American journal of hospital pharmacy
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Societal forces behind the increased use of outcomes to measure the quality of health care are described, and continuous improvement of outcomes as a goal for pharmacy is discussed. Consumerism, the demands of the aging American population, and problems of access to care for many Americans have helped to bring about an examination of quality. The effectiveness of clinical decision-making methods has been challenged. ⋯ Documentation of quality assurance efforts will be required. Drug-use evaluations should include assessment for therapeutic failure. Pharmacy quality improvement efforts can improve patient care and expand the pharmacist's role on the health-care team.
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The development of indicators for monitoring medication use is described. The Joint Commission on Accreditation of Healthcare Organizations is establishing a national database for use in measuring performance. Initially, indicators were developed for specialties or clinical departments and for disease entities or procedures; now, indicators for key functions that cross departmental and specialty lines, such as medication use, are under development. ⋯ The indicator data will enable institutions to identify areas for improvement. Although the Joint Commission will not use indicator rates per se to determine accreditation, it will ask an institution to provide an interpretation of indicator data that differ markedly from previous data or data for comparable institutions and to review its strategy for analyzing the rates. Use of indicator data will enhance the accreditation process by allowing for ongoing monitoring of particular aspects of performance between onsite surveys.
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A process for selecting and evaluating indicators for use in monitoring the quality of patient care is described. An indicator is a quantitative measure that provides information and reveals ways in which care could be improved. It is a specific set of conditions whose presence signals that the care being provided should be examined. ⋯ Analysis and interpretation of the data and a plan for using the information are discussed. For the use of indicators to succeed in improving the quality of care, the total institution must be committed to the process. Pharmacy quality assurance efforts need to move from evaluation of the use of specific drugs (i.e., focus on the product) to continuous measuring, monitoring, and quality improvement.