Cost of medicines, value for money of pharmacy services and the risks associated with medicine use continue to grow as issues for hospitals. Finding the most appropriate metrics and tools to actively measure, monitor and manage these things is a challenge for hospital managers and pharmacists, writes PharmConsult Director Michael Ryan.
Although the cost of medicines in private hospitals is substantially underwritten by the Pharmaceutical Benefits Scheme (PBS), the cost of non-PBS intrinsic medicines (including some new biologics) and imprest medicines is borne by private hospitals. These non-subsidised intrinsic medicines have the potential to significantly increase hospital costs unless actively managed.
Medicines are the most common treatment used in health care and contribute to significant improvements in health when used appropriately. However, medicine use can also be associated with harm and the common use of medicines means they are associated with more errors and adverse events than any other aspect of health care.
More comprehensive pharmacy services are required to manage the increasing complexity, cost, and risk associated with medicines, and as a consequence, the cost of providing these services is also increasing.
This triumvirate of medicine safety, pharmacy services, and associated costs needs to be actively monitored, not only to satisfy hospitals’ concerns about value for money and performance but to provide a way to compare with national standards and benchmarks.
Things to consider when making decisions on what to monitor
A core role of any hospital service including pharmacy is to support the achievement of the hospital's vision and objectives. As such, pharmacy can and should contribute to enhancing the patient’s experience, increasing medicine safety, ensuring appropriate use of medicines, providing cost-effective distribution and managing costs to meet budgets.
Pharmacists can do this by:
- Delivering clinical pharmacy services targeted to patients at the highest risk of medicine-related problems e.g. through medication reconciliation, medication management review, therapeutic drug monitoring, patient counselling, providing medicines information to doctors/nurses and training pharmacy and other health professionals.
- Providing management services that improve patient safety system-wide e.g. prescribing policies, medicine use evaluation, managing high risk medicines, and staff development.
- Safely and cost-effectively supplying imprest and dispensed medicines including aseptically-prepared products and cancer chemotherapy, clinical trial drugs, and providing services to support optimal storage of medicines, prevention of selection errors and appropriate labelling and packaging.
The metrics associated with these and other medicine-related activities need to be meaningful, credible, validated and easily monitored. They should be developed with input from hospital management and pharmacy. Baseline data should be obtained to assist in establishing performance target goals for each measure. Local and national benchmarks should also be used.
What specifically needs to monitored?
There are a number of key aspects of medicine safety (including all those related to National Standard 4 – medication safety), pharmacy operations, financial aspects of medicine and pharmacy, and education and research which should be monitored.
These could include KPIs related to:
- Medicine reconciliations and medication chart reviews completed;
- Medicines information provided to patients;
- Pharmacy-attributed dispensing errors;
- Participation in the Antimicrobial Stewardship (AMS) Program;
- Occasions a medicine is unavailable to administer;
- Identification and appropriate billing of extrinsic medicines;
- Medicines provided in the most cost effective manner;
- Clinical, professional and imprest management services provided and costs / fees;
- Pharmacy costs in relation to key hospital financial markers; and
- Participation in nursing education and involvement in clinical drug trials.
There are at least two tools (i.e. a balanced scorecard (BSC) and a dashboard) which can be used to quickly and accurately find out if something is wrong or something is right in relation to medicine use and pharmacy services. Although the terms BSC and dashboard are often used interchangeably, these tools are distinctly different.
A BSC containing essential data reports trends in performance metrics over weeks, months and quarters. If designed properly and updated consistently, a BSC can present a broad view of medicine use and pharmacy performance, serve as a guide for strategic decision making, and improve performance. A BSC tends to include detailed measures that closely align with a hospital operator’s strategic goals and objectives.
Dashboards track performance over shorter intervals and typically serve as tactical indicators on the state of a process instead of progress toward pre-specified goals. A dashboard tends to focus on graphical monitoring of operational processes.
A BSC is likely to be more effective than a dashboard in monitoring trends in medicine use and pharmacy performance. A well-designed BSC is an effective tool that can consistently track the progress of the pharmacy in assisting hospitals to meet strategic goals in relation to medicine use and pharmacy performance.