PHCY 420 Exam

Job Application and Quality Improvement

- "Participate in ongoing service improvement" - Mentorship of the technician team - Core skills = involvement in QI initiatives - Med rec. service, reporting of KPIs - Drug utilisation reviews - Participate in Drug Utilisation Reviews, Quality Use of Medicines and Medication Safety initiatives when required including the reporting, reviewing and monitoring of medication incidents reported - Develop guidelines and protocols in consultation with direct patient care personnel - Undertake research and / or investigational work which is patient orientated and designed to improve patient care and/or departmental efficiency

Medication Errors

- 98% in a community pharmacy setting - Psychotropic medications were most commonly involved - Most common error was dispensing the wrong medication, followed by dispensing the wrong dose/strength - Most common contributing factors = failure to follow policies/procedures, inadequate policies/procedures, business, physical space layout issues, similarly named medications, lack of communication with customer, distractions, medications with similar packaging

How could pharmacy benefit from health data?

- Access to the data from places such as mental health providers, physios and more to provide a more holistic patient view - Smoking rates to identify NRT need in a particular area

Benefits of Integrated Data in Healthcare

- Allows assessment of these services, helping them to be more effective - Improves overall health outcomes, by seeing which treatment option provides the best outcomes - Making sure that nobody 'slips through the cracks' - Identify patterns, eg. medicine vs therapy use

Documenting incident forms

- Any incidents in the pharmacy that staff members are concerned about and feel that management needs to address - Eg. Verbal abuse, threatening or inappropriate behaviour, suspected thief, injuries or any other "out of the ordinary" event - When cases of abuse/neglect of any kind are brought to the attention of the pharmacist manager, this must be escalated

Common Leadership Traits

- Compassion, willingness to help - Varying areas of leadership = often multiple roles - Focused on what they believe is important - Ask themselves; "how am I going to solve this?" - Of the attitude that there is always room to improve, further work to be done - Giving - Pioneer - Continuously educating themselves, staying up to date - Mentorship - Volunteering

Reduction of Distractions/Interruptions

- Ensure adequate lighting, counter space, cleanliness - Designated areas for entering, dispensing, checking - Sufficient staff numbers and appropriate workloads, plus direction for staff around how to prioritise work during periods of high demand - Safety-critical work could be moved to a specific area away from distractions, ensuring that pharmacy staff know not to interrupt colleagues while they are dispensing/checking prescriptions, and training dispensing staff to avoid interruptions/distractions during the dispensing process.

Strategies for Managing Group Conflict

- Establish organisational protocols for conflict - Equip employees so they can manage their own conflict - Screen for conflict competence when hiring - Have the manager as a 'last resort' - Establish a conflict escalation protocol - Make the process of conflict resolution transparent = so that employees will understand the criteria for making decisions in the future.

Pace-Setting Leadership

- Expect immediate results. - Work quickly and to a high standard, and expect others to do the same. - Are quick to point out weaknesses — in people and processes — and demand more. - Are more likely to set employees new goals to work on than stop to offer feedback or rewards

Positive Culture Characteristics

- Fosters employee development - Encourages employees to take the initiative, set challenging goals, be innovative, become better leaders and mangers, and take more responsibility for the success of their work unit/organisation (eg. suggestion boxes) - Allows talented employees to exercise their talents - Creates an environment where employees are engaged, challenged motivated - Good system of compensation and recognition of their performance

Coercive Leadership

- Give a lot of orders. - Tend to take charge. - Tell team members exactly how to do tasks. - Make decisions without consulting the team.

Legislation and SOPs

- Health and Safety in Employment Act 1992 - Health and Safety at Work Act 2015

Changing the Culture

- Identify the exisiting culture, and identify the characteristics of the desired culture = need a clear vision - Vision needs to be communicated to all staff so that they can buy into the culture and share the vision 1. Analyse current cultural situation in terms of processes, environment, availability and quality of resources 2. Diagnose the causes of any problems identified that will need to be overcome 3. Make plans to change. May need to alter mission + value statements, or may involve human factors such as skills, behaviour, motivation and staff commitment. 4. Implement the action plan to deliver results

Benefits of Digital Health

- Increased access to services - Better cohesiveness across healthcare providers - More efficiency and accuracy - Early detection - Convenience - Cost effective.

Organisational Factors leading to Conflict

- Lack of effective leadership - Lack of respect and fairness - When problems are ignored - When there are ineffective processes for addressing concerns - Employers can hold training sessions to teach effective communication skills, assertive skills, and respectful workplace behaviors.

Overcoming Resistance to Cultural Changes

- Lead by example = as a leader, be present in the organisation, demonstrate enthusiasm, listen to employees, act on their concerns - Communicate! - Be personal = get to know employees, offer flexibility - Be consistent - Thank employees for their work - Demonstrate the difference that employee suggestions have on the organisation

Democratic Leadership

- Listen first, act second. - Encourage their people to work together. - Solve problems by consensus. - Make sure everyone's voice is heard. - Won't impose their own decisions. - Make sure no-one dominates meetings.

Authoritative Leadership

- Make time to find new and better ways of doing things - Show people the part they play in bringing the business vision to life. - Rally people to achieve their goals - Take a step back to work on the big picture

Purpose of Recording Near Misses

- May help identify patterns or trends - Record should be made of when the near misses were discussed and reviewed, and who was present (should be carried out with all staff) - Resulting actions taken should also be documented, particularly in the pharmacy's SOPs

Optimal Working Environment

- Minimise distractions/interruptions - Adequate staff - Well laid out dispensing environments - Training on relevant policies/procedures - Reinforced emphasis on following SOPs - Values checking as an important defence against error

Root Causes of Interpersonal Conflict

- Personal differences (eg. values, morals, beliefs) - Informational deficiencies (lack of accurate info in a situation - addressed through information sharing) - Role ambiguity or incompatibility (role clarification needed) - Disagreement over methods rather than outcomes - Environmental stressors (eg. competition for scarce resources - time, money, praise, promotion, space)

Individual Factors leading to Conflict

- Poor communication skills - Passive/aggressive behaviours - Bullying with anger, aggression, isolation and/or intimidation - When they engage in competitive rather than cooperative relationship styles. - Need to take responsibility for their own behaviour

Affiliative Leadership

- Put people first. - Focus on building strong emotional relationships and trust. - Make sure they have processes in place to support their teams. - Create teams who get on well and look out for one another.

Coaching Leadership

- Recognise employees' strengths and weaknesses. - Support their personal and professional development. - Readily delegate and give people constructive feedback on how they've done. - Encourage people to establish long term goals and plan how to get there.

Communication with the Patient following a Medication Error

- Show concern and willingness to correct any error immediately. - Try and give a sensible explanation. If the error is obvious it is no use being evasive - admit the mistake. - Do not offer compensation (looks like bribery) - Do not mention that you have insurance cover - Show empathy with the patient. This gives them the opportunity to vent their feelings, and opens the opportunity for dialogue. - At all times remain calm, sympathetic and cooperative. Advise that you will investigate how the incident occurred and revise any procedures to help prevent any recurrence. - Ensure you let the customer know what measures have been taken, and follow up promptly. If there is a delay, e.g. relevant staff member away, inform the customer. - Do not send anything in writing without asking advice from the PDA - Inform patient that they have the right to make a complaint to the Health and Disability Commission

Informatics and AI in Healthcare

- Speech recognition software (eg. to take notes) - Health tracking on phone/wearable apps - 3D Printing - AI assisted robotic surgery - Virtual nursing assistants - Aid diagnosis = eg. skin cancer detection - Automation of administrative tasks - Radiology analysis

Reasons for Cultural Changes

- The existing culture does not match current requirements (eg. regulatory requirements) - A company is underperforming or has a high staff turnover rate - The company merges with another company or business - The business environment within which a company operates is becoming increasingly competitive

Technology and Staff Innovations that help with Risk Reduction

1. Barcode verification = verifies that the medication type and strength that has been selected matches what has been entered into the pharmacy computer system. - Has been found to be superior to a visual check by a pharmacist, plus reduces pharmacist workload - Could be an alternative to the final check 2. Dispensing robots = have been shown to reduce medication selection error 3. PACTs

Pharmacy Factors which may cause Conflict

1. Heavier than normal workloads 2. Being understaffed 3. Introduction of new staff members and/or leaders 4. Scheduling disagreements 5. High noise levels 6. Introduction of new protocols or procedures 7. Inadequate understanding of job duties 8. Impression that pharmacist makes the money but technician does the work 9. After a medication error has occurred

Enhancing Collaboration in Pharmacy Teams

1. Role clarity/definition (in regard to workflow) 2. Learn conflict management skills (prevent small problems from escalating) 3. Recognise and value the contributions of all pharmacy team members 4. Pay attention to the physical constraints of the workplace (small spaces will exacerbate conflict) 5. Diffuse either the intellectual disagreement or emotional involvement components.

Preceptorship

A preceptor is a registered pharmacist who has been approved by the Society to take responsibility for, and oversee the training of, an intern pharmacist. - At least 3 years' experience in practice - Current APC - Undertake preceptor training within 2 months of becoming a preceptor - Acts as a role-model, teacher, guide, facilitator of learning, evaluator and safety net. Needs to be authentic.

Health Informatics

A term that describes the acquisition, storage, retrieval and use of healthcare information to foster better collaboration among a patient's various healthcare providers. - Plays a critical role in the push toward healthcare reform, partially fuelled by increased use of Electronic Health Records - In pharmacy: eg. looking at medication dispensing rates to identify the most common conditions, overall picture of glucose control

Big Data

A term that describes the large volume of data (big datasets) that inundates a business on a day-to-day basis - Both structured and unstructured - Can be analysed computationally

Risk Management

An approach to prevent or mitigate a potential risk through identification, analysis, planning and tracking of root causes and their consequences. - Integral to QI and clinical governance - Need to be able to identify the causes and risks of errors, and implement strategies for their prevention or mitigation - Eg. record near misses in the dispensary, re-designing the workflow of the dispensary

Pharmacy Quality Audit

Assess all services provided from the premises - Takes 6-8 hours to conduct - Covers all audit criteria applicable to the pharmacy services provided from the premises (up to 67 criteria)

How could AI cause health inequities?

By generalising the real-world data of which it is based - which often is lacking in regard to minority groups - treatment options and diagnoses may be made that are inappropriate for the patient at hand. - A.I. must learn to diagnose disease on large data sets, and if that data doesn't include enough patients from a particular background, it won't be as reliable for them. - This may lead to further health inequities, in addition to those that already exist. - Risks contributing bias, and incorporating, entrenching and perpetuating the economic and social biases that contribute to health disparities in the first place.

Mentorship

Can be defined as the "naturally formed, one-on-one, mutual, committed, nonsexual relationship between a junior and senior person designed to promote personal and professional development beyond any particular curricular or institutional goals" - Long-term relationship - Support and guide someone who is new to the field - Mentee: has the most to benefit, opportunity to network, gain confidence in taking leadership roles themselves - Mentor: can be provided with up-to-date info, passing down of knowledge, experiences and skills - Help the junior pharmacists to recognize and achieve their potential contributions to the pharmacy profession.

Big Data in Healthcare

Can be used in: - Product development - Improving patient outcomes - Operational efficiency - Driving innovation - Improve staff management - Better patient engagement And more

How to improve the 'self-checking' process

Checks are most effective when they are conducted independently by a second person - Where this is not possible, the pharmacist should ensure that a "fresh eyes" check is conducted = separation of dispensing and checking with another task - Potential to do independent double checks for high-alert medications that have the potential to cause greater harm, and those that are known to be more prone to error

Risk Management Portfolio

Civil defence emergencies, armed hold up, hazardous spills and first aid, infection control, needle stick injury, influenza pandemics, disaster planning

Conflict Management vs Resolution

Conflict Management = Identifying and handling conflict in a sensible, fair and efficient manner - Resolution = it is not feasible to expect that all problems will be solved, accommodated, or settled. - Collaborative conflict management is not always easy - it takes time and effort from all parties and requires that participants be sensitive to the needs and feelings of others.

Last opportunity to prevent medication errors

During the patient counselling process - Provides consumers with the opportunity to pick up on and clarify any potential discrepancies, and it acts as an additional accuracy check for the pharmacist.

Conflict and Meetings

Good to have a neutral facilitator, reminding of the importance of separating interests from positions 1. Before the Meeting - Analysing your own interests and those of others, define desired outcome, develop strategies to keep conversation on track, identify common ground, pay attention to timing. 2. During the Meeting - Identify the problem (each person), identify all possible solutions, decide which solution is best (make sure if appeals to all involved), plan the implementation, assess the outcome of the solution.

Advantages of IoMT

Improved efficiency, lower costs, faster implementation, early detection - Paired with smartphone applications, the technology allows patients to send their health information to doctors in order to better surveil diseases and track and prevent chronic illnesses. - AI may be integrated into these devices, allowing for real-time, remote measurement and analysis of patient data.

Transformational Leaders

Influence and direct the process of change, are assisted by managers and other who carry our the day-to-day operations associated with implementing change

Management vs Leadership

Leadership: - Expected to inspire, motivate, think and act strategically - Associated words: change, vision, communication, proactive, high risk, aligning, motivational Management: - Described as accessible, consensual, entrepreneurial, empowering, innovative and trusting - Associated words: Organising, planning, budgeting, rationality, control, reactive, risk avoidance

Near Miss vs Dispensing Error

Near Miss = any error detected during the checking process up to and including the point at which the medication was handed over to the patient - Does not include errors that are picked up during a self-check, but does include anything picked up in the final check. Dispensing Error = An error detected and reported after the medication has been consumed by the patient on the premises or the medication has left the pharmacy - Charge pharmacist takes lead of this, making sure to inform the owner within 24 hours. Debrief with staff afterwards.

Prescriptive Analytics

Offers specific and actionable next steps for how to solve the issues brought up in the predictive data analysis. - Can optimise the processes for a better future outcome. - Provides you with data-backed decision options that you can weigh against one another

Competence Standards when Supplying Medication

Pharmacists must: 1. Assess prescriptions, and available medical history, undertake a clinical assessment, consult with patient/prescriber to address any identified issues 2. Maintain a logical, safe and disciplined dispensing procedure, including monitoring the dispensing process for potential errors and acting promptly to mitigate them 3. Provide patient counselling, including providing the patient with sufficient information to ensure the safe and proper use of medicine

Integrated Data

Pooled data from various agencies/organisations, used to then provide services to the public - Provides a single unified view

Pros/Cons of Coercive Leadership

Pros - Benefits employees who need close supervision and direction. - Highly effective in an emergency or crisis. - Useful when working towards tight deadlines. - Allows the leader to demonstrate their talents and expertise. Cons - Can alienate employees. - May stifle creativity and stop employees from expressing their own opinions and ideas. - Can stop people from using their initiative. - May make employees feel they have no independence in their work. - Can negatively affect motivation.

Pros/Cons of Pace-Setting Leadership

Pros - Can work well when people are highly motivated and competent. - Well suited to short timeframes - Useful for situations when competition is fierce or when decisions and actions needs to be made quickly. Cons - Can only be sustained for relatively short periods - Tends to hurt culture, motivation and employee performance. - There's no room for employees to develop. - People can feel lost if the leader leaves.

Pros/Cons of Coaching Leadership

Pros - Encourages employees to take ownership of how they perform. - Creates a supportive environment where people are happy to give constructive feedback - Ongoing dialogue helps build relationships and communicate your expectations and purpose. - Good for developing employees' skills - Positively affects your business long-term. - Eventually frees up your time. Cons - May be problematic when the person is unskilled and has never done the task. - Not useful in a time of crisis or when things need to be done quickly. - Feedback needs to be motivating and positive to avoid micromanaging. - May not work when people are resistant to change. - You need to be ready to accept short term failure to achieve long term learning.

Pros/Cons of Democratic Leadership

Pros - Helps people take ownership of projects. - Talking things through helps you uncover ways to keep staff motivated. - Helps shape or establish a collective vision. - Ensures people have a voice. Cons - May be difficult for people who aren't used to having a say in things. - People can end up frustrated and unclear what they're responsible for doing. - Meetings can go on with no clear outcome. - Can be time-consuming especially if it involves multiple stakeholders. - Employees with limited communication and interpersonal skills may feel left out.

Pros/Cons of Authoritative Leadership

Pros - Provides vision and a clear path for getting there. - Works well in almost any business situation. - Good when the business is entering new territory (markets, products). - Most effective for getting people behind ideas, performing well and acting with integrity. - Motivates employees - Gives employees flexibility — the business vision and goals are clear and employees are free to find their own way to meet them. Cons - Less effective if you're working with a team of experts, or with people who are more experienced than you.

Pros/Cons of Affiliative Leadership

Pros - This style works when you're facing conflict or turbulent times. - Builds strong team relationships and trust. - Employees feel loyal to the business. - People feel confident experimenting Cons - Always looking for agreement can mean you avoid conflict or making hard decisions. - Focusing on relationships can leave employees wondering what tasks they're meant to be doing. - This style isn't helpful when you just need to get things done. - May not work well in a time of crisis or when something is urgent.

Inspection Audit

Risk based audit assessing some of the services provided from the premises - Takes 1-2 hours, covers 10 current risk-based criteria - When a partially attained (PA) or unattained (UA) level has been assigned, the medicines control auditor considers both safety and regulatory consequences, and the likelihood of occurrence to determine the risk

Challenges of IoMT

Standardization issues, regulatory challenges, high infrastructure costs, strain on existing networks, insurance companies, privacy

IoMT

Stands for the "Internet of Medical Things" - A combination of medical devices and applications that can connect all the healthcare information technology systems through networking technologies. - A connected infrastructure of medical devices, software applications, and health systems and services.

Digital Health Initiatives in NZ

The implementation of: - Patient health portals (As of September 19, 898,132 people. Better digitalization and access of data, putting patients more in charge of their own health is likely to improve literacy and outcomes) - eMedicines (provide health professionals with accurate, up-to-date information about people's medications) - Telehealth - Digital Health Portfolio Reports (monthly reports provide updates on key digital health initiatives) - Digital Systems Landscape (provides a snapshot of DHB core digital services)

Workplace Culture

The shared beliefs that are reflected in habits and behaviours - The personality of the organisation = often shaped by the leaders/managers - Can be seen in business objects (decor, brochures, websites etc.) 1. Power culture = competitive, power-oriented and political 2. Role culture = driven by procedures and rules, power is linked to positions not people 3. Person culture = individuals operate fairly autonomously 4. Task culture = reasonable degree of autonomy for decision-making, based more on expert power than on position or personal power

Digital Health

The use of digital technologies and accessible data, and the associated cultural change it induces, to help New Zealanders manage their health and wellbeing and transform the nature of healthcare delivery - Using technology to help improve individuals' health and wellness = eg. wearable tech, AI - Aims include: preventing disease, helping patients monitor and manage chronic conditions, lowering the cost of healthcare provision, and making medicine more tailored to individual needs

Predictive Analytics

Uses technology and statistical methods to search through massive amounts of information; analysing it to predict outcomes for individual patients - Predictions can range from responses to medications, to hospital readmission rates - Although predictive analytics offers amazing insights that can support patient outcomes, personalizing healthcare also requires prescriptive and cognitive analytic capabilities coupled with stringent security features