The National Quality Forum included in its Safe Practices for Better Healthcare—2009 Update modifications to the medication management chapter. By combining four existing practices into one, the NQF has called for increased leadership and accountability on the part of hospital pharmacists.
Medication management has been a part of the NQF's Safe Practices since they were released in 2003. Currently, Safe Practices 17 and 18 concern medication safety.
"I can't think of one area that is more complicated to try and hit the right balance of," said Peter B. Angood, MD, FRCS(C), FACS, FCCM, senior advisor to the NQF in patient safety and former vice president and chief patient safety officer for The Joint Commission. Angood spoke during a recent NQF and Texas Medical Institute of Technology Webinar called "Medication Safety: Complex Issues for All."
"The difficulty comes with the fact that these are common problems, but highly complex in terms of finding solutions." Many organizations struggle with crafting policies that encourage change in the medication management process, he said.
Increased leadership by pharmacists
Pharmacists should have a larger presence on the leadership team to help navigate the increasingly complicated world of medication management, said Mary Andrawis, PharmD, MPH, director, clinical guidelines and quality improvement for the American Society of Health-System Pharmacists during the Webinar. To ensure that the existing practices to prevent medication errors as well as development of new practices continue, pharmacists will be an important piece of the puzzle.
"Literature shows that when pharmacists are involved in care, the result is improved patient care, fewer adverse events, and reduced costs," said Andrawis, speaking about Safe Practice 18. "But, in order for that full benefit to be realized, it's really important that those pharmacists be given appropriate authority, and consequently that they continue to take accountability for patient outcomes."
Greater integration of pharmacists with the healthcare team is a benefit not only to the organization by way of more efficient care, but more importantly to the patient, as his or her care will become safer with a pharmacist around at all time to be involved in the decision-making associated with care, said Andrawis.
She presented some actions that facilities can do take to realize an effect on medication safety:
- Open the lines of communication between the leadership team and the hospital's pharmacists. Pharmacists want to have a greater role in decision making, said Andrawis. They can also best explain how medication management can lower the facility's costs. She gave the example of a new service opening up within the hospital. "It's really the pharmacy leader that can best anticipate any disruptions or changes that might result on the medication use system from other decisions that are made.”
- Create a medication safety committee. Led by a pharmacist, this committee can be tasked with reviewing errors, performing root cause analyses related to medication errors, and brainstorming how to plug gaps in the medication system. This group should also be involved in any Walkrounds that take place, said Andrawis.
- Make sure pharmacists are involved in technology planning and implementation. Today, many types of technology are used to manage medications in the hospital. Examples include smart pumps, bar coding, and computer physician order entry. "I really believe the results could just be catastrophic if the technology is not planned for adequately and implemented safely," said Andrawis.
- Include a pharmacist on the clinical team. Instead of referring to pharmacists at certain stages of the process, Andrawis encouraged hospitals to consider making the pharmacist another part of the team, much like the nurse, doctor, and any specialists. Doing so will eliminate delays in care, promote collaboration, and better decision-making for each patient's care, and encourage a sense of shared responsibility for each patient, said Andrawis.