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Healthcare Systems and Population Health Flashcards

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1
Q

Principles of quality improvement

A
  1. Focus on system and team as large contributors to errors
  2. Recognize humans are human
  3. Errors = opportunity to learn
  4. Checks and balances to support individuals and prevent errors
  5. Peer-review errors to identify contributors to the occurrence so change can be adopted
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2
Q

Plan-Do-Study-Act

A

Cycle for quality improvement

Changes can be evaluated for effectiveness and issues before being adopted by entire organization

Tests for change

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3
Q

Quality improvement frameworks

A

Six Sigma
Lean
Lean Six Sigma

Focus = removing waste, duplication, and non-value-added steps in a process

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4
Q

Failure Modes and Effects Analysis (FMEA)

A

Quality Improvement tool

Look at OUTCOME and predict where, how, and to what extended a system failure could occur

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5
Q

Flowchart

A

Quality improvement tool

look at OUTCOME and IDENTIFY contributing factors, variations and create a visual map showing steps in a process

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6
Q

Cause-and-Effect diagram (Ishikawa, fishbone)

A

Quality improvement tool

look at OUTCOME and graphically display relationship of many causes contributing to the outcome

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7
Q

Driver diagram

A

Quality improvement tool

Look at OUTCOME and visually display the primary and secondary items contributing to achievement of an aim

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8
Q

Histogram

A

Quality improvement tool

identifies factors & Variation, displays continuous data over time to show variation

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9
Q

Pareto chart (80/20 rule)

A

Quality improvement tool

Identify contributing factor and create a bar chart in order from largest contributing factor to smallest

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10
Q

Run chart

A

Quality improvement tool

Identify contributing factor and graph data over time.

Can add upper and lower control limits to distinguish causes of variation -(control chart)

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11
Q

Scatter diagram

A

Quality improvement tool

Identify contributing factor and create scatter plot to identify cause-and-effect relationship between two variables

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12
Q

Project planning

A

Quality improvement tool

Systematically plan for testing a change

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13
Q

Formulary

A

Standardized list of medications for use to reduce variability and improve efficiency

TJC Standard: must develop and approve criteria for identifying formulary medications (indication for use, interactions, ADE, potential for error/sentinel event, cost)

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14
Q

Formulary management tools by P&T

A

-Preference for generics
-Restricted use for specific drugs
-Policy/procedure for non-forms
-Therapeutic interchange according to protocol
-Medication use criteria

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15
Q

Medication Use Evaluations (MUE)

A

Interprofessional quality improvement program, with responsibility falling on P&T

-Goal: improve safety, efficacy, cost

May evaluate any OR all steps of med use process (prescribing, dispensing, administration, monitoring, system management)

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16
Q

Antibiotic Stewardship

A

TJC Requirement for hospitals, critical access hospital, and nursing care centers

-Identify patients with redundant antimicrobial coverage
-Review antibiotic use quarterly
-Daily review of antibiotics from proposed list of restricted-use agents
-Daily escalation/de-escalation, IV-to-PO, PK monitoring, renal dose adjustments

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17
Q

CDC Core Elements of Antibiotic Stewardship

A

Hospital Leadership Commitment
Accountability (leader needed)
Pharmacy Expertise (pharmacist as co-leader)
Action (interventions)
Tracking (monitoring prescribing, monitor Cdiff infections, etc.)
Reporting
Education

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18
Q

IDSA role in Antibiotic Stewardship

A

-Describe purpose for the program
-Requires pharmacist trained in ID with a physician, microbiologist, infection control expert

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19
Q

Adverse Drug Reaction (ADR)

A

Any response to a drug at doses normally used in humans

ALL ADRS ARE ADE, BUT NOT ALL ADE ARE ADR*

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20
Q

Programs that assess causality in ADRs

A

Naranjo Algorithm and WHO Uppsala Monitoring Centre Scale

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21
Q

Adverse Drug Event (ADE)

A

An injury resulting from a medical intervention related to a drug

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22
Q

National Action Plan for ADE Prevention

A

Outlines goals to identify significant ADDEs and align efforts to reduce ADEs

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23
Q

Medication error

A

any preventable event that may cause or lead to inappropriate medication use or patient harm while medication is in control of healthcare professional, patient or consumer

Most do not lead to significant patient harm

If significant patient harm, then also ADR or ADE.

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24
Q

Where to report med ADRs

A

MedWatch

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25
Where to report vaccine ADRs
VAERS
26
What medication use process do medication errors occur in?
Can occur in dispensing, administering, prescribing, monitoring
27
Naranjo algorithm
10 questions to standardize assessment of ADE Helps determine if a drug caused the clinical event
28
Root cause analysis
Tool for ADE monitoring Reconstruct occurrence of event that resulted in undesired outcome, and multidisciplinary analysis of how and why that happened Use quality improvement tools
29
ADE review key components
Start within 72 hours by a team of 4-6 people (provided time during normal work hours for meetings/data collection)
30
Opioid Stewardship
Effective way to ensure facility meeting TJC requirement of surveillance over pain assessment & management
31
When is medication reconciliation required
Transitions of care -hospital admission -between settings in hospital -discharge
32
Who benefits most from med recs
-older adults -pts taking >=5 meds -pts taking high risk meds -pts with renal impairment -pts in critical care settings -transplant recipients -pts with low health literacy
33
TJC 5 steps for med rec
1. develop list of current meds 2. develop list of meds to be prescribed 3. compare the two lists 4. make clinical decisions according to the comparison 5. communicate new list to caregiver/patient
34
CMS Part D MTM 5 core elements
1. Medication therapy review 2. Personal medication record 3. Medication-related action plan 4. intervention and referral 5. documentation and follow up
35
Comprehensive Medication Management
Part of MTM = holistic strategy including goals of care and patient shared decision-making improves outcomes, access to care, reductions in cost esp in diabetes, bp management, and copd
36
Population Health Management Cornerstones
Disease surveillance Disease prevention (immunizations, screenings) Preventative medication Emergency preparedness
37
Disease surveillance
Cornerstone of population health management ongoing systematic collection, analysis, and interpretation of health-related data essential to planning, implementing, and evaluation public health practice COVID
38
APhA role in vaccinations
Maintains vital information on storage and administration of vaccines
39
Immunization Action Coalition
www.immunize.org provides info for healthcare providers, the public, and immunization coalitions
40
USPSTF
Independent, volunteer panel of experts that develop evidence-based recommendations for health screenings
41
Primary disease prevention
focus on general population for reduction to exposure of risk factors immunizations, awareness campaigns
42
Secondary disease prevention
focus on individuals with early disease before morbidity occurs to provide postexposure prophylaxis ex: antivirals for nursing home in flu outbreak; colonoscopy after age 45
43
Tertiary disease prevention
focus on pts with disease causing morbidity to reduce mortality and get back to health ex: support groups to improve diabetes adherence, prevent blindness; antivirals for influenza to prevent pneumonia, hosp, death
44
Ready or Not 2022
Trust for America's Health report that evaluated 10 indicators of emergency preparedness to rank states' level of preparedness
45
Pharmacist role in emergency plans
procurement and distribution of medications mass immunization antibiotic dispensing mobilization **key consideration: pharmacists need to get supplies & materials to where the population experiencing disaster is located**
46
Bloom's taxonomy
Way to design, assess, and diagnose student learning Defined levels of learning for 3 different learning paradigms: cognitive, psychomotor, affective
47
Cognitive learning (blooms taxonomy)
Surface > deep remembering > understanding > applying > analyzing > evaluating > creating **most widely used domain in education
48
Psychomotor learning (blooms taxonomy)
Surface > deep observing > modeling > developing standards > applying > coaching
49
Affective learning (blooms taxonomy)
surface > deep receiving > responding > valuing > organizing >characterizing
50
Kirkpatick's four levels of evidence
perception, knowledge, behavior, results
51
Perception/Reaction
One of kirkpatricks four levels of evidence includes course evaluation, perceptions/confidence, self-assessment
52
Knowledge
one of kirkpatricks four levels of evidence includes quizzes, exams, case questions
53
Behavior
one of kirkpatricks four levels of evidence includes observed standardized clinical encounter (OSCE) and experiential learning APPEs
54
Results
one of kirkpatricks four levels of evidence includes entrustable professional activities (EPA), NAPLEX/MPJE, performance in practice
55
low health literacy associations
increased visits to hospital/ER decreased mammography decreased influenza vaccination **increasing health literacy is a Healthy People 2030 goal
56
Objectives related to health literacy
1. Increase providers who check pt understanding 2. Decrease providers with poor communication 3. Increase providers who involve pts in decision-making (as much as they want) 4. Increase people who understand online medical record 5. Increase adults with limited English to say their providers explain things clearly
57
Office of Minority HEalath
within health & human services published standards for providing services that are culturally and linguistically appropriate (CLAS)
58
ETHNICS Frame work
Handy tool to honor a patient's culture during encounter Explanation Treatment Healers Negotiation Intervention Collaboration Spirituality
59
Teach-Back
Useful tools to ensure patients understand info they have been given -- useful for all patients, regardless of health literacy level promotes adherence, quality, pt safety
60
Motivational interviewing
Useful tools to ensure patients understand info they have been given -- useful for all patients, regardless of health literacy level Evidence-based, pt-centered method of communicating increases likelihood of change in behavior
61
Motivational Interviewing Principles
Express Empathy Develop Discrepancy Supporting Self-Efficacy Rolling with Resistance Avoiding Argumentation

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