Patient Care Final

Card Set Information

Patient Care Final
2011-12-05 22:01:11
Joint Commission Patient Care Pharmaceutical

Patient Care
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  1. Describe Purpose & Scope of The Joint Commission
    Set Standards & Subsequently Accredit Thousand of Hospitals, Home Health Care, Long-Term Care, & other Organizations Based on those Standards
  2. The Joint Commission & ___ Collaborated on Creating Core Measures of Quality Imporvent
    CMS (Centers for Medicaid & Medicare)
  3. Core/Accountability Areas. Be Able to ID at Least 4.
    • AMI (Acute Myocardial Infarction)
    • HF (Heart Failure)
    • Pneumonia Care
    • Surgical Care
    • Childen's Asthma Care
    • Inpatient Psychiatric Service
    • VTE (Venous Thromboembolism) Care
    • Stroke Care
  4. Describe what FOCUS-PDCA stand for & how it Relates to Quality Improvement.
    • Find a Process to Improve
    • Organize a Team Who Understands the Process
    • Clarify Current Knowledge of the Process
    • Understand the Causes of Variation in Process
    • Select the Improvement that Needs to Take Place
    • Plan Imporvement Based on Studying the Opportunity
    • Do the Improvement
    • Check the Result by Collecting & Analyzing Data
    • Act to Hold the Gain if Process was Imporved OR go Back to the Drawing Board & Try Something Else While Going thru Cycle Again
  5. Describe Relationship b/t Continuous Quality Improvement & Pharmaceutical Care.
    to Maintain Superior Pharmaceutical Care, You must Keep up with Continuous Quality Improvement
  6. Continuous Quality Improvement
    • For a Group or Population
    • Comprised of Individual Encounters w/ the Health System
  7. Define Pharmaceutical Care
    • For an Individual
    • Responsible Provision of D Therapy for the Purpose of Achieving Definite Outcomes that Improve a Patient's Quality of Life
  8. 4 Outcomes that Improve Patient's Quality of Life
    • Curing Disease
    • Reducing or Eliminating Symptoms
    • Arresting or Slowing of Disease Process
    • Preventing Disease or Symptoms
  9. ID 8 Categories of D-Related Problems
    • Untreated Indication
    • Improper D Selection
    • Subtherapeutic Dosage
    • Failure to Receive a D
    • Overdosage
    • Adverse D Rxn
    • D Interaction
    • D Use w/o Indication
  10. Describe Roles of Structure & Process as they Relate to Outcomes
  11. ECHO Model stands for:
    • Economic
    • Clinical
    • Humanistic
    • Outcomes
  12. Provide example of Economic, Clinical, & Humanistic Outcomes as Describe in the ECHO model.
  13. Economic Outcomes
    (Examples: Cost Effective Analysis, Cost-Benefit Analysis, Cost-Utility Analysis)
    • *Direct Cost:
    • ~Prevention, Detection, & Treatment (Hospitalization, Immunization, Lab Tests, Ds, etc.)
    • *Indirect Cost:
    • ~Morbidity or Mortality due to Disease (Time away from School/Work
    • *Intangible Cost:
    • ~Pain, Suffering, or other Non-financial Aspects of Care
  14. Clinical Outcomes
    (Ex: Decrease BP, ^ Heart Rate, Morbidity, Mortality)
    Medical Events that Occur as a Result of Disease or Treatment
  15. Humanistic Outcomes
    (Ex: Health-Related Quality of Life, Patient Preferences, Patient Satisfaction, Willingness-to-Pay)
    • Resuls of Disease or Treatment on Patient's Functional Status or Quality of Life
    • Measured as Phsical or Social Functioning, General Health Perceptions, Well-Being
  16. From the Hepler & Strand article, Describe 5 Causes that Lead to < Optimal Outcomes
    • 1. Inappreopriate Prescribing
    • ~Inap. Regimen (D, Dosage Form, Dose, Route, Dosage Interval, or Duration)
    • ~Unnecessary Regimen

    • 2. Inappropriate Delivery
    • ~ D not Available when Needed b/c of:
    • (1)Economical Barriers (Pharmacy doesn't stock, Patient Can't/Won't Purchase)
    • (2)Biopharmaceutical Barriers (Inappropriate Formulation)
    • (3)Sociological Barriers (Institutional D Distribution or Patient Caretaker Fails to Administer D)
    • ~Dispensing Error Involving
    • (1)Incorrect or Inappropriately Labeled Rx
    • (2)Incorrect or Missing Patient Info or Advice

    • 3. Inappropriate Behavior by Patient
    • ~Compliance w/ Inappropriate Regimen
    • ~Noncompliance w/ Appropriate Regimen

    • 4. Patient Idiosyncracy
    • ~Idiosyncratic Response to D
    • ~Mistake or Accident

    • 5. Inappropriate Monitoriing
    • ~Failure to Detect & Resolve an Inappropriate Therapeutic Decision
    • ~Failure to Monitor Effects of Treatment Regimen on Patient
  17. 3rd Party Payer
    Insurance Company (Entity) that Pays
  18. 3 Step Process for Billing Rx
    • 1.) Determine Price of Product
    • *Provider (pharmacy) determines based on cost of D
    • *will not necessarily be paid by provider
    • 2. Claim is Sent from Provider to 3rd Party Payer...Online Billing Begins
    • *NPI, NDC, Cost, Dispensing Fee
    • *Patient Contract Info (3rd Party Reviews Contract w/ Patient & Provider)
    • 3. Reimbursement "Promise" Sent to Provider
    • *Provider Receives what 3rd Party agrees to Pay
  19. What happens after 3 Step Process for Billing Insurance Takes Place?
    • *Collect Data for Each Payer
    • *Reimbursement & Reconciliation
    • *Discrepancies
    • *Re-file Discrepancies
  20. Why 3rd Party Payers also Collect & Use Rx Data, & Why they May also Conduct Audits.
    • *Look for Statistical Outliers (ex. 6oo test strips, 30 day---not realistic) or charging too much for product
    • *If provider is outside norm, payer can conduct audit
    • *Create Chargebacks
  21. Describe when MTM got started & how MTM is associated w/ Medicare Part D
    Medicare Rx D, Improvement, & Modernization Act of 2003 (Medicare Modernization Act) created Medicare Part D which is required to have some form of MTM
  22. Describe why Medicare was Chosen to be Associated w/ MTM
    Medicare Beneficiaries =20% of All Health Care Spending
  23. Discuss the Criteria for Medicare Beneficiaries to be Eligible or MTM Services
    • Multiple Chronic Diseases
    • Multiple Part D Covered Ds
    • likely to Incure Annual Costs for Medicare Part D covered Ds > $4,000
  24. Describe Who may Provide MTM Services
    Pharmacists or Other Qualified Providers
  25. Discuss the Focus of MTM Services
    Optimize Medication Usage to Reach Target Therapeutic Outcomes & Reduce Adverse Effects & D Interactions
  26. Discuss the Goals of MTM Services
    • 1. Enhanced Understanding of Appropriate medication Usage & Adverse D Events thru Patient Edu
    • 2. Increase Adherence to D Regiments
    • 3. Detection of Adverse D Events & D Over/Under Use
  27. Discuss what CMS has Stated that MTM Services may Include
    • 1. Providing Patient Edu & Training
    • 2. Health Status Assessments
    • 3. Developing or Formulating Rx D Regimens
    • 4. Evaluating & Monitoring Patient Response to D Therapy
    • 5. Coordinating Care w/ the Patient's Health Care Team
  28. Describe what's Needed before Beginign MTM Services
    • 1. Consistent Documentation & Charting Process
    • *SOAP Note Format (Subjective Data, Objective Data, Assessment, Plan)
    • *Methods for Collecting Objective Data
    • *Methods for Communicating w/ Physicians
    • 2. HIPAA Paperwork (to obtain Patient's Paperwork)
    • 3. Dedicated Sit-Down Edu Area
    • 4. Address Workflow Issues w/ Staff...MTM Sessions should NOT be Interrupted
    • 5. Set Aside Dates for MTM Appt. (no Mon or 1st of Mth)
  29. Discuss thoroughly the 5 Essentials of an MTM Program & Each of their Components
    • 1. Medication Therapy Review
    • *Brown Bad of all Ds (including OTCs)
    • *Prevent, ID, & Resolve all D-Related Problems
    • *Each D:duplicate, indication, adverse, expired, directions, dose, route, time, generic, any untreated disease
    • 2. Personal Medication Record
    • *Patient has list of all Ds (Dosage, Route, Time, Indication, Special Instructions, Start/Stop Date), Dr & Pharmacists info
    • 3. Medication Action Plan (1 for Patient & 1 for Dr)
    • *Patient(D issue, steps to resolve, method for measuring outcome, follow up method)
    • *Dr (SOAP/SBAR note format for patient visit SBAR note format (Situation, Background, Assessment, Recommendation), elements of patient action plan, recommendations for D adjustments, thereapeutic sub., request lab data, any add. recommendation)
    • 4. Intervention &/or Referral
    • *PhD addresses Med. Issues, Communicates w/ all Health Providers, & Refers Appropriate Provider
    • 5. Documentation & Follow-Up
    • *Consistent Documentaion w/ All Patients (keep for 10 years...Medicare Requirement)
  30. Discuss Issues Related to Health Reform & MTM Services
  31. Discuss what's Required for Part D plans that Pay Community Pharmacists to do this Service
  32. Discuss thoroughly the Importance of Medication Adherence Monitoring to MTM, including the 3 Main Reasons for Non-Adherence & How these can be Resolved