Measurement of Clinical Pharmacy Key Performance Indicators to Focus and Improve Your Hospital Pharmacy Practice

Clinical pharmacy is defined as “a health science discipline in which pharmacists provide patient care that optimizes medication therapy and promotes health, wellness, and disease prevention” and “embraces the philosophy of pharmaceutical care.” 1 The role of the clinical pharmacist is to promote safe, effective, and cost-conscious drug therapy and improve patient outcomes. 2 Published evidence from observational studies, randomized controlled trials, and systematic reviews has shown that clinical pharmacist activities improve patient, medication, and surrogate outcomes; reduce health resource utilization and costs; reduce morbidity and mortality; and improve patients’ quality of life. 3-6 Despite published evidence supporting the benefits of clinical pharmacy services for health and economic outcomes, quantitative expressions that describe whether or how often a process of care or outcome of care occurs, also known as performance indicators, must be monitored to ensure that these services are delivered consistently. However, until recently, there was no established consensus as to which activities are key indicators of clinical pharmacy performance. A grass-roots collaborative of Canadian hospital pharmacists recently addressed this unanswered question by systematically establishing clinical pharmacy key performance indicators (cpKPIs) using a Delphi technique. 7 Some questions remain, including “What activities do pharmacists perform, and how consistently do they perform them?” To answer these questions, we first must understand what cpKPIs are; why cpKPIs should be measured and reported; who will be affected by these measurements; where and how cpKPIs can be measured, reported, and utilized: and when we should begin to capture cpKPIs. This article aims to address these questions about cpKPI adoption and measurement from multiple perspectives (including those of front-line pharmacists, leadership, external stakeholders, and the public), supplemented by examples from the authors’ experience. WHAT ARE cpKPIs? Key performance indicators are quantifiable measures of quality that can be used to track an organization’s progress toward achieving intended goals related to process inputs, process outputs, or outcomes. 8 These indicators are discrete events that, when they occur for an individual patient, have been proven to result in a positive outcome for that person. The US Agency for Healthcare Research and Quality (AHRQ) defines a process measure as “a health care-related activity performed for, on behalf of, or by a patient” and assesses the activities carried out by health care professionals to deliver services. 9 These types of measures are most useful when there is strong evidence associating processes with clinically important outcomes. The AHRQ defines an outcome measure as “a health state of a patient resulting from health care”, noting that such measures can encompass a vast range of health states, including physiologic measurements, laboratory test results, or a patient’s symptoms, morbidity, functional state, and quality of life. 10 Many “outcome measures”