Patient Safety Opportunity (CEI)

Transcription

1 Patient Safety Opportunity (CEI) Adverse Drug Event Surveillance Rachel Digmann, Pharm.D, BCPS Medication Safety & Program Lead Quality Innovation Network-National Coordinating Center Telligen

2 Disclosures Rachel has no conflict of interest to disclose. 2

3 Learning Objectives Upon completion of this activity, participants should be able to: Define ADE, pade, medication error and adverse drug reaction Explain the role of medication safety on hospital admissions and re-admissions and how these issues are currently affecting hospitals Discuss the role of other community stakeholders on medication safety and care transitions Identify the emerging role of the pharmacist in the quality based reimbursement structure of healthcare 3

4 Overview HHS ADE prevention strategy Relationship between surveillance & quality improvement Stakeholder and partner engagement 4

5 Opportunity for Impact on Quality 5 Classen DC et al. Health Aff (Millwood) 2011;30:581 9; HCUP Statistical Brief #109, 2011; HCUP Statistical Brief #158, 2013; Forster AJ et al. Ann Intern Med 2003;138:161 7; Bourgeois FT et al. Pharmacoepidemiol Drug Saf 2010;19: ; CDC, unpublished data. Update to Budnitz DS et al. JAMA 2006;296:

6

7

8 National Action Plan: Adverse Drug Event (ADE) Defined by the IOM as an injury resulting from medical intervention related to a drug 8

9

10 National Action Plan for ADE Active versus Passive surveillance Active= proactive collection of information, primarily from health records, or databases Passive= relies on clinicians or patients to voluntarily report information Active surveillance typically required to quantify scope and magnitude of health problem and assess trend 10

11 National Action Plan for ADE Actual harm versus potential harm/medication errors Surveillance of actual harm (ADE) Prioritized to evaluate population-based ADE prevention efforts Surveillance of potential harm/med errors Helpful for screening Helpful to monitor safety within a facility Not ideal for National ADE surveillance 11

12 You Sell Cars 12

13 Evaluation Tied to Outcomes 13

14 Safe Motorcyle 14

15 Standardize Measurement Uniform definitions ADE Medication Error/Near miss May vary target populations Evaluate the data monthly Roll up data Use the data to evaluate systems/trends NON-PUNATIVE Praise reporting indivduals 15

16 Medication Safety isn t just about Medication Readmissions ER visits Physician Office Visits Loss of patient productivity Increased healthcare costs Decreased quality of life Revenue Wait what??? 16

17 Inconsistent Measurement How does your organization measure patient safety (ADE)? What is your organization s rate of ADE for the highrisk classes of medications? How does your organization compare to other similar organization s? Who is responsible for monitoring and managing ADE at your facility? Across all CAH facilities? 17

18 Telligen- Medication Safety 10 th SOW ( ) Recruited 5 pharmacy based teams Community, clinic (faculty), LTC, FQHC ~ 500 pts followed Identified High-risk populations Anticoagulation Diabetes Antipsychotic Provided training, tools & resources Assessed outcomes and data 18

19 Data monthly into a template (gasp, extra work!) 19

20 Training on Standard Definitions 20

21 Standard Definitions: What happened 21

22 22 What is the Cost Implication for Pharmacist Intervention on ADE?

23 Give the People What They Want 23

24

25 Detour Prospective Payment System Hospital Critical Access Hospital Number of beds varies 25 or less Payment Based on DRG 100% of cost + 1% Distance Urban Rural Number in Iowa

26 Medicare PPS Value Based Purchasing Breakdown FY 2015 Domain Weighting FY 2016 Domain Weighting 26

27 Elderly Patients at Increased Risk for ADE Hospital admissions related to ADEs in adults > 65 years was 24.9% 1 One-quarter of all ADEs are preventable 2 The CDC estimates that $3.5 billion is spent on extra medical costs associated with ADEs every year 27 1 Bourgeois FT, Shannon MW, Valim C, Mandl KD. Adverse drug events in the outpatient setting: an 11-year national analysis. Pharmacoepidemiology and Drug Safety. September 2010;19(9): Neumiller J, Corbett C. Prevention of Medication Errors in the Older Adult Patient. Postgraduate Healthcare Education, LLC. Power-Pak C.E. Mylan Pharmaceuticals, 2013.

28 Bonuses & Penalties for US Hospitals 28

29 Outcome Analysis 1. You identify a patient who appears to be having hypoglycemic events at home based on monitor readings. You contact the doctor to adjust the patient diabetes medications. Does this intervention prevent the patient from having any of the following: a) Hospital admission b) ER visit c) Physician office visit d) New medication added to treat her problem e) Not sure, but I would really LOVE to know!! 29

30 Outcome Analysis 2. Which stakeholders would benefit from knowing about your interaction with the diabetic patient: a) Patient b) Physician c) Payer d) Employer 30

31 Antipsychotic Aggregate Trend Over Time 31

32 Pharmacist Quality Improvement: Antipsychotics vs. Falls 32

33 The Future of Adverse Drug Event Metrics 33

34 Leaving in Action Which profession is in the best position to provide assistance to those who be measured/assessed by ADE outcomes? How will you demonstrate that you are better equipped than any else to handle this job? 34

35 35 A person with a problem and no data, is just another person with an opinion. - unknown

36 Thank you for your participation! 36