The QI Initiative that I will embark on is to find out if the Patient-Centered Medical Home (PCMH) is functioning the way it is intended to provide comprehensive care, patient centered care, coordinated care, and access to care. the Agency for Healthcare Research and Quality (AHRQ) defines a PCMH as a model for delivering primary health care using assessments of the five pillars mentioned above (AHRQ, 2013). Each pillar has a set of guidelines and standards for care delivery with The National Committee for Quality Assurance (NCQA) review the standards for recognition for outstanding care at a PCMH. The Joint Commission also review the standards for accreditation by looking at the crosswalk of their standards compared to the NCQAs standards.
This organization is a smaller clinic compared to the larger Medical Centers in the Military. It has its challenges based on the needs of the military and the mission of the Soldiers working in the clinic. This initiative will be to ensure the PCMH is meeting the standards of care and that staff understands what “right” looks like. The goal is to establish a survey about staff satisfaction and get a clear understanding what needs to be changed or maintained in preparation for the three-year NCQA Certification and TJC Accreditation. After the gathering the information from the survey, I will delve into the findings and establish the needs of the PCMH in meeting its mission. I will provide training or assist in the education and training of the staff. I will develop a brochure or booklet for the patients and staff to understand the Ins and Outs of the PCMH. In addition to using the standards for project management that was discussed in prior discussion post.
The PCMH providers have empanelment of Active-Duty Soldiers, their families, and retired service members. Age range varies from newborns to geriatrics. The article that I read discussed a case of a71 year old geriatric patient who was given thiothixene (Navane), an antipsychotic, instead (Norvasc), for her hypertension. This was given over a period of three months. The patient developed personality changes, tremors, ambulatory dysfunction, and psychological changes (Da Silva & Krishnamurthy, 2016). This medication error occurred because the outpatient pharmacy dispensed Narvane instead of Norvasc. Fortunately for the patient after they found and corrected the medication error she was back to her normal self.
According To the article, “The alarming reality of medication error: a patient case and review of Pennsylvania and National data,” Adverse drug events (ADEs) account for more than 3.5 million physician office visits and 1 million emergency department visits each year. ADE errors impact more than 7 million patients and cost almost $21 billion annually across all care settings (Da Silva & Krishnamurthy, 2016).
Reading about this type of event can impact public and internal perspectives on healthcare quality as it relates to Adverse Drug Events. It can cast doubt about the prescriptions a provider may write for his/her older patients. They may not get the prescription filled, or perhaps get it filled, but not take the medication. According to the National Action Plan for Adverse Drug Event Prevention, the elderly is two to three times more likely to have an ADE compared to others. They make up about 35% of inpatient stay, and have the highest percentage of ADE at 53% (Health.Gov, 2021). This is very alarming and need to be addressed across all healthcare quality.
The PCMH has a metric that tracks all ADE that have occurred from medication administration in the clinic, medication pick up at the outpatient pharmacy, and any incidents that may involve prescribed medication that was obtained from an outside pharmacy. This provides transparency for the organization, the patients and their family. For any adverse events, be it medication, or anything else, risk management have a meeting with the leadership team, so that they are aware. Based on the area where the event occurred, the staff are required to do an After-Action Review (AAR) and go over what occurred, how it occurred, and how to prevent it from occurring again. This is done for all errors, to include near misses. Although it is not formal, it is treated as a very serious matter, and all staff have to report to the discussion.
References:
Agency for Healthcare Quality. (2013). Creating Quality Improvement Teams and QI Plans. Agency for Healthcare Research and Quality, Rockville, MD. Retrieved from: https://www.ahrq.gov/ncepcr/tools/pf-handbook/mod14.html
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