QUIZ ONE hospital pharmacy

Question Answer
where was the first hospital? and why? Pennsylvania; temporarily set up in Kinsey house to serve the poor until the first hospital building was built, it was the first hospital in colonial america (est. 1752) and it was the hub of colonial america
who was the first hospital pharmacist? jonathan roberts
who was the second hospital pharmacist and what did he believe? John morgan (practice of pharmacy and physicians should be kept separate)
in the 1800s how many hospitals were in the nation? only 2…by 1811 the New York hospital had a full-time pharmaceutical practitioner (solely dedicated to pharmacy)
drug therapy in the 1800s consisted of? strong cathartics (lax), emetics, and diaphoretic (sweat it out), clean air and good food were treatments, the medical elite avoided use of drugs or used newer alkaloidal drugs such as morphine, strychnine, and quinine
by 1873 how many hospitals were in the country? only 178 with fewer than 50,000 beds
when was the adoption of aseptic surgery? 1890s
in the 1900s RPhs had what role traditional role of compounding
in the 1930s the American Hospital Assoc. (AHA) created? committee of pharmacy; developed min. standards for hospital pharmacy departments and prepared a manual of pharmacy operations
what occurred in pharmacy practice in 1950s? bulk compounding (to be used for multiple patients), and sterile solution manufacturing
in 1949 hospital standards of the american college of surgeons was est. to? minimum standard for pharmacies in hospitals, pharmacy was perceived as a complementary service department, not an essential service
by the late 1950s what percent of hospital beds were located in facilities that had a full time pharmacist? what percent of hospitals had services of a pharmacist? 47%, 39%
so who provided pharmacy services (around 1957 for hospitals that didn't have full-time pharmacists) non pharmacist personnel (generally nurses)=45%; non pharmacist personnel plus community pharmacists=45%; supervision by local community pharmacist=9%
what was implemented in response to results of medication error studies, physician direct orders? unit-dose distribution, point-of-use dispensing (considered major developments in hospital pharmacy)
what was the study of hospital pharmacy conducted from 1957 to 1960 called? "mirror to hospital pharmacy"
what did the study of hospital pharmacy that was conducted from 1957 to 1960 do? provided road map to improve hospital pharmacy; results from federal audit of pharmaceutical services in hospitals
what was "directions for clinical pharmacy practice"? invitational conference conducted in 1985 in Hilton Head, South Carolina (often called the Hilton Head conference)
what was the purpose of the directions for clinical pharmacy practice? the result? to assess the progress of hospital pharmacy depts in implementing clinical pharmacy; hospital pharmacies should fxn as clinical depts with a mission of fostering appropriate use of medications
where was the Pharmacy in the 21st Century Conference and what did it seek to do? 1989 williamsburg, Va; brought together pharmacy leaders in an invitational meeting to draft statements on issues and problems that would face the profession in the next 15-20 years
where was the implementing pharmaceutical care conference held and what was it designed to do? 1993 san antonio tx; to give an overview of society, the forces that were changing health care, and how pharmacy fit into that "big picture"
what was PPMI professional practice model initiative; initiative of ASHP; goal to sig. advance the health & well being of its by dev. & disseminating a futuristic practice model that supports the most effective use of pharmacists as direct pt care providers
now what is PPMI PAI (practice advancement initiative); goal is to sig. adv. the health and well being of its by supporting futuristic practice models that support the most effective use of pharmacists as direct pt care providers
recap of major themes see top of p 6
professional associations include ASHP (American Society of Health System Pharmacists); in 1936 it was APhA subsection on hospital pharmacy; in 1942 it became indep. organization orig. called American Society of Hospital Pharmacists (charter membership of 154)
see role of eduction on bottom p 6
what are the evolutions of minimum requirements for pharmacist education in the US 1907-2 years (graduate in pharmacy); 1925-3 years (grad. in pharmacy or pharmaceutical chemist); 1932-4 years (bachelor of science); 1960-5 years (bachelor of science); 2004-6 years (pharm D.)..some states are longer
what are the three ways to classify hospitals ownership, type of care, teaching affiliation
what are the subclasses of the ownership classification of hospital profit; non-profit
what are the subclasses of the type of care classification of hospitals primary, secondary, tertiary (smaller facilities with limited services)
what is meant by the teaching affiliation classification of hospitals whether or not it's linked to a medical school or not
governance of hospitals today board of governors, board of directors, board of trustees
what must the board of trustees provide mission, goals, progress evaluation, financial stability
who are the members of the board of directors medical staff and hospital director
who and what is the hospital director oversee marketing and planning, director of nursing, director of finance, director of operations
what does the director of operations oversee pharmacy, lab radiology, respiratory therapy
what groups are responsible for hospital accreditation? the joint commission (other accrediting bodies too), board of health, board of pharmacy, board of nursing, board of medicine
why do hospitals need accreditation? w/o accreditation, they can't accept payments from Medicare, Medicaid, or private insurance
who falls under the pharmacy department in a hospital director, assistant director, clinical coordinator, staff pharmacists, technicians, interns
what are some in-patient services provided in hospital pharmacy central pharmacy, decentralized (satellite) pharmacy, intravenous medications, medication carts, automation (pyxis, MedSelect)
Hospital pharmacist duties include order entry, appropriateness of medication, preparing medication, distribution/delivery, monitoring, change therapy, outpatient medication services (not all hospital pharmacies do the last one)
clinical pharmacy services formulary review, P&T, DUE (drug utilization review), order review, drug info, consults, order clarification, kinetics, TPN, Patient rounds, discharge counseling, monitoring labs
traits of hospital pharmacist must pay attn to detail, expect interruptions, know how to prioritize, good comm. skills, good manager, quick thinker, proficient in pharmaceutical calculations, flexible
quality improvement consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted pt groups
quality improvement is directly linked to an organization's service delivery approach or underlying systems of care
quality improvement principles QI work as systems and processes, focus on patients, focus on being part of the team, focus on use of the data.
see slide number 5 from week 2 powerpoint
sentinel events pt safety event that reaches a patient and results in any of the following: death, permanent harm, severe temporary harm and intervention required to sustain life
what is expected for sentinel event response? identify and respond approp. to every event. (especially finding out where the process fell apart and where the error occurred)
what is an appropriate response for sentinel events. conducting a timely, thorough, and credible root cause analysis, developing an action plan designed to implement improvements to reduce risk, implementing the improvements, monitoring the effectiveness of improvements
what is accreditation? acknowledgement that a hospital or other health care organization has met or exceeded the requirements of an accrediting body
what are some accrediting bodies the joint commission, healthcare facilities accreditation program (HFAP), National Integrated Accreditation for Healthcare Organizations (NIAHO)
who is the joint commission independent, not for profit org., dedicated to improving the safety and quality of health care in organized health care settings (est. in 1951). sets the standards for accreditation in health care (Comprehensive Accreditation Manual for Hospitals (CAMH))
what does JC do? engages in issues and activities concerning the advancement of health care safety and quality (public policy initiatives, standards development, accreditation and certification programs)
JC mission to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations
the JC sets continually evolving standards for acute care hospitals and other health care organizations…standards should establish performance expectations (explain what this means) their standards should describe what needs to be done and provide enough detail for professionals to make decisions on how to best accomplish any given standard in their individual organizations
how many and what kind of health care organizations does JC evaluate and accredit? >16,000; hospitals, healthcare networks, long term care facilities, ambulatory care facilities, home care organizations, clinical laboratories, behavior healthcare facilities, office-based surgery practices
why seek accreditation? enhance public image and commun. confidence, provide report card for public, offers obj. eval. of performance, stimulates qual. improvement efforts, aids in prof. staff recruitment, provides staff edu. tool, ensures reimbursement from 3rd parties,
what are standards? (like the ones set by JC) stmnts tha define the performance expectations, structures, or processes that must be in place for an organization to provide safe and high quality care, treatment, and services. often reflect best practices (typically evidence based and consensus driven)
what standards are relevant to pharmacy practice medication management, infection control, patient care, medical records, safety and security, education, performance improvement, environment of care (facilities)
list some of the hospital national patient safety goals of 2017 identify the pts correctly, improve staff communication, use medications safely, use alarms safely, prevent infection, identify patient safety risks, prevent mistakes in surgery
what are some of the specific guidelines listed for avoiding mistakes in surgery conducted pre procedure verification process, mark the procedure site, a time-out is performed before the procedure
ORYX initiative first national program for the measurement of hospital quality, integrates outcomes and other performance measurement date into the accreditation process
accountability measures designed to identify measures that produce the greatest positive impact on patient outcomes when hospitals demonstrate improvement (research, proximity, accuracy, adverse effects)
list some accountability measure sets inpatient psychiatric services, perinatal care, immunization, tobacco treatment, substance use
non-accountability measures more suitable for secondary uses like exploration or learning w/in indiv. health care organizations & are good advice in terms of approp. pt care (ex: discharge instruct. (heart fail. care) & LVS (left ventricular systolic) fxn assess. (heart fail. care)
survey process is designed to be? individualized to each organization, to be consistent, and to support the organization's efforts to improve performance
survey assessment is accomplished through evaluating an organization's compliance with the applicable standards: tracing the care delivered to pts (pull pt records); verbal & written info provided by JC, on-site observations/interviews by JC surveyors, documents provided by the organization
how frequent are surveys every 3 years and they are unannounced (hospitals can provide list of days they cannot have a survey (ex: director of pharmacy is going to be out of town))
who are surveyors? physicians, nurses, administrators
length of surveys determined by info supplied on the application
format of surveys reviews, interviews and visits…pharmacy interacts with all surveyors
how many reasons are there for conducting UNANNOUNCED surveys? there are 5 (see the list on slide 27) won't fit on flashcard.
what is the early survey option allows health care org. to undergo a survey prior to having the ability to demonstrate full compliance with all JC standards and receive a preliminary accreditation decision
are early survey's conducted announced or unannounced? announced
how many on site surveys are required of an organization through the early survey option two
who is the early survey option available for? new organizations before they begin operations, new org. that are being surveyed for the 1st time, org. that have not participated in the accredit. process during the prev. 2 years, org. that were denied accred. during prev. 2 years
what is the on-site survey visit agenda? survey planning session, opening conference & orientation to the org., leadership sess., tracer methodology, competence assessment process, enviro. of care sessions (includes building tour), exit conference (survey team presents summary of findings)
what is tracer methodology uses actual clients, pts, or residents as the framework for assessing standards compliance. indiv. tracers follow the experience of care for individuals through the entire health care process
after the survey what happens report of survey findings is posted on the organization's secure JC connect extranet; org may or may not receive RFIs
what is an RFI requirements for improvement
what happens if an organization does not receive any RFIs? the accreditation decision becomes official at the same time the org's summary report is available and is effective the day after the completion of the survey
what happens if an organization does receive RFIs? then the organization's accreditation decision is made after the submission of an acceptable evidence of standards compliance (ESC) report
What does PPR stand for? periodic performance review
define a PPR compliance assessment tool designed to help org's w/ their continuous monitoring of performance improvement activities. provides framework for continuous standards compliance & focuses on the critical systems & processes that affect pt care/safety
scoring and decision process is based on? the criticality of the standards and other requirements regarding their relationship to the quality and safety of pt care
scoring is done in EP (elements of performance) explain
what must happen to all partially compliant or insufficiently compliant EPs? must be addressed via the ESC submission process
the time line for completing the ESC submission is? well, it depends on the "criticality" of findings and immediacy of risk
EPs that have a direct impact on patient, individual served or resident care require submission of an ESC within what time frame? 45 days
EPs that have an indirect impact on patient, individual served or resident care require an ESC within what time frame? 60 days
what are the accreditation decisions preliminary accreditation, accreditation, accreditation with follow-up survey, continent accreditation, preliminary denial of accreditation, denial of accreditation
what are the accreditation decisions for initial surveys accreditation or denial of accreditation (only for new facilities)
what is preliminary accreditation? health care organization demonstrates compliance with selected standards used in th surveys conducted under the Early Survey Policy
what is accreditation given to healthcare org. in compliance w/ all standards during onsite survey or successfully addressed all RFIs in ESC submission w/in 45-60 days after Accred. survey findings report is posted & doesn't meet any other rules 4 other accred. decisions
what is accreditation with follow up survey awarded when healthcare org is not in compliance w/ specific standards that req. a follow up survey w/in 30 days to 6 months; the org. must also successfully address the identified problem area(s) in an ESC
what is contingent accreditation see slide number 41 (too much to fit on flashcard.)
what in preliminary denial of accreditation? results when there's no justification to deny accred. to an org. due to immediate threat to health or pt safety; submission of falsified documents; lack of req. license; failure to resolve req's of a contingent accred. status; significant noncompliance
before the determination to deny accreditation the decision of preliminary denial of accreditation is subject to? review and appeal
what is denial f accrediation results when all review and appeal opportunities heave been exhausted
previous standards include DO NOT USE list, and review of look alike sound alike lists
what is the do not use list standardized list of abbrev., acronyms, and symbols that are NOT to be used
list some of the things on the Do Not Use list U, u (units); IU (international units); QD, Q.D. qd, q.d. (daily); QOD (every other day); trailing zero (X.0mg); lack of leading zero (.Xmg); MS, MSO4, MgSO4
what is a way to better identify/distinguish look-alike sound-alike drugs? use tall man lettering

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