Background: Adherence to guideline-based venous thromboembolism (VTE) prophylaxis recommendations is often inadequate. Effective improvement strategies are needed. Objective: The purpose of this quality improvement initiative was to increase use of the facility’s preferred pharmacologic VTE prophylaxis, reduce unnecessary VTE prophylaxis use, and reduce use of pharmacologic VTE prophylaxis in high bleeding risk patients, in accordance with guideline-based recommendations. Methods: Clinical pharmacists spearheaded the development and implementation of a clinical decision-support tool (CDST) integrated within a Veterans Health Administration electronic health record (EHR). The CDST focused on VTE prophylaxis in acutely ill medical patients and guided prescribers to guideline-based recommendations. Following review and approval, the CDST underwent activation in the EHR. A subsequent intervention occurred, year 2 post-intervention, which embedded this CDST into the EHR admission process and admission menus. A drug message was added in the EHR to alert prescribers that low-molecular-weight heparin was the preferred agent. Measures were evaluated pre-intervention, year 1 post-intervention, and year 2 post-intervention. Results: After intervention, there were statistically significant increases in the proportion of patients receiving the facility’s preferred pharmacologic VTE prophylaxis agent, enoxaparin, and a statistically significant decrease in the proportion of unwarranted VTE prophylaxis. The proportion of inappropriate pharmacologic VTE prophylaxis in high bleeding risk patients decreased, but this result did not reach statistical significance. Conclusion: The improvements observed suggest the beneficial role of CDSTs integrated into the EHR to increase adherence to guideline-based VTE prophylaxis recommendations.
Purpose To assess a quality improvement initiative aimed at improving clinic utilization and encounter and intervention workload capture for clinical pharmacy specialists. This initiative aided in justification of clinical pharmacy services, identification of clinical areas for intervention, and incorporation of all modalities to appropriately document clinical care. Methods In order to objectively demonstrate clinical pharmacy service value to stakeholders, pharmacy administrators and clinical pharmacy specialists at the North Florida/South Georgia Veterans Health System performed clinic scheduling and profile reviews using data extracted from the Veterans Health Administration electronic health record and analytic software. Outpatient clinical pharmacy specialty practice areas were primarily investigated; the specialty areas included are as follows: cardiology, infectious disease, mental health, oncology, pain management/palliative care, and specialty clinics (a collection of medical and surgical subspecialties). The first intervention entailed completing a worksheet and assessing clinic utilization data. Then, an evaluation was performed to assess the number of encounters, clinical interventions, clinic modalities, and coding for each clinic. Next, a meeting was arranged with each like clinical pharmacy specialist practice group to discuss this collected data. During these meetings, the delineation of where workload was generated and the activities taking place in an average workday were discussed. Finally, clinics were adjusted to reflect appropriate clinic coding and mapping of the average workday. Metrics were evaluated pre intervention (October through December 2017) and post intervention (July through September 2018). Results After intervention, there were statistically significant increases in clinic utilization, total encounters completed, and total interventions recorded in the composite group of clinical pharmacy specialists. Conclusion The increases in clinic utilization, total encounters, and interventions observed for the clinical pharmacy specialists suggest the beneficial role of pharmacy administrators’ collaboration with clinical pharmacy specialists to improve workload capture and access to quality care, to justify clinical pharmacy services, and to identify opportunities for pharmacy clinical intervention.
Introduction This quality improvement initiative aimed to implement a strategy to increase access to care with clinical pharmacy specialists (CPSs), optimize CPS direct patient care activities, and promote clinical pharmacy services. The primary objective was to assess the impact of patient marketing on expanding access to care and clinic utilization in a CPS clinic. Methods A marketing technique was applied by a mental health (MH) CPS to expand clinical pharmacy services. Direct-to-patient brochures advertising MH CPS comprehensive medication management services were placed at the check-in window of an interdisciplinary outpatient MH clinic. Brochure content included a description of an MH team, the role of MH CPSs, and benefits of being managed by MH CPSs. Patients could contact the MH CPS or speak to their primary provider for referral. The preintervention and postintervention evaluation periods were 4-month time frames. Clinic utilization for the MH CPS clinic was compared before and after dissemination of marketing brochures. Additional outcomes evaluated were number of encounters, number of patients seen, and number of clinical interventions completed by the MH CPS. Results There was a significant increase in clinic utilization postintervention. The total number of encounters, patients, and clinical interventions were numerically increased postintervention. Discussion The observed improvements in clinic utilization suggest the benefit of marketing in optimization of access to care in CPS clinics and justification of clinical pharmacy services.
Introduction TCAs and paroxetine, a SSRI, are associated with safety risks in geriatric patients because of anticholinergic properties. The purpose of this project was to evaluate the impact of a clinical decision-support tool (CDST) on adherence with medication prescribing and practice guidance to enhance patient safety. Methods Mental health clinical pharmacy specialists and clinical pharmacy leadership led a multidisciplinary creation and integration of a CDST within a Veterans Health Administration EHR. The CDST focused on the following elements when prescribing TCAs and paroxetine in geriatric patients: clinical justification for initiation of the medication, provision of patient/caregiver education specific to the medication prescribed, evaluation of comprehension of education provided, medication reconciliation, and follow-up completed within 30 days of medication initiation. Following activation of the CDST in the EHR, measures were evaluated before intervention and after intervention. Results After intervention, an increase was observed in the primary outcome of the proportion of patients having documentation of all of the following: clinical justification for medication initiation, provision of patient/caregiver education, evaluation of comprehension of education provided, medication reconciliation, and follow-up completed within 30 days of medication initiation (P = .01). Individual proportions of patients with documented medication reconciliation and follow-up completed within 30 days significantly increased. All other secondary outcomes numerically increased but did not reach statistical significance. Discussion Improvement was seen in adherence with prescribing and practice guidance following the implementation of the CDST. This suggests the beneficial role of CDSTs within the EHR to optimize patient safety.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.