Exam 3

Question 1

Four objectives for Pharmacy Service Development 2

Answer 1

(1) discuss IMPLEMENTING pharmacy services (2) describe existing successful/sustainable services (3) promote idea generation for future services

Question 2

Four types of implementation issues

Answer 2

(1) action plan (2) start-up coordination (3) monitoring performance and adjusting as needed (4) commitment to refining and sustaining

Question 3

Define an action plan

Answer 3

(1) listing of tasks needed to be performed for start-up, (2) when they should be completed, (3) and who is responsible for doing them.

Question 4

What are 4 issues regarding start-up coordination

Answer 4

(1) operational readiness 2) cash flow (3) awareness of service (4) staying informed on performance, i.e. feedback

Question 5

What are three issues regarding monitoring rollout

Answer 5

(1) during first weeks and months monitor closely (2) debrief staff after each service encounter - areas for improvement (3) call back or survey patients to ask about their experience with service

Question 6

What are five issues in refining and sustaining service/ monitoring performance

Answer 6

(1) promotional activites (2) number of patients using service/# of service episodes (3) revenue from services (4) expenses and accounts receivable (5) workflow - what needs to be addressed

Question 7

How to achieve patient loyalty?

Answer 7

(1) identification by consumer (2) and faithfulness demonstrated by repeated use

Question 8

Two issues in achieving sustainability

Answer 8

(1) track performance - service uptake, quality of care, profitability (2) positive profit expected - adjust costs over time, change marketing mix.

Question 9

Two examples of sustainable pharmacy services

Answer 9

(1) pharmacy-based immunization programs (flu, travel) (2) disease state management

Question 10

Five learning objectives for implementation science

Answer 10

(1) dissemination research vs. implementation research (2) describe principles of Designing for Dissemination - how they may improve your work (3) list and define attributes influencing implementation (4) describe intervention mapping and the RE-AIM framework (5) describe pragmatic clinic trials and mixed methods designs

Question 11

Define implementation research

Answer 11

“Scientific study of the use of strategies to adopt and integrate evidence-based interventions into practice”

Question 12

Define dissemination research

Answer 12

“Scientific study of targeted distribution of information to best spread and sustain knowledge of evidence-based interventions”

Question 13

Describe 4 principles of designing for dissemination (D4D)

Answer 13

(1) set of activities performed through intervention planning, development and evaluation to increase likelihood of dissemination, implementation and sustainability (2) start early (3) donabedian model (4) intervention mapping

Question 14

describe 3 aspects of the donabedian model

Answer 14

(1) structures (2) processes (3) outcomes

Question 15

define intervention mapping

Answer 15

a protocol for developing theory-based and evidence-based health promotion intervention

Question 16

List six (6) steps of intervention mapping

Answer 16

(1) needs assessment (2) performance and change OBJECTIVES (3) selection of theory-based intervention methods and practical applications to change (DESIGN) (4) PRODUCTION of program components, design and production (5) program PLAN: adoption, implementation and sustainability (6) process and effect EVALUATION

Question 17

List four (4) components of a needs assessment

Answer 17

(1) systematic process for determining and addressing needs (2) should be interdisciplinary (3) provides justification for why decisions were made (4) the discrepancy between the current condition and the wanted condition must be measured to appropriate identify the need

Question 18

List five (5) components of the RE-AIM framework

Answer 18

(1) reach (2) effectiveness (3) adoption (4) implementation (5) maintenance

Question 19

Define pragmatic trials

Answer 19

“A randomized controlled trial in which the research question focuses on EFFECTIVENESS in a normal practice setting with the full range of study participants.”

Question 20

Define mixed methods (2 components)

Answer 20

(1) uses qualitative and quantitative methods of data collection (2) provides practical way to understand multiple perspectives, different causal pathways, and multiple types of outcomes

Question 21

Four (4) learning objectives for Quality Improvement

Answer 21

(1) recognize the six domains of healthcare quality (2) differentiate quality-related vocabulary (3) describe the IHI’s Model for Improvement (4) describe root cause analyses, fishbone diagrams, PDSA cycles and how these tools can be used to improve healthcare quality.

Question 22

List six (6) domains of healthcare quality

Answer 22

(1) safe (2) effective (3) patient-centered (4) timely (5) efficient (6) equitable

Question 23

Define quality assurance, quality control, and continuous quality improvement

Answer 23

QA: conforming processes to standards, QC: catch failures in QA; stop defective products, CQI: continous process of improving systems (incorporates QA and QC)

Question 24

Describe IHI Model for Improvement (4 components)

Answer 24

(1) heart is the Plan-Do-Study-Act cycle (2) Three key questions answered by root-cause analysis: what are we trying to accomplish? (AIM) (3) How will we know that a change is an improvement? (MEASURES) (4) What change can we make that will result in an improvement? (Changes)

Question 25

List three (3) components of root cause analysis

Answer 25

(1) a process for identifying causal factors underlying variation in performance (2) variation in performance produce undesired outcomes, including risk of sentinel event

Question 26

List six (6) most likely areas for causes in a root cause analysis

Answer 26

(1) communication (2) training (3) fatigue/scheduling (4) environment/equipment (5) rule/policies/procedures (6) barriers

Question 27

Two methods for a Root Cause Analysis

Answer 27

(1) 5 Whys (2) Fishbone diagram

Question 28

List five objectives for Medication Safety 1

Answer 28

(1) medication safety terminology (2) link between medication error and adverse drug events (3) types of medication errors in U.S. (4) common causes of pharmacist-related medication errors (5) examples of medication error incidents

Question 29

Define adverse drug event, medication error and adverse drug reaction

Answer 29

ADE: unintended, medication-induced injury; medication error: preventable event, adverse drug reaction: mostly non-preventable, medication related ahrm

Question 30

Describe link between Medication Error and Adverse Drug events (3 components)

Answer 30

(1) adverse drug events may be due to medication error (2) medication error is preventable (3) often a series of mistakes.

Question 31

List 4 types of medication errors

Answer 31

(1) prescribing error (2) administration error: wrong time error, improper dose error, wrong route/technique error (3) dispensing error (4) deteriorated drug error

Question 32

Define skill-based errors and list causes.

Answer 32

In-attentional blindness (knows the right action but fails to conduct as such) causes: distractions, interruptions, fatigue, stress, inadequate lighting

Question 33

List three kinds of rule-based errors

Answer 33

Learned the wrong rule, applied the wrong rule, bypassed the rule.

Question 34

Define knowledge-based errors

Answer 34

Work outside of expertise

Question 35

List three (3) objectives of medication safety 2

Answer 35

(1) describe the Systems Engineering Initiative for Patient Safety (SEIPS) model of work system and its applications to improve medication safety and health outcomes (2) discuss a study applied the SEIPS model to ADEs in NHs (3) applying SEIPS work system to pharmacy practice

Question 36

Describe SEIPS model (four components)

Answer 36

(1) explains influence of work system, represented by a person and work environment, on health outcomes (2) a work system is composed of: person, organization, technologies&tools, tasks, and environment (3) in a work system, a person performs range of tasks using tools and technologies (4) performance of tasks occurs within physical environment under specific organization condition.

Question 37

List four (4) objectives of team-based care 1

Answer 37

(1) recognize and define main domains of the Chronic Care Model (2) recognize the main principles of the Collaborative Care model (3) define a patient-centered medical home (PCMH) (4) discuss pharmacy's role in PCMH)

Question 38

List six (6) elements of the Chronic Care Model

Answer 38

1. health system leadership and support 2. community resources 3. self-management support 4. delivery system design 5. decision support 6. clinical information systems

Question 39

Describe the Collaborative Care Model (2 components)

Answer 39

1. Co-location of primary care providers and mental health specialists PLUS 2. Collaboration to develop and adjust treatment plans based on measurement of symptom-related outcomes.

Question 40

Define the medical Home

Answer 40

1. Approach to primary care that is: | (1) person centered, (2) comprehensive (3) committed to quality and safety (4) coordinated (5) accessible.

Question 41

List 5 roles of pharmacist in patient-centered medical home (PCMH)

Answer 41

1. comprehensive therapy reviews 2. resolve medication-related problems 3. optimize complex regimens 4. design adherence programs 5. recommend cost-effective therapies

Question 42

List four (4) learning objectives for Team-based Care 2

Answer 42

1. Define transitional care 2. Define patient-centered care 3. Identify and define the four pillars of transitional care 4. Describe different current team-based care models in primary care

Question 43

Define transitional care

Answer 43

1. Set of actions 2. Designed to ensure coordination and continuity. 3. at all stages of care.

Question 44

define patient-centered care

Answer 44

1. care that is responsive 2. to patient preferences, needs and values 3. and ensures patient values guide all clinical decisions.

Question 45

List four (4) pillars of transitional care

Answer 45

1. medication self-management 2. use of dynamic patient-centered record 3. primary care and/or specialist follow-up 4. knowledge of red flags