Medication Safety LAN Event Psychologically-integrated approaches to pain management Wednesday, January 10, 2018 3:00-4:30 PM ET
Welcome and Reminders Please be prepared for sharing and open discussion Slides and a recording from today s session can be found on the QIO Program website: http://qioprogram.org/medication -safety-lan-event-january-2018 Rachel Digmann Event Lead Amanda Ryan Chat Manager 2
Agenda Continuing Education (CE) details Amy Wachholtz, University of Colorado Denver Mitzi Daffron, Qsource Panel discussion Wrap-up 3
Learning Outcome The purpose of this session is to prepare healthcare quality improvement professionals to identify and implement effective healthcare strategies by exploring promising practices to implement psychologically-integrated approaches to pain management. We expect that this experience will help participants demonstrate and promote successful delivery of care practices and identify opportunities for improvement, all of which may promote advances in care that impact the Medicare beneficiaries served by the work of the QIO Program. 4
Continuing Education Credit Continuing education credit is available for: Physicians and Physician Assistants Registered Nurses and Nurse Practitioners Dietitians Pharmacists and Pharmacy Technicians Certificate of Attendance 5
CE Information Physicians: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare, CRW & Associates and Telligen. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians. AKH Inc., Advancing Knowledge in Healthcare designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physician Assistants: NCCPA accepts AMA PRA Category 1 Credit from organizations accredited by ACCME. Pharmacists: AKH Inc., Advancing Knowledge in Healthcare is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. AKH Inc., Advancing Knowledge in Healthcare approves this knowledge-based activity for 1.5 contact hours (0.15 CEUs). UAN 0077-9999-18-001-L04-P; UAN 0077-9999-18-001-L04-T. Initial Release Date: 1/10/18 6
CE Information, Continued Registered Nurses: AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. This activity is awarded 1.5 contact hours. Nurse Practitioners: This activity has been planned and implemented in accordance with the accreditation Standards of the American Association of Nurse Practitioners (AANP) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare, CRW & Associates and Telligen. AKH Inc., Advancing Knowledge in Healthcare is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 030803 This activity is accredited for 1.5 contact hour(s) which includes 0 hour(s) of pharmacology. Activity ID #21868-1 Dietitians: AKH Inc., Advancing Knowledge in Healthcare is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 1.5 continuing professional education units (CPEUs) for completion of this program/material. CDR Accredited Provider #AN008. The focus of this activity is rated Level 2. Learners may submit evaluations of program/materials quality to the CDR at www.cdrnet.org. 7
Disclosure of Financial Relationships & Commercial Support The planners and faculty do not have any relevant financial relationships to disclose. AKH Inc., CRW & Associates, and Telligen do not have any relevant financial relationships to disclose. No commercial support was received for this activity. 8
Disclosure of Financial Relationships & Commercial Support Disclosures: It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review. Disclosure of Unlabeled Use and Investigational Product: This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Disclaimer: This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant's misunderstanding of the content. 9
Instructions for Obtaining CE Attend the entire event Complete the post-event assessment that will appear at the conclusion of the event Complete a separate CE evaluation that is linked near the end of the assessment Once you submit your CE evaluation, you will be provided with a certificate to retain for your records For technical assistance, please email Nikki Racelis (nikki.racelis@qinncc.hcqis.org) If you have questions about this CME/CE activity, please contact AKH Inc. at service@akhcme.com. 10
Who s in the room? What entity or type of organization do you represent? Academic Faculty Government agency (CMS, CMMI, CDC, etc.) Home Health Agency Hospital Nursing Home/LTC/SNF Patient, Family, or Caregiver Patient or Family Representative Pharmacist: Clinic Pharmacist: Community Pharmacist: Hospital Pharmacist: LTC Prescriber/Practitioner QIN-QIO staff Other (please chat in) 11
Session Goals By the end of today s call, you will be able to: Describe the interactions between biology and psychology, and their effects on the patient pain experience Identify the difference between pain sensitivity and pain tolerance Identify 3 home-based strategies to reduce pain Describe why a functional pain assessment may be useful to reduce unnecessary opioid prescribing and how to implement this in a standard 15-minute appointment 12
Campaign for Meds Management Identifies and promotes resources and interventions that support the following: Improve medication use and management, especially in high-risk medication populations High-risk medications include opioids, anticoagulants, and diabetic drugs Advance patient-centered shared decision-making Emphasize the patient voice in healthcare Disseminate favorable resources and tools utilized, promoted, and/or created by QIN-QIOs 13
Why Should I Join Participate in Learning and Action Network (LAN) events and receive free continuing education credit Access numerous resources to improve medication safety and communication between providers, patients, and caregivers Identify various medication safety quality improvement activity opportunities Spread medication safety interventions regionally and nationally Be a leader in medication improvement activities and interventions 14
CMM Website http://qioprogram.org/campaign-medsmanagement Who should join the CMM EVERYONE 15
Patient Perspective Katharin (Kay) Laughton Patient 16
Meet Your Speakers Amy Wachholtz, PhD, MDiv, MS, ABPP, FACHP Assistant Professor of Psychology University of Colorado Denver 17
Pain Management: Change the Focus - Change the Outcome Amy Wachholtz, PhD, MDiv, MS Assistant Professor Of Psychology Director of the COAP Lab
Psychological Pain vs Real Pain? Physiological Musclo-skeletal Neuropathic Psychological Stress Depression Social
Gate Control Theory of Pain Melzack & Wall, 1965
Bi-directional Pain Pathway
ALL PAIN HAS A PSYCHOLOGICAL COMPONENT
Emotions and Pain
Thoughts and Pain
Thoughts and Pain Catastrophizing Fear of pain Low self-efficacy
Behaviors and Pain
Pain Sensitivity vs. Tolerance: What are you are measuring? Sensitivity: What is the level of your pain? Tolerance: What can you do despite that pain level?
Treatment Goal The patient resumes normal daily activities NOT JUST PAIN REDUCTION!
Treatment Efficacy Need Functional Pain Assessment Not just 0-10 scale Is treatment helping them engage in more activities? Should be a sliding scale, not either/or When my pain is gone then I will
Measuring Pain
Psycho-behavioral Treatment Interventions Cautions Benefits Needs
Emotions Laughing with friends Hobbies Pets
Thoughts Increase patient self-efficacy Decrease patient thoughts that medication is the only answer Education regarding realistic expectations of pain management Positive self-statements
Behaviors
Basics of Pain Coping Therapy Progressive Relaxation Brief Practices Pain Suppression Imagery Wound Healing Imagery Pleasant Activity Scheduling Communication Skills Challenge Catastrophizing Activity-Rest Cycling Distraction Techniques Problem Solving Cognitive Restructuring Altering Self-Efficacy Beliefs Increasing Internal LOC Relapse Prevention Chemical Coping Assessment
Challenges Hyper-focus on pain Catastrophizing Hyperalgesia Long term effects Aberrant Drug Use Behaviors Addiction Diversion
Individual Care Plan Remind of goals quality of life not pain gone Pain functioning assessment 3 goals to accomplish in the next month SMART goals Example: attending child s baseball game, volunteering, completing household chores; exercise Selfies; phone records; GPS/steps as evidence
Things to Monitor CAM tx used Activity Levels Sleep Basic needs met Monitor Social Support Mood Addiction Potential Weight Gain Schedule of Meds
Finding a health psychologist American Psychological Association APA.org American Board of Professional Psychology AABP.org If there are no local resources contact your closest medical center or academic medical center and ask about tele-psychology services with a health psychologist
Questions? Amy.wachholtz@UCDenver.edu CUD Health Psychology
Meet Your Speakers Mitzi Daffron, RN, MS, CPHQ Indiana State Director Qsource 41
Fighting Back Against Opioid Misuse A Community Approach Mitzi Daffron, RN, MS Indiana State Director January 10, 2018
Overview Indiana in 2014, 15 percent of all medications prescribed to Medicare Beneficiaries were opioids Ground swell of effort across the State to address the opioid problem, but no real focus on the senior population Developed proposal for pilot in one county selected due to higher prescribing rate and recommendation of the Indiana State Department of Health 43
44 Key Interventions and Target Population
45 Hospital Intervention Intervention listed in RFP process implemented at Indiana University Paoli Hospital Identification of frequent visitors to the ED, particularly related to opioid requests Letter sent from the hospital to those frequent visitors noting: frequency of visits prescriptions for opioids (identified also through INSPECT database) offering other resources to the patient Measuring ED visits after receipt of letter; through INSPECT database also tracking whether they go elsewhere for prescription
Practitioner Intervention Recruitment of all Part D prescribers in the county Using First Do No Harm toolkit developed by Indiana Drug Prevention Task Force offers resources for prevention and treatment of opioid misuse, as well as non-opioid intervention resources - http://www.in.gov/bitterpill/files/first_do_no_harm_v_1_0.pdf Mainly educational focus with practitioners Measured through prescriptions for opioids from participating practitioners INSPECT database, as well as claims when available 46
Community/Beneficiary Intervention Working with Healthy Communities of Clinton County anywhere from 8 to 11 health fairs and educational events per month within the county Showing patient-centered videos from the American Chronic Pain Association (ACPA) at events, as well as on loops in the hospital waiting areas, ED, and in practitioner offices - https://theacpa.org/opioids/default.aspx Providing patient-directed materials in both English and Spanish Opportunities to do educational presentations at these events 47
Goals of the Project Goal of decreasing ED visits by 40 percent, which translates to 863 fewer ED visits over the course of the contract Goal of 25 percent decrease in inappropriate prescribing would result in a reduction of 1,160 opioid claims for the two-year contract Goal of 25 percent decrease in opioid related admissions/readmissions translates to 315 fewer hospitalizations over the course of the contract 48
Where We Are Hospital ED intervention implemented December 2017 Practitioners recruited and toolkit distributed December 2017 Community outreach to begin February 2018 Preliminary data should be available for ED late January 2017 49 This material was prepared by atom Alliance, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO), coordinated by Qsource for Tennessee, Kentucky, Indiana, Mississippi and Alabama, under a contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Content presented does not necessarily reflect CMS policy. 17.INS1.10.008
Additional Resources CDC Rx Awareness Resources https://www.cdc.gov/rxawareness/resources/index.html Intermountain Healthcare Tools - https://intermountainhealthcare.org/services/painmanagement/patient-education/ 50
Questions? Contact information Cheryl Riddell Project Lead Cheryl.Riddell@area-g.hcqis.org Mitzi Daffron Indiana State Director Mitzi.Daffron@area-g.hcqis.org 51
Facilitated Panel Discussion Chat in your questions and comments. Press *1 on your telephone key pad to enter the teleconference queue. 52
Call to Action Visit the CMM at http://qioprogram.org/campaign-medsmanagement Join the CMM Share your resources/interventions and stories Complete the post-event assessment upon exiting WebEx: https://www.surveymonkey.com/r/9r5t2w3 53
Save the Date! Join us for the next Medication Safety LAN Event! Wednesday, April 11, 2018 3:00-4:30 PM ET Registration is required! Register at https://qualitynet.webex.com/qualitynet/onstage/g.ph p?mtid=e84bca76f95932f7c1d9aa61899fdaa18 54
Follow the QIO Program on Social Media! https://twitter.com/qioprogram https://www.youtube.com/channel/ucp- 3KliHRoKeozEs-7ohQnw 55
Thank you! 56 This material was prepared by Telligen, the Quality Innovation Network National Coordinating Center, 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. 11SOW-QINNCC-01787-12/18/17