When Medications Hurt: Preventing Adverse Drug Events Rachel Crowe, MPH, BSN, RN Danielle Watford, CMQ OE, MS Patient Safety Academy September 8, 2016 This material was prepared by Healthcentric Advisors, the Medicare Quality Innovation Network Quality Improvement Organization for New England, 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. CMSMA_C3 2_010516_0344 Plan for today. Overview of the New England QIN QIO Program Overview of Medication Safety and the National Action Plan Reducing Patient Harm Opportunities for Collaboration Breakout Session 9/9/2016 2 1
New England QIN QIO Led and administered by Healthcentric Advisors in partnership with Qualidigm Healthcentric Advisors: MA, ME, RI Qualidigm : CT, NH, VT 9/9/2016 3 Primary Goal of the NE QIN QIO Improve the quality and efficiency of healthcare for all Medicare Beneficiaries 9/9/2016 4 2
11th SOW Focus Areas Cardiovascular Health and Million Hearts Initiative Health for Life Everyone with Diabetes Counts Meaningful Use and HIT Quality Reporting and Incentive Programs Antibiotic Stewardship and C. Difficile Prevention Nursing Home Quality Improvement Safe Transitions of Care and Medication Safety and Adverse Drug Event (ADE) Prevention 9/9/2016 5 Medication Safety and Adverse Drug Event Prevention 9/9/2016 6 3
Adverse Drug Event (ADE) 9/9/2016 7 The National Action Plan for Adverse Drug Event Prevention US Dept. of HHS Identifies efforts to measure and prevent adverse drug events (ADEs) Patient Safety Prevention of ADE among three primary classes Anticoagulants Diabetes agents Opioids 9/9/2016 8 4
National Action Plan: Anticoagulants Inpatient 10% of drug related adverse outcomes 1/3 of ADEs for hospitalized Medicare beneficiaries Outpatient Among most frequently implicated drug classes in ADEs that contribute to ED visits and admissions Driver for ADE related hospital readmissions Long term Care Settings Common cause of preventable harm ~34,000 fatal, life threatening, or serious warfarin related ADEs per year in nursing home settings 9/9/2016 9 National Action Plan: Diabetes Agents Inpatient Hypoglycemia is third most common ADE nearly all of which are preventable Insulin implicated in 33% of medication error related deaths Outpatient Among top medications classes resulting in emergent hospitalizations for ADEs From 1999 2010, hospitalizations for hypoglycemia increased by almost 23% Long Term Care Settings Approximately 34% of residents have Type 1 or Type 2 diabetes and possess primary risk factors for ADEs (advanced age, recent hospitalization, and polypharmacy) 9/9/2016 10 5
National Action Plan: Opioids Number of prescription opioids dispensed doubled between 1999 and 2010 Opioid analgesics are one of the top classes of prescribed medications overall Prescription opioid related deaths are considered to be one of the Nation's leading preventable public health problems 9/9/2016 11 Health System Related ADE Implications 1/3 of hospital adverse events 1 280,000 hospital admissions annually 1 One quarter of all ADEs are preventable 3 The CDC estimates that $3.5 billion is spent on extra medical costs associated with ADEs every year Hospital admissions related to ADEs in adults > 65 years was 24.9% 2 1 U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2014). National Action Plan for Adverse Drug Event Prevention. Washington, D.C.: Koh, H. 2 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):901 910. 3 Neumiller J, Corbett C. Prevention of Medication Errors in the Older Adult Patient. Postgraduate Healthcare Education, LLC. Power Pak C.E. Mylan Pharmaceuticals, 2013. 12 6
Patient Related ADE Implications Loss of patient productivity Increased healthcare costs Decreased quality of life 9/9/2016 13 Reducing Patient Harm Surveillance Prevention Incentives and Oversight Research 9/9/2016 14 7
ADE Surveillance Importance Quantify the scope and magnitude; identify new or previously unrecognized issues Basis for measuring progress Inform future program development or policy revision Considerations Active vs. Passive Surveillance Actual Harm/Injuries vs. Potential Problems/Med Errors 9/9/2016 15 9/9/2016 16 8
Prevention Patient & Family Engagement Awareness, readiness and education Standardized care processes Decision support Safe transitions of care Prevention of failure 9/9/2016 17 Incentives and Oversight Explore opportunities within existing safety and quality programs, measures and payment models Research Identify current knowledge gaps and future research needs 9/9/2016 18 9
QIN QIO Program Requirements: Primary Goal: Improve medication safety and aim to reduce and prevent ADEs Implement evidence based and proven best practices Population of Focus: Medicare FFS patients 3 or more medications At least one CMS identified high risk medication Anticoagulant Diabetic Agent Opioid 9/9/2016 19 Achieving Our Goals Screen patients for ADEs and pades Implement new tools / build upon existing tools Improve Medication Safety and Reduce ADEs Develop partnerships & collaborations within community Promote evidence based / proven best practices 9/9/2016 20 10
Opportunities for Collaboration Provide analytic support and review of shared data as well as technical assistance to help identify areas for possible QI initiatives Highlight role of the pharmacist intervention in the prevention of unnecessary healthcare utilization Provide platform to share and discuss your work with thought partners locally, regionally and nationally Identify opportunities for participation in community coalitions Partner together to identify potential areas to improve medication safety and adverse drug event prevention Identify ways to support current work and help add additional value (analytic support, claims data, educational sessions, tools and resources) Identify surrogate measures to help track, monitor and report medication safety related data (recommendations pades vs. ADEs; lab values INR, glucose; antidotes Vitamin K, glucagon, naloxone) Using QIN QIO claims data and ICD 9 and 10 codes to report and reduce utilization associated with anticoagulants, diabetic agents and opioids 9/9/2016 21 Breakout Session 9/9/2016 22 11
Lessons Learned Many medication safety related initiatives underway across the region Limited focus on tracking and monitoring of ADE data from the provider and system level Lack of communication between pharmacists in practice settings Limited capacity for pharmacists to get involved Align efforts to improve efficiencies and reduce duplication Continue to partner and develop relationships at the provider level Processes and approaches will continuously evolve as we continue to learn more and move forward 9/9/2016 23 Questions? Contact Information Medication Safety Program Coordinator: Rachel Crowe, MPH, BSN, RN rcrowe@healthcentricadvisors.org Nursing Home Program Coordinator: Danielle Watford, CMQ OE, MS dwatford@healthcentricadvisors.org 9/9/2016 24 12