School of Pharmacy, University of Maryland, Baltimore, MD 21201, USA.
Am J Health Syst Pharm. 2010 Nov 15;67(22):1933-40. doi: 10.2146/ajhp100153.
The development, implementation, and evaluation of a protected peer-review process for clinical pharmacists with advanced scopes of practice are described.
A protected practice evaluation committee (PPEC) was created at a Veterans Affairs medical center to formulate policies and procedures for conducting peer reviews. The committee comprises six clinical pharmacists, none of whom hold a supervisory position, and assigns appropriate peers to review and rate clinical pharmacists' cases based on PPEC-developed performance measures. Peers rate the level of pharmacist-provided care by deciding whether most experienced, competent practitioners would have handled the case similarly in all aspects (level 1), might have handled the case differently (level 2), or would have handled the case differently (level 3). Each practitioner receives a report summarizing the findings and recommendations for improvement. The data are protected from legal discovery and shared with management only in aggregate. Of the 250 cases reviewed between January and October 2009, 236 (94.4%) received level 1 care and 14 cases (5.6%) received level 2 care; none received level 3 care. The number of cases judged as receiving level 2 care decreased to 1 by September 2009. Improvements in process indicators, including documentation of medication reconciliation and patient adherence, were noted. A survey of the clinical pharmacists indicated strong support for the review process.
Protected practice evaluation engaged clinical pharmacists in a continuous quality-improvement effort, generated data regarding practicewide as well as individual practitioner performance, and encouraged self-reflection. Frontline practitioners agreed that peer review is important for quality-improvement purposes.
介绍具有高级实践范围的临床药师的保护同行评审流程的开发、实施和评估。
在退伍军人事务医疗中心创建了一个受保护的实践评估委员会（PPEC），以制定进行同行评审的政策和程序。该委员会由六名临床药师组成，他们都没有担任监督职务，并根据 PPEC 制定的绩效措施为临床药师的病例分配适当的同行进行审查和评分。同行根据他们提供的护理水平进行评分，方法是确定是否大多数经验丰富、有能力的从业者在各个方面都能以类似的方式处理案例（级别 1），或者可能以不同的方式处理案例（级别 2），或者是否会以不同的方式处理案例（级别 3）。每位从业者都会收到一份总结发现和改进建议的报告。数据受到法律保护，仅以汇总形式与管理层共享。在 2009 年 1 月至 10 月期间审查的 250 个案例中，236 个（94.4%）获得了 1 级护理，14 个（5.6%）获得了 2 级护理；没有 3 级护理。到 2009 年 9 月，被判定为接受 2 级护理的案例数量减少到 1 个。注意到包括药物一致性和患者依从性记录在内的过程指标的改进。对临床药师的调查表明，他们强烈支持审查过程。
受保护的实践评估使临床药师参与了持续质量改进工作，生成了关于整个实践以及个人从业者表现的数据，并鼓励了自我反思。一线从业者认为同行评审对于质量改进目的很重要。
