Development of health-system inpatient pharmacy clinical metrics

Abstract

Purpose To describe a process to identify metrics that represent the impact of inpatient pharmacy services on patient outcomes across a health system. Summary The authors describe a systematic process of identifying inpatient clinical outcome measures that could represent pharmacists’ impact on patient outcomes and eventually be displayed in a dashboard within the electronic medical record (EMR). A list was generated through literature review, assessment of practices at other sites, evaluation of current pharmacy services, and collaboration with the quality department and System Pharmacy Clinical User Group. The project team narrowed the list through assessment against standardized criteria. An assessment tool was designed and distributed to stakeholders to prioritize clinical outcome measures for inclusion on the dashboard. The clinical outcome measures were transformed into metrics by determining measurement criteria, inclusion and exclusion parameters, and review time frame. After validation, the metrics are planned to be displayed on an inpatient pharmacy EMR dashboard. Exemption from institutional review board review was granted for this project. Conclusion A systematic process was developed and used to identify inpatient clinical outcome metrics.

Development and application of quality measures of clinical pharmacist services provided in inpatient/acute care settings

“…Resources providing guidance on the development of quality measures in the acute care setting were also used. 8,[20][21][22][23] The end result of this review and development process was a list of 137 crude candidate quality measures, some of which were redundant.…”

“…However, these obstacles should not minimize the necessity and value of establishing and using similar quality measures across the profession of pharmacy. 8 Integrating perspectives that are important to stakeholders is essential in delivering quality CMM and designing care models that prioritize the activities of perceived value. In fact, with so many perspectives to be considered (health system, payer, patient, quality organization), it is more important than ever to create common measures for inpatient/acute care clinical pharmacists and pharmacist extenders to demonstrate their impact.…”

Quality measures of clinical pharmacy services during transitions of care

“…If a strong association between these intermediate and major outcome measures can be shown, individual processes can more effectively be compared, which remains a significant gap in the current literature. 7 Ultimately, future research should establish how intermediate outcome measures can reliably be linked to patient and institutional outcome measures as "surrogate" markers, similar to how incremental blood pressure reductions correlate with major clinical • Difference between actual and expected cost for a service, medication, or other health care-related resource (eg, planned vs (Continues) medication history and reconciliation processes. 8,9 The most critical prerequisite for identifying discrepancies is to assume that all medication lists are inaccurate, a practice best-suited for trained pharmacists.…”

“…To further clarify the impact of processes related to iQMs, such as the resolution of medication discrepancies and MTPs, iQMs can allow for the benchmarking of quality among pharmacists or practice settings. If a strong association between these intermediate and major outcome measures can be shown, individual processes can more effectively be compared, which remains a significant gap in the current literature 7 . Ultimately, future research should establish how intermediate outcome measures can reliably be linked to patient and institutional outcome measures as “surrogate” markers, similar to how incremental blood pressure reductions correlate with major clinical outcomes.…”

Maintaining comprehensive pharmacy services during a pandemic: Recommendations from a designated COVID-19 facility

“…Information generated from activities such as emergency response and code cart exchanges, order verification, sterile compounding, drug procurement, ADC turnover and stockouts, medication regimen complexity scoring, clinical interventions, and safety incidents will be valuable in optimizing staffing and reallocating operational or clinical resources if necessary. 26,27 Functionalities of the EMR and business analytics can be leveraged to monitor and trend prescribing patterns to identify opportunities for therapeutic interventions, forecast upcoming usage for better inventory management, and implement cost-avoidance strategies.…”