Posted on February 25, 2021
The Michigan Medicine Quality month was held in October and Pharmacy was well represented, reflecting the quality effort pharmacy provides for our patients and stakeholders on a daily basis.
Quality Month poster submission require implementation of a process improvement effort that has completed at least one “Plan-Do-Check-Adjust” (PDCA) cycle.
- measureable assessment of the outcomes of experiments
- connections between improvement objectives and organizational goals of Optimizing Quality & Safety in Patient Care, Leading in Value Creation, Enhancing the Patient Experience, Developing Our Employees, Improving Financial Performance, and Improving Diversity & Inclusion
- clear relationship between root cause and countermeasures.
Pharmacy is accountable and responsible for the complex medication management use cycle across the health-system enterprise. The medication use process starts with formulary decision-making, progressing to purchasing the medication from the wholesaler, ordering the medication, preparing the product, administering the medication, and concluding with monitoring patients for effectiveness, drug interactions, and possible adverse effects.
Figure 1: Medication Management Use Cycle
Michigan Medicine is expansive and pharmacy personnel are involved in each step in the medication management processes. The Department of Pharmacy annually supports medication use for 2.3 million annual clinic visits, 106,000 emergency department visits, 53,000 hospital admissions, and much more. Our mission is to assure the safe, timely and appropriate use of medications. We prepare and dispense over 6.7 million inpatient doses, 251,000 outpatient prescriptions and review 4 million medication orders each year for accuracy and appropriateness. A sampling of lesser known services for inpatients includes advising on medication use during patient care rounds, cardiac arrest team participation, performing pharmacokinetic monitoring and dosing adjustments, and sepsis and antimicrobial therapy optimization. In the outpatient setting, pharmacists provide chronic disease state management, infusion services, in addition to traditional prescription services at our community pharmacies.
The 2020 Quality Month poster session highlighted many examples of pharmacy’s contributions to multidisciplinary teams and medication management improvement efforts:
Quantitative Outcomes – Efficiency:
- Poster #30 – Reducing Ambulatory Infusion Patient Wait Times
- Poster #27 – Outmigration of R-EPOCH Chemotherapy
- Poster #33 – Impact of Aortic Dissection Management Protocol
- Poster #58 – Outpatient Induction for Acute Leukemia
Decreased in number of steps
- Poster #64 – Bolus Administration of Comfort Medication in PICU
- Poster #50 – Proactive Patient Outreach Initiatives during COVID-19
- Poster #14 – Chemotherapy Remote Care Monitoring
Quantitative Outcomes – Effectiveness:
- Poster #56 – UMMG Blood Pressure & A1C Drive-Through Chronic Disease Management during COVID
Increased preventative behaviors
- Poster #12 – Med Management in Ambulatory Clinics
- Poster #28 – Pressure Injury Prevention in the CVICU
Decrease incident & prevalence
- Poster #8 – C Diff stewardship
- Poster #37 – Reducing Postop Atrial Fibrillation
Organizational design improvements
- Poster #6 – IV concentration standardization in C&W
- Poster #16 – Implementation of Dispense Prep in C&W
- Poster #20 – Implementation of Pharmacist Oncology Symptom Management
- Poster #25 – Implementation of Insulin Infusion Calculator
- Poster #34 – Implementation of CancelRx to Reduce Dispensing Discontinued High Risk Medications
- Poster #44 – Reduce tablet splitting by optimizing inventory in Pyxis
- Poster #45 – Antimicrobial Stewardship Team Review of Real-time alerts for Multi-Drug Resistant Infections
Qualitative Outcomes – Effectiveness:
Quality enhancement, services
- Poster #2 – ICU handbook
- Poster #7 – Dexmedetomidine protocol
Quality enhancement, systems
- Poster #53 – Improving Transition of Care
The 2020 virtual Quality Month identified five exemplar posters, 3 of the which had significant pharmacy involvement:
- Chemotherapy Remote Care Monitoring Program
- Improving Transitions in Care
- Bolus Administration of Comfort Medications in the Pediatric ICU: A Pilot Program to Improve Efficiency and Satisfaction and Decrease Waste
Figure 2: Chemotherapy Remote Care Monitoring Program
Figure 3: Improving Transitions of Care
Figure 4: Bolus Administration of Comfort Medications in the Pediatric Intensive Care Unit: A Pilot Program to Improve Efficiency and Satisfaction and Decrease Waste
Pharmacy strongly advocates for putting patients and family first. We strive to do that through interdisciplinary efforts to improve medication use across the enterprise. Please do not hesitate to connect with your pharmacy colleagues to work on new efforts or contact us PharmQuality@med.umich.edu.