The Physician Practice Patient Safety Assessment

Transcription

1 The Physicia Practice Patiet Safety Assessmet

2 Table of Cotets Itroductio ad Istructios...2 Cofidetiality...2 Feedback of Aggregate Results to Respodig Practices...2 Istructios for Coductig the Physicia Practice Patiet Safety Assessmet...3 Ackowledgemets...5 The Physicia Practice Safety Assessmet Practice Demographics Sectio Curret Level of Iformatio Techology Adoptio...10 Scorig...16 Scorig Key...16 Importat Scorig Guidelies Assessmet of Practice Safety Medicatios Hadoffs ad Trasitios Surgery/Aesthesia ad Sedatio/Ivasive Procedures Persoel Qualificatios/Competecy Practice Maagemet ad Culture Patiet Educatio ad Commuicatio Frequetly Asked Questios (FAQs)...32 Geeral FAQs...32 Assessmet FAQs...33 Supported by a grat from The Commowealth Fud. The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio 1

3 Itroductio ad Istructios The purpose of the Physicia Practice Patiet Safety Assessmet (PPPSA) is to heighte physicia practices awareess of distiguishig characteristics of a safe physicia practice, ad create a referece poit ad baselie for practice efforts to ehace ad support patiet safety. Developmet of the Physicia Practice Patiet Safety Assessmet was supported by a grat from The Commowealth Fud. The desig of the assessmet istrumet reflects the judgmet of its authors ad does ot ecessarily represet the positio of The Commowealth Fud. By completig this assessmet, your practice could beefit i several ways, such as (a) eablig safer ad better care, (b) reducig liability exposure, ad (c) facilitatig coversatio ad dialogue amog staff ad physicias to idetify opportuities to improve patiet safety. Please read ad review the self-assessmet ad the directios i their etirety before begiig the assessmet process. Cofidetiality This self assessmet is to be completed by physicia group practices ad the results submitted to a aggregate database via a secure Web site ( at the Medical Group Maagemet Associatio Ceter for Research. All resposes to this self-assessmet will be kept cofidetial by the MGMA Ceter for Research. Aggregate results will be used for research, educatio ad improvemet purposes, icludig feedback to practices that respod to the survey. Oly aggregated results will be published or otherwise distributed. You will be asked to eter a ID code desigatig each specific practice or locatio, which will allow you to submit a separate aalysis for each cliical site or locatio of your practice. Feedback of Aggregate Results to. Respodig Practices Each practice should retai a paper copy of its completed self assessmet i order to compare the practice s resposes to the aggregate comparative results. Each participatig practice ca the determie areas i which safety could be improved ad cosider chages to improve patiet safety ad to reduce the practice s risk of potetial malpractice liabilty. The PPPSA team does ot represet idepedetly or collectively a stadard-settig orgaizatio. The assessmet characteristics i this documet are ot purported to represet a miimum stadard of practice ad should ot be cosidered as such. I fact, some of the assessmet criteria represet iovative practices ad system ehacemets that are ot widely implemeted i physicia practices today. Their value i reducig errors is grouded i scietific research ad expert aalysis of medical errors ad their causes. They are provided as stretch goals for higher achievemet i patiet safety. 2 The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio

4 Itroductio ad Istructios Istructios for Coductig the Physicia Practice Patiet Safety Assessmet 1. Establish a multidiscipliary team for each practice site cosistig of, or similar to, the followig: Medical director or other physicia Admiistrator or office maager Nursig supervisor or urse cliicia Nophysicia provider Laboratory supervisor Radiology / imagig supervisor Pharmacist Risk maager Admiistrative support staff member Smaller practices will have a smaller team sice oe perso may fill several of these roles. Depedig o the services provided by the practice, other staff members may eed to joi the core team for evaluatio of certai sectios of the self-assessmet. For example, you may wat to ivite laboratory or radiology techicias to the meetig i which elemets of testig procedures are discussed. Your team should be provided with sufficiet time to complete the assessmet ad be charged with resposibility to accurately ad hoestly evaluate the curret status of safety practices i your facility. Because medical care is a complex, iterdiscipliary process, the value ad accuracy of the assessmet is sigificatly reduced if it is completed by a practice maager or other idividual actig aloe. You may wish to schedule several short meetigs with the team rather tha try to complete the etire assessmet at oe meetig. 2. Read ad review the self assessmet ad the directios i their etirety before begiig the assessmet process. The team leader should prit this PDF versio of the self assessmet ad make copies of the assessmet ad sed them to team members for review before the first team meetig. After the team has completed the paper self assessmet istrumet, the team leader or desigee is asked to iput the results ito the idetical olie versio of the assessmet items (at 3. Complete the Demographic Iformatio. The team leader if ot the practice admiistrator or maager should verify the resposes i this sectio with admiistratio. 4. Covee the team. It is importat to use this opportuity to critically assess the curret realities of the practice as idetified by the team. Goig through the tool rapidly or with a overly optimistic view of the practice will miimize the learig opportuities preseted by the assessmet process. 5. Discuss each key area ad evaluate the practice s curret success with implemetig the assessmet items. Whe a cosesus o the level of implemetatio for each assessmet item has bee reached, place a check mark i the appropriate colum usig the scorig key. If the team caot agree o a item s score, cosider further ivestigatio to verify the level of implemetatio ad ivolve other health care practitioers outside your team to assist i the ivestigatio. Retur to those items at aother meetig. The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio 3

5 Itroductio ad Istructios 6. Go to the olie assessmet ad eter the results for the practice. Oce the team has completed all the items i the assessmet, the team leader or desigee is asked to eter the results ito the olie versio of the assessmet at org. The items i the PDF / paper versio of the istrumet are idetical to those olie. The respodet will be asked to eter a ID code to idetify the particular practice or site. The ID code ca be purchased through the Web site ad grats users access to the olie assessmet. It will eable you to access your questioaire after it has bee partially or completely aswered ad to access the comparative results oce you have completed the assessmet. ID codes for bechmark reports are available at 1-4 reports for $145 per report, 5-14 reports for $125 per report, reports for $95 per report ad 50 or more reports for $65 per report. 7. Review your practice s results i compariso to the aggregate results. Whe you are doe eterig your results, you will be able to prit out your aswers, the aggregate results for other practices who have completed the assessmet ad a PPPSA Workbook. We suggest that you use the PPPSA Workbook to compare your results to the aggregate results to idetify areas where you may wish to improve patiet safety. The Workbook also provides resources available at a umber of patiet safety Web sites that ca be used to improve particular areas i the practice. If you have questios or eed more iformatio, please cotact the MGMA Practice Maagemet Resources Departmet toll-free at , ext. 1880, or patietsafety@mgma.com. We also welcome your commets o the PPPSA self assessmet tool. 4 The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio

6 Ackowledgemets Fudig Source HRET, ISMP ad MGMA thak the Commowealth Fud for its cotiued support of our efforts to improve patiet safety i physicia practices. The Commowealth Fud provided fiacial support for the 2006 Physicia Practice Patiet Safety Assessmet. Expert Pael Health Research ad Educatio Trust (HRET), Istitute for Safe Medicatio Practices (ISMP) ad MGMA thak the followig members of our voluteer Expert Pael ad Advisory Committee, who helped iform the cotet of the 2006 Physicia Practice Patiet Safety Assessmet. Pascale Carayo, PhD Professor of Idustrial ad Systems Egieerig Director of the Ceter for Quality ad Productivity Improvemet Uiversity of Wiscosi-Madiso, Departmet of Idustrial ad Systems Egieerig Madiso, Wis. Frak Federico, RPh Director Istitute for Healthcare Improvemet Cambridge, Mass. Joh Hicker, MD, MSc Professor of Family Medicie Pritzker School of Medicie The Uiversity of Chicago Chicago Naomi Kuzets, PhD Director Accreditig Associatio for Ambulatory Health Care (AAAHC) Istitute for Quality Improvemet Wilmette, Ill. Jue Leigh Director, Risk Maagemet Services CNA HealthPro Chicago Paul M. Schyve, MD Seior Vice Presidet Joit Commissio o Accreditatio of Healthcare Orgaizatios Oakbrook Terrace, Ill. Doa Woods, EdM, PhD NRSA Fellow Istitute for Health Service Research ad Policy Studies Feiberg School of Medicie, Northwester Uiversity Chicago Ala Yig, MD Chief Executive Officer Mercury MD, Ic. Durham, N.C. The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio 5

7 Ackowledgemets Advisory Committee Patricia A. Buelow, CMPE Cliic Maager Physicias Cliic of Iowa PC Cedar Rapids, Iowa Frak Federico, RPh Director Istitute for Healthcare Improvemet Cambridge, Mass. Nacy Foster Seior Associate Director, Policy America Hospital Associatio Washigto, D.C. Tejal Gadhi, MD, MPH Director of Patiet Safety Brigham & Wome s Hospital Bosto Deborah Kedall-Gallagher, RN, JD, MSN Uiversity of Colorado Health Scieces Ceter Dever Julie Mohr, MSPH, PhD Assistat Professor of Medicie Geeral Iteral Medicie / Uiversity of Chicago Chicago Roger Resar, MD Chage Aget Mayo Health System Eau Claire, Wis. Stephe C. Weeg, MA Executive Director Health West Ic. Pocatello, Idaho Roxae J. Goeltz Bursville, Mi. Bradford T. Hill, DBA Chief Executive Officer Cliical Laboratory Cosultats Aurora, Colo. 6 The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio

8 Ackowledgemets Assessmet Developmet Team We also wish to thak the staff at HRET, ISMP, MGMA ad other idividuals who have cotributed their time ad effort to make the safety assessmet possible. Joh Combes, MD Presidet ad COO Ceter for Healthcare Goverace Chicago David N. Gas, MSHA, FACMPE Vice Presidet, of Practice Maagemet Resources Medical Group Maagemet Associatio Eglewood, Colo. Ruth Gaulke Survey Aalyst III, Survey Operatios Medical Group Maagemet Associatio Eglewood, Colo. Terry Hammos, MD, MS Seior Fellow Medical Group Maagemet Associatio Eglewood, Colo. Ray Kag Research Assistat Health Research ad Educatioal Trust Chicago Joh Medez, MBA Project Maager Medical Group Maagemet Associatio Eglewood, Colo. Radhika Nath, PhD Seior Research Scietist Medical Group Maagemet Associatio Eglewood, CO Neill Pilad, DrPH Cosultat Research Professor, Istitute of Rural Health ad Seior Research Scietist MGMA Ceter for Research Pocatello, Idaho Mary A. Pittma, DrPH Presidet Health Research ad Educatioal Trust Chicago Jeifer Reiter Project Coordiator Health Research ad Educatioal Trust Chicago Christopher D. Stokes Project Maager Medical Group Maagemet Associatio Eglewood, CO Alle Vaida, PharmD, FASHP Executive Director Istitute for Safe Medicatio Practices Hutigdo Valley, Pa. Lorri Zipperer, Cybraria Project Maager Health Research ad Educatioal Trust Chicago The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio 7

9 The Physicia Practice Patiet Safety Assessmet Practice Demographics Sectio 1. Write dow your ID code for each practice locatio that you will assess. Whe you access the Web site, you will be asked to eter your ID code, which will eable you to retur to complete your results, if ecessary, ad to access curret results. If you do ot already have a ID code, it ca be purchased through the Web site ID 2. Which of the followig statemets best describes your health care orgaizatio? (*Required) Free stadig, idepedet medical group [go ext to questio 2A] Medical practice compoet of hospital Itegrated Delivery System (IDS) [go ext to questio 2A] Freestadig ambulatory / urget care ceter [go ext to questio 3 ad skip questio 2A] Hospital-owed ambulatory / urget care ceter [go ext to questio 3 ad skip questio 2A] Federally Qualified Health Ceter, commuity health ceter or similar practice [go ext to questio 3 ad skip questio 2A] Certified Rural Health Ceter or similar practice [go ext to questio 3 ad skip questio 2A] Medical school faculty practice pla [go ext to questio 3 ad skip questio 2A] Medical school cliical sciece departmet [go ext to questio 3 ad skip questio 2A] Other [go ext to questio 3 ad skip questio 2A] 2A. What best describes your type of practice? Multispecialty [go ext to questio 3] Sigle-specialty [go ext to questio 2B] 2B. What is the specialty of your practice? Specialty 3. How may full-time equivalet (FTE) physicias are i your health care orgaizatio? (*Required) Orgaizatio FTEs 3A. How may FTE physicias are i your practice / locatio? (*Required) Locatio FTEs 4. How may FTE ophysicia providers are i your health care orgaizatio? (*Required) Orgaizatio ophysicia provider FTEs 4A. How may FTE ophysicia providers are i your practice / locatio? (*Required) Locatio ophysicia provider FTEs 8 The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio

10 The Physicia Practice Patiet Safety Assessmet 5. What best describes the majority ower of your practice? (*Required) Govermet Hospital / Itegrated Delivery System (IDS) Isurace compay or health maiteace orgaizatio (HMO) Maagemet Services Orgaizatio (MSO) or Physicia Practice Maagemet Compay (PPMC) Physicias Uiversity or medical school Orgaizatioal compoet of a academic medical istitutio Other 6. Which of the followig statemets best describes how your practice relates to other health care orgaizatios? (*Required) Free stadig, idepedet of hospitals, other medical groups, govermet etities ad other health care orgaizatios Compoet of hospital or IDS Practice is idepedetly owed ad maaged but with a cotractual relatioship with outside orgaizatio(s) that provide guidace or iformatio o patiet safety Other 7. Which is the legal orgaizatio of your practice? (*Required) Busiess corporatio Limited liability compay Not-for-profit corporatio / foudatio Partership Professioal corporatio / associatio Sole proprietorship Other 8. Which populatio desigatio best describes the area surroudig the primary locatio of your practice? If your practice had multiple sites, choose the optio that represets the locatio with the largest umber of FTE physicias. (*Required) No-metropolita (10,000 or less) No-metropolita (10,001 to 20,000) No-metropolita (20,001 to 50,000) Metropolita (50,001 to 250,000) Metropolita (250,001 to 1 millio) Metropolita (more tha 1 millio) The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio 9

11 The Physicia Practice Patiet Safety Assessmet 9. Who participated i completig the Physicia Practice Patiet Safety Assessmet for the specific practice / locatio? (Select all that apply) (*Required) Medical director or physicia Admiistrator or office maager Nursig supervisor or urse cliicia Nophysicia provider Laboratory supervisor Radiology / imagig supervisor Pharmacist Risk maager Admiistrative support staff member Other 10. Is your health care orgaizatio accredited by a atioal orgaizatio or i the process of beig accredited? (*Required) Yes, the health care orgaizatio is accredited [go ext to questio 10A] The health care orgaizatio is i process of beig accredited [go ext to questio 10A] No, the health care orgaizatio is ot accredited or i process of accreditatio [go ext to questio 11] 10A. Who is the accreditig etity? (Select all that apply) America Associatio of Accreditatio for Ambulatory Surgery Facilities (AAAASF) Accreditig Associatio for Ambulatory Health Care (AAAHC) Joit Commissio o Accreditatio of Healthcare Orgaizatios (JCAHO) Natioal Committee for Quality Assurace (NCQA) Other Not Sure 11. What is your orgaizatio s seior admiistrator s curret status / credetial i the followig associatios? (Select all that apply.) (*Required) America College of Medical Practice Executives (ACMPE): Nomiee ACMPE: Certified Medical Practice Executive (CMPE) ACMPE: Fellow i the College of Medical Practice Executives (FACMPE) America College of Healthcare Executives (ACHE): Member ACHE: Diplomate (Certified Healthcare Executive, CHE) ACHE: Fellow of the America College of Healthcare Executives (FACHE) America Academy of Medical Admiistrators (AAMA): Member 10 The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio

12 The Physicia Practice Patiet Safety Assessmet AAMA: Credetialed Member of the America Academy of Medical Admiistrators (CAAMA) AAMA: Fellow of the America Academy of Medical Admiistrators (FAAMA) Affiliated with aother associatio specifiy: Not affiliated with a professioal credetialig ad certificatio associatio 12. How may days per week ad total hours per week is the specific practice / locatio ope for geeral patiets? Days per week Hours per week 13. Which of the followig satisfactio surveys are routiely performed i the specific practice / locatio? (Select all that apply) (*Required) Patiet satisfactio Employee satisfactio Physicia ad / or provider satisfactio Curret Level of Iformatio Techology Adoptio 14. What best describes the cosult trackig system curretly used for the majority of patiets served by the specific practice / locatio? Maual system that tracks if a cosult was requested ad if a cosultig physicia s report was received Computerized system that tracks if a cosult was requested ad if a cosultig physicia s report was received Combiatio of maual ad computerized systems Practice does ot track referrals Other 15. What best describes the cliical laboratory order etry system curretly used for the majority of patiets served by the specific practice / locatio? Maual system usig paper forms, fax ad telephoe requests Computerized system that uses computer termials, persoal digital asssistats (PDAs) or other electroic meas to order laboratory tests Combiatio of maual ad computerized systems The practice / locatio does ot order cliical laboratory tests Other The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio 11

13 The Physicia Practice Patiet Safety Assessmet 16. What best describes the cliical laboratory results system curretly used for the majority of patiets served by the specific practice / locatio? Maual system usig paper documets, fax ad telephoe resposes Computerized system that uses computer termials, PDAs or other electroic meas to receive laboratory test results Combiatio of maual ad computerized systems The practice / locatio does ot receive cliical laboratory test results Other 17. What best describes the radiology / imagig order etry system curretly used for the majority of patiets served by the specific practice / locatio? Maual system usig paper documets, fax ad telephoe requests Computerized system that uses computer termials, persoal digital assistats (PDAs) or other electroic meas to order radiology / imagig procedures Combiatio of maual ad computerized systems The practice / locatio does ot order radiology / imagig studies Other 18. What best describes the radiology / imagig results system curretly used for the majority of patiets served by the specific practice / locatio? Maual system usig paper documets, fax ad telephoe requests Computerized system that uses computer termials, persoal digital assistats (PDAs) or other electroic meas to receive radiology / imagig procedures Combiatio of maual ad computerized systems The practice / locatio does ot receive radiology / imagig studies Other 19. What best describes the prescriptio writig system curretly used for the majority of patiets served by the specific practice / locatio? Maual system usig paper documets, fax ad telephoe requests Computerized system that uses computer termials, persoal digital assistats (PDAs) or other electroic meas to write a prescriptio Combiatio of maual ad computerized systems The practice / locatio does ot write prescriptios Other 12 The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio

14 The Physicia Practice Patiet Safety Assessmet 20. What best describes the prescriptio refill system curretly used for the majority of patiets served by the specific practice / locatio? Maual system usig paper documets, fax ad telephoe commuicatios Computerized system that uses computer termials, persoal digital assistats (PDAs) or other electroic meas to commuicate with a pharmacy to refill a prescriptio Combiatio of maual ad computerized systems The practice / locatio does ot refill prescriptios Other 21. What best describes the drug iteractio warig system curretly used for the majority of patiets served by the specific practice / locatio? Maual system usig publicatios (Physicias Desk Referece, reports from pharmaceutical compaies, etc.) Madatory use of computerized system that uses computer termials, persoal digital assistats (PDAs) or other electroic meas Volutary use of computerized system that uses computer termials, persoal digital assistats (PDAs) or other electroic meas Verificatio with maual chart review Combiatio of maual ad computerized systems The practice / locatio does ot routiely scree for drug iteractios Other 22. Describe how the health / medical records system stores iformatio for the majority of patiets served by the specific practice / locatio. If the specific practice / locatio uses multiple techologies, choose the system used for the majority of your patiets medical records. Paper medical records / charts filed i record cabiet A scaed image of a paper medical record / chart filed electroically usig a documet imagig maagemet system (DIMS) A electroic health record (EHR) that stores patiet medical ad demographic iformatio i a data base accessible by computer termials or other electroic meas. A EHR may also icorporate features of a DIMS. Other 23. As of today, what is your degree of EHR implemetatio for the specific practice / locatio? Fully implemeted for all physicias Implemetatio i process or EHR is fully implemeted for a portio of practice physicias Implemetatio plaed i ext 12 moths Implemetatio plaed i ext 13 to 24 moths Process has ot yet started The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio 13

15 The Physicia Practice Patiet Safety Assessmet 24. Estimate the percetage distributio of patiet ethicity for the specific practice / locatio. White, ot of Hispaic or Latio origi White, Hispaic or Latio origi Black or Africa America Asia or Pacific Islader America Idia, or Alaska ative Other Total 100% 25. Estimate the percetage distributio of your patiets ages for the specific practice / locatio. Ifat (uder 2 years of age) Pediatric (betwee 2 ad 12 years of age) Adolescet (betwee 13 ad 17 years of age) Adult (betwee 18 ad 64 years of age) Geriatric (betwee 65 ad 79 years of age) Aged (80 years of age ad older) Total 100% 26. Estimate the percetage distributio of your patiets primary laguages for the specific practice/ locatio. Eglish Spaish Europea other tha Spaish Asia or Pacific Islader America Idia, Eskimo, Aleut Other Total 100% 27. Estimate the patiets level of literacy (i the patiets primary laguage, ot ecessarily Eglish) for the specific practice / locatio. Illiterate, uable to read Readig ability less tha 8th-grade level Readig ability at 8th-grade level or higher Total 100% 14 The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio

16 The Physicia Practice Patiet Safety Assessmet 28. Estimate the percetage of the specific practice / locatio s total gross charges by type of payer. Medicare Medicaid Commercial fee-for-service Commercial capitatio Workers compesatio Charity ad ucompesated care Self pay Other Total 100% The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio 15

17 Scorig Please use the scorig key o this page to complete the Assessmet of Practice Safety Sectio, which comprises the rest of the assessmet. Scorig Key A. Uaware of this issue or aware but there has bee o activity to implemet this item. B. This item has bee formally discussed ad cosidered, but it has ot bee implemeted. C. D. E. NA. This item has bee partially implemeted i the practice for some areas, patiets, drugs, procedures ad/or staff. (For example, the practice is begiig a disease maagemet program for its diabetic patiets, but oly ew patiets are curretly erolled.) This item is fully implemeted i the practice for some areas, patiets, drugs, procedures ad/ or staff. (For example, some patiets are erolled i a disease maagemet program but other patiets with chroic diseases are ot erolled i a disease maagemet program.) This item is fully implemeted i the practice for all areas, patiets, drugs, procedures ad/or staff. This item is ot applicable to our practice. (This choice is available for certai items ad icludes a specific defiitio.) Importat Scorig Guidelies For all assessmet items: Uless otherwise stated, assessmet items refer to policies, protocols, procedures, medicatios, staff ad patiets typically see ad treated i most practices. See aswerig NA, below, for items ot applicable to your practice. For assessmet items with multiple compoets: Full implemetatio (score D or E) should be selected oly if all compoets are preset i some (D) or all (E) areas of the practice. If oly oe or some of the compoets have bee partially or fully implemeted i some or all areas of the practice, assessmet scores should ot exceed level C. For assessmet items that offer a optio for Not Applicable (NA): Select NA oly if the item does ot correspod to ay patiet types (e.g., pediatrics), procedures, medicatios or other services you provide i your practice. A specific defiitio for the items i which this choice appears is icluded with the item. 16 The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio

18 Assessmet of Practice Safety 29. Medicatios There are a umber of risks to patiet safety related to various aspects of medicatio use. Because this is the area of patiet safety most thoroughly studied, this sectio icludes a large umber of items. A B C D E NA No activity Cosidered, but ot implemeted Partially implemeted i some areas Fully implemeted i some areas Fully implemeted i all areas Item ot applicable to our practice A B C D E NA A complete medicatio history, icludig over-the-couter medicatios, vitamis ad herbal products, is obtaied ad documeted for every patiet durig each office visit. Up-to-date, useful writte iformatio about medicatios is available to patiets of the practice who do ot speak Eglish. Patiets are provided with a up-to-date list of all medicatios they are receivig whe leavig the practice or at the ed of the ecouter (e.g., o a coveiet wallet referece card). A system is i place to track all patiets receivig warfari therapy that icludes otices to patiets for periodic laboratory testig of INRs ad a documeted review of INRs before prescriptio reewals are approved. (If you do ot prescribe warfari for ay patiet i your practice the aswer this item with NA.) All prescriptios are etered ito a office-based electroic prescribig system that produces either a computer-geerated prescriptio or electroic trasmissio of the prescriptio directly to a pharmacy. Idicatios for medicatios are icluded o writte ad electroic prescriptios. (See FAQ 1 for further explaatio.) A list of high-alert drugs (e.g., warfari, low molecular weight hepari, oral methotrexate for oocology use) is established, from a list of drugs ofte prescribed i the practice, that require direct cotact of the physicia ad pharmacist for phoed-i prescriptios icludig reewals. Exteral medicatios (e.g., bezoi, podophyllie) are labeled For Exteral Use Oly ad are separated from iteral-use medicatios i all storage areas. The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio 17

19 Assessmet of Practice Safety 29. Medicatios A B C D E NA No activity Cosidered, but ot implemeted Partially implemeted i some areas Fully implemeted i some areas Fully implemeted i all areas Item ot applicable to our practice A B C D E NA All patiets who are takig medicatios are asked at each office visit what medicatios they are curretly takig ad if they have had side effects. Their resposes are documeted i their medical record (e.g., takig medicatios without problems or record the ature ad type of reactio or iteractio). All practice staff who prescribe, dispese, admiister ad provide patiet educatio o medicatios have easy access to curret drug iformatio ad other decisio support resources. All drug iformatio ad cliical decisio support resources used i the practice are stadardized, maitaied ad updated at least yearly or wheever a ew editio is available.. All medicatios, reagets ad other products that carry a expiratio date are routiely checked (at least quarterly) by a desigated staff member ad discarded oce they have expired. All female patiets of childbearig age are required to have a documeted egative pregacy test or other otatio i the chart before teratogeic medicatios are prescribed (icludig refill reewals). Patiet educatio regardig the eed for effective birth cotrol while takig these medicatios is provided. A maual or electroic system is i place to documet all prescribed drug therapy ad aticipated dates of prescriptio reewals.. 18 The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio

20 Assessmet of Practice Safety 29. Medicatios A B C D E NA No activity Cosidered, but ot implemeted Partially implemeted i some areas Fully implemeted i some areas Fully implemeted i all areas Item ot applicable to our practice A B C D E NA All multiple-dose vials of ijectable medicatios used i the practice (e.g., lidocaie, dexamethasoe, prochlorperazie, vitami B12) are labeled with the date opeed ad iclude a date o which the uused product would be discarded (o later tha 30 days after opeig). (Note: If the practice does ot use or stock ay ijectable medicatios, eve i emergecies, the aswer this item with NA.) All medicatios dispesed to patiets, icludig samples, are properly labeled ad are documeted i the medical record. This labelig ad documetatio icludes the ame of the medicatio, stregth, dose, frequecy, lot umber, expiratio date, quatity of medicatio alog with the patiet s ame, date dispesed ad prescriber iformatio. (Note: If the practice does ot dispese ay medicatios, icludig samples, the aswer this item with NA.) All vaccies dispesed or admiistered by the practice are documeted i a log that cotais the ame of the vaccie, lot umber, expiratio date, patiet ame, dose, ad date admiistered or dispesed. (Note: If the practice does ot dispese ay vaccies, the aswer this item with NA.) The practice does ot compoud drugs or products ad purchases commercially prepared complex / compouded drugs ad products or cotracts with a outside source to provide these products. (Note: If the practice does ot dispese ay medicatios, icludig samples, the aswer this item with NA.) The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio 19

21 Assessmet of Practice Safety 30. Hadoffs ad Trasitios Patiets ofte receive care from a umber of differet cliicias ad facilities. The physicia ad practice with pricipal resposibility for coordiatig the patiet s care edeavors to track the patiet ad the patiet s cliical iformatio across time ad space. It is recogized that coordiatig ad trackig these cliical evets is ot simple or easy ad that practices istitute a variety of maual ad computerized systems to accomplish them. A B C D E NA No activity Cosidered, but ot implemeted Partially implemeted i some areas Fully implemeted i some areas Fully implemeted i all areas Item ot applicable to our practice A B C D E NA Whe the practice trasfers resposibility for the care of a patiet to aother physicia, practice or istitutio, the practice idetifies the cliicia resposible for acceptig the patiet ad cofirms that the cliicia receives ad accepts resposibility for the patiet. Necessary cliical iformatio about the patiet is trasmitted to the acceptig cliicia; the practice determies that the iformatio was received. It is documeted i the patiet s medical record that the patiet has bee trasferred ad that resposibility has bee accepted by the receivig cliicia, practice or other istitutio. (See FAQ 2 for further explaatio.) Whe a patiet is referred to a outside pathology laboratory or a patiet s specime is set to a outside pathology laboratory, the practice tracks the testig process, icludig whe the patiet is referred, whe the specime is set, to what laboratory the patiet or specime is set, the test(s) to be performed, whe a report is expected, ad which cliicia(s) i the practice ad outside the practice are to receive the report. The practice esures ad documets i the patiet s medical record that the report has bee received by the practice ad has bee delivered to the desigated cliicia(s), AND the cliicia(s) is iformed if a report has ot bee received by the expected date. The practice also has a mechaism to cotact the pathology laboratory whe reports are ot received by the expected date. The practice maitais a process to commuicate all medicatios (ame, dose, frequecy, route ad purpose) that a patiet is receivig whe admitted to a hospital, ursig home, home care agecy, rehabilitatio ceter, etc. (See FAQ 3 for further explaatio.) 20 The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio

22 Assessmet of Practice Safety 30. Hadoffs ad Trasitios A B C D E NA No activity Cosidered, but ot implemeted Partially implemeted i some areas Fully implemeted i some areas Fully implemeted i all areas Item ot applicable to our practice A B C D E NA Whe a patiet is set to aother physicia or practice for cosultatio, the practice tracks the cosultatio, icludig whe the referral for cosultatio is made, to which cosultig physicia / practice, the purpose of the cosultatio, whe a report is expected, ad which cliicia(s) i the practice ad outside the practice are to receive the report. The practice esures ad documets i the patiet s medical record that the cosultatio report is received by the practice ad is delivered to the specified cliicia(s), AND the practice iforms the specified cliicia(s) if a report has ot bee received by the expected time. The practice also has a mechaism to cotact the cosultig physicia / practice whe reports are ot received by the expected date. A determiatio has bee made as to which laboratory, pathology ad imagig test results are to be cosidered critical ad the practice has a mechaism that is distict from the process for hadlig routie test results to determie whe a critical test result is received ad to immediately deliver that result to the appropriate cliicia(s) ad, whe appropriate, to the patiet. This mechaism for dissemiatig critical or emerget test results to cliicias ad patiets also fuctios outside ormal busiess hours. The practice tracks whe ad to what imagig facility each patiet is set, the test(s) to be performed, whe a report is expected, whether that report is received as expected, ad which cliicia(s) i the practice ad outside the practice are to receive the report. The practice esures that the imagig test report is received by the practice ad is delivered to the specified cliicia(s), AND iforms the specified cliicia(s) if a report has ot bee received by the expected time.the practice documets the results ad their receipt i the patiet s medical record. The practice also has a mechaism to cotact the imagig facility whe reports are ot received by the expected date. The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio 21

23 Assessmet of Practice Safety 30. Hadoffs ad Trasitios A B C D E NA No activity Cosidered, but ot implemeted Partially implemeted i some areas Fully implemeted i some areas Fully implemeted i all areas Item ot applicable to our practice A B C D E NA The results of laboratory, pathology ad imagig tests are commuicated to the patiet i a timely maer (24 to 48 hours), ad the practice cofirms ad documets that the patiet received the results. Patiets are otified of all laboratory, pathology ad imagig test results, icludig those that are egative, whether or ot they require further cliical actio. The practice provides all patiets with easy access to their cosultative, laboratory, imagig ad other results ad all patiets are educated o how to obtai this iformatio. The practice has idetified emerget situatios wherei patiets i the office are at immediate risk (e.g., chest pai / myocardial ifarctio, bowel obstructio, allergic reactio to medicatios admiistered i the office) that require that the patiet be trasferred quickly to aother level of care. The practice has decided how to respod to each of these emerget situatios should they occur i the practice. Cliicias i the practice periodically (at least oce every 12 moths) perform a team review of what must be doe i emerget situatios. The practice has a process to lear of essetial ew iformatio from outside the practice about a patiet for whom the practice has cotiuig resposibility ad to record it i the patiet record (e.g., ew prescriptios ad sigificat chages i the patiet s coditio or pla of care). (See FAQ 4 for further explaatio.) Whe a patiet for whom the practice has resposibility is discharged from a hospital or other facility, the practice has a system that cofirms the discharge iformatio ad eters it ito the patiet record. 22 The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio

24 Assessmet of Practice Safety 31. Surgery/Aesthesia ad Sedatio/ Ivasive Procedures May physicia practices perform surgery ad ivasive procedures that were oce limited to hospitals. These activities etail a variety of risks, icludig those associated with sedatio ad aesthesia. A B C D E NA No activity Cosidered, but ot implemeted Partially implemeted i some areas Fully implemeted i some areas Fully implemeted i all areas Item ot applicable to our practice A B C D E NA The practice has idetified ad commuicated to cliicias all surgical ad other ivasive procedures that may be performed osite. (Note: If the practice does ot perform ay ivasive procedures the aswer this item with NA.) (See FAQ 5 for further explaatio.) Policies ad procedures for patiet selectio, medicatios to be give, eed for aesthesia support ad post-procedure care are established for all ivasive procedures performed osite ad are kow by all staff. (Note: If the practice does ot perform ay ivasive procedures the aswer this item with NA.) For each patiet, the site of ay ivasive procedure is cofirmed ad documeted by two staff members ad the patiet, before the procedure is begu. (Note: If the practice does ot perform ay ivasive procedures the aswer this item with NA.) (See FAQ 6 for further explaatio.) Coscious sedatio is oly admiistered whe two qualified persoel are i attedace. Oe idividual moitors the patiet while the secod idividual performs the procedure. (Note: If the practice does ot admiister coscious sedatio the aswer this item with NA.) (See FAQ 7 for further explaatio.) The practice maitais a list of all cliicias who may perform surgical or ivasive procedures that icludes the specific procedures a particular cliicia may perform. (Note: If the practice does ot perform ay ivasive procedure the aswer this item with NA.) The practice maitais ad moitors a curret list of cliical persoel authorized to admiister ad moitor aesthesia ad sedatio for all ivasive procedures. (Note: If the practice does ot perform ay ivasive procedures the aswer this item with NA.) The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio 23

25 Assessmet of Practice Safety 32. Persoel Qualificatios/Competecy Practitioers ad practice staff receive sufficiet orietatio to elemets of safe care ad udergo educatio ad evaluatio of skills to esure cosistet ad appropriate applicatio of those skills.. A B C D E NA No activity Cosidered, but ot implemeted Partially implemeted i some areas Fully implemeted i some areas Fully implemeted i all areas Item ot applicable to our practice A B C D E NA Employees are educated about ew drugs or products by practice staff or other practitioers withi the commuity before they are prescribed or used by the practice. Pharmaceutical ad vedor sales represetatives are ot used as the sole source of ew product educatio for professioal ad oprofessioal staff i the practice. The practice maitais a system to provide cotiuig educatio to cliical ad support persoel that is both specific ad appropriate for the level of services provided i the practice. (See FAQ 8 for further explaatio.) The practice maitais a system to periodically (at least aually) assess ursig ad support staff competecy that is appropriate for the services ad procedures they perform. The practice maitais a system to periodically (at least aually) assess physicias competecy that is appropriate for the services ad procedures they perform. All ew physicias, physicia assistats ad urse practitioers receive a structured orietatio to the practice s policies, procedures, admiistrative guidelies, etc. All ew ursig ad techical staff receive a structured orietatio to the practice s policies, protocols, procedures, admiistrative guidelies, etc. 24 The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio

26 Assessmet of Practice Safety 32. Persoel Qualificatios/Competecy. A No activity B Cosidered, but ot implemeted C Partially implemeted i some areas D Fully implemeted i some areas E Fully implemeted i all areas NA Item ot applicable to our practice A B C D E NA Surgical procedures are provided by Board-eligible, Boardqualified or Board-certified physicias traied i the appropriate subspecialty. (Note: If the practice does ot perform ay ivasive procedures the aswer this item with NA.) Surgical procedures are provided by licesed ad/or certified ophysicia medical staff traied i the specific procedure ad who have curret privileges to perform them i this settig. (Note: If the practice does ot perform ay ivasive procedures the aswer this item with NA.) Aesthesia is provided by licesed aesthesiologists or urse aesthetists. (Note: If the practice does ot perform ay aesthesia the aswer this item with NA.) The practice maitais separate policies, procedures, competecy traiig ad cotiuig educatio programs for the treatmet of pediatric patiets. (Note: If the practice does ot treat ay pediatric patiets the aswer this item with NA.) (See FAQ 9 for further explaatio.) The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio 25

27 Assessmet of Practice Safety 33. Practice Maagemet ad Culture I additio to the specific actios related to particular aspects of patiet care such as medicatios or trackig diagostic tests, there are other thigs a practice ca do as a whole that support ad complemet the specific actios. Some of these help create a culture of safety i the practice. A B C D E NA No activity Cosidered, but ot implemeted Partially implemeted i some areas Fully implemeted i some areas Fully implemeted i all areas Item ot applicable to our practice A B C D E NA A system of reportig errors, such as icidet reports, is i place ad is supported by a culture of safety that allows for ope collectio ad sharig of the data withi the practice. (See FAQ 10 for further explaatio.) A protocol to report potetial threats to patiet safety ad ear misses is i place, kow to all staff, routiely followed ad supported by a culture of safety that allows for ope collectio ad sharig of the data withi the practice. (See FAQ 11 for further explaatio.) Whe errors or ear misses occur, rather tha direct remedial efforts oly at ivolved practitioers, educatioal efforts are diffusely directed at all cliicias ad ocliical persoel who may make a similar error. Such educatioal efforts foster orgaizatioal learig, icreased provider awareess ad promote system chages to decrease the possibility of future error. The published literature about errors ad adverse evets that have occurred i other locatios is actively moitored ad the practice uses the iformatio to proactively make system chages withi the practice. (See FAQ 12 for further explaatio.) Patiets are istructed o the proper use ad maiteace of ay device prescribed or dispesed to them by the practice. (See FAQ 13 for further explaatio.) Whe prescribig or dispesig oral liquid medicatios for patiets, a proper measurig device (e.g., a oral syrige) is used or suggested ad caregivers are istructed o its use to measure the prescribed dose. 26 The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio

28 Assessmet of Practice Safety 33. Practice Maagemet ad Culture A No activity B Cosidered, but ot implemeted C Partially implemeted i some areas D Fully implemeted i some areas E Fully implemeted i all areas NA Item ot applicable to our practice A B C D E NA The practice has protocols i place for providig emotioal support to cliicias ad other staff members that have bee ivolved i a adverse evet at the practice. These are kow to all staff ad they are ecouraged to utilize them. (See FAQ 14 for further explaatio.) Job descriptios for all office persoel iclude requiremets to speak up about safety issues, chage practices to ehace safety, share errors, ask for help whe eeded ad other elemets of shared accoutability for safe practices. Job descriptios for all cliical persoel iclude requiremets to speak up about safety issues, chage practices to ehace safety, share errors, ask for help whe eeded ad other elemets of shared accoutability for safe practices. All office staff receive iitial traiig o HIPAA regulatios. Periodic ogoig educatio, review ad evaluatio is offered (at least aually). The practice documets all patiet complaits ad/or cocers about their care or outcomes icludig problems commuicatig with the cliicias ad staff withi the practice ad cosultig / testig ceter staff. All complaits are periodically reviewed, shared with staff ad resposes ad resolutios are documeted. The practice ecourages patiets to share ay safety cocers they may have verbally, i writig or through a patiet survey. Huma factors ad the key priciples of error reductio such as stadardizatio, use of costraits ad redudacy are reviewed with all office staff durig orietatio ad durig each performace evaluatio. (See FAQ 15 for further explaatio.) The Physicia Practice Patiet Safety Assessmet Copyright All rights reserved. Istitute for Safe Medicatio Practices, Health Research ad Educatioal Trust ad Medical Group Maagemet Associatio 27