24 research outputs found
Effect of Electronic Alerts on Nurses' Intentions to Perform Medication Education: An Application of the Theory of Planned Behavior
No full textPURPOSE: Inadequate education about medications can increase the risk of medication-related errors. The national average of patients who reported that staff “Always” explained about medicines before giving it to them” was 65% for measurement period from 10/01/2015 to 09/30/2016. A multi-disciplinary team consisting of pharmacists, nurses, and informaticists developed an innovative solution utilizing electronic alerts to facilitate medication education. The authors of this study aim to understand the motivational factors that may influence nurses’ behavioral intentions to perform medication education to patients at the bedside and determine the effect of the electronic alerts on nurses’ intentions to perform medication education. METHODS: This pre-post questionnaire study was conducted at a 907-bed academic medical center. The survey was developed based upon a framework called, the theory of planned behavior, to examine motivational factors that may influence nurses’ intention to perform medication education. The study sample composed of 150 nurses working on the six pre-designated pilot units for medication education alerts. The medication education alerts were built in the form of BestPractice Advisories (BPA) available within the electronic health system. An elicitation study was arranged in focus groups to develop the questionnaire that was given to nurses before and after the implementation of the medication education alerts. Descriptive statistics, logistic and multivariate regression analyses were used to achieve the objectives of this study.
RESULTS: 95 questionnaires were collected in the pre-BPA group and 98 questionnaires were collected in the post-BPA group. Attitude and subjective norm were significantly correlated with nurses’ intentions to perform medication education. After the implementation of medication education BPAs, there was a significant increase on the control beliefs and perceived power to perform medication education. CONCLUSION: The theory of planned behavioral was useful in understanding the motivational factors that may influence nurses to perform medication education. Interventions that address key influential factors may be helpful in driving medication education initiatives.Pharmacy Practice and Translational Research, Department o
Evaluating the Impact of In-Hospital Clinical Pharmacists’ Activities on 30-day Readmissions among High Risk Medicare Shared Savings Program (MSSP) Patients
No full textPurpose: Hospital readmissions reduction continue to be a major goal for healthcare institutions. It costs the Center for Medicare and Medicaid Services (CMS) more than $26 billion annual and hospitals are penalized financially by CMS for not meeting readmissions goal. This study aimed to evaluate the impact of in-hospital pharmacists’ activities on readmissions among high-risk patients.
Objective: To determine the difference in 30-day hospital readmission rates among high-risk Medicare Shared Savings Program (MSSP) patients who received a pharmacist intervention compared those who did not receive an intervention.
Methods: This multi-center retrospective cohort study was completed at Houston Methodist Health System. Patients admitted between June 2018 to December 2018 were included if they were ≥18 years, designated as high-risk MSSP patient, and received a pharmacist consult.
Patients who received a consult-related pharmacist activity (intervention) were compared to patients who did not receive a consult-related pharmacist activity (control). The primary endpoint was 30-day readmission rate between the groups. Secondary endpoint included the effect of each pharmacy activity or combination of activities on readmission rates.
Results: A total of 333 patients (53.8% female, median age, 72 years) were included in the primary analysis, including 235 patients in the intervention group and 98 in the control group. There was a nonsignificant reduction in 30-day readmission rate between the intervention and control group 38.3% vs. 42.9% [RR 0.89 (95% CI, 0.68-1.18)]. Median time to 30-day readmission was 13 days (4-23) and 12 days (3-19) for the pharmacist activity and control groups respectively. The risk of readmissions within 30-days after discharge was lower in the subset of patients who received medication history and discharge support provided by a pharmacist (HR, 0.68; 95% CI, 0.46-0.98).
Conclusion: This study showed that pharmacists’ activities may reduce 30-day readmission among high-risk MSSP patients.Pharmacy Practice and Translational Research, Department o
Geotechnical uncertainties and reliability-based assessments of dykes
No full textThis thesis utilises the random finite element method (RFEM) to provide practical guidance and tools for geotechnical engineers to account for the influence of soil spatial variability. This has involved: (a) practical insight and guidance on the choice of characteristic soil property values and scales of fluctuation; (b) a robust approach to reliability assessment and design that obviates the need for explicit calculation of characteristic values; and (c) the benchmarking and improving of simpler analysis tools.Geo-engineerin
Evaluation of the impact of unit-based pharmacy technicians in a tertiary academic medical center
No full textPurpose: This study aimed to evaluate the impact of a unit-based pharmacy technician service on the quality of patient care provided within a tertiary academic medical center, defined by its effect on clinical pharmacist efficacy, the discharge process, and operational efficiency.
Methods: A quasi-experimental, single-center pilot study was conducted to evaluate the integration of two unit-based pharmacy technicians on four acute care cardiology and neurology floors. Their specific primary functions included completing medication histories, performing insurance coverage verification, screening for high-cost medications and prior authorizations, and facilitating utilization of the bedside medication delivery program. The primary endpoint was a composite of clinical pharmacist efficacy, defined as the documented number of advanced clinical interventions (aside from pharmacy consult-related interventions), prior authorizations, discharge counseling, and discharge process support. Secondary endpoints included various operational and outcomes metrics, such as medication re-dispense rates, medication message rates, length of stay, length of stay index, 30-day readmission rates, and patient satisfaction scores. Patients were included only with a discharge disposition to home in the pre-intervention period from October 2020 to January 2021 and the post-intervention period from October 2021 to January 2022.
Results: Of the 2076 patients who met inclusion criteria in the post-intervention period, approximately 35.5% had an intervention performed by a unit-based pharmacy technician during hospitalization. The composite rate of clinical pharmacist interventions per number of patients discharged significantly increased from 31% in the pre-intervention period to 38% in the post-intervention period (95% CI, -12.86 to -2.03, p<0.01). There was also a significant increase in the rate of prior authorizations completed from 2% to 7% (95% CI, -6.65 to -2.98, p<0.01). A nonsignificant increase was noted in the number of discharge counseling from 9% to 10% (95% CI, -5.06 to 2.38, p=0.47), other discharge support interventions from 3% to 4% (95% CI, -1.77 to 0.37), and non-consult interventions from 17% to 18% (95% CI, -3.91 to 2.83) performed between the pre- and post-intervention periods. A statistically significant reduction in the 30-day readmission rate from 9.7% to 7.3% was observed (95% CI, 0.43 to 4.29, p=0.02). There was no significant difference in length of stay, length of stay index, or satisfaction scores for patients who were seen by unit-based pharmacy technicians.
Conclusion: Unit-based pharmacy technicians contributed to improving clinical pharmacist efficacy, decreasing 30-day readmission rates, and decreasing the rate of missing doses through various patient care support and operational tasks in this study. Additional studies are needed to identify the most optimal workflow and productivity metrics for unit-based pharmacy technicians to achieve desired goals in a targeted area of focus.Pharmacy Practice and Translational Research, Department o
Discharge Medication Complexity Effect on 30-Day Heart Failure Readmission
No full textObjective: To evaluate discharge medication regimen complexity index’s (MRCI) effect on heart failure (HF) patients being rehospitalized 30 days after discharge at a large tertiary teaching facility.
Methods: The institutional review board approved this single center, retrospective, cohort study. The University HealthSystem Consortium (UHC) database was used to identify HF patients from January 2011 to December 2013. Inclusion criteria consisted of men and women aged 18 and older who had a primary discharge diagnosis of HF, a discharge medication list, and discharged to home. Patients were excluded if they had received a heart transplant or left ventricular assist device, and/or died during hospitalization. A 30-day readmission was defined as being readmitted to the same hospital within 30 days of discharge with a principal discharge diagnosis of HF. Only patient’s index admission was included in the study, and patients admitted within the first and last 30 days of the study were excluded to avoid excluding a 30-day readmission. A pilot analysis was conducted involving randomly selected 55 patients to compare manual MRCI collection tool and an automated scoring MRCI system. Multivariable logistic regression was used to examine MRCI effect on 30 day rehospitalization after controlling for other factors.
Results: The pilot analysis revealed that the manual and automated MRCIs were moderately correlated with an R of 0.74 and R2 of 0.55. For the main analysis, a total of 1,455 patients were included in the study with 81 patients (5.6%) readmitted within 30 days of discharge. In the 30-day readmission group, 54 (67%) patients were male with a mean age of 67, and 783 (57%) patients were male with a mean age of 68 in the non-readmit group. Bivariate analysis revealed no statistically significant difference in MRCI in patients readmitted within 30 days of discharge versus patients not readmitted (MRCI: 14.5 versus 13, p=0.13). However, significantly more patients had systolic HF and coronary artery disease (CAD) in the 30-day readmit group [SHF: 57 (70.4%) versus 761 (55.4%), p<0.01; CAD: 27 (33.3%) versus 264 (19.2%), p<0.01]. The variables (p<0.25) included in the multivariate logistic regression analysis consisted of sex, systolic HF, diabetes mellitus (DM), hypertension (HTN), CAD, chronic kidney disease (CKD), length of stay, MRCI, ACEI or ARB, digoxin, and loop diuretics. The multivariate logistic regression analysis revealed that patients prescribed ACEI or ARB were less likely to be readmitted 30 days after discharge (OR: 0.59; CI: 0.36-0.96), and patients with CAD were more likely to be readmitted 30 days after discharge (OR: 1.70; CI: 1.00-2.89). However, there was no effect of MRCI on 30 day rehospitalization after controlling for other factors.
Conclusion: The automated MRCI score was moderately correlated with manual MRCI score. Although ACE/ARB and CAD were significantly associated with 30 day readmission for HF, the automated MRCI was found non-significant. More research is needed to automate MRCI and to evaluate its utility in clinical care.Pharmacological and Pharmaceutical Sciences, Department o
Systemization and evaluation of the impact of a pharmacy technician career ladder in a multi-hospital system
No full textPurpose: Career ladders have been formally designed to assist in the motivation of pharmacy technician employees to undertake more of an active approach in career progression and participate in the advancement of innovative pharmacy leadership practices. The ability to identify organizational benefits and perceptions of a career ladder for technicians will support the imperatives set forth at the 2017 Pharmacy Technician Stakeholder Consensus Conference and in the American Society of Health-System Pharmacists 2018 Pharmacy Forecast.
Methods: A retrospective multi-center study was performed to evaluate organizational and pharmacy technician-oriented outcomes. The timeframe encompasses a pre-intervention period from January 2013 through December 2015 and a post-intervention period from January 2017 through December 2019. The main intervention was the implementation of a systemized pharmacy technician career ladder. The primary endpoint was to assess the perceptions of pharmacy technicians toward career advancement through a theory of reasoned action survey. Secondary endpoints included new hire pharmacy technician one-year and two-year promotion and turnover rates.
Results: Survey assessment revealed significance within one domain, leadership and career advancement, indicated by Pharmacy Technician IIs and IIIs (P=0.006). The promotion rate of new hire employees in the post-intervention period was comparatively reduced in a one-year timeframe but maintained similar to historic information in a two-year timeframe. The turnover rate maintained relatively constant despite a systemized career ladder.
Conclusion: Pharmacy technicians demonstrate inherent attributes to pursue employment with career advancement and leadership opportunities. An employee’s organizational commitment is not linearly associated with the institution of a career ladder or incentivized benefits.Pharmacy Practice and Translational Research, Department o
Impact of CMS designated Hospital Acquired Condition (HAC) regulations compared to a currently non-CMS regulated hospital acquired infection—Clostridium difficile
No full textINTRODUCTION: Healthcare-associated infections (HAIs) are among the leading causes of death in the United States. Many HAIs are preventable, considering the fact that effective strategies to reduce the incidence of HAIs are readily available. According to the U.S. Department of Health and Human Services (HHS), up to 70% of central line-associated bloodstream infections can be prevented. In 2008, the Centers for Medicare and Medicaid Services (CMS) implemented a policy intended to reduce the incidence of specific preventable conditions and to restrict reimbursement for services provided to treat such conditions. CMS has initially designated ten conditions as hospital-acquired conditions (HACs) or complications deemed preventable if not documented as present on admission (POA). Three of these conditions are HAIs—catheter-associated urinary tract infections, surgical site infections, and vascular catheter-associated infections.
METHODS: The purpose of this study is to assess the incidence of a designated HAC (central line-associated blood stream infection) compared to a non-HAC, hospital-acquired infection (Clostridium difficile). In order to do so, an interrupted time series design with a comparator group will be used to assess for any changes in Clostridium difficile infection (CDI) ICU rates compared to ICU rates of central line-associated blood stream infection (CLABSI) both before and after the implementation of reduced reimbursement for the treatment of HAIs designated as HACs by CMS. A case-series study design will also be performed to assess for potential opportunities for intervention prior to discharge for patients readmitted within 30 days of a previous admission that have C. difficile enteritis documented as the principle diagnosis upon readmission.
RESULTS: ICU CLABSI rates did not statistically change over time during the study time period (Student’s t test 1.04, p=0.3); meanwhile, ICU CDI rates trended in an upward direction during the study period (Student’s test 2.68, p=0.01). For patient specific data analysis, 54 patients were readmitted for C. difficile enteritis coded as the principle diagnosis upon readmission. 33 of these 54 patients (61.1%) were discharged home prior to the readmission. Reasons for readmission varied but included new onset CDAD (10), potentially premature discharge (8), medication reconciliation discrepancies including patients being discharge on a gastric acid suppressant without a valid indication for therapy (5), poor adherence to medication therapy on an outpatient basis (4), duration of therapy less than recommended guidelines (3), and relapse or failed a previous therapy regimen (3).
CONCLUSIONS: While efforts have been made to reduce HAIs at the local, state, and national; the incidence of CDI in the ICU setting at an adult teaching hospital trended in an upward direction and the incidence of CLABSI in the same ICU setting did not significantly change over time during the study time period. Patient specific data revealed that potential interventions prior to discharge for patients readmitted with C. difficile enteritis documented as the primary diagnosis upon readmission include: utilization of a CDI severity assessment prior to discharge to minimize premature discharges, optimization of treatment strategies following IDSA guidelines, and completion of medication reconciliation prior to discharge.Pharmacy, College o
Evaluation of the Impact of Revisiting Just Culture Within a Pharmacy Department in an Academic Medical Center
No full textBackground: The Institute of Medicine’s report To Err is Human in 2000, served as a catalyst for the healthcare industry to make deliberate assurances that quality and safety are at the center of every patient care discussion. An essential component of a safety culture is a just culture which is often defined as an environment of shared accountability that recognizes the potential for human error and where individuals feel empowered to report errors or express concerns without fear of retribution or discipline. Since the creation and validation of the Just Culture Assessment Tool (JCAT) in 2013, the JCAT has been used with other survey tools to assess various aspects of culture in hospitals. However, a gap in literature exists evaluating the perception of a pharmacy department’s just culture. Given the major role pharmacy departments play in medication and patient safety, evaluation of interventions focused on improving just culture are needed. Methods: A quasi-experimental single-center study was performed to evaluate the perceived just culture of a pharmacy department. The study timeframe included a pre-intervention and a post-intervention survey period, from November 16th through November 30th, 2020 and March 26th to April 9th, 2021, respectively. The baseline JCAT identified an opportunity to improve departmental communication regarding safety event outcomes. A medication safety newsletter was distributed to the department which served as the intervention of this study. The primary objective was to assess change in perceived just culture after distribution of the medication safety newsletter, which was measured by change in percentage of negative responses (PNR) to the JCAT. A subgroup analysis was performed to see if employee role and demographics influenced the perceived just culture. Results: For the primary endpoint there was an unexpected statistically significant increase in overall JCAT PNR between the pre- and post-surveys (p=0.035). These results were likely due to confounders related to response rate rather than the intervention itself. There were statistically significant increases in PNR for the ‘Openness of Communication’ (p=0.009) and ‘Continuous Improvement’ (p=0.032) domains. Among reduction in ‘Feedback and Communication’ among Operations Pharmacists (p=0.003). Conclusion: Cultivating a just culture is developed over time and is a dynamic process that is influenced by many factors. Just culture process improvements are likely to impact more than one just culture domain thus utilizing a validated tool to measure changes at the domain level may be beneficial.Pharmacy Practice and Translational Research, Department o
Evaluating Risk Factors to Commit Medication Errors in Hospital Pharmacy Operations
No full textPurpose: Financial constraints and increased awareness of medication errors are two prevailing factors that influence hospital pharmacy operations. Hospital pharmacy increasingly has to do more with less, potentially increasing the pharmacist’s risk of committing medication errors. Evaluating and minimizing these risk factors can lead to a safer, more efficient work environment. The purpose of this study is to identify modifiable and non-modifiable risk factors that increase a pharmacists risk to commit errors during the medication order verification process.
Methods: A retrospective, observational study of pharmacist-related medication errors was conducted from July 2011 to June 2012. Medication error data was obtained from the institution’s voluntary reporting system. Risk factors that were assessed were workload (average number of orders verified per pharmacist per shift), work environment (type of day, type of shift, and average number of pharmacists per shift), and non-modifiable pharmacist characteristics (type of pharmacy degree obtained, age, number of years practicing, and number of years at the institution). Statistical analysis was conducted using univariate analysis and multivariate logistic regression.
Results: A total of 1,887,751 medication orders, 92 PSN error events and 50 pharmacists were included in the study. The overall error rate identified per 100,000 orders verified was 4.87. The workload stratified analysis demonstrated an increasing rate of error associated with an increasing number of orders verified per pharmacist (p = 0.007). The work environment analysis had significant error rate differences for type of shift, type of day, and average number of pharmacists per shift categories (p = 0.021, 0.002, 0.001, respectively). The pharmacist demographic variables (degree, number of years practicing, number of years at site, age) did not have statistically significant outcomes.
Conclusions: Type of shift, type of day, average number of pharmacists per shift, and average number of orders verified per pharmacist can be utilized as medication safety benchmarks in hospital pharmacy.Pharmacy, College o
Assessment of an Integrated Clinical Surveillance Alert System
No full textPURPOSE: To assess the changes in alert acknowledgment and intervention rate after
integration of a clinical surveillance alert system with an electronic health record.
METHODS: This is a 60-day pre-post quasi-experimental study completed at a large academic
medical center which assesses the utilization of eight medication alerts within a stand-alone
clinical surveillance system before and after integration with the electronic health record. The
primary outcome assessed is alert acknowledgment rate by clinical pharmacists.
RESULTS: 176 alerts were activated during the pre-assessment period and 230 alerts in the postassessment
period. Results will be described in higher detail including acknowledgment rate,
alert accuracy, pharmacy consult rate, and pharmacy intervention related to alerts.
CONCLUSION: The use of clinical surveillance alerting systems can identify meaningful
pharmacy led therapy interventions regardless of clinical pharmacy service model. Integration of
such systems into the EHR improves their utilization and in our study was associated with a
higher rate of alert identified therapy intervention.Pharmacy Practice and Translational Research, Department o
