Panel Presentation - Kim Borschowa

I think we've defined safety and between Dr. Oberholzer and Kay they have covered much of how patient safety has improved so my discussion will be brief.

When first approached about the collaborative I wasn't really sure what I was getting into but thought I'd give it a try for the first learning workshop. I soon realized what a great opportunity the collaborative would provide.

The most important feature provided by the collaborative was the opportunity to further develop the relationship amongst our team. Dr. Oberholzer and Helms office and I had a good relationship prior to the collaborative but now it is even stronger. I didn't have a relationship with Kay or Susan prior to the collaborative and really didn't even know there was a diabetes nurse educator available for the region. With the collaborative we have developed the ability to have comfortable conversations regarding changes to patient's therapy and now I feel completely comfortable calling and asking what to do with a situation that I need help with. This applies especially to the diabetes nurse educator and the dietician-whom I believe should have also been here on this panel even though dieticians were not part of the organizing committee. This level of comfort improves patient safety greatly by allowing easy conformation of changes and suggestion of changes amongst the team. Without familiarity sometimes things slip through the cracks because it would be so difficult and perhaps uncomfortable to confirm and discuss things. The majority of my communication with the Dr.'s office is via fax for two reasons this is the least disruptive to the workflow of the office and it eliminates the need to document because it is already in writing. Both the Dr's office and Kay or Susan are very accessible in a timely fashion should the need arise to speak to them.

Focusing on the four factors that affect patient safety:

Improved access to service

I am there and available and the patients know this. They feel comfortable asking questions of me especially when either the Drs or nurse or dietician has referred them.

Patients are bringing in their One-Touch and Accu-chek meters to have their data downloaded each time they refill their strips. I have been printing 14 day summaries to share with the patient, doctor and diabetes nurse educator. This has allowed for quick identification of patients who would benefit from further education. If doing well is a visual confirmation of a job well done. If urgent problems then the Dr and/or nurse are faxed.

Improved service

My patients are safer because the collaborative has allowed me to stay up to date with the latest therapies and allows me to be proactive in my patient's care. For example:

suggest switch to lantus and humalog for 4 year old that was not doing well on N & R
help poorly controlled patient switch to Humalog by getting EDS in place prior to switchover
encourage 2 patients to switch to pens rather than drawing insulin to decrease chance of errors
re-educate two patients who were not testing following a low to ensure adequate blood sugar recovery.

As part of the collaborative I gathered current smoking status of all patients in the database. This has improved patient safety by enabling me to have a discussion about quitting with those that are smokers and allowed me to encourage those that have quit to keep up the good work.

The most important of our collaborations thus far I believe is the patient education handbook that Dr. Oberholzer has written with contributions from each member of our team. The book has been printed and is being provided to each diabetic in the practice. The book is large print and easy to read for any patient.

During the summer my student Lacey Devrees was also involved in the collaborative. She spent time making posters to put up at the clinic to teach the patients about the collaborative and show them the results that they are achieving. She made a poster for the pharmacy regarding diabetic foot care and she participated in a group education session with Kay and (Candace) the dietician.

Sept 11, 2007 Kay and I discussed how to minimize no shows at clinic appointments. So we have a plan to address that (our next PDSA). Kay will fax the list of appointments to me the week before the clinic. I will call the patients to remind them of their appointment. I will also print a list of current meds and 14 day summaries for those that I have and fax them to the nurse educator (Kay or Susan) whoever will be seeing them at their appointment. The results and benefits of this will be determined.

Evidence based service

We are all using the guidelines to practice from and telling patients the same things which continue to reinforce the information with the patient.

Measurable outcomes

The collaborative data from health quality council speaks for itself.

Things I've learned

don't say "yes" when asked to participate in a collaborative or you may end up here speaking to a large group of people.
a team approach helps people buy into their care. When 4 different people say similar things they eventually start to believe it. (Dr/nurse/dietician/pharmacist)
it's not necessarily the person you think will be most motivated who is and conversely the one you don't think takes things seriously actually does.
it is possible to provide quality care for a patient while still doing all the regular day to day dispensary functions---you don't need an office and unlimited time to improve care. I am the only pharmacist at my store and I have one technician who is learning on the job who started 4 months ago.
small town sk offers a great opportunity to provide quality care even if there may be isolation. The town of Radville is an amazing place to work. From the first day when I was welcomed with open arms to today with the collaborative and the great relationships we have developed.
I like my job (finally!!)

For further information contact Kim Borschowa at Pharmasave #442, Radville SK
Phone: 306-869-2272 or kborschowa@rubiconpharmacies.com

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