Terri L.WarholakDavid P.NauQuality & Safety in Pharmacy Practice2010McGraw- Hill MedicalNew York, NY273 pages, $54.95 (paperback). ISBN 978-0-07-160385-0

Abstract

Formal instruction on quality and safety improvement is often lacking in pharmacy education, yet pharmacists play an integral part in optimizing patient outcomes in various practice settings. The editors of Quality & Safety in Pharmacy Practice provide a comprehensive and practical text designed to educate pharmacists and pharmacy students about principles in quality improvement and patient and medication safety. The editors provide examples of key concepts to allow applicability, implementation, and assessment of safety and quality initiatives in different pharmacy settings. The text is divided into 5 major sections, with each section addressed through succinct chapters that start with defined learning outcomes and end with key points. The first section (chapters 1-4), “Status of Quality Improvement and Reporting in the U.S. Health Care System,” establishes the need for examining quality and safety models in pharmacy settings. The authors introduce quality concepts and discuss the future of health care in establishing the value of rendered medical services. The authors provide an excellent review of drug-related morbidity by discussing the types of drug-related problems, epidemiology of medication errors, and the impact on patient safety. In the final chapters of the section, the authors explain the “business case” intervention for improving quality, and summarize national organizations recognized for leading quality and outcome efforts, such as the Joint Commission and the Agency for Healthcare Research and Quality. The second section, “Quality Improvement Concepts,” discussed in chapters 5-8, provides a great synopsis on how to identify and solve health care quality-related problems using a “system” level approach (compared to a “person” based approach) to improve medication management systems. Tools to identify risk or causes of failure in systems such as Healthcare Failure Mode and Effects Analysis (HFMEA) and Root Cause Analysis (RCA) are explained and illustrated with flowcharts and worksheets to allow the understanding of these somewhat complicated processes. In addition, chapter 8 provides a summary of “statistical process control tools” that can be used to monitor systems to insure quality and examine new ideas for improvement. The next section, “Quality Measurement,” chapters 9-11, provides several methodologies for measuring medication safety, such as direct observation, surveillance, and voluntary reporting systems. Models discussed include Lean, FOCUS-PDCA, (Find, Organize, Clarify, Understand, Select - Plan, Do, Check, Act) and continuous quality improvement methods. The authors provided examples for each method to allow the readers to gain a better understanding and appreciation of applicability. A unique aspect of this section is the consumer assessment of pharmacy quality. In this chapter there is a great insight to the value consumers provide for improving safe practices. The authors describe a survey that assesses consumer perceptions of the quality of pharmacy services. The goal is to have widespread use of similar surveys that serve as a motivation for quality improvement efforts. Finally, the last chapter focuses on risk management including identifying and dealing with risks as well as responding to medication errors when they occur. At the end of the chapter, the authors provide an important lesson to the readers: errors will occur because pharmacists are humans; however, pharmacists are committed to providing quality care and are part of a risk management team. The fourth section “Quality-based Interventions and Incentives” (chapters 12-15), discusses changing pharmacy processes to improve quality and offers guidance on overcoming challenges when implementing those changes. The authors explain the role of technology, not only in dispensing medications but also in monitoring quality electronically. Since transparency is considered one of the roots for value-driven health care, the authors outline different principles for reporting performance and quality. This is important for organizations to adapt as performance data can be used when pursuing government-sponsored programs. Moreover, financial incentives are awarded for providing high levels of quality or for significantly improving the quality of care. In the final section, “Application of Quality Improvement to the Pharmacy Practice Setting,” (chapters 16-17) the authors present additional examples on how to implement changes in response to outside assessment. The authors conclude the section by describing the concept of continuous quality improvement to increase quality in pharmacy practice. This model allows pharmacists to identify causes of problems, intervene to reduce or eliminate such causes, and reassess the process to ensure its effectiveness. Quality & Safety in Pharmacy Practice is a well-organized, easy to read text, and a great resource for pharmacists, academic clinicians, and students who may be involved in quality improvement initiatives at their clinical or practice settings. The book explains quality and safety concepts and methodologies that can be implemented regardless of setting. We highly recommend this book especially at a time when quality improvement and patient safety awareness is on the rise. The book should be a resource in libraries (medical and academic), and drug information centers, and a required reading for pharmacists completing postgraduate education programs in medication and patient safety.