prioritizing pharmaceutical activities - a simulation
TRANSCRIPT
The tool of prioritization Example of a team’s prioritization
Prioritizing pharmaceutical activities - A simulation
Renet S1, Rochais E
1, Hall K
2 Bussières JF
1,3
1Pharmacy practice research unit, Pharmacy department, CHU Sainte-Justine, Montréal, QC, Canada ,
2Faculty of pharmacy, University of Alberta, Edmonton, AB, Canada
3 Faculty of pharmacy, University of Montreal, Montreal, QC, Canada
INTRODUCTION
There is a relative paucity of literature regarding the decision-making processes that are used by pharmacy managers and practitioners to prioritize the pharmaceutical services that they provide
We developed a simulation game to examine how prioritization decisions are made by hospital pharmacy managers in a simulated environment where the available resources are constrained
Contact: [email protected]
Acknowledgements: Aurélie Guérin for the creation of this poster
The primary objective of the exercise was to examine the consistency of prioritization decisions made by pharmacy managers
The secondary objective was to identify and rank the factors that influenced individual and team prioritization decisions
OBJECTIVES
RESULTS / DISCUSSION
Cross-sectional, descriptive study
The selection of pharmaceutical activities and their relative resource requirements were established by our research team based on data from the Hospital Pharmacy in Canada Report(1) and the investigators’ knowledge of hospital pharmacy practice
METHODS
This study illustrates a simulation game to examine how prioritization decisions are made by hospital pharmacy managers
Our study indicates that most of the eight teams involved in the simulation game opted to provide a wide range of services, but at a low level of comprehensiveness
Pharmacy managers should examine their perceptions, if we aim at an evidence-based profession
This simulation game supports the observation that pharmacy leaders do not agree on a core set of pharmaceutical activities that should be prioritized
CONCLUSIONS
Secondary objective
Our pilot study identified a number of factors that influenced individual and team prioritization during the simulation game
Participants ranked “perception of the favorable impact of the service or activity” higher than “conclusive evidence” that supports the activity or service
Table 2. Individual and team ranking of factors that influenced individual and team
prioritization
Primary objective
The majority (6/8) of teams prioritized more than two-thirds of the 32 suggested pharmaceutical activities
Two (2/8) teams did appear to focus their resources on a smaller number of activities, providing a more comprehensive service
Table 1. Pharmaceutical activities prioritized
Pharmacy directors tended to prioritize clinical activities more than drug distribution activities
Pharmacy leaders gave a high priority to human resource management (all teams covered 100 % of needs) and financial management
Some other areas that were given a low prioritization by the participants included original research by members of the pharmacy department, the provision of education to external groups, and the provision of support for clinical trials
1 - Hall K, Wilgosh C, Musing E, Babich M, Mcgregor P, Bussières JF et al. Hospital pharmacy report in Canada
2009-2010. [online] http://www.lillyhospitalsurvey.ca
Primary objective
Pharmacy practice was divided into five areas, each represented by one color
Participants were divided into teams representing the management team of a fictitious pharmacy department
For each team member was designated as a department head
32 pharmaceutical activities were offered as a set of 142 color labels
Each team had 30 minutes to select 60 among the 142 labels on offer
Teams may decide to only partially implement a service or to fully implement a service
Secondary objective
Each participant had to rank in order of decreasing importance the 16 proposed factors that influenced their decision-making ranking of pharmaceutical activities:
► Individual ranking
► Team ranking after consultation with other team members
Population
During a symposium attended by 39 anglophone and 10 francophone pharmacy managers from all regions of Canada
Proportion of activities covered, per team (%)
Team 1 Team 2 Team 3 Team 4 Team 5 Team 6 Team 7 Team 8
50 56 72 75 78 81 88 88
Pharmacy practice domains
Relative weight of each domain
for all eight team (%)
Pharmaceutical activities
Pharmaceutical activity
prioritization Mean (%)
Drug distribution
24
Unit dose system-centralized 40
Parenteral Admixture Service (PAS) 55
Cytotoxic Admixture and Hazardous Drugs 73
Central packaging and robotization 25
Automated Decentralized Cabinets 39
Order entry validation by the pharmacist 54
Hours of pharmacy operation 55
Clinical 34
Decentralized pharmaceutical care-inpatient 59
Decentralized pharmaceutical care-outpatient 34
Pharmacology & Therapeutics committee 100
Infection Control Committee 25
Ethics Review Committee 25
Medication Safety Committee 88
Adverse Drug reaction Committee 38
Medication Reconciliation Process 33
Drug Information Center 25
Evaluation of clinical pharmacy services 23
Dependent/independent drug prescribing 25
Teaching 16
Inservice education to maintain technical staff competency 56
Inservice education to maintain pharmacists’ staff competency 63
Inservice education to maintain other healthcare professional’s staff competency
31
Internship training for undergraduate pharmacy students 35
Internship training for post-graduate pharmacy students 35
External education 0
Research 5
Clinical Trial support 31
Original evaluative research 10
Drug utilization reviews 31
Management 21
Human resources management 100
Material resources management 50
Financial resources management 75
Project management 44
Other management needs 19
Factors Re-ranking based on individual averages
Re-ranking based on team averages
Perception of the favorable impact of activities on the safe provision of healthcare (i.e. reduction in medication errors)
2 1
Perception of the favorable impact of activities on health outcomes (i.e. improvement or maintenance of the patient’s health status)
1 2
Conclusive evidence available to support the decisions 3 3
Required to address audits/inspections 12 4
Desire to comply with the legislative or normative framework 11 5
Leadership of the person designated as the department director 5 6
Perception of the favorable impact of activities on healthcare ex-penses (i.e. optimization of costs)
8 7
Having sufficient expertise to offer the activity 9 8
Dominant influence of a member of the team other than the de-partment director
10 9
Popularity of the activities among the members 7 10
Ease of implementing and maintaining the activity 15 11
Professional interests of the members of the team 6 12
Management support (i.e. at the financial and/or political level) or support from other stakeholders in the organization
13 13
Favorable departmental (e.g. team) dynamics 4 14
Relative quantities of one item over another (i.e.. items with more labels were prioritized more or less)
14 15
External pressure from media/public/politicians (e.g., occurrence of an adverse event covered in the media, social and media pressure, etc.)
16 16
Drug distribution Research
Clinical Management
Teaching
Fig.1 Example of a team’s prioritization
REFERENCE