Improving care processes

Like Medical Care, Nursing Care etcetera PC consists of core components the philosophy, the patient care process, and the practical management system to support the practice. PC was developed from Clinical Pharmacy Services (see below) with more focus on the patients need and on the practitioners (pharmacist) responsibilities towards the patient and the outcome of the drug therapy. To be able to show the improved process of care a categorisation system for drug-related problems was developed. The taxonomy has been further developed into seven categories (Cipolle et al. 1998). This can be used for practice and in studies. 

All the objectives presented in Box 11.1 can be described as quality improvement in the structure and process to support improvement in each patient s health outcome. This support the patient medication care process presented in Fig. 3.1. Various problems and tools and models for improvement have been described in this book. Another approach to prevent medication errors and to improve care is to be open and continuously learn from mistakes. The basis for this is not to punish health care providers who make errors, as this may lead to less reporting of errors. In Britain, the government has taken steps away from this blame-culture (Wise 2001). In a declaration it is stated that honest failure should not be responded to primarily by blame and retribution, but by learning and by a drive to reduce risk for future patients. 

The main process (Fig. 1.1) for the care of a patient is normally the Primary care process (the patient handles their own drugs)—or the community care process (the patient gets help from community nurses at home or at a nursing home). All other processes such as hospital care (secondary/tertiary care) and the pharmacy process must support the main patient process. For improvement we must focus on patient safety and reduce drug-related problems. This means correct prescription and correct use (follow-up, documentation and communication) from the supportive process to the main process. 

ACC has published a resource guide to aid member companies in implementing the Responsible Care Process Safety Code (ACC, 1989). Although the guide provides suggestions on how to continually improve process safety, it does not prescribe how to comply with the code. It does not list specific requirements for reactive hazard management, but does require management systems to be developed-several of which could apply to reactive hazards as determined by each member company. 

The Guide to Process Safety is designed to help with implementation of the Responsible Care Process Safety Code (SOCMA, 1999). The guide presents voluntary, proactive initiatives for the continuous improvement of process safety performance. 

What kinds of time management techniques can you employ in your practice to help improve the process of health care delivery ... 

Because there is always risk when equipment, instrumentation, and human activity are involved, there is no method of making a plant completely safe. However, facilities can be made inherently safer by careful examination of all aspects of design and management, using modem techniques that are now available. If we are to improve our process safety performance and our public image, inherently safe process design coupled with inherently safe process management is imperative. 

Steps 9 and 10 involve assessing the effectiveness of the actions taken in Step 8 a continuous quality improvement (CQl) process (see Chapter 14) and communicating the findings, actions, and follow-up to the appropriate individuals involved. These individuals may be the patients, the provider, or the managed care organization. 

Perhaps measures which promise to produce a relatively small favorable perturbation of the approximately 50% oceanic component of carbon dioxide uptake would have a chance of achieving a more substantial reduction in atmospheric carbon dioxide. Preliminary experiments have shown that provision of soluble iron can dramatically improve this process. Addition of iron sulfate at the 2 nM level to iron deficient but otherwise fertile regions of the oceans doubled the phytoplankton growth [61]. Great care should be taken to try to determine any possibly serious side effects before measures of this kind are undertaken on a larger scale. Promotion of an appropriate mix of these measures will help to limit the continued increase in atmospheric carbon dioxide. 

Indicate what conclusions you came to as a result of the work, why you came to these conclusions, and what are your recommendations. Be careful with recommendations, however, as many things must be left up to the client, such as whether to sue someone, whether to tire someone, whether to spend money to improve a process, etc. We don t want to recommend something that is none of our business. 

First of all, the indicators developed should be reliable, practical and useful to decision makers, helping them to improve the processes and outcomes of pharmaceutical care. Concrete issues directly related... 

Our results indicate that on average Americans receive about half of recommended medical care processes. These deficits, which pose serious threats to the health and wellbeing of the US public, persist despite initiatives by both the federal government and private healthcare delivery systems to improve care. 

An example of how an evidence-based quality framework can be used to improve healthcare has been seen with improvements in stroke services in the United Kingdom following the implementation of the National Service Framework (NSF) for older people in 2001— The Biannual Sentinel Stroke Audit for 2008 has recently been published, and it demonstrates a continued significant improvement in stroke services. In terms of healthcare structure, 96% of hospitals in the United Kingdom now offer specialist stroke services, with an increasing number of specialist stroke unit beds 98% of hospitals employ a physician with a specialist interest in stroke. There also have been improvements in process of care measures, including the uptake of thrombolysis services and secondary prevention measures. A similar initiative has been beneficial for coronary heart disease and more recently has been broadly applied to cancer. 

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