HRSA patient safety and pharmacy collaborative is off to a good start
HRSA patient safety and pharmacy collaborative is off to a good start
Safety partnerships appear to work
More than 200 organizations have joined in a national patient safety and pharmacy collaborative, and federal officials say the program remains popular as it enters its second year.
The Health Resources and Services Administration (HRSA) of the U.S. Department of Health & Human Services (HHS) of Rockville, MD, has been reaching out to hospital pharmacies, among others in health care, to lead the way in adopting leading practices that will improve patient safety and health outcomes through the integration of clinical pharmacy services.
Called the Patient Safety and Clinical Pharmacy Services Collaborative (PSPC), the initiative began with the idea in the spring of 2007 and then followed up later when HRSA officials visited 34 high-performing sites.
The sites were identified by a contractor in consultation with HRSA and were visited by both HRSA officials and the contracting organization. They're listed on the HRSA web site at www.hrsa.gov/patient safety. One site chosen was El Rio Health Center of Tucson, AZ.
The health center received grant funding in 2001 for a clinical pharmacy demonstration program, says Sandra Leal, PharmD, CDE, clinical pharmacy supervisor at El Rio Health Center. Leal also is the immediate past president of the Association of Clinicians for the Underserved and is a consultant with the HRSA Pharmacy Services Support Center.
"I was the pharmacist hired at the time, and now we have three pharmacists at different locations," Leal says. "We specialize in diabetes management, hypertension, and cholesterol control."
HRSA officials looked for best practices among the high-performing sites as a beginning for its collaboration.
"We looked at what they were doing, how they were doing it," says Jimmy Mitchell, RPh, MPH, MS, director of HRSA's office of pharmacy affairs.
"We documented their activities and created a change package, which is on our web site," Mitchell says. "We invited teams to form in communities across the country."
Sixty-eight teams formed for the purpose of focusing on a particular patient population and to implement the change package and improve patient safety and outcomes in their own environments, he adds.
The teams include various health care entities, including ambulatory clinics, hospitals, state health departments, university pharmacy schools, and community pharmacies. They focus on the safety net population.
"It's been exciting to see what's taking place across the country and what the teams are doing to improve patient safety because it requires an entire community to improve systems and patient safety and outcomes," Mitchell says.
El Rio Health System has joined one of the 68 teams, collaborating with Maricopa Integrated Health System in Phoenix, the University of Arizona in Tucson, Flagstaff North Country in Flagstaff, and Arizona Pharmacy Alliance, Leal says.
Joining the collaborative and handling the information generated by it has been somewhat overwhelming, says Brad Mattke, RPh, an assistant director of pharmacy who is in charge of outpatient pharmacy operations for Maricopa Integrated Health System.
"I hope this collaboration will advance the practice of pharmacy," Mattke says.
Each of the PSPC teams represent different health care models, including a rural model, a non-pharmacist model, integrated systems, nonintegrated systems, telepharmacy models, etc., says Krista Pedley, PharmD, MS, an improvement advisor in the office of pharmacy affairs at HRSA.
As the teams produce results, their activities can be replicated by other health care systems, Mitchell says.
The first round of the collaborative will end in September 2009, and new teams already are being formed for enrollment into the second round of this work, he adds.
"There are four opportunities for teams to come together with us and meet in the Washington, DC, area to share their results and learn from each other," Mitchell explains. "Then they can go back to their communities and continue to improve their processes."
The teams pay for their own travel expenses and initiatives, which is part of their commitment to the collaborative, Pedley says.
"Travel and cost is a big concern among all participants, particularly as we go into this economy," Mitchell says. "For the next session, we anticipate connecting various sites around the country to satellite learning sessions."
Various sites, including schools of pharmacy, have made their facilities available for satellite downloads of several hours of the learning sessions that will be held in Washington, DC, he explains.
"This reduces costs, increases efficiency, and increases the education's spread to have the satellite sites around the country," Mitchell says.
Also, the National Association of Chain Drug Stores offered grants to fund six teams that included a community pharmacy, Pedley says.
"Communities are reaching out to pharmacy and partners within their community to be able to get funding and be involved in this work," she says. "We encourage them as much as possible to integrate the work they're doing day-to-day as part of the collaborative into their usual activities."
The teams submit monthly reports of their qualitative and quantitative results in the areas of clinical pharmacy services, health outcomes, and patient safety with regard to adverse drug events and potential ADEs, Pedley says.
Anecdotal evidence of improvements
So far, the data collection is too new to produce any trends, but there has been anecdotal evidence of improvements, she notes.
For example, El Rio Health Center in Tucson and Paynesville (MN) Area Health Care System have been good models for how well the collaborative model can work, Mitchell says.
Paynesville Area Health Care System, a 25-bed, critical access hospital with three full-time pharmacists, was one of the original 34 high-performing sites selected by HRSA, says Todd Lemke, PharmD, CDE, director of pharmacy service. Lemke is a member of the faculty for the collaborative.
The hospital's pharmacists are involved with the hospital in handling a number of chronic diseases, including handling patients with diabetes, heart failure, hypertension, and anticoagulation needs, Lemke says.
Since becoming involved with the PSPC, Paynesville Area Health Care System has continued to improve outcomes and has focused on an interdisciplinary team approach for such initiatives as a medication safety committee and an error reduction committee. Disciplines involved include nurses, information technology representatives, social services, pharmacists, and physicians on the hospital's pharmacy and therapeutics committee to which reports are given, Lemke explains.
"We're looking at ways to change the process in the hospital to make medications safer," he says.
For instance, the health system is addressing the issue of confusing standard orders. Sometimes the surgery order might conflict with the anesthesia order in how they're written, so one goal is to develop an electronic standard order that everyone would use and understand, Lemke explains.
The PSPC will provide health care system pharmacists with documented proof that having a pharmacist involved in patient care can result in tangible medical improvements, Lemke says.
"By showing these positive outcomes, then down the road, this will help pharmacists become recognized as providers who should be able to bill for services in a more uniform way," Lemke adds.
"For health systems and communities and patients, I think they'll see that by having pharmacists in patient care the patients will have better outcomes," Lemke says. "And by having better outcomes, we'll be able to reduce health care costs and make people's lives better."
Also, the PSPC is a way for pharmacists and others to educate the public about patient safety and the efforts pharmacists and others are taking to improve health care outcomes, Lemke says.
"HRSA's collaborative has provided a great way for us to get the information out, and that's something that's hard to do on your own," he says.
The collaborative teams themselves have proven to be innovative. For instance, some teams have formed partnerships with poison control centers in states, Pedley says.
This initiative isn't a new enterprise for HRSA, Mitchell notes.
"Keep in mind that HRSA has a decade or more of history in running national collaboratives," he says. "We have run them in numerous settings from the community health centers to HIV/AIDS programs to organ donation."
HRSA doesn't have a completion date for the collaborative, Mitchell says.
"It'll depend on the impact and the leadership with the organizations and the community's receptivity," he explains.
"This is a volunteer effort, and they have to invest a tremendous amount of resources to participate," Mitchell adds. "If the return on investment is positive, and we're convinced it will be, then it will continue on whether or not the government is in the driver seat."
Other HRSA collaboratives have run on their own once they've matured, he says.
The original 68 teams will be invited to continue with the collaborative and to reach out and develop even larger partnerships, Mitchell says.
"The value of the collaborative becomes so immense to the community of stakeholders that leadership develops, and they pick up on collaboratives and lead it into the future," Mitchell says. "Where there's success and they're making improvements, we'd like to see them continue."
More than 200 organizations have joined in a national patient safety and pharmacy collaborative, and federal officials say the program remains popular as it enters its second year.Subscribe Now for Access
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