Protected professional practice evaluation: A continuous quality-improvement process

Abstract

The development, implementation, and evaluation of a protected peer-review process for clinical pharmacists with advanced scopes of practice are described. A protected practice evaluation committee (PPEC) was created at a Veterans Affairs medical center to formulate policies and procedures for conducting peer reviews. The committee comprises six clinical pharmacists, none of whom hold a supervisory position, and assigns appropriate peers to review and rate clinical pharmacists' cases based on PPEC-developed performance measures. Peers rate the level of pharmacist-provided care by deciding whether most experienced, competent practitioners would have handled the case similarly in all aspects (level 1), might have handled the case differently (level 2), or would have handled the case differently (level 3). Each practitioner receives a report summarizing the findings and recommendations for improvement. The data are protected from legal discovery and shared with management only in aggregate. Of the 250 cases reviewed between January and October 2009, 236 (94.4%) received level 1 care and 14 cases (5.6%) received level 2 care; none received level 3 care. The number of cases judged as receiving level 2 care decreased to 1 by September 2009. Improvements in process indicators, including documentation of medication reconciliation and patient adherence, were noted. A survey of the clinical pharmacists indicated strong support for the review process. Protected practice evaluation engaged clinical pharmacists in a continuous quality-improvement effort, generated data regarding practicewide as well as individual practitioner performance, and encouraged self-reflection. Frontline practitioners agreed that peer review is important for quality-improvement purposes.