best possible QOL
 Review Rxs to make sure they are accurate
 Fill Rxs and dispense medications in a timely, accurate way
 Store medications in a way that is safe and secure
 Prevent, monitor and promptly respond to any adverse effects resulting from
their use
15.2 Clients receive written and verbal feedback about the…
 Medications and other therapeutic technologies that are available
 Potential benefits and adverse effects
 The risks of not complying with instructions
15.3 The team has access to current information, advice and support about using
medication and other therapeutic technologies
15.4 The use of medication and other technologies
 Meets legal requirements and standards of practice
 Is monitored and reported through an ongoing utilization review
15.5 The organization monitors the quality of its pharmacy services by
 Carrying out an internal quality control program
 Participating in external quality control or accreditation
 Continually reviewing and improving performance as part of a QI process
Accreditation process: Strengths and Weaknesses
Accreditation process Strengths
 Comprehensive
 Consistent
 Objective
 Shared expertise
 Educational process
 Structure, process and outcome based
 Team building opportunity
 public seal of approval
 second d set of eyes (outsider) to critique
 QI emphasis- ids areas for improvement
 Ids areas of excellence
 Validated through multiple strategies
 Holds hospitals accountable
 Source of pride and celebration
Process Challenges
 Expensive
 Labor intensive
 Self-assessment- how honest?
 Standards vague and repetitious
 Agreement on standards?
 Stressful
 Surveyor variability – bias, expertise
 Worth the effort?
****INSERT: “value of pharmacists’ services handout Oct 11, “ The value of Your
services” article Oct 11.02, **********************************************
OCT 18TH
FRAN PARADISO – HARDY
OPPORTUNITIES FOR PHARMACISTS IN THE CARE OF THE CV PATIENT
(CLASS NOTES)
 Cv disease complex, costly, prevalent
 Clinics ambulatory
o Cardiac rehab
o Chf
 Inpatient: warfarin dosing
 Cath lab
 Administrative
o Involvement in CV drug use/outcomes programs or QC activities
(standard orders, hospital guidelines, heparin nomograms)
o Written DI monographs
*** INSERT: “seamless Care workshop” article Oct 18, 02 Jim
Mann*************