FROM THE EDITOR
The Many Dimensions of Quality Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction, and skillful execution; it represents the wise choice of many alternatives. — William A. Foster WW II Medal of Honor Recipient
I
n these pages, you have recently read about the Medicare Five-Star Quality Ratings System, the Quality Indicator Survey, and other topics related to quality of care and medication use in long-term care. The Minimum Data Set, a required assessment for individuals receiving care in nursing facilities, provides a rich database of metrics on individual resident health. In addition, it allows researchers and individual facilities to look at the overall health of their populations and identify opportunities for improvements in care delivery and outcomes. Quality Assurance and Performance Improvement (QAPI) is one of the latest in a long string of initiatives to address care quality in nursing facilities. In this issue, Joanne Kaldy provides an overall assessment of this new interdisciplinary initiative. Pharmacists certainly have the appropriate credentials to be an active participant in QAPI, and this article provides a glimpse into how they can play a key role on the health care team. The resources included in the article should be a good starting point for preparing for the formal rollout of this requirement by the Centers for Medicare & Medicaid Services, as mandated by the Affordable Care Act. Warfarin has been the primary oral anticoagulant used for the treatment and prevention of venous thromboembolism for more than 50 years. Since 2010, there have been four new oral anticoagulants approved by the Food and Drug Administration. There are some nuances with these new agents, and all pharmacists practicing in long-term care need to be well versed in these details. Anne Metzger and Tara Nagaraj provide a comprehensive clinical review of these agents, covering the basics as well as the clinical evidence and relevant practice guidelines.
THE CONSULTANT PHARMACIST
JUNE 2015
They also review the cost-effectiveness data and guidelines for perioperative procedures. All in all, an excellent resource. Falls are a major source of morbidity in older adults, resulting in increased cost of care, loss of function, and potentially avoidable hospitalizations. Often, the cause of falls can be elusive. Medications are frequently implicated as contributing to falls, but the research on this issue is limited in quality and scope. In a Student Forum article this month, L. Rebekah Findley and mentor Marilyn N. Bulloch review the evidence and causality data on the relationship between nonsteroidal anti-inflammatory drug use and falls. This topic is a crucial one because of the extensive use of this class of medications in older adults. Journal clubs are a timetested educational strategy to improve the integration of clinical evidence into practice. In this issue, several pharmacy students and their faculty mentors, Erica Estus and Kristina Ward, describe their experience with implementing a student-run journal club at the University of Rhode Island College of Pharmacy. Using a survey, they evaluated students’ confidence in critically evaluating medical literature. This information should serve as an impetus to initiate or revise current journal clubs to enhance students’ critical skills needed to evaluate the medical literature. In our final article, Hope E. Campbell and student collaborators review the contemporary topic of physicianassisted suicide. This is a controversial topic; however, it is one that we all need to understand in our role as medication experts. H. Edward Davidson, PharmD, MPH Editor-in-Chief
Doi:10.4140/TCP.n.2015.305.
VOL. 30, NO. 6
305
The Many Dimensions of Quality Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction, and skillful execution; it represents the wise choice of many alternatives. — William A. Foster WW II Medal of Honor Recipient
I
n these pages, you have recently read about the Medicare Five-Star Quality Ratings System, the Quality Indicator Survey, and other topics related to quality of care and medication use in long-term care. The Minimum Data Set, a required assessment for individuals receiving care in nursing facilities, provides a rich database of metrics on individual resident health. In addition, it allows researchers and individual facilities to look at the overall health of their populations and identify opportunities for improvements in care delivery and outcomes. Quality Assurance and Performance Improvement (QAPI) is one of the latest in a long string of initiatives to address care quality in nursing facilities. In this issue, Joanne Kaldy provides an overall assessment of this new interdisciplinary initiative. Pharmacists certainly have the appropriate credentials to be an active participant in QAPI, and this article provides a glimpse into how they can play a key role on the health care team. The resources included in the article should be a good starting point for preparing for the formal rollout of this requirement by the Centers for Medicare & Medicaid Services, as mandated by the Affordable Care Act. Warfarin has been the primary oral anticoagulant used for the treatment and prevention of venous thromboembolism for more than 50 years. Since 2010, there have been four new oral anticoagulants approved by the Food and Drug Administration. There are some nuances with these new agents, and all pharmacists practicing in long-term care need to be well versed in these details. Anne Metzger and Tara Nagaraj provide a comprehensive clinical review of these agents, covering the basics as well as the clinical evidence and relevant practice guidelines.
THE CONSULTANT PHARMACIST
JUNE 2015
They also review the cost-effectiveness data and guidelines for perioperative procedures. All in all, an excellent resource. Falls are a major source of morbidity in older adults, resulting in increased cost of care, loss of function, and potentially avoidable hospitalizations. Often, the cause of falls can be elusive. Medications are frequently implicated as contributing to falls, but the research on this issue is limited in quality and scope. In a Student Forum article this month, L. Rebekah Findley and mentor Marilyn N. Bulloch review the evidence and causality data on the relationship between nonsteroidal anti-inflammatory drug use and falls. This topic is a crucial one because of the extensive use of this class of medications in older adults. Journal clubs are a timetested educational strategy to improve the integration of clinical evidence into practice. In this issue, several pharmacy students and their faculty mentors, Erica Estus and Kristina Ward, describe their experience with implementing a student-run journal club at the University of Rhode Island College of Pharmacy. Using a survey, they evaluated students’ confidence in critically evaluating medical literature. This information should serve as an impetus to initiate or revise current journal clubs to enhance students’ critical skills needed to evaluate the medical literature. In our final article, Hope E. Campbell and student collaborators review the contemporary topic of physicianassisted suicide. This is a controversial topic; however, it is one that we all need to understand in our role as medication experts. H. Edward Davidson, PharmD, MPH Editor-in-Chief
Doi:10.4140/TCP.n.2015.305.
VOL. 30, NO. 6
305
