11/15/2012. Objectives

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1 ASHP Live Webinar: Building a Medication Safety Community - Leveraging the Partnership for Patients Initiative John B. Hertig, PharmD, MS Jaclyn Jeffries, PharmD Medication Safety Project Manager Medication Safety Resident Assistant Clinical Professor of Pharmacy Center for Medication Safety Practice Advancement Center for Medication Safety Advancement Purdue University College of Pharmacy Purdue University College of Pharmacy Indianapolis, IN Indianapolis, IN Dan Degnan, M.S., Pharm.D., CPHQ Moderator Thursday, November 15, :00 3:00 PM ET Planned by the ASHP Section of Inpatient Care Practitioners Section Advisory Group on Medication Safety value added service for members. ASHP Live Webinar: Building a Medication Safety Community - Leveraging the Partnership for Patients Initiative John B. Hertig, PharmD, MS Medication Safety Project Manager Assistant Clinical Professor of Pharmacy Practice Center for Medication Safety Advancement Purdue University College of Pharmacy Indianapolis, IN Jaclyn Jeffries, PharmD Medication Safety Resident Center for Medication Safety Advancement Purdue University College of Pharmacy Indianapolis, IN Objectives Describe the Partnership for Patients initiative and explain how pharmacists play an important role in its success Discuss the role Indiana has played in coordinating Partnership for Patients efforts with state organizations, professional groups and health-systems Outline the framework for the Medication safety Alliance Community of Practice and explain strategies for maintaining and growing a medication safety community 1

2 Outline Review Partnership for Patients Initiative Discuss the various engagement networks and Indiana s role Outline the framework of Indiana s Medication Safety Alliance Specifically discuss the events and strategies that have been launched Describe future directions for the alliance Questions Ask the Audience Getting to know you Polling Question What type of practice do you represent? A) Front-line Pharmacist B) Pharmacy Administrator C) Medication Safety Pharmacist/Officer C) Medication Safety Pharmacist/Officer D) Nursing or Physician Safety Leader E) Other 2

3 Polling Question How much do you know about the Partnership for Patients Initiative? A) Nothing: this is the first I have been exposed to it B) A little C) I feel like I know more than most people D) I am a true expert Partnership for Patients About Partnership for Patients Partnership for Patients (PfP) launched by the Department of Health and Human Services (HHS) $1 billion in new funding provided by the Affordable Care Act Public and private partners Better care and lower cost of health care for all Americans Quality Safety Affordability Two core goals of this partnership Keep patients from getting injured or sicker in the health care system Help patients heal without complication by improving transitions from acute-care hospitals to other care settings 3

4 Two Main Goals (end of 2013) Keep patients from getting injured or sicker Decrease preventable hospital-acquired conditions by 40% compared to million fewer injuries (60,000 lives saved over three years) Help patients heal without complication Decrease preventable complications by 20% compared to million patients avoid re-hospitalization within 30 days of discharge Potential to save up to $35 billion across the health care system $10 billion in Medicare savings, over the next three years Hospital Engagement Networks $218 million was awarded to 26 state, regional, national, or hospital system organizations to be Hospital Engagement Networks (HEN) as part of PfP Identify solutions already working Work to spread them to other hospitals and health care providers Develop learning collaborative for hospitals and provide a wide array of initiatives iti and activities iti to improve patient safety Intensive training programs Technical assistance to hospitals Establish and implement a system to track and monitor hospital progress American Hospital association Health Research and Educational Trust (HRET) How HEN Contracts Fit in the PfP 4

5 National HEN Targeted Harms PfP has identified nine areas of focus Not limited, but these areas of focus are obvious and important places to begin 1) Adverse drug events 2) OB Adverse Events/Birth-related injuries 3) Central line-associated blood stream infections 4) Catheter-acquired urinary tract infections 5) Falls 6) Surgical infections and complications 7) Venous thromboembolism 8) Pressure ulcers 9) Ventilator-associated pneumonia 10) Readmissions HRET/AHA HEN 34 states / 1,621 hospitals IHA as Part of the AHA/HRET HEN 26 Hospital Engagement Networks nationwide Largest is the AHA/HRET HEN 30 state hospital associations, DC and Puerto Rico are participating in the HRET HEN Indiana Hospital Association contingent is 2nd largest among 32 HRET HEN jurisdictions 5

6 Indiana/HRET HEN Summary 119 Indiana hospitals aligned with IHA/HRET Includes: - 26 critical access hospitals - 8 psychiatric hospitals - 5 rehabilitation hospitals - 4 long term acute hospitals Key Focus Areas National (CMS) Early Elective Deliveries before 39 weeks (EED) Readmissions (Readmissions Race) Indiana EED CAUTI Readmissions Adverse Drug Events Falls Prevention Building a Network 6

7 Eleven regional safety coalitions Members agree not to compete on patient safety Layered model of regional coalitions and affinity groups supports transformation, learning and spread Benefits: Innovate at the front lines Align with state and national efforts, and standardize when beneficial Builds local and hospital-specific capacity for improvement and innovation Encourages safety leadership at all levels across multiple professions Purdue University Involvement Focus on building lasting capacity for improvement in Indiana Purdue Healthcare Advisors: Lean/Six Sigma Belt training Coaching for Lean/Six Sigma projects Readmission i simulation Center for Medication Safety Advancement: Medication Safety Course ADEs and Readmissions Coaching calls Medication Safety Alliance (MSA) Medication Safety Alliance Purpose Framework Partnerships Pharmacist s Role 7

8 Alliance Framework Educating Medication Safety Sharing Supporting Special Thanks Betsy Lee Director, Indiana Patient Safety Coalition Indiana a Hospital Association o blee@ihaconnect.org (317) Indiana Medication Safety Alliance Let s take a closer look at the Medication Safety Alliance (MSA) Medication Safety CE Pre-work webinar and strategies Pre-work webinar and strategies Self-assessment on high-risk medications leading to readmissions Conference on Readmissions and ADEs Coaching calls Future directions 8

9 Medication Safety CE Course Launched on September 17 th On-line, on-demand course 7 CE hours for MDs, nurses and pharmacists 10 spots per hospital for inter-professional medication safety team Readmissions Partnership for Patients Reduce preventable hospital-acquired conditions by 40% by December 31, 2013 Reduce all hospital readmissions by 20% by December 31, 2013 PfP focus is on anticoagulants, narcotics, sedatives, and insulin U.S. Department of Health & Human Services Partnership for Patients. Health Research & Educational Trust. Implementation Guide to Reducing Harm from High-Alert Medications. Accessed at August 4, Step 1: Identify Problem Identify highrisk medications Discuss mitigation strategies Provide examples on how to implement 9

10 Data Collection Formulate research question: Readmissions ADEs High-risk Medications Search strategy: PubMed & MEDLINE MeSH terms readmissions rehospitalizations ADEs high-risk meds high-alert meds transitions post-discharge Cross-reference Data Abstraction 300+ abstracts Inclusion criteria Readmitted ADE High-risk meds Exclusion criteria Drug/alcohol abuse Article selection Limited results 9 articles Analyzed occurrence of most common offending classes Data Discovery and Delivery Medications Studies Why implicated Hematologic Forster, Budnitz, McDonnel, Beckett, Complexity of dosing and monitoring Classen, Ruiz, Roughead, Evans Patient adherence Drug interactions Dietary interactions Anti-diabetic Budnitz, McDonnel, Beckett, Classen Pharmacology of drugs Complexity of dosing Medication adjustments Narrow therapeutic range Anti-neoplastic Budnitz, McDonnel, Ruiz, Roughead, Pharmacology of drugs Adverse effects Dose scheduling Drug interactions Depressed immune system Analgesics (including Forster, Boockvar, Budnitz, Beckett, Evans Dose mix ups narcotics) Allergic reactions Enhanced CNS effects Ambiguous directions Cardiovascular Forster, Boockvar, Budnitz, McDonnel, Patient adherence Beckett, Classen, Roughead, Evans Polypharmacy Adverse effects Anti-infectives Forster, Budnitz, Beckett, Classen, Evans Patient adherence Overuse/misuse Kill normal flora Adverse effects/allergies Drug interactions 10

11 Strategic Thinking Step 2: Strategic Thinking Identify highrisk medications Discuss mitigation strategies Provide examples on how to implement Strategic Thinking Resolution Develop an attainable intervention Focus on avoidable readmissions Strategy Focused on transitions of care Team-based approach Patient-centered 11

12 Mitigation Strategies Intervention Medication Reconciliation Impact Discrepancy recognition Decrease ADEs Transition Communication Discrepancy recognition Decrease ADEs Patient Education Follow-up Telephone Call Post-discharge Clinics/ Improved Monitoring Side effect awareness Greater medication understanding Decrease ADEs Discrepancy recognition Increase patient adherence Decrease ADEs Optimize therapy Decrease ADEs ADE/Readmission Challenges Identify when ADEs occur and talk Make doing the right thing feasible Reporting should not be so time constraining Biased self-reports Promote cross-monitoring U.S. Department of Health & Human Services Partnership for Patients. Health Research & Educational Trust. Implementation Guide to Reduce Avoidable Readmissions. Accessed at September 5, There is no shortage of successful strategies to help patients avoid rehospitalization. What has been lacking is the will to adopt them. - Experts O Reilly, KB. Reducing readmissions: How 3 hospitals found success. American Medical Association. Accessed at August 28,

13 Step 3: Taking Action Identify highrisk medications Discuss mitigation strategies Provide examples on how to implement Implementation Make sure patients understand how to care for themselves upon discharge Make sure patients get the follow-up medical care they need to manage their conditions Implementation Easier said than done Failures due to: Lack of strategy Encountered barrier Lack of adoption 13

14 Implementation- PDSA ACT Implement change OR restart process PLAN Determine problem STUDY Interpret & assess results DO Implement change & collect data Utilize cyclical method to immediately impact and assess change Explore relationship between variables in process and outcomes Small and frequent PDSAs are most effective Hughes RG, eds. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality; The journey of a thousand miles begins with one step. -Lao Tzu Self-Assessment Hematologics Anti diabetics Antineoplastics Analgesics Cardiovascular Anti infectives Warfarin Heparin/LMWH Clopidogrel Insulin Oral hypoglycemics Cyclophosphamide Gemcitabine HCl Capecitabine Fluorouracil platins rubicins zumabs taxels Meperidine Indomethacin Ketorolac Aspirin Naproxen Meloxicam Ibuprofen α1 blockers zosins Dronedarone Antiarrhythmics Nifedipine Spironolactone Digoxin Nitrofurantoin 14

15 Self-Assessment Assessment Goals and Strategies Initial Score Mid Point Score Final Score Medication reconciliation is performed effectively every time on admission and discharge. Primary care physician (PCP) information is obtained upon admission. Appointments are made with PCPs and/or specialists prior to discharge. A risk assessment is performed on patients upon admission. Patients are educated on potential side effects/symptoms from their medications and are counseled on what to do if either present. The teach back method is utilized when discussing patient s medication & self care knowledge. The patient and family/caregiver are considered part of the, team during hospital stay. Follow up telephone calls are performed within 72 hours of hospital discharge. Patients are referred to specialty clinics, when appropriate, prior to discharge. The importance of monitoring particular medications is emphasized during patient stay. Reducing readmissions is a strategic goal of the organization. Strategy implementation is supported with adequate resources. Efforts are made for collaborating with other organizations/facilities within the community to reduce readmissions (i.e. local pharmacies, long term care facilities, home health organizations, Area Agencies on Aging, etc.). Total IHA Conference Held November 8 th Readmissions and ADEs: Causal Links and Strategies for Action Medication Safety Alliance Work with organizations to drive improvement Keeping the Momentum Subsequent webinars Coaching Calls Exemplars Sharing Best Practices Networking Web portal 15

16 Alliance Framework Educating Medication Safety Sharing Supporting Conclusion Partnership for Patients Partnership with IHA Medication Safety Alliance Specific strategies and events Keeping the Momentum Questions? Contact us: John B. Hertig, PharmD, MS Medication Safety Project Manager Assistant Clinical Professor of Pharmacy Practice Purdue University College of Pharmacy Center for Medication Safety Advancement Jaclyn Jeffries, PharmD Medication Safety Resident Purdue University College of Pharmacy Center for Medication Safety Advancement 16

17 ASHP Live Webinar: Building a Medication Safety Community - Leveraging the Partnership for Patients Initiative John B. Hertig, PharmD, MS Medication Safety Project Manager Assistant Clinical Professor of Pharmacy Practice Center for Medication Safety Advancement Purdue University College of Pharmacy Indianapolis, IN Jaclyn Jeffries, PharmD Medication Safety Resident Center for Medication Safety Advancement Purdue University College of Pharmacy Indianapolis, IN 17