Welcome to the New England QIN-QIO Medication Safety Webinar! Thank you for joining. Our presentation will begin shortly. If you haven t already, please dial in to the audio line: 888-895-6448 Passcode: 519-6001 1
Speaker Disclosures Today s speakers have no conflicts of interest to disclose In adherence to the regulation standards of the Connecticut Pharmacists Association, the Accreditation Council of Pharmacy Education, Northeast Multistate Division (NE-MSD) this notice confirms that the information contained in this presentation is free of commercial bias and the speakers have no related vested financial interest in any capacity, inclusion of shareholder, recipient of research grants, consulting or advisory committees. 2
The New England Journey Enhancing Medication Safety New England QIN-QIO Medication Safety and Adverse Drug Event Prevention Margherita R. Giuliano, R.Ph., CAE Regional Medication Safety Lead, New England QIN-QIO Madeleine Ng, PharmD Medication Safety Consultant, New England QIN-QIO November 15, 2016 11:00am 12:00pm This material was prepared by the New England Quality Innovation Network-Quality Improvement Organization (NE QIN-QIO), the Medicare 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 CMSQINC322016110800
Learning Objectives Differentiate between an adverse drug event (ADE), a potential ADE (pade), and a medication error Describe why Antibiotics, Anticoagulants, Diabetic Agents and Opioids are considered high risk-high opportunity medication classes Identify tools and resources available to assist improving medication safety during care transitions 4
Chat in Introduce yourself please type in your name, organization and state. 5
Does this Look Familiar? 6
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. 7
The National Action Plan for Adverse Drug Event Prevention Department of Health & Human Services Identifies efforts to measure and prevent ADEs Patient Safety Prevention of ADE among three classes Anticoagulants Diabetic agents Opioids http://www.health.gov/hai/ade.asp 8
Categorization of Medication Harm Adverse Drug Event (ADE) Defined as injury resulting from medical intervention related to a drug 9
An ADE is an injury resulting from medical intervention related to a drug 10
NCC MERP Index for Categorizing Medication Errors 11
Why do ADEs Happen Incomplete medication profile Failure to consider underlying risk factors Failure to consider progressive nature of certain drug-drug interactions Lack of communication with patients and caregivers Failure to communicate when to stop taking medications Fragmented system Multiple providers Complex patients Polypharmacy Transitions of care 12
Disparate, Fragmented Med Info Sources in Primary Care MTM Remote Monitoring E-Consults w/ PCP EHR/Medical Charts Medication Monitoring and Outcomes Prescribing PATIENT HEALTH RECORDS PATIENT MED DISCUSSIONS HEALTH INFO EXCHANGES Multiple Prescribers Paper Prescriptions E-Prescribing Rx Processing Pharmacy Profiles - Multiple Stores - Mail Order Rx Claims Paid - Health Plan - PBM Patient Self-Report Caregiver/Family Patient Med Use at Home Home Visits/Brown Bag Sessions Webcam Med Reviews HIE is a shared platform for centralized patient medication history, usage patterns, and outcomes that can be accessed by all health care professionals ( and patients??) 2008, Marie Smith, PharmD - Written permission required for any use including copying, modifying, duplication, or distribution in any media or format.. 13
ADEs - Transitions of Care AAAs ASAPs SNFs Hospital to home - lack of communication Hospital to NH -medication changes NH to home - no prescriptions or too expensive * 14
Chat In Is your organization looking at Medication Safety as part of your care transitions effort? If so, what is your current focus 15
What do we need to know about Medications? 16
Antibiotics 17
CDCs Outpatient Antibiotic Stewardship Core Elements Commitment Demonstrate dedication to and accountability for optimizing antibiotic prescribing and patient safety. Action for Policy and Practice Implement at least one policy or practice to improve antibiotic prescribing, assess whether it is working, and modify as needed. Tracking and Reporting Monitor antibiotic prescribing practices and offer regular feedback to clinicians, or have clinicians assess their own antibiotic prescribing practices themselves. Education and Expertise Provide educational resources to clinicians and patients on antibiotic prescribing, and ensure access to needed expertise on optimizing antibiotic prescribing. Learn More Today (11/15 1pm-2pm) CDC's Core Elements of Outpatient Antibiotic Stewardship Register at: http://www.healthcarefornewengland.org/ 18
Help Us Raise Awareness Targeting providers, pharmacists and patients Get Smart Week Nov 14-20 19
Diabetic Agents In 2014, 29.1 million (9.3%) of population had diabetes 1 7th leading cause of death in the United States 2 1. Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services; 2014. 2. 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, DC: Author. Hypoglycemia 3rd leading cause of ADEs 2
Diabetic Agents Uncontrolled diabetes may cause cardiovascular, renal, ocular, and skin complications Medications more common in causing hypoglycemia: Insulin Sulfonylurea: Glipizide, glyburide, and glimepiride 21
Anticoagulants 10% of inpatient ADEs due to anticoagulants 1 Warfarin caused 17% of ER visits in older adults 1 33% of ADE hospitalizations due to warfarin 1 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, DC: Author.
Anticoagulants Prescribed for treatment/prevention of Atrial fibrillation (AFib) and venous thromboembolism (VTE) Warfarin is most commonly prescribed anticoagulant Direct oral anticoagulants (DOAC) Pradaxa (Dabigatran) Xarelto (Rivaroxaban) Eliquis (Apixaban) 23
Opioids 100 million Americans report having chronic pain 1 201 million opioid prescriptions dispensed in 2009 1 16,651 prescription opioid overdose deaths in 2010 1 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, DC: Author.
Opioids Opioids have place in pain management in both inpatient and outpatient settings Complete pain relief is unrealistic Goal is to minimize burden to daily activities 1 Common opioids Morphine (MSContin ) Oxycodone (Oxycontin ) Hydrocodone (Norco ) Hydromorphone (Dilaudid ) 1. Guideline for Prescribing Opioids for Chronic Pain [internet]. CDC. 2016 Mar 15. Available from: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
ADEs Over sedation Respiratory depression Constipation Prescribers and patients need to be cognizant of risks of dependence and overuse Opioids 26
Addressing High Risk / High Opportunity Medications 27
Improve Medication Safety Address Antibiotic Resistance with Community Antibiotic Stewardship CDC Core Elements Reduce Adverse Drug Events Reduce Hospital Utilization for Patients on HRM Readmissions Hospitalization (ED, Obs, Admissions, Readmissions) 28
Achieving The Goal Screen beneficiaries for ADEs and pades Implement CDCs Core Elements Improve Medication Safety Spread best practices Promote evidence based / proven best practices 29
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 Medication Reconciliation across care settings is inconsistent and not standardized Align efforts to improve efficiencies and reduce duplication Continue to partner and develop relationships at the provider level Tools and Processes need to evolve as we continue to learn more and move forward in improving medication safety 30
Projects in Progress URI Experiential Program Meds-to-Go Pharmacists as part Care Team Prescription Drug Monitoring Program report Lunch & Learn Series Medication Reconciliation Training Community Pharmacy HRM Tools Single source for tools/resources healthcarefornewengland.org/ 31
Chat In Tell us about your successaddressing High Risk Meds or Antibiotic Stewardship in your setting. What works and what do you need from us 32
Conclusion Adverse drug events have a major impact on patient outcomes and healthcare costs Clinicians must work together to improve communication and develop new tools and protocols to prevent errors along care transitions Empower the patient with knowledge Good systems - create good outcomes * 33
Comments, Questions & Insights 34
The New England Journey - Enhancing Medication Safety Lunch & Learn: A special webinar series addressing high-risk/high opportunity medications December 12/8: Med Rec to improve Care Transitions One Insurer s Experience January 1/10: Clinical Perspective Treatment and Management 1/24: Treatment Tracking - New England Prescription Drug Monitoring Programs March 3/14: Getting SMART- Antibiotic Stewardship 3/28: Implementing CDC s Core Elements May 5/9: Anticoagulation in the Ambulatory Setting - Clinical Guidelines and Protocols 5/23: Best Practices in Care Transitions for Patients with Anticoagulants July 7/11: Maintaining Glycemic Control 7/25: Tools and Tips to Enhance Safe Care Transitions for Type II Diabetics 35
ACPE Code Safety 36
Maine Amanda Gagnon agagnon@healthcentricadvisors.org 877 904 0057 X 3108 Contact Your Medication Safety State Lead Massachusetts Colleen Kordana ckordana@healthcentricadvisors.org 877 904 0057 X3202 Rhode Island Cynthia Stephanopoulos cstephanopoulos@healthcentricadvisors.org 401 528 3205 Connecticut, New Hampshire & Vermont Margherita Giuliano, RPh, CAE mgiuliano@ctpharmacists.org 860-563-4619 Questions regarding CE status may be submitted to Ileizy Victor at Ivictor@healthcentricadvisors.org 37