R.Ph.s can take reins of quality improvement

Delmarva, Medicare's Quality Improvement Organization for Maryland and the District of Columbia, has announced the winners of its Medicare Quality Excellence Awards. The hospital award recognizes the top 10% of institutions that improve the most in the composite of a set of 10 performance measures: five acute myocardial infarction (AMI), two congestive heart failure (CHF), and three pneumonia measures.

The hospitals lauded for 2005 were: Garrett County Memorial Hospital, Oakland, Md.; Edward McCready Memorial Hospital, Crisfield, Md.; Saint Joseph Medical Center, Towson, Md.; Sibley Memorial Hospital, Washington, D.C.; and Upper Chesapeake Medical Center, Bel Air, Md. The awards were given at Delmarva's "Courage to Improve III: Best Practices and Transparency in Quality Improvement Conference," held recently in suburban Maryland.

"The pharmacist visits patients at bedside who have not been vaccinated, interviews them, and educates them about the benefits of immunization. We can also provide patients with the Centers for Disease Control & Prevention Vaccine Information Statement sheet."

Similar systems are in place at Garrett County Memorial Hospital, reported Lance Rhodes, Pharm.D., director of pharmacy. "The pharmacy department has added cues to the different forms our hospital uses," he said. "On our emergency department's initial assessment form, we ask if the nursing and medical staff have considered giving aspirin and beta-blockers to those admitted with AMI and administered antibiotics as soon as possible for those with pneumonia."

To improve compliance with the Delmarva measures, the pharmacy department is performing some patient assessment functions, particularly for pneumococcal and influenza vaccines, Rhodes noted.

"We are a small [34-bed] hospital, so a pharmacist can visit the room of all patients who come in, and speak with them regarding their vaccination status," said Rhodes. "If the influenza or pneumococcal vaccine is indicated but has not been administered, a standing order has been approved by our medical staff allowing the pharmacist to write the order so that patients can be immunized prior to discharge."

Rhodes added that "pharmacists document their assessment in the patient's chart, so that it becomes part of the clinical record and is available to our quality improvement officer when she reviews it."

Ness and Rhodes both agree that successful performance improvement requires a team effort. "We work as a team, one made up of the doctors, nurses, pharmacists, and information systems and data collection people, to improve medication therapy management," Ness said.

"Many of these measures deal with medication, so they involve the ordering of these drugs," Rhodes explained. "Pharmacy cannot impact what medications are ordered unless it gets involved in the different committees that set guidelines or clinical pathways that physicians will follow."

Something bigger than simply improving performance and winning an award is at stake, though. "We developed these policies and made them pharmacy functions-not just to improve our performance according to the standards set by Delmarva and the Joint Commission on Accreditation of Healthcare Organizations but to achieve the six goals set by the ASHP 2015 initiative as well," Rhodes said. One objective of this initiative, he added, is to have half of all recently hospitalized patients recall an interaction with the pharmacist while hospitalized.

More information about the Delmarva Foundation's quality improvement projects is available at http:// http://www.delmarvafoundation.org/. Further information about the ASHP 2015 initiative is available at http:// http://www.ashp.com/2015.