Healthcare improving quality

For improved quality of care in the elderly we must first define and measure the problem and the magnitude of the problem. We must also prioritise between problems and select the most important issue. Of course the aim must be improvement for the individual patient. But since quality in healthcare normally is complicated and multifactorial a systematic change in structures and processes is required. 

SIG (prescription instructions), and RxNorm (standard name, dose, and form availability) were not considered ready for implementation because of numerous approaches used in these three areas across health information technology. Electronic prescribing is not required under MMA, but plans are to have it available should providers choose to use it. As standards are developed, the adoption of e-prescribing is expected to improve patient safety by reducing prescribing and dispensing errors (Agency for Healthcare Research Quality, 2007). 

Figure 26.2 is a flowchart of appropriate, safe, effective, and efficient use of medications in the hospital setting (12). It incorporates the role of the prescriber, nurse, pharmacist, and patient in a typical inpatient environment. It also depicts the role of the organization s pharmacy and therapeutics committee and quality improvement functions, which will be discussed later in this chapter. The decision to treat a patient in a hospital or extended-care facility typically adds a nurse or other healthcare provider (respiratory therapist, etc.) to the trio described in the ambulatory care setting. Every time that individual has to read, interpret, decide, or act is yet another opportunity for a mistake to occur. Each of the steps in the medication use process provides an opportunity for correct or incorrect interpretation and implementation of the tactics that support the therapeutic plan. With this many opportunities for medication misadventures to occur, it is easy to understand why tracking and improving quality are important aspects of medication use. 

The pharmacy profession has recognized that the benefits to society greatly exceed the cost of the drugs. The benefits of the drugs and pharmacy care center around an improved quality of life, a decrease in overall healthcare expenditures, and an increased life span. ... 

Between 1984 and 1995 the place of quality improvement in the British NHS was transformed. At the start of that period... clinicians took part in a range of informal and quasi-educational activities aimed at improving the quality of practice, but there were few, if any, healthcare organizations who could claim to have a systematic approach to measuring or improving quality. Moreover many clinicians and professional organizations had a record of being disinterested, sceptical, or even actively hostile towards the idea that systematic or formal quality improvement activities had much to offer in healthcare. 

The Institute for Healthcare Improvement (IHI) has pioneered quality improvement in healthcare, drawing together ideas and practical experience from healthcare and many other sources. We will use their approach to reducing medication error as an overall framework to illustrate the potential of process improvement, addressing the particular role of technology in a later section. 

Nieva, V.F. and Sorra, J. (2003) Safety culture assessment a tool for improving patient safety in healthcare organizations. Quality and Safety in Health Care, 12(Suppl. II), iiI7-ii23. 

The world s highest priority in the 21st century is healthcare. In economically developed Asian-Pacific societies, there is a well-established perception that improvements in healthcare and quality of life depend on advancements in bioengineering and biotechnology. 

Wreathall, J, Nemeth, C, 2004, Assessing risk the role of probabilistic risk assessment in patient safety improvement, Quality and safety in healthcare, 13 206-2. 

Dixon-Woods, M., McNicol, S. and Martin, G. 2012. Ten challenges in improving quality in healthcare Lessons fiom the Health Foundation s programme evaluations and relevant literatnre. BMJ Quality and Safety, 21, 876-84. 

For example. Memorial Hermann used nine measures developed by the Institute for Healthcare Improvement as a starting point for reducing ventilator-acquired pneumonias (VAPs) and increasing safety and quality of care for ventilated patients. Individuals traveled to an IHI collaborative meeting and then returned to Memorial Hermann and passed on what they had learned to multidisciplinary teams from each of the hospital system s ICUs. 

We thank the authors for their contributions and wish them success in their ongoing pursuit for novel biomaterials and advanced technologies that contribute to improvement in healthcare and quality of life. Thanks are also due to the ACS Division of Polymeric Materials Science and Engineering, hic. for sponsoring the symposium and to the ACS books department for being patient through the compilation of this symposium series book. 

Further, Mid-Atlantic Hospital System is a big supporter of the Institute for Healthcare Improvements initiative, which states that health system performance designs must be developed to simultaneously pursue (1) improving the patient experience of care, including quality and satisfaction, and (2) reducing per capita healthcare costs. 

Healthcare providers who work with the elderly must understand and address not only the physical but mental, emotional, and social changes of the aging process. They need to be able to distinguish between normal characteristics associated with aging and illness. (60) Most crucially, they should look beyond symptoms and consider ways that will help a senior maintain and improve her quality of life. 

Figure 2.5. Improvements in the quality of care reduce healthcare expenses. [Source Institute of Medicine, 1999, p. 26 American Hospital Association, Hospital Statistics, Chicago, 1999.)...

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