美國(guó)臨床藥師的臨床實(shí)踐管見(jiàn)課件

美國(guó)臨床藥師的臨床實(shí)踐管見(jiàn)1精選ppt美國(guó)臨床藥師的臨床實(shí)踐管見(jiàn)1精選ppt內(nèi)容提要美國(guó)醫(yī)院從事藥學(xué)技術(shù)工作的分類(lèi)，配置的，比例和職責(zé)。美國(guó)的住院藥師（在臨床工作的，相當(dāng)國(guó)內(nèi)的臨床藥師）如何參與臨床藥物治療工作，保證患者用藥安全、合理用藥的；制度、資質(zhì)、工作流程、績(jī)效、酬報(bào)等，有無(wú)書(shū)面的文書(shū)，如藥歷等。美國(guó)的住院藥師在用藥安全、合理方面做出的成績(jī)，課題，數(shù)據(jù)等。2精選ppt內(nèi)容提要美國(guó)醫(yī)院從事藥學(xué)技術(shù)工作的分類(lèi)，配置的，比例和職責(zé)。美國(guó)臨床藥師資質(zhì)本科藥學(xué)管理碩士藥學(xué)博士住院藥師訓(xùn)練專(zhuān)業(yè)證書(shū)（BoardofPharmacotherapy)BoardCertifiedPharmacotherapySpecialistBoardCertifiedOncologySpecialistBoardCerfitifiedAmbulatoryCareSpecialistBoardCertifiedNutritionSupportSpecialistBoardCerfitifedPediatricSpecialistBoardCertifiedInfectiousDiseaseSpecialist3精選ppt美國(guó)臨床藥師資質(zhì)本科3精選ppt美國(guó)臨床藥師分類(lèi)政府機(jī)關(guān)教學(xué)機(jī)構(gòu)保險(xiǎn)公司醫(yī)藥公司的藥物信息部醫(yī)院住院部門(mén)診（獨(dú)立門(mén)診和醫(yī)院門(mén)診）藥店（獨(dú)立或連鎖）4精選ppt美國(guó)臨床藥師分類(lèi)政府機(jī)關(guān)4精選ppt醫(yī)院臨床藥師分類(lèi)職能住院部中心藥房普通病房專(zhuān)科病房（ICU,各個(gè)專(zhuān)科-心臟，腎臟，兒科，腫瘤，流行病，心理精神）門(mén)診部?jī)?nèi)科和家庭醫(yī)生門(mén)診各個(gè)專(zhuān)科5精選ppt醫(yī)院臨床藥師分類(lèi)職能住院部5精選ppt推廣臨床藥師的數(shù)據(jù)五個(gè)花錢(qián)最多的病癥

糖尿病、心衰、高血壓、高血脂、肺氣腫五個(gè)返診率最高的疾病

心肌梗死、心衰、腎衰、呼吸系統(tǒng)疾病、精神病五個(gè)門(mén)診病人最集中的科室

心腦血管疾病、腫瘤、糖尿病、關(guān)節(jié)炎、肥胖6精選ppt推廣臨床藥師的數(shù)據(jù)五個(gè)花錢(qián)最多的病癥6精選ppt2010DiseaseTargets

GregoryDill,CentersforMedicare&MedicaidServices,RegionVAssociateRegionalAdministratorforFinancialManagementandFee-for-ServiceOperations7精選ppt2010DiseaseTargets

GregoryD2010MultipleChronicDiseases“Sponsorscannotrequiremorethan3chronicdiseases

astheminimumnumberofmultiplechronicdiseases”and“sponsorsmusttargetatleastfourofthesevencorechronicconditions:”HypertensionHeartFailureDiabetesDyslipidemiaRespiratoryDiseases(Asthma,COPD,ChronicLungdisorders)BoneDisease-Arthritis(Osteoporosis,RA,OA)MentalHealthissues(Depression,Schizophrenia,BipolarDisorder,others)GregoryDill,CentersforMedicare&MedicaidServices,RegionVAssociateRegionalAdministratorforFinancialManagementandFee-for-ServiceOperations8精選ppt2010MultipleChronicDiseasesHennepinCountyMedicalCenter藥師配置465張病床藥房管理人員-全職：主任，住院部經(jīng)理，臨床藥學(xué)部經(jīng)理，門(mén)診部經(jīng)理，特種藥房經(jīng)理，用藥安全經(jīng)理兼職：藥物治療學(xué)經(jīng)理，住院藥師經(jīng)理，藥學(xué)博士生經(jīng)理，中心藥房臨床藥師普通病房專(zhuān)科病房門(mén)診藥師普通門(mén)診專(zhuān)科門(mén)診住院藥學(xué)博士技術(shù)員藥學(xué)院學(xué)生9精選pptHennepinCountyMedicalCente臨床藥師參與醫(yī)院工作介紹臨床用藥安全經(jīng)理-用藥安全醫(yī)院用藥安全決策（院辦，臨床藥物治療）領(lǐng)導(dǎo)各級(jí)用藥安全委員會(huì)（用藥安全，醫(yī)療事故，臨床藥學(xué)，護(hù)理）臨床藥物治療經(jīng)理-合理用藥藥物種類(lèi)藥物使用分析臨床用藥政策10精選ppt臨床藥師參與醫(yī)院工作介紹臨床用藥安全經(jīng)理-用藥安全10精選p臨床藥師在用藥安全上對(duì)醫(yī)療體系的影響患者出院藥學(xué)查房案例分析11精選ppt臨床藥師在用藥安全上對(duì)醫(yī)療體系的影響患者出院藥學(xué)查房案例分析（危機(jī)）挑戰(zhàn)In2007,multipleuntowardeventsoccurredtopatientsdischargedtonursinghomesComplaintsfromnursinghomepatientsaboutconfusingdischargeordersAugustananursinghomeBenedictinehealthcaresystemTransplantclinicOutpatientdialysisunitExtendedcare12精選ppt（危機(jī)）挑戰(zhàn)In2007,multipleuntowa追根溯源Oneunitwithoneteamover12weeksDocumentmedicalrecordnumber,numberofmedications,timespentErrorswerereportedinHCMC’seventreportingsystemandtrackedbythemedicationsafetycommittee13精選ppt追根溯源Oneunitwithoneteamove追根溯源Reviewed37patientsdischargedtoSNF17dischargemedsperpatientAveragingabout20minutesperpatient,plusadditionalcommunicationtimewiththeteammembers,mostlyphysicians14精選ppt追根溯源Reviewed37patientsdisch追根溯源InvestigationconfirmsexistingproblemOfthe37patients,only3(8%)wereerror-freeCommonthemesnoted:Formulationerrors(extendedreleaseetc)InappropriateduplicatesIncorrectdoses(e.g.antibioticathalfdose,anticoagulantatdoublethedose)Missingmedications(e.g.missedBPmed)Insulindosingerrors(missingss,duplicateorders,etc)15精選ppt追根溯源Investigationconfirmsexi問(wèn)題在哪里？MultipleresidentphysicianstakingcareofonepatientPhysiciansdonothaveenoughtimefordischargepaperworkMissingcoordinationatdischargeTheexistingEMRprocessesallowedforerrors.Note:MedRecwascompleted90+%ofthetime16精選ppt問(wèn)題在哪里？Multipleresidentphysic相關(guān)文獻(xiàn)Dischargeerrorsoftenresultedinreadmissionstothehospital1-3Medicationerrorsinterferewiththepatient’sconfidenceintheirmedicalservices41.GillespieU,AlassaadA,HenrohnD,etal.Acomprehensivepharmacistinterventiontoreducemorbidityinpatients80yearsorolder:arandomizedcontrolledtrial.ArchInternMed.2009;169(9):894-900.2.KoehlerBE,RichterKM,YoungbloodL,etal.Reductionof30-daypost-dischargehospitalreadmissionoremergencydepartment(ED)visitratesinhigh-riskelderlymedicalpatientsthroughdeliveryofatargetedcarebundle.JHospMed.2009;4(4):211-218.3.SchnipperJL,HamannC,NdumeleCD,etal.Effectofanelectronicmedicationreconciliationapplicationandprocessredesignonpotentialadversedrugevents:acluster-randomizedtrial.ArchInternMed.2009;169(8):771-780.4.BurroughsTE,WatermanAD,GallagherTH,etal.Patients'concernsaboutmedicalerrorsduringhospitalization.JtCommJQualPatientSaf.2007Jan;33(1):5-14.17精選ppt相關(guān)文獻(xiàn)Dischargeerrorsoftenres減少患者再次入院率OneoutoffivepatientsdischargedfromaUShospitalwillbereadmittedin30days17.4billion(outof102.6billion,17%)ofMedicareannualcostJencks,SF,Williams,MV,Coleman,EA.RehospitalizationsamongPatientsintheMedicareFee-for-ServiceProgram.NEnglJMed2009;360:1418-1428.18精選ppt減少患者再次入院率Oneoutoffivepatie行動(dòng)方案ReportedtothehospitalexecutivecommitteePresentedasolutionCollaboratedwithamultidisciplinaryteamMedicationsafetymanager19精選ppt行動(dòng)方案Reportedtothehospitale執(zhí)行方案Taketheadvantageofnewtechnology20精選ppt執(zhí)行方案TaketheadvantageofnewPDSAModelLangleyGL,NolanKM,NolanTW,NormanCL,ProvostLP.TheImprovementGuide:APracticalApproachtoEnhancingOrganizationalPerformance

(2ndedition).SanFrancisco:Jossey-BassPublishers;2009:23-2421精選pptPDSAModelLangleyGL,NolanKMFailureModesandEffectsAnalysis(FMEA)IdentifypatientdischargingtoSNFatroundsSocialWorker(SW)obtainsbedandimmediatelypagesClinicalCoordinator(CC),MD,andPharmDMDhas4hourswithinwhichtowritethedischargeorders.Ifnotifiedafter2:00p.m.,MDmusthaveordersexceptI/Pdischargeinbefore8:00a.m.thenextday.CCscansordershourlyandpagesPharmD22精選pptFailureModesandEffectsAnaFMEAProcessPharmDandCChave2hourswithinwhichtocompletereview:PharmDreviewsmedicationorders.Ifissue,pagesMDtoreconcile.IfOK,sonotes:MarksasreviewedinMedRecscreenCCreviewsotherorders.Ifissue,pagesMDtoreconcile.CCchecksforI/Pdischarge;notifiesbedsidenurseandPSCwhenorderscompleted23精選pptFMEAProcessPharmDandCChav方案實(shí)施Individual1-1communicationbyPharmDtoorderingresidentandRNcoordinator.Communicationsenttoallattendingphysicians,notingthattheyareaccountabletoreviewresidents’dischargeordersandwillbenotifiediferrorsarefoundbypharmacists.24精選ppt方案實(shí)施Individual1-1communicati多邊合作25精選ppt多邊合作25精選ppt再檢查PharmDreportserrors(nearmiss)usingeventreportingprocessNotifiedPM&IofthisriskNotifiedPatientCareV.P.’sReporttoExecutiveLeadershipTeam26精選ppt再檢查PharmDreportserrors(near臨床藥學(xué)的大規(guī)模推廣和應(yīng)用MDDischargeOrdersPharmDandCCReviewSNFWithEPICupdate,Errorratewithoutreview-70%ofdischargesErrorrateafterreview-0%27精選ppt臨床藥學(xué)的大規(guī)模推廣和應(yīng)用MDDischargePharm病情危重與再入院率的關(guān)系

AllCauseReadmissionRelatedReadmissionSeverityofIllnessControlCaseControlCaseMinor14.29%(18/126)0%(0/1)7.94%(10/126)0%(0/1)Moderate19.03%(114/599)13.64%(3/22)7.85%(47/599)4.55%(1/22)Major26.54%(280/1055)31.37%(16/51)10.62%(112/1055)5.88%(3/51)Minor+Moderate+Major23.15%(412/1780)25.68%(19/74)9.49%(169/1780)5.40%(4/74)Extreme33.23%(104/313)38.46%(5/13)9.90%(31/313)23.08%(3/13)Overall24.65%(516/2093)31.03%(27/87)9.56%(200/1893)8.05%(7/87)Horn,SDetal.SeverityofIllnesswithinDRGs:Impactonprospectivepayment.AmJPublicHealth.1985;75,1195-928精選ppt病情危重與再入院率的關(guān)系

AllCauseReadmis患者再入院率29精選ppt患者再入院率29精選ppt臨床藥學(xué)對(duì)醫(yī)療質(zhì)量的影響PhysiciansrequestittobeappliedtoallourpatientsImprovedpatientsatisfactionImprovedcustomerserviceReducedreadmissionrateby47%(5.7%vs10.2%)30精選ppt臨床藥學(xué)對(duì)醫(yī)療質(zhì)量的影響Physiciansrequest經(jīng)濟(jì)分析HCMChasapproximately1850SNFdischargesperyear;witheachpatient,medicationreconciliationtakesonaverage24minutesinmind,thisequivalentto700hoursclinicalpharmacytimeannually.PharmaciststohelpwithmedicationreconciliationintheemergencyroomMedicationsafetymanager31精選ppt經(jīng)濟(jì)分析HCMChasapproximately185藥事管理Costtoincreasestaffing $112,000Reductioninexpenses $587,000(ReducedReadmissionsby47%)TheUSpaymentsystemisintransitionfromafeeforservicetopayforperformance.ImprovedQualityforthePatient32精選ppt藥事管理CosttoincreasestaffingInstituteforSafeMedicationPractices

2010CheersAward33精選pptInstituteforSafeMedicationTheJointCommissionNationalPatientSafetyGoals國(guó)家認(rèn)證“…theNPSGonreconcilingmedicationinformation(originallyNPSG.08.01.01,butnowNPSG.03.06.01)wasstreamlinedandfocusedtoplaceaspotlightoncriticalriskpointsinthemedicationreconciliationprocess.NPSG.03.06.01iseffectiveJuly1,2011”./assets/1/18/National_Patient_Safety_Goals_6_3_111.PDF34精選pptTheJointCommissionNational小結(jié)Needforachange-IdentifytheproblemMeansforachange -Executivecommittee(budgetandsupport) -Actionplanandmodification(PDSA)Teamforachange-multidisciplinaryteam(MD,RN,RPhSocialServiceandclinicalclerks)35精選ppt小結(jié)Needforachange-Identify臨床藥學(xué)小結(jié)ClinicalPharmacistsinvolvementinateambasedmodelRealtimefeedbackEmpoweringfrontlinestafftosuggestandenactsolutionsStandardizingworkandprocesses36精選ppt臨床藥學(xué)小結(jié)ClinicalPharmacistsinv廣而告之ISMP-CanadaNCPDPNAPHIHINQFCMSAJHPLuY.CliffordP,BjornebyA,ThompsonB,VanNormanS,WonK,LarsenK,QualityImprovementCaseStudy:DischargeOrderReconciliationforSkilledNursingFacilityDischargesinaSafetyNetTeachingHospital.AmJHealth-SystPharm,(inpress).37精選ppt廣而告之ISMP-CanadaLuY.Clifford美國(guó)臨床藥師對(duì)臨床藥學(xué)影響數(shù)據(jù)政策其他行業(yè)支持醫(yī)生護(hù)士醫(yī)助高級(jí)護(hù)師38精選ppt美國(guó)臨床藥師對(duì)臨床藥學(xué)影響數(shù)據(jù)38精選ppt為中國(guó)臨床藥學(xué)進(jìn)言天時(shí)地利人和國(guó)家政策引領(lǐng)，專(zhuān)家進(jìn)言星星之火可以燎原重點(diǎn)突出，以點(diǎn)帶面39精選ppt為中國(guó)臨床藥學(xué)進(jìn)言天時(shí)地利人和39精選ppt美國(guó)臨床藥師的臨床實(shí)踐管見(jiàn)40精選ppt美國(guó)臨床藥師的臨床實(shí)踐管見(jiàn)1精選ppt內(nèi)容提要美國(guó)醫(yī)院從事藥學(xué)技術(shù)工作的分類(lèi)，配置的，比例和職責(zé)。美國(guó)的住院藥師（在臨床工作的，相當(dāng)國(guó)內(nèi)的臨床藥師）如何參與臨床藥物治療工作，保證患者用藥安全、合理用藥的；制度、資質(zhì)、工作流程、績(jī)效、酬報(bào)等，有無(wú)書(shū)面的文書(shū)，如藥歷等。美國(guó)的住院藥師在用藥安全、合理方面做出的成績(jī)，課題，數(shù)據(jù)等。41精選ppt內(nèi)容提要美國(guó)醫(yī)院從事藥學(xué)技術(shù)工作的分類(lèi)，配置的，比例和職責(zé)。美國(guó)臨床藥師資質(zhì)本科藥學(xué)管理碩士藥學(xué)博士住院藥師訓(xùn)練專(zhuān)業(yè)證書(shū)（BoardofPharmacotherapy)BoardCertifiedPharmacotherapySpecialistBoardCertifiedOncologySpecialistBoardCerfitifiedAmbulatoryCareSpecialistBoardCertifiedNutritionSupportSpecialistBoardCerfitifedPediatricSpecialistBoardCertifiedInfectiousDiseaseSpecialist42精選ppt美國(guó)臨床藥師資質(zhì)本科3精選ppt美國(guó)臨床藥師分類(lèi)政府機(jī)關(guān)教學(xué)機(jī)構(gòu)保險(xiǎn)公司醫(yī)藥公司的藥物信息部醫(yī)院住院部門(mén)診（獨(dú)立門(mén)診和醫(yī)院門(mén)診）藥店（獨(dú)立或連鎖）43精選ppt美國(guó)臨床藥師分類(lèi)政府機(jī)關(guān)4精選ppt醫(yī)院臨床藥師分類(lèi)職能住院部中心藥房普通病房專(zhuān)科病房（ICU,各個(gè)專(zhuān)科-心臟，腎臟，兒科，腫瘤，流行病，心理精神）門(mén)診部?jī)?nèi)科和家庭醫(yī)生門(mén)診各個(gè)專(zhuān)科44精選ppt醫(yī)院臨床藥師分類(lèi)職能住院部5精選ppt推廣臨床藥師的數(shù)據(jù)五個(gè)花錢(qián)最多的病癥

糖尿病、心衰、高血壓、高血脂、肺氣腫五個(gè)返診率最高的疾病

心肌梗死、心衰、腎衰、呼吸系統(tǒng)疾病、精神病五個(gè)門(mén)診病人最集中的科室

心腦血管疾病、腫瘤、糖尿病、關(guān)節(jié)炎、肥胖45精選ppt推廣臨床藥師的數(shù)據(jù)五個(gè)花錢(qián)最多的病癥6精選ppt2010DiseaseTargets

GregoryDill,CentersforMedicare&MedicaidServices,RegionVAssociateRegionalAdministratorforFinancialManagementandFee-for-ServiceOperations46精選ppt2010DiseaseTargets

GregoryD2010MultipleChronicDiseases“Sponsorscannotrequiremorethan3chronicdiseases

astheminimumnumberofmultiplechronicdiseases”and“sponsorsmusttargetatleastfourofthesevencorechronicconditions:”HypertensionHeartFailureDiabetesDyslipidemiaRespiratoryDiseases(Asthma,COPD,ChronicLungdisorders)BoneDisease-Arthritis(Osteoporosis,RA,OA)MentalHealthissues(Depression,Schizophrenia,BipolarDisorder,others)GregoryDill,CentersforMedicare&MedicaidServices,RegionVAssociateRegionalAdministratorforFinancialManagementandFee-for-ServiceOperations47精選ppt2010MultipleChronicDiseasesHennepinCountyMedicalCenter藥師配置465張病床藥房管理人員-全職：主任，住院部經(jīng)理，臨床藥學(xué)部經(jīng)理，門(mén)診部經(jīng)理，特種藥房經(jīng)理，用藥安全經(jīng)理兼職：藥物治療學(xué)經(jīng)理，住院藥師經(jīng)理，藥學(xué)博士生經(jīng)理，中心藥房臨床藥師普通病房專(zhuān)科病房門(mén)診藥師普通門(mén)診專(zhuān)科門(mén)診住院藥學(xué)博士技術(shù)員藥學(xué)院學(xué)生48精選pptHennepinCountyMedicalCente臨床藥師參與醫(yī)院工作介紹臨床用藥安全經(jīng)理-用藥安全醫(yī)院用藥安全決策（院辦，臨床藥物治療）領(lǐng)導(dǎo)各級(jí)用藥安全委員會(huì)（用藥安全，醫(yī)療事故，臨床藥學(xué)，護(hù)理）臨床藥物治療經(jīng)理-合理用藥藥物種類(lèi)藥物使用分析臨床用藥政策49精選ppt臨床藥師參與醫(yī)院工作介紹臨床用藥安全經(jīng)理-用藥安全10精選p臨床藥師在用藥安全上對(duì)醫(yī)療體系的影響患者出院藥學(xué)查房案例分析50精選ppt臨床藥師在用藥安全上對(duì)醫(yī)療體系的影響患者出院藥學(xué)查房案例分析（危機(jī)）挑戰(zhàn)In2007,multipleuntowardeventsoccurredtopatientsdischargedtonursinghomesComplaintsfromnursinghomepatientsaboutconfusingdischargeordersAugustananursinghomeBenedictinehealthcaresystemTransplantclinicOutpatientdialysisunitExtendedcare51精選ppt（危機(jī)）挑戰(zhàn)In2007,multipleuntowa追根溯源Oneunitwithoneteamover12weeksDocumentmedicalrecordnumber,numberofmedications,timespentErrorswerereportedinHCMC’seventreportingsystemandtrackedbythemedicationsafetycommittee52精選ppt追根溯源Oneunitwithoneteamove追根溯源Reviewed37patientsdischargedtoSNF17dischargemedsperpatientAveragingabout20minutesperpatient,plusadditionalcommunicationtimewiththeteammembers,mostlyphysicians53精選ppt追根溯源Reviewed37patientsdisch追根溯源InvestigationconfirmsexistingproblemOfthe37patients,only3(8%)wereerror-freeCommonthemesnoted:Formulationerrors(extendedreleaseetc)InappropriateduplicatesIncorrectdoses(e.g.antibioticathalfdose,anticoagulantatdoublethedose)Missingmedications(e.g.missedBPmed)Insulindosingerrors(missingss,duplicateorders,etc)54精選ppt追根溯源Investigationconfirmsexi問(wèn)題在哪里？MultipleresidentphysicianstakingcareofonepatientPhysiciansdonothaveenoughtimefordischargepaperworkMissingcoordinationatdischargeTheexistingEMRprocessesallowedforerrors.Note:MedRecwascompleted90+%ofthetime55精選ppt問(wèn)題在哪里？Multipleresidentphysic相關(guān)文獻(xiàn)Dischargeerrorsoftenresultedinreadmissionstothehospital1-3Medicationerrorsinterferewiththepatient’sconfidenceintheirmedicalservices41.GillespieU,AlassaadA,HenrohnD,etal.Acomprehensivepharmacistinterventiontoreducemorbidityinpatients80yearsorolder:arandomizedcontrolledtrial.ArchInternMed.2009;169(9):894-900.2.KoehlerBE,RichterKM,YoungbloodL,etal.Reductionof30-daypost-dischargehospitalreadmissionoremergencydepartment(ED)visitratesinhigh-riskelderlymedicalpatientsthroughdeliveryofatargetedcarebundle.JHospMed.2009;4(4):211-218.3.SchnipperJL,HamannC,NdumeleCD,etal.Effectofanelectronicmedicationreconciliationapplicationandprocessredesignonpotentialadversedrugevents:acluster-randomizedtrial.ArchInternMed.2009;169(8):771-780.4.BurroughsTE,WatermanAD,GallagherTH,etal.Patients'concernsaboutmedicalerrorsduringhospitalization.JtCommJQualPatientSaf.2007Jan;33(1):5-14.56精選ppt相關(guān)文獻(xiàn)Dischargeerrorsoftenres減少患者再次入院率OneoutoffivepatientsdischargedfromaUShospitalwillbereadmittedin30days17.4billion(outof102.6billion,17%)ofMedicareannualcostJencks,SF,Williams,MV,Coleman,EA.RehospitalizationsamongPatientsintheMedicareFee-for-ServiceProgram.NEnglJMed2009;360:1418-1428.57精選ppt減少患者再次入院率Oneoutoffivepatie行動(dòng)方案ReportedtothehospitalexecutivecommitteePresentedasolutionCollaboratedwithamultidisciplinaryteamMedicationsafetymanager58精選ppt行動(dòng)方案Reportedtothehospitale執(zhí)行方案Taketheadvantageofnewtechnology59精選ppt執(zhí)行方案TaketheadvantageofnewPDSAModelLangleyGL,NolanKM,NolanTW,NormanCL,ProvostLP.TheImprovementGuide:APracticalApproachtoEnhancingOrganizationalPerformance

(2ndedition).SanFrancisco:Jossey-BassPublishers;2009:23-2460精選pptPDSAModelLangleyGL,NolanKMFailureModesandEffectsAnalysis(FMEA)IdentifypatientdischargingtoSNFatroundsSocialWorker(SW)obtainsbedandimmediatelypagesClinicalCoordinator(CC),MD,andPharmDMDhas4hourswithinwhichtowritethedischargeorders.Ifnotifiedafter2:00p.m.,MDmusthaveordersexceptI/Pdischargeinbefore8:00a.m.thenextday.CCscansordershourlyandpagesPharmD61精選pptFailureModesandEffectsAnaFMEAProcessPharmDandCChave2hourswithinwhichtocompletereview:PharmDreviewsmedicationorders.Ifissue,pagesMDtoreconcile.IfOK,sonotes:MarksasreviewedinMedRecscreenCCreviewsotherorders.Ifissue,pagesMDtoreconcile.CCchecksforI/Pdischarge;notifiesbedsidenurseandPSCwhenorderscompleted62精選pptFMEAProcessPharmDandCChav方案實(shí)施Individual1-1communicationbyPharmDtoorderingresidentandRNcoordinator.Communicationsenttoallattendingphysicians,notingthattheyareaccountabletoreviewresidents’dischargeordersandwillbenotifiediferrorsarefoundbypharmacists.63精選ppt方案實(shí)施Individual1-1communicati多邊合作64精選ppt多邊合作25精選ppt再檢查PharmDreportserrors(nearmiss)usingeventreportingprocessNotifiedPM&IofthisriskNotifiedPatientCareV.P.’sReporttoExecutiveLeadershipTeam65精選ppt再檢查PharmDreportserrors(near臨床藥學(xué)的大規(guī)模推廣和應(yīng)用MDDischargeOrdersPharmDandCCReviewSNFWithEPICupdate,Errorratewithoutreview-70%ofdischargesErrorrateafterreview-0%66精選ppt臨床藥學(xué)的大規(guī)模推廣和應(yīng)用MDDischargePharm病情危重與再入院率的關(guān)系

AllCauseReadmissionRelatedReadmissionSeverityofIllnessControlCaseControlCaseMinor14.29%(18/126)0%(0/1)7.94%(10/126)0%(0/1)Moderate19.03%(114/599)13.64%(3/22)7.85%(47/599)4.55%(1/22)Major26.54%(280/1055)31.37%(16/51)10.62%(112/1055)5.88%(3/51)Minor+Moderate+Major23.15%(412/1780)25.68%(19/74)9.49%(169/1780)5.40%(4/74)Extreme33.23%(104/313)38.46%(5/13)9.90%(31/313)23.08%(3/13)Overall24.65%(516/2093)31.03%(27/87)9.56%(200/1893)8.05%(7/87)Horn,SDetal.SeverityofIllnesswithinDRGs:Impactonprospectivepayment.AmJPublicHealth.1985;75,1195-967精選ppt病情危重與再入院率的關(guān)系

AllCauseReadmis患者再入院率68精選ppt患者再入院率29精選ppt臨床藥學(xué)對(duì)醫(yī)療質(zhì)量的影響PhysiciansrequestittobeappliedtoallourpatientsImprovedpatientsatisfactionImprovedcustomerserviceReducedreadmissionrateby47%(5.7%vs10.2%)69精選ppt臨床藥學(xué)對(duì)醫(yī)療質(zhì)量的影響Physiciansrequest經(jīng)濟(jì)分析HCMChasapproximately1850SNFdischargesperye