Assignment: Hospital Pharmacy Services Case Summary

Assignment: Hospital Pharmacy Services Case Summary ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Hospital Pharmacy Services Case Summary Please read this case and answer the four questions. University of Alberta Riverside COMM3501Hospital Pharmacy Services Case Summary using word document within 2 pages Assignment: Hospital Pharmacy Services Case Summary questions_for_riverside.pdf case_3.pdf Assignment: Hospital Pharmacy Services Case Summary. COMM 3501 Case Discussion Questions Riverside Hospital’s Pharmacy Services Below are some questions for you to discuss using the discussion board. You will discuss within your assigned group. One of you will summarize the discussion points into about a half to one page and will post it out into the main discussion board under the topic “Case 4 Synopses”. We will have a similar assignment for the other cases (using a different person each time, so everyone gets a crack at being the leader). The deadline for posting the summary is Tuesday, October 26, 11:59 p.m. (Halifax time). After the summaries have been posted to the main board, I want everyone to have a look at the suggestions made by the other groups and react to at least one of them, positively or negatively. In particular, you should anticipate the reactions of the various stakeholders to the proposed changes. This second phase of the discussion must be completed by Tuesday, 3 December, 11:59 p.m. (Halifax time). In Canada, hospitals such as RDMH are funded mostly by public money (that is, federal and provincial grants). Keep this in mind as you answer questions 1 through 4 below. Q.1 Identify the key stakeholders in medication management at Riverside District Memorial Hospital (RDMH). What are the most significant concerns of these stakeholders? Q.2 Identify questionable practices in RDMH’s pharmacy management. Q.3 Why does the pharmacy follow the questionable practices you identified in Q.2? In other words, are there reasons or mitigating factors? Q.4 What options are there for improving the situation? What decisions would you make and why? What are the implications of your decisions? 1 9B11D014 Dr. Anne Snowdon and Hannah Standing Rasmussen wrote this case solely to provide material for class discussion. University of Alberta Riverside COMM3501Hospital Pharmacy Services Case Summary The authors do not intend to illustrate either effective or ineffective handling of a managerial situation. The authors may have disguised certain names and other identifying information to protect confidentiality. This publication may not be transmitted, photocopied, digitized or otherwise reproduced in any form or by any means without the permission of the copyright holder. Reproduction of this material is not covered under authorization by any reproduction rights organization. To order copies or request permission to reproduce materials, contact Ivey Publishing, Ivey Business School, Western University, London, Ontario, Canada, N6G 0N1; (t) 519.661.3208; (e) [email protected]; www.iveycases.com. Copyright © 2011, Richard Ivey School of Business Foundation Version: 2014-02-06 As she drove to work on a Monday morning in the spring of 2009, Barbara Jordan, vice-president of patient services and chief nursing executive at Riverside District Memorial Hospital (RDMH), thought about the upcoming board meeting about pharmacy services at the rural hospital. RDMH was unable to afford a full-time pharmacist, and since it was only a 62-bed hospital, there wasn’t enough work to justify a full-time pharmacy position. RDMH had been “making do” with short-term arrangements with a variety of pharmacists in the region. Five different pharmacists would come to RDMH from other hospitals once a week to supply their services. More recently, Jordan had uncovered some evidence that the quality and safety of pharmacy services might be becoming compromised. There had been an increasing number of medication errors resulting in adverse drug events (ADEs — events where there were injuries to patients resulting from the use of medication 1). University of Alberta Riverside COMM3501Hospital Pharmacy Services Case Summary Assignment: Hospital Pharmacy Services Case Summary. Jordan knew there was a need to examine the quality of service delivery in the pharmacy department. Three weeks earlier, an elderly patient at RDMH, Mrs. Farell, died from a reaction between her anticholesterol medicine (Lipitor) and one of the antibiotics she had been prescribed by a hospital physician following a hip replacement operation at RDMH. The patient had been on the anti-cholesterol drug since 2008 due to cardiac problems. The surgery, performed in late January 2009, went well but while in hospital recovering she developed a secondary bleed and an infection in her wound. In early February 2009, the physician ordered antibiotics to treat the infection. Farell’s antibiotics were changed during her treatment throughout February and included teicoplanin and fusidic acid, flucloxacillin with fusidic acid, and doxycycline. In late February 2009, the physician took her off the drug Lipitor as a precaution because of the drug’s risk of reaction with antibiotics. 2 However, by this time it was too late. Farell died in early March. The pathologist’s report found that the cause of death was rhabdomyolysis and renal failure due to probable drug reaction between Lipitor and an antibiotic. The pathologist added that it was not possible to say which antibiotic had the adverse reaction with Lipitor. 1 J. Lazarou, B. H. Pomeranz, and P. N. Corey, “Incidence of Adverse Drug Reactions in Hospitalized Patients,” The Journal of the American Medical Association, 279:15, 1998, p. 1200. 2 “Lipitor,” Drugs.com, www.drugs.com/lipitor.html, accessed June 21, 2011. Authorized for use only by xinxin zhang in COMM 3501 at Dalhousie University from Sep 03, 2019 to Dec 06, 2019. Use outside these parameters is a copyright violation. RIVERSIDE HOSPITAL’S PHARMACY SERVICES Page 2 9B11D014 A final issue that concerned the board was not a death but was still a substantial problem. A patient had been prescribed a painkiller in pill form. University of Alberta Riverside COMM3501Hospital Pharmacy Services Case Summary Assignment: Hospital Pharmacy Services Case Summary. When he complained that he was still in pain after several doses, the head nurse investigated. While the pills looked correct on first inspection, she noticed when she looked closer that many of the pills in the bottle were not for pain, but were instead antibiotics that looked almost identical to the pain medication. The nurse contacted the hospital pharmacy and the correct medication was sent to the floor and given to the patient. Jordan’s role in the organization was the hospital risk manager, which was over and above her role as chief nursing executive. It was her responsibility to manage risk, investigate all adverse events (including pharmacy-related events), and recommend solutions or changes in practice to improve the quality of care and prevent future adverse events. Any recommendations to improve risk were made with consideration of existing budget limitations. Jordan had been involved in a recent survey of RDMH regarding hospital safety. This survey had revealed widespread fear of blame related to reporting events of patient risk, and a lack of awareness of risk management strategies. Surprised by this result, RDMH had introduced a series of initiatives to improve patient safety. The hospital began to encourage staff to report any concerns or problems in the hospital. Many of the staff reported problems, and potential problems, with medication management in the hospital. For example, staff reported that: i. ii. iii. There were errors in the timing, dosage and type of medication being given to patients. Pharmacy technicians were performing duties that would normally be the job of the pharmacist. Medications were being contaminated (unused doses of medications that had been dispensed to the patient floor to fill prescriptions were being returned to the pharmacy and placed back in the stock supply). Jordan knew these issues had to be resolved before there was another serious adverse event for a patient. These issues raised by the staff had to be resolved, and quickly. The hospital board wanted a solution. University of Alberta Riverside COMM3501Hospital Pharmacy Services Case Summary Assignment: Hospital Pharmacy Services Case Summary. She needed to make a recommendation at tonight’s meeting. There were several different options for RDMH. The question was — what should she recommend at the board meeting tonight? HOSPITAL BACKGROUND Riverside, Ontario Riverside, Ontario, was a rural municipality in Southwestern Ontario. Its population was roughly 25,000 people. RDMH served Riverside, as well as the farms and villages that surrounded the municipality. The majority of people in Riverside spoke English. However, there was a growing population of seasonal laborers that came from Mexico and Jamaica. Additionally, Mexican Mennonite settlers had also begun to settle outside Riverside. Authorized for use only by xinxin zhang in COMM 3501 at Dalhousie University from Sep 03, 2019 to Dec 06, 2019. Use outside these parameters is a copyright violation. This death was not the first death at RDMH that had been brought to the attention of the board. In 2008, there were several deaths reported due to errors in the volume of morphine given to patients. All patents had been prescribed morphine 1 to 2 mg subcutaneously but a different form of morphine product was available in the hospital. Several times the patients received correct volumes of morphine. However, on the day of the death of each patient, a different amount was administered in error. A different nurse administered the morphine at each death. Each cause of death was determined to be heart failure caused by the administering of the wrong dose of morphine. Page 3 9B11D014 The Riverside District Memorial Hospital (RDMH) was opened in 1948. It was a rural community hospital with both inpatient beds and a large outpatient population. RDMH considered outpatient treatment and the medical management of geriatric patients to be its specialty, which was a strong fit with the needs of the population it served. University of Alberta Riverside COMM3501Hospital Pharmacy Services Case Summary Assignment: Hospital Pharmacy Services Case Summary. Outpatient surgeries were the most common type of procedure offered by RDMH. A fully staffed emergency department managed the urgent care needs of the town, and more complex cases were referred to one of two nearby community hospitals in a medium-sized urban centre. RDMH had been increasingly working with the two nearby hospitals to reduce costs and improve efficiency by streamlining infrastructure and services including information technologies, referrals to specialists, and obstetrical services. RDMH Outpatient Population In 2004, RDMH had 100 inpatient beds. However, due to ongoing budget cuts, by 2009 there were only 62 inpatient beds remaining. The majority of these were acute care beds since wherever possible, healthy patients were served as outpatients. One of RDMH’s main strengths was its outpatient surgical program, which included procedures such as cholecystectomy (removal of gallbladder, endoscopy, bladder surgery and lumpectomy). With these surgeries, a patient was allowed to return home on the same day that a surgical procedure was performed. 3 Outpatient services were considered by many experts as the most economical and patient-focused way to provide health care to individuals. 4 For example, outpatient surgery often reduced the amount of medication prescribed, and used a doctor’s time more efficiently. It was also preferred by most patients as they could return to the comfort of their own homes to recover. 5 More than 60 per cent of elective surgery procedures in the United States were performed as outpatient surgeries in 2005. 6 Health experts expected that this percentage would increase to nearly 75 per cent over the next decade. 7 Although not all types of surgeries and/or patients were suitable for outpatient surgery at RDMH, 90 per cent of all surgical cases, regardless of suitability, were performed on an outpatient basis. Geriatric Patients RDMH considered the medical management of geriatric patients to be its other specialty. On any given day in 2009, the average age of an inpatient at RDMH was 86. Most of these inpatients were admitted for acute illnesses. For example, they were admitted for acute exacerbations of one or more chronic illnesses, 3 “Definition of Outpatient,” MedicineNet.com, April 27, 2011, www.medterms.com/script/main/art.asp?articlekey=4700, accessed May 12, 2011. 4 L. Peng and E. J. Norris, “Outpatient Surgery,” emedicinehealth, January 11, 2006, www.emedicinehealth.com/outpatient_surgery/article_em.htm, accessed June 21, 2011. 5 Ibid. 6 Ibid. 7 Ibid. Authorized for use only by xinxin zhang in COMM 3501 at Dalhousie University from Sep 03, 2019 to Dec 06, 2019. University of Alberta Riverside COMM3501Hospital Pharmacy Services Case Summary Use outside these parameters is a copyright violation. According to the census, the average age of people living in Riverside was 72 years. The economy of Riverside was based on farms and greenhouses. In 2009, Riverside had the largest number of commercial greenhouses in North America. Historically, tobacco was an important crop in the Riverside economy. However, this was now in fast decline. Recently, Riverside was becoming a retirement community. Riverside had many golf clubs and beautiful waterfront parks, and had a very warm climate compared to most of Canada. Page 4 9B11D014 Geriatric patients could be challenging to treat since they most often suffered multiple co-morbidities, that is, two or more coexisting medical conditions. As people aged, they were increasingly likely to suffer from a compromised nutritional state, have balance and gait problems, suffer from sight and hearing loss, have out-of-date immunizations, and have cognition problems or dementia, and were more likely to suffer from depression. 8 As a result of experiencing one or more of these illnesses, many geriatric patients were prescribed many different medications, resulting in a challenge referred to as “polypharmacy.” Polypharmacy referred to the interactions of multiple medications, which, when taken together, interacted to cause adverse effects such as fatigue, dizziness, nausea and loss of coordination. 9 The adverse effects of polypharmacy could make it very difficult for a physician to diagnose a geriatric patient quickly and correctly. 10 Additionally, numerous medications also caused side effects that could be very dangerous, if not deadly, to patients. 11 For example, many geriatric patients were on the blood thinner Coumadin. Coumadin interacted negatively with many medications, including simple aspirin (both drugs prevented platelets from clotting), which, when ingested at the same time, caused excessive bleeding that was difficult to control. 12 Local Health Integration Network RDMH was a part of the South East Local Health Integration Network (SELHIN). This network was one of 14 networks that were established in 2006 in Ontario. University of Alberta Riverside COMM3501Hospital Pharmacy Services Case Summary These networks were intended to coordinate health care across the province and to provide effective and efficient management of the health system at the local level. The goal of local health integration networks (LHINs) was to plan and allocate resources more efficiently to ensure better access to health care now and in the future. One of their secondary goals was to work with local health service providers to identify ways to reduce duplication in the health system and to improve health services in Ontario. 13 The SELHIN serviced three rural regions in Ontario that made up more than 649,000 people. It had an annual budget of more than $900 million. Jordan knew, from her years of working in the region, that the population had some specific health issues that needed to be considered whenever health services were reviewed for RDMH. Specifically, the population of the region was older, more likely to be either overweight or obese, more likely to practice poor lifestyle habits, and more likely to have chronic health conditions (such as diabetes, chronic heart failure, and asthma). As a result, the population of the SELHIN had higher rates of hospitalization than the rest of Ontario. 8 J. W. Yates, “Comorbidity Considerations in Geriatric Oncology Research,” CA: A Cancer Journal for Clinicians, 51:6, 2001, pp. 329-336. 9 S. N. Hilmer and D. Gnjidic, “The Effects of Polypharmacy in Older Adults,” Clinical Pharmacology & Therapeutics, 85:1, 2009, pp. 86-88. 10 Ibid. 11 K. E. Miller, R. G. Zylstra, and J. B. Standridge, “The Geriatric Patient: A Systematic Approach to Maintaining Health,” American Family Physician, February 15, 2000, www.aafp.org/afp/20000215/1089.html, accessed June 21, 2011. 12 C. Bartecchi and R. W. Schrier, “The Bad (Polypharmacy) and the Ugly (cocaine, methamphetamines, marijuana, and anabolic steroids),” Online Guide to Living Healthier and Longer, www.healthierlongerlife.org/?page_id=72, accessed June 21, 2011. 13 “About LHINs,” Ontario’s Local Health Integration Networks, www.lhins.on.ca/aboutlhin.aspx?University of Alberta Riverside COMM3501Hospital Pharmacy Services Case Summary ekmensel=e2f22c9a_72_184_btnlink, accessed June 21, 2011. Authorized for use only by xinxin zhang in COMM 3501 at Dalhousie University from Sep 03, 2019 to Dec 06, 2019. Use outside these parameters is a copyright violation. such as chronic obstructive pulmonary disease (COPD), diabetes, infections (e.g., pneumonia) or injury (falls). 9B11D014 Across the province, at least 50 per cent of hospitals (75 hospitals) were in deficit in 2008 and almost 70 per cent (104 hospitals) were projected to be in deficit in 2009. In 2008, there was a major round of hospital restructurings and cuts across the province of Ontario. The LHINs were told to review services in all hospitals to either avoid a deficit or reverse a projected deficit. With the increasing costs of hospital services across the province, there had been some discussion at the provincial level of either amalgamating services across the regions or amalgamating hospitals, as a way to reduce health system costs. 14 The Riverside community had always feared it would be forced to amalgamate with one of the larger community hospitals in the region, a 40-minute drive away from Riverside. The LHINs were required to make cuts to eliminate any waste. The LHINs’ cuts included the closure of emergency departments, cuts to hospital departments and beds, closure of small and rural hospitals, privatization of support services, lay-offs and attrition, increased fees for patients and their visitors, and other measures. The South East Local Health Integration Network had hired consultants to review the role of the emergency rooms in three small rural hospitals, including RDMH. Additionally, service reviews to identify cuts were underway in other hospitals within the LHIN. Another challenge for small rural hospitals like RDMH was the availability and retention of health professionals. Due to the small number of beds, there were always challenges ensuring that specialist care was available when needed. University of Alberta Riverside COMM3501Hospital Pharmacy Services Case Summary For example, there was only one obstetrician in the community, pharmacists were in short supply across the province, and diagnostic imaging technicians were difficult to retain. Adding to this challenge was the relatively small volume of patients at RDMH, which was not large enough to sustain full-time health professionals in practice. This was particularly an issue in the pharmacy, which, on occasion, had no pharmacist coverage for parts or all of busy weekends. In 2008, both the federal and provincial governments created funding for special infrastructure projects for Ontario hospitals. LHINs could make appeals for funding for both minor capital projects and projects for hospitals within LHINs that would result in systems that enabled authorized health care providers to access, manage, share and safeguard patients’ medication histories. These grants had been used in other hospitals for upgrades to heating, ventilation and air-conditioning systems, fire alarms, and master medical gas equipment, as well as drug information systems, laboratory information systems, and telehealth. 15 RDMH Hospital Operations RDMH had a long history of fiscal prudence and accountability, finishing each of the previous decades with a balanced budget. No other hospital in its region had been able to achieve a balanced budget the previous five years. The culture of the organization was one filled with pride about this accomplishment. The senior team promoted this message and most of the staff saw themselves as intimately involved in producing the balanced budget (see Exhibit 1). Being a small community hospital, the hospital staff was composed of people who had … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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