HRET HIIN Adverse Drug Events Virtual Event Opioid Safety Fishbowl Event #4: Moving the Fish Forward August 24, 2017 1
Erin Craig Senior Program Manager, HRET WELCOME AND INTRODUCTIONS 2
Webinar Platform Quick Reference Mute computer audio Today s presentation Chat with participants Download slides/resources Register for upcoming events 3
Poll 1: How did you get here? How did you hear about today s virtual event? a. HRET HIIN flyer b. HRET HIIN website c. HRET LISTSERV d. State hospital association e. QIN-QIO f. Your organization/colleague g. Other, please specify 4
Today s Agenda 11:00 11:05 a.m. Welcome and Introductions Introduction to today s event and agenda overview. 11:05 11:07 a.m. HIIN ADE Data Update The HRET HIIN ADE data will be shared inclusive of opioid baseline and monitoring data. 11:07 11:45 a.m. Following the Fish! Let s hear from the four fish as they apply their learnings to new process designs for postop, post-cabg, med-surg and endoscopy sedation safety. 5 Erin Craig, MPA Senior Program Manager, HRET 11:45 11:57 a.m. Open Dialogue All attendees 11:57 a.m. - 12:00 p.m. Action Items and Next Steps Close today s event with a discussion on designing small tests of change. Steven Tremain, MD, FACPE Physician Improvement Advisor, Cynosure Health Steven Tremain, MD, FACPE Physician Improvement Advisor, Cynosure Health Maryanne Whitney, RN, CNS, MSN Improvement Advisor, Cynosure Health Erin Craig, MPA Senior Program Manager, HRET
ADE DATA UPDATE 6
Rate definition: (number of patients treated with opioids who received naloxone/number of patients who received an opioid agent)*100
Poll 2: I have joined A. All three Opioid Fishbowl events B. Two of the three Opioid Fishbowl events C. One of the three Opioid Fishbowl events D. This is my first Opioid Fishbowl event 8
Poll 3: The fishbowl events have A. Stimulated our team to refine and focus our aim for opioid safety. B. Assisted our planning and doing one or more tests of change. C. [Both A and B above] D. Did not have much effect on our efforts. 9
Chat! 10
Following the fish! 11
Medical West Bessemer, Alabama 200+ community hospital Team members Meredith Lutz, Chief Quality Officer Demetrios Holmes, Director, Pharmacy 12
Rapid Cycle PDSA Updates Overall aim: Reduce post-operative respiratory failure associated with over-sedation from opiates Aim statement for small tests of change: Reduce over-sedation among patients with OSA who receive PCA post-operatively 13
Rapid Cycle PDSA Updates 1 case 14
Rapid Cycle PDSA Updates What we tried: Standardized documentation CPAP Protocol How we measured: Review of all naloxone doses pulled from dispensing system Results: 15
Rapid Cycle PDSA Learnings What worked: CPAP Protocol What did not work: Standardized documentation What we learned: BiPAP CPAP Need for better communication to frontline staff about improvement goals 16
Rapid Cycle PDSA Updates Next steps: Evaluate each case and address any issues that are identified Monitor sustainability of improvements 17
Slidell Memorial Hospital Slidell, Louisiana 229 bed community hospital Team members Kisha Gant, Clinical Coordinator Pharmacy Michael McKendall, Director of Pharmacy Teri Ramon, Clinical Nurse Auditor Jeanne Wilson, CHSP, Director, Quality 18
Rapid Cycle PDSA Updates Overall aim: By September 2017, reduce naloxone administration by 20% on the Med-Surg units with the implementation of the Pasero Opioid-induced Sedation Scale (POSS) Aim statement for small tests of change: Increase the number of nurses using the POSS to 50% 19
Rapid Cycle PDSA Updates What we tried: Collaborated with champion RN to recruit more nurse participants Enlisted the assistance of RN leadership to further rollout the POSS scale implementation Created a collection folder for the forms Investigated adding POSS to the emar 20
Rapid Cycle PDSA Updates How we measured: Tallied the number of data collection sheets completed Results: Ten data collection sheets were completed What we learned: The lack of incentive and requirement to complete the form, along with adding another task, resulted in a low number of participants 21
Rapid Cycle PDSA Learnings What worked: Meeting with the nurse informatics group Resulted in interest by the CNO, VP of Medical Affairs, and medical staff What did not work: Not sharing the initiative with senior management and incorporating POSS into emar Our next test of change: Work on adding POSS to emar 22
Newton-Wellesley Hospital Newton Lower Falls, Massachusetts 350 bed community hospital Partners Healthcare System Team members Cheryl Bardetti, Manager, QI and IC Jeanne Guerin, Q &S RN Specialist Dave Berkowitz, Assistant Director Pharmacy David Marshall, Q &S Specialist 23
Rapid Cycle PDSA Updates Overall aim NWH will decrease Naloxone use by 20% in the Adult GI unit by October 1, 2017 Aim statement for small tests of change NWH will remove Meperidine for one month starting September 1 NWH will add restrictive criteria for use of Meperidine by September 1 24
Rapid Cycle PDSA Updates What we tried and measured: Draft policy on use of meperidine across hospital, stating an inferior analgesic to first line opioids (e.g. morphine and hydromorphone) and has the potential for neurotoxic effects due to its toxic metabolite (normeperidine), use at NWH is restricted to six indications Focus group with GI Unit RNs at September 13 staff meeting 25
Rapid Cycle PDSA Updates Results: Second quarter 2017 thru August 11 th, ZERO naloxone reversals in GI Unit Draft meperidine restricted use policy ready for presentation to appropriate committees (pain, P&T, anesthesia, nursing, GI) 26
Rapid Cycle PDSA Updates What we learned: Slow and steady wins the race What worked: Planned policy for restricted use of meperidine What did not work: Rapid removal of Meperidine use in GI unit Rapid removal of Meperidine from NWH formulary 27
Rapid Cycle PDSA Updates Next tests of change: Focus group with GI nurses RN review of process and variables for patients who are reversed Review of sedation orders and nursing clinical policies Removing Meperidine for one month in GI Unit as sedation medication choice Qualifying usage limitations/criteria to Meperidine sedation orders Removal of Meperidine from Conscious Sedation Policy/ Order Set 28
All OPEN DIALOGUE 29
Erin Craig Senior Program Manager, HRET ACTION ITEMS AND NEXT STEPS 30
Continuing Education Credits Launch the CE instructions and complete the survey below in the download section. If viewing as a group, each viewer will need to submit the survey separately. 31
ADE Resources Change Package ADE Change Package Link 32
ADE Resources - Checklist ADE Top Ten Checklist Link 33
ADE Resources - LISTSERV Join the LISTSERV Ask questions Share best practices, tools and resources Learn from subject matter experts Receive follow-up from this event and notice of future events 34
Join the last ADE Fishbowl Series Event Opioid Safety Fishbowl Series 5 September 26 11 a.m.- 12 p.m. CT 35
Thank You! Find more information on our website: www.hret-hiin.org Questions or Comments: HIIN@aha.org 36