Whether or not a hospitalized patient will get better depends on the quality of the healthcare service that he or she receives. In line with this, the prescription of medication is one of the most important procedures in the discharge of medical services and should be undertaken with thorough due care and skill. Yet studies show that at least 20 to 50 percent of all prescriptions, visits, procedures and hospitalizations in the United States are considered inappropriate as a result of overuse, underuse and misuse of what has been demonstrated to be effective and beneficial care (Delfini group, 2009). Several performance measures have been developed to ascertain how effectively prescription is done to hospitalized patients in different institutions. This paper analyzes five of this in detail, with emphasis on how they relate to the selection of the right medication for patients.
One of the performance measures used is the analysis of acute stroke management in relation to the percentage of inpatients with a primary diagnosis of acute stroke who are prescribed and administered antihypertensive medication prior to discharge. Beinecke et al (2006) noted that this measurement technique mainly aims to ascertain whether standard procedure has been followed in the treatment of acute stroke. The use of antihypertensive medication is important in the treatment of patients suffering from acute stroke in the stages prior to discharge (The Australian Council on Healthcare Standards, 2011). The rationales mainly involved the reduction of blood pressure in patients, and consequently reduce the risk of stroke. The measurement guideline was developed by the Australian Council on Healthcare Standards (ACHS) and was published in 2011.
Another performance measure that relates to the accurate prescription of medication is NQMC-6491. It analyses the diagnosis and management of chronic obstructive pulmonary disease (COPD), In relation to the percentage of patients with COPD diagnosis who are prescribed appropriate therapy (NQMC, 2011). An analysis is made of the number of patients with the complication who were appropriately diagnosed and the most suitable therapy was prescribed to remedy the situation. This assessment technique is important as the use of appropriate therapy is fundamental in the treatment of COPD (Institute of clinical systems improvement, 2013). The guideline was developed by the institute of clinical systems improvement in 2011, after an analysis of patients aged 18years and above who were prescribed appropriate therapy.
A third measure that touches on the accuracy of prescriptions made is the measurement and analysis of the diagnosis and treatment of respiratory illness in adults and children, with particular focus on the percentage of patients with strep pharyngitis prescribed antibiotics with documentation of being educated on taking the complete course. This assessment technique is important as it determines whether the patient had enough information to successfully complete treatment. The main priority in this technique is to increase the patient and caregiver knowledge about strep pharyngitis and pharyngitis care. The measurement guideline was developed by the institute of clinical systems improvement and was published in January 2011.
The fourth performance measurement technique is the study and analysis of the medication errors that occur as a result of confusion of the abbreviations, symbols and dose designations used in medical prescriptions (NQMC, 2009). The measure considers the average number of non recommended abbreviations, symbols and dose designations that occur in comparison to the total number of prescriptions written. The main aim of such an assessment is to improve the patient’s safety through the use of recommended prescriptions, abbreviations and symbols. The measure was developed in 2009, by the Spanish ministry of health.
The last performance measure considered is the assessment of the percentage of acute myocardial infarction (AMI) patients, 18 years of age and older, who are prescribed a beta-blocker at hospital discharge. Prolonged use of beta blockers for Myocardial infarction has been observed to reduce mortality and morbidity (NQMC, 2013). The performance measure was developed by a joint commission from the centers for Medicare & Medicaid Services (CMS).
References
American College of Physicians. (2011). Evidence based performance measures: Preventing
unintended consequences of quality management. Annals of internal medicine 155(9).
Beinecke R. H. Shepard D. S. & Hurley C. L. (2006). Implementing Evidence-Based Mental Health Practices and Performance Measures in Massachusetts. Springer science business media inc.
Delfini Group. (2009). Evidence based Performance Measurement: Validity Issues and Avoiding Important Pitfalls. Retrieved from: http://www.delfini.org/Delfini_WhitePaper_Performance%20measures_Short.pdf
National Quality Measures Clearing House. (2013). Measures. Retrieved from: http://www.qualitymeasures.ahrq.gov/browse/by-topic.aspx
The Australian Council on Healthcare Standards. (2011). Australasian Clinical Indicator Report. 13th Edition 2004–2011. Retrieved from: http://www.achs.org.au/media/50245/achs_clinical_indicators_report_web.pdf
