A quality improvement project to reduce falls and improve medication management.

This paper describes the implementation of a medication management model within a medical-center based home health agency. The model was integrated into the agency's quality improvement falls prevention program and was selected in part because it directly addressed two medication-related accreditation standards for home health care agencies. During a five-month period, a staff pharmacist conducted medication reviews for 228 HHA patients who met the program's inclusion criteria. Thirty-three percent of these patients required some type of follow-up to resolve potential medication-related problems. By far, falls were the most common reason for referral, with 71 patients, or 30% of all participating patients, referred to the pharmacist due to a recent fall. From a quality improvement standpoint, the program met and even exceeded expectations in that it enabled staff to identify a serious threat to patient safety-medication-related problems, especially falls--and gave them the tools to resolve these potential problems.

Evaluating the accuracy of technicians and pharmacists in checking unit dose medication cassettes.

The accuracy rates of board-registered pharmacy technicians and pharmacists in checking unit dose medication cassettes in the inpatient setting at two separate institutions were examined. Cedars-Sinai Medical Center and Long Beach Memorial Medical Center, both in Los Angeles county, petitioned the California State Board of Pharmacy to approve a waiver of the California Code of Regulations to conduct an experimental program to compare the accuracy of unit dose medication cassettes checked by pharmacists with that of cassettes checked by trained, certified pharmacy technicians. The study consisted of three parts: assessing pharmacist baseline checking accuracy (Phase I), developing a technician-training program and certifying technicians who completed the didactic and practical training (Phase II), and evaluating the accuracy of certified technicians checking unit dose medication cassettes as a daily function (Phase III). Twenty-nine pharmacists and 41 technicians (3 of whom were pharmacy interns) participated in the study. Of the technicians, all 41 successfully completed the didactic and practical training, 39 successfully completed the audits and became certified checkers, and 2 (including 1 of the interns) did not complete the certification audits because they were reassigned to another work area or had resigned. In Phase II, the observed accuracy rate and its lower confidence limit exceeded the predetermined minimum requirement of 99.8% for a certified checker. The mean accuracy rates for technicians were identical at the two institutions (p = 1.0). The difference in mean accuracy rates between pharmacists (99.52%; 95% confidence interval [CI] 99.44-99.58%) and technicians, (99.89%; 95% CI 99.87-99.90%) was significant (p < 0.0001). Inpatient technicians who had been trained and certified in a closely supervised program that incorporated quality assurance mechanisms could safely and accurately check unit dose medication cassettes filled by other technicians.