Medication Safety Quality Improvement: Collaboration to Reduce Adverse Drug Events

Transcription

1 Medication Safety Quality Improvement: Collaboration to Reduce Adverse Drug Events Jayme Steig, PharmD, RPh Quality Improvement Specialist - Pharmacy Quality Health Associates of North Dakota

2 Disclosure I have had no financial relationship over the past 12 months with any commercial sponsor with a vested interest in this presentation. 2

3 Objectives Review the National Action Plan (NAP) for Adverse Drug Event (ADE) Prevention Name the three drug classes targeted in NAP and explain the reasons for their inclusion Compare ADE data at national, state and community level and identify strengths and areas for improvement in North Dakota Review and discuss current collaborative approaches to prevent ADEs Formulate opportunities to improve medication safety in your practice 3

4 Expectations All teach, all learn Active participation and discussion Leave in action Learn approaches to collaborate and improve medication safety in your practice 4

5 Background 5

6 The National Action Plan for Adverse Drug Event Prevention 6

7 Adverse Drug Event (ADE) Definition Source: National Action Plan for Adverse Drug Event Prevention 7

8 National Action Plan - The Need Nationally Source: National Action Plan for Adverse Drug Event Prevention 8

9 National Action Plan for ADE Prevention Released in fall 2014 by US Department of Health and Human Services Modeled after successful National Action Plan to Prevent Healthcare-Associated Infections Federal interagency steering committee and workgroups 9

10 National Action Plan for ADE Prevention Four-Pillared Approach Surveillance Prevention Incentives and Oversight Research 10

11 National Action Plan for ADE Prevention High Impact Targets and Populations Common Clinically significant Preventable Measurable 11

12 National Action Plan for ADE Prevention 3 targeted drug classes Source: National Action Plan for Adverse Drug Event Prevention 12

13 National Action Plan for ADE Prevention The most vulnerable Elderly Low health literacy Limited access to health care service Low socioeconomic status Certain minority and ethnic groups Source: National Action Plan for Adverse Drug Event Prevention 13

14 National Action Plan for ADE Prevention Source: National Action Plan for Adverse Drug Event Prevention 14

15 National Action Plan the Goal Reduce preventable ADEs The Triple Aim 15

16 Question to Run On In what way(s) may the National Action Plan to Prevent ADEs impact your practice? 16

17 Medication Safety Data 17

18 12/1/2009 2/1/2010 4/1/2010 6/1/2010 8/1/ /1/ /1/2010 2/1/2011 4/1/2011 6/1/2011 8/1/ /1/ /1/2011 2/1/2012 4/1/2012 6/1/2012 8/1/ /1/ /1/2012 2/1/2013 4/1/2013 6/1/2013 8/1/ /1/ /1/2013 2/1/2014 4/1/2014 6/1/2014 8/1/ /1/ /1/2014 2/1/2015 Admissions per 1000 Medicare FFS Beneficiaries Hospital Admissions Nation ND Year Ending 18

19 12/1/2009 2/1/2010 4/1/2010 6/1/2010 8/1/ /1/ /1/2010 2/1/2011 4/1/2011 6/1/2011 8/1/ /1/ /1/2011 2/1/2012 4/1/2012 6/1/2012 8/1/ /1/ /1/2012 2/1/2013 4/1/2013 6/1/2013 8/1/ /1/ /1/2013 2/1/2014 4/1/2014 6/1/2014 8/1/ /1/ /1/2014 2/1/2015 Readmissions per 1000 Medicare FFS Beneficiaries Hospital Readmissions Nation ND Year Ending 19

20 ADE Surveillance Types Active Collects data from health records or previously collected information Technology driven Passive Voluntary reporting to surveillance system Manual Example FDA Adverse Event Reporting System Source: National Action Plan for Adverse Drug Event Prevention 20

21 ADE Surveillance Barriers Active Coding not designed for ADE Cause and effect Passive Manual Sampling Voluntary Underreporting Source: National Action Plan for Adverse Drug Event Prevention 21

22 ADE Surveillance Additional considerations Reporting requirements Severity Settings Timeliness Source: National Action Plan for Adverse Drug Event Prevention 22

23 ADE Data National, Regional, State State Total Beneficiaries % at high risk for ADE Anticoagulants Diabetic agents Opioids Total Kansas 404, % 13.7% 14.5% 25.1% Nebraska 260, % 12.2% 11.3% 22.9% North Dakota 97, % 14.9% 11.1% 25.6% South Dakota 125, % 12.6% 10.6% 22.7% United States 37,079, % 13.3% 13.2% 23.8% Source: 2013 Medicare Part D claims analysis 23

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25 Admissions per 1,000 FFS Beneficiaries by Drug Class (CY 2013) FFS Beneficiaries HRM Benes - Diabetic Agents North Dakota HRM Benes - Anticoagulants Nation HRM Benes - Opioids 25

26 250 Readmissions per 1,000 FFS Beneficiaries by Drug Class (CY 2013) FFS Beneficiaries HRM Benes - Diabetic Agents HRM Benes - Anticoagulants HRM Benes - Opioids North Dakota Nation 26

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28 The Good News (and the Bad) Probably Adverse Drug Event Rates (CY 2013) ND s National Rank (lower is better) 3 Diabetic agents Anticoagulants Opioids

29 A Broader Picture Sources: aths.html 29

30 Community Level Data Minot Bismarck Grand Forks Fargo 30

31 Probable ADE per 1000 HR Beneficiaries Probable ADE Rates State Bismarck Minot Fargo Grand Forks Outside Combined Anticoagulants Diabetic Agents Opioids Source: QHA analysis of Medicare Part D and Part A claims 8/1/14 thru 7/31/

32 Questions to Run On What are your thoughts after seeing this data? Have you noticed similar data/trends in your practice? What is your greatest area of concern in relation to the three targeted high-risk drug classes? 32

33 ADE Prevention Approaches 33

34 ADE Determinants Source: National Action Plan for Adverse Drug Event Prevention 34

35 ADE Determinants Underlying drivers Communication failures Suboptimal management systems Inadequate access to medication information Low patient activation What are drivers within your community? Source: IPRO. Parade: Preventing and Reducing Adverse Drug Events in Care Coordination Communities (webinar). January 6,

36 Improving Medication Safety Establish partnerships to improve communication among hospitals, skilled/ltc nursing facilities, home health agencies, pharmacists, physicians and other community stakeholders Develop partnerships with patients and families to improve readiness for transitions of care, chronic disease self-management and to reduce medication harm 36

37 Example Interventions: Suboptimal Communication/Management Nurse-to-nurse calls SBAR Follow-up MD appointments made before hospital discharge Medication reconciliation by pharmacist Readmission risk assessment Post discharge telephone follow-up with highrisk patients 37

38 Example Interventions: Inadequate Access to Medication Information Communication between senders and receivers Medication reconciliation Patient and family involvement during transitions 38

39 Example Interventions: Low Patient Activation Teach-back Patient and family education Chronic disease self-management Medication adherence programs Personal health record 39

40 Example Interventions: Multiple Drivers INTERACT Quality Improvement Program Cross-setting workgroups Project RED (Re-engineered Discharge) Advance care planning Medication Therapy Management (MTM) 40

41 Medication Safety Resources

42 Resources and Assistance Great Plains QIN provides Learning and Action Network Facilitation Technical Assistance Tools and best practices Data analysis Promote and share resources 42

43 Area Examples Medication reconciliation Hospital-SNF: Organizational Pharmacist Inpatient Med Rec - Orders per SNF readmit requiring clarification Orders per readmit requiring clarification - Readmit Linear (Orders per readmit requiring clarification - Readmit ) 43

44 Area Examples Medication reconciliation Hospital-SNF: Collaborative 3.5 SNF Cover Sheet - Orders per readmit requiring clarification Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Orders per readmit requiring clarification - Readmit Linear (Orders per readmit requiring clarification - Readmit) 44

45 Readmission Rate Area Examples More Hospital-SNF collaboration 18% 16% 14% 12% Readmission Trends - Workgroup SNFs vs. Other SNFs 15.7% 15.9% 15.7% 15.8% 15.2% 14.0% 14.2% 14.3% 14.3% 14.5% 14.2% 13.8% 13.9% 14.1% 13.2% 13.9% 10% 8% 11.0% 10.7% 10.1% 11.3% 6% 1 - Year Period Ending Workgroup SNFs All Other SNFs 45

46 Area Examples ADE screening as part of medication adherence program - Pilot Improving anticoagulation education Increasing awareness of community resources HEN Inpatient and admission ADE tracking SD PMP utilization 46

47 Great Plains QIN ADE Environmental Scan WHAT: A tool to collect information regarding current status of medication safety efforts to detect and prevent Adverse Drug Events (ADE) within the Great Plains Quality Innovation Network (QIN) HOW: Link to environmental scan placed on the Great Plains QIN website during July and August 2015 and s sent to providers and stakeholders WHO: Distributed to providers and stakeholders within the Great Plains QIN (Kansas, Nebraska, North Dakota and South Dakota) 47

48 Overview Great Plains 48

49 Overview all settings 60.0% 50.0% Most track ADEs via electronic records 40.0% 30.0% 20.0% 10.0% 0.0% Electronic Manual Other 49

50 ND Responses Use of data P&T/Medication safety committee review RCA on each event with aggregate reporting for trending Barriers Time/resources Turnover Pharmacist availability (CAH, SNF) 50

51 ND Responses Current initiatives Increase med rec reviews Bar coding Anticoagulant (INR w/antibiotic starts) Opioids (staff training, Narcan availability) 51

52 Question to Run On What are some examples of your involvement in medication safety initiatives? 52

53 Reflection & Action 53

54 Learning Assessment Which three drug classes are targeted in the NAP for ADE preventions? Why were these 3 classes chosen? Which drug class does ND have higher probable ADE rates than national average? 54

55 Questions to Run On What action will you take to reduce ADEs in your practice? What will you do in the next seven days to start this effort? Name one community partner you will contact in the next two weeks regarding collaborative efforts to improve medication safety. 55

56 Action Plan Exercise 56

57 Action Plan Example 57

58 Leave in Action Follow through on Action Plan Sign up for the Learning and Action Network Medication safety, care coordination, immunization, diabetes, and others View website resources Care Coordination Medication Safety 58

59 Contact Information Jayme Steig, PharmD, RPh Quality Improvement Specialist-Pharmacy P: Quality Health Associates of North Dakota 3520 North Broadway Minot, ND P:

60 Thank You! This material was prepared by the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11S0W-GPQIN-ND-C3-43/0216