PROFESSIONAL PRACTICE

Professional Practice

Professional Practice

Purpose

A strategic approach to improving the medication-use process in health systems by using a framework for setting priorities on the basis of feasibility, the potential for financial return, and the effect on quality and safety is described.

Introduction

A panel consisting of leaders in health-system pharmacy identified seven dimensions of high-performance pharmacy (HPP) framework: medication preparation and delivery, patient care services, medication safety, medication-use leadership, financial performance, human resources, and education. Performance elements, which are specific policies, procedures, activities, and practices that indicate high performance and result in a financial or clinical return on investment of resources, within each dimension were identified. References, practice standards, and policies related to each performance element were also identified. (Rice, Bell, 2005, 315)By consensus, the panel assigned qualitative metric scores for each of the 69 performance elements that represent the panel's assessment of the resources necessary to achieve full implementation of the element and the potential financial and quality and safety returns if the element has not yet been implemented. It is noted that a pharmacy department's actual outlay of resources and expected financial return will differ depending on the size of the health system, the size of pharmacy staff, and the extent of previous implementation efforts. The framework can also be used to rejustify existing services and programs and identify opportunities for improvement.

Discussion

For the past three decades, literature documentation and empirical evidence have shown that the performance of the pharmacy department can be a vital element in the success of a health system and the health of its patients.[1,2] The high cost of medications and drug- related technology, combined with the potential effect of medications and pharmacy services on patient care outcomes and patient safety, makes it imperative that pharmacy departments perform at the highest level possible.

The project described in this article is the result of the continuing efforts of the Health Systems Pharmacy Executive Alliancea (EA) to delineate the components of high- performance pharmacy (HPP) practice, which is defined as "one that aspires to maximize its contributions to the clinical outcomes of patients and the financial position of the health system by functioning at the highest levels of effectiveness and efficiency."[3] While there are scores of articles, standards, and regulations related to different aspects of practice with accompanying tools for assessing a pharmacy department's practices compared with best- practice benchmarks,[4-6] the sheer volume of information in such resources can be overwhelming. Therefore, the EA attempted to compile this information, not into an operational benchmark against which pharmacy departments can be compared, but rather, into a tool that pharmacy departments can use to assess current performance, make plans for improvement, and identify relevant references and standards. (Koppel,Metlay,Cohen,Abaluck,2005,1197)

As phase I of the ongoing HPP project, members of the EA published an article addressing the leadership skills necessary for developing a HPP practice.[3] Leadership within the pharmacy department is necessary to create and sustain the vision and impetus for meaningful changes in the ...