The PeaceHealth Ambulatory Medication Safety Culture Survey by CQkc23E

VIEWS: 3 PAGES: 8

									The PeaceHealth Ambulatory
 Medication Safety Culture
          Survey

Ron Stock MD MA
Geriatrics & Care Coordination
PeaceHealth
Rstock@peacehealth.org

Bill Mahoney PhD
Director, Survey Development & Research
PeaceHealth
Bmahoney@peacehealth.org
Aim


To develop a self-report instrument that
measures the degree to which the staff in a
clinic see specific attributes of a culture of
medication safety as being present.
                     The Measure
• Rasch/IRT psychometric approach
• 18 items, unidimensional scale
• Cronbach alpha = .93
        • Site A = .96
        • Site B = .94
        • Site C = .90
• Scoring
        • Can be summated rating, Rasch/ IRT calibrated better
        (scores are linear).
        • 0-100 Scale (higher = more)
• The between group variance is 5x that of the within group variance. It
does measure the culture of the site.
• Rasch/ IRT = we know the item difficulty = we know what comes
first…last in building the culture of medication safety.
         The Difficulty of Putting the Components of the Culture in Place

                62
                60               Have defined medication safety protocols.
                58
                56
                54
                52
                50
        O-100




                48
                46
                44
                42
                40
                38
                36
                34
                     7   3   9    8   12    4   16   2    5   6   11   13   14   1   10    18
                                                      Item

                                           Easy to learn from mistakes of others.
Mgmt does not
compromise med                                                No concern if family a pt.
safety for productivity.
                                                              Protocols for learning from near misses.
Intervention
• Redesigned clinic office medication
  reconciliation process
• Developed an electronic medication list
  (PHR) owned by patients that was
  accessible to the office and community
• Provided staff feedback on clinic culture of
  med safety
            Mean Culture of Medication Safety Score by Year by Site


       85         Site
                                                           Statistically
                     A
                                                           Significant
       80            B                                    Improvement
                     C
       75

       70                                                  Statistically
Mean




                                                           Significant
                                                          Improvement
       65

       60                                                      No
                                                           Significant
                                                            Change
       55

       50

                          2004                     2005
                                       Year
Results
   Made the initial changes in the direction of a culture of
    medication safety:
          Moving to protocols
          Attending to rules
          Moving away from blame
          Know how to ask questions
       But some changes in culture did NOT occur:
          Worry that we have information
          Waffle on Family as patients & not being concerned
          Providers taking responsibility
       Because we are not yet a Learning Organization:
          Not moving in making it easy to learn from mistakes
Conclusions
• This measure of outpatient med safety
  culture has strong psychometric properties
• Appears to be an effective tool to improve
  safety culture in the ambulatory setting
• Med safety doesn’t just happen…it requires
  creating and maintaining. It is as much, or
  more, a social phenomenon than a medical
  phenomenon

								
To top