Application of system-level root cause analysis for drug quality and safety problems: a case study.

Background: Automated surveillance indicators are used to identify problems with drug therapy. A previous study automated 39 indicators of possible drug-related emergency department visits and hospitalizations. These indicators were used to investigate the quality and safety of drug use in a large health care coalition in Florida.

Computerized indicators of potential drug-related emergency department and hospital admissions.

Objectives: To computerize indicators of potential drug-related emergency department and hospital admissions and to report the incidence of these potential drug-related morbidities for a managed care organization.

Study Design: Retrospective review of healthcare organizations' pharmacy and administrative claims databases.

Methods: Thirty-nine indicators were coded and were used in an automated search of claims data.

A pharmacist model of perceived responsibility for drug therapy outcomes.

Pharmacists in community and ambulatory care settings are in a unique position to reduce drug-related morbidity and to optimize patient outcomes by identifying, resolving, and preventing drug therapy problems. This particular approach to pharmacy practice expands traditional pharmacist responsibilities of dispensing pharmaceuticals and providing drug information to optimizing patients' drug therapy outcomes. However, pharmacists in general, and community pharmacists in particular, have yet to incorporate this expanded professional role into daily practice.

Clinical pharmacy, pharmaceutical care, and the quality of drug therapy.

Background: Because of concerns about patient safety and the quality of health care in America, in particular about drug therapy, pharmacists have unprecedented opportunities to increase their value and significance. When defining clinical pharmacy and pharmaceutical care, pharmacists long ago recognized the need to improve the safety and effectiveness of drug therapy.

Objective: To describe how clinical pharmacy and pharmaceutical care, closely related concepts, can contribute to a strategy for improving the quality of drug therapy.

Preventable drug-related morbidity in older adults 1. Indicator development.

Objective: To develop viable clinical indicators of preventable drug-related morbidity (PDRM) in older adults.

Methods: A survey was constructed, listing the clinical outcome and pattern of care related to a number of possible PDRMs in older adults. Using the Delphi technique, a geriatric medicine expert panel of 6 physicians and one clinical pharmacist from a hospital-based health care system was asked to judge whether the outcome in each situation was foreseeable and recognizable, and whether causality was identifiable and controllable.

Indicators of preventable drug-related morbidity in older adults 2. Use within a managed care organization.

Objective: To determine the incidence of preventable drug-related morbidity (PDRM) in older adults in a provider-sponsored network and identify risk factors for PDRM.

Methods: The study was based on a retrospective review of an integrated health care database, using 52 newly developed clinical indicators of PDRM. The incidence of PDRM was determined by identifying individuals in the database who matched an outcome and pattern of care associated with an indicator.

Critically examining pharmaceutical care.

In the past decade, growing numbers of practitioners worldwide have adopted pharmaceutical care as an integral component of pharmacy practice. Established models of pharmaceutical care can reduce the burden of preventable drug therapy problems, but this promise has not yet been realized. Although many challenges remain, the profession has key resources to expand and improve the delivery of pharmaceutical care.

Preventable drug-related hospital admissions.

Objective: To estimate the prevalence of preventable drug-related hospital admissions (PDRAs) and to explore if selected study characteristics affect prevalence estimates.

Methods: Keyword search of MEDLINE (1966-December 1999), International Pharmaceutical Abstracts (1970-December 1999), and hand search. Two reviewers independently selected studies published in peer-reviewed journals and extracted crude prevalence estimates and study characteristics.