Coordination and Medication Safety by CIMRO of Nebraska Kansas - - PowerPoint PPT Presentation

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Coordination and Medication Safety by CIMRO of Nebraska Kansas - - PowerPoint PPT Presentation

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Introduction to Improving Care Coordination and Medication Safety by CIMRO of Nebraska Kansas Foundation for Medical Care Quality Health Associates of North Dakota South Dakota Foundation for Medical Care July 23, 2015 Welcome and Reminders

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Introduction to Improving Care Coordination and Medication Safety

by CIMRO of Nebraska Kansas Foundation for Medical Care Quality Health Associates of North Dakota South Dakota Foundation for Medical Care July 23, 2015

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Welcome and Reminders

  • Welcome!
  • Thank you for joining
  • Slides and recording will

be available on the Great Plains Quality Innovation Network website

  • *6 to mute your line -

*6 to unmute Sally May, RN, BSN, CH-GCN

Senior Quality Improvement Specialist Quality Health Associates of North Dakota

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Expectations

Ours

  • Attentive
  • Open-minded
  • Actionable
  • “All teach – all learn”
  • Chat

Yours

  • Commitment to success
  • Mindfulness of demands
  • Expertise
  • Support
  • Technical assistance
  • Data

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Polling Question - 1

  • Which healthcare setting, agency, or long-term

services or support organization best describes you? Include all that apply:

  • Hospital
  • Skilled nursing facility
  • Long-term care facility
  • Home health agency
  • Community pharmacy
  • Healthcare consumer
  • Other

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Carol B.

  • A family perspective . . .

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Care Coordination

Paula Sitzman, RN, BSN

Quality Improvement Advisor CIMRO of Nebraska

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Great Plains Quality Innovation Network- Quality Improvement Organization

  • North Dakota, South Dakota, Nebraska and Kansas
  • A new approach to quality improvement
  • Each state partner working collaboratively
  • Multiple tasks: cardiovascular health, diabetes,

healthcare-associated infections, improvement in immunization rates, health information technology, nursing home quality improvement, quality reporting, care coordination and medication safety

  • Five-year contract with CMS

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Make-Up of the Great Plains QIN

These four states choose to work together because of:

  • Commonalities of Medicare

consumers

  • Provider characteristics
  • Rural and frontier issues
  • Similar corporate

philosophies and general approaches to the QIO work These common factors are strengths in working cohesively

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Care Coordination Goals

  • Reduce hospital admission and readmission rates

by 20% by July 2019

  • Increase community tenure, as evidenced by

number of nights Medicare fee-for-service beneficiaries spend at home, by 10% by July 2019

  • Reduce the prevalence of ADE, ED visits,
  • bservation stays, hospital admissions or

readmissions as a result of the care transition process

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Improving Care Coordination

  • Establish partnerships to improve

communication among hospitals, skilled/LTC nursing facilities, home health agencies, pharmacists, physicians and other community stakeholders

  • Develop partnerships with patients and

families to improve readiness for transitions of care, chronic disease self-management and to reduce medication harm

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Drivers of Readmission

  • Low patient activation
  • Lack of standard, known process
  • Inadequate transfer of information

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Example Interventions: Low Patient Activation

  • Teach-back
  • Patient and family education
  • Chronic disease self-management
  • Knowledge of medications
  • Medication planner
  • Knowledge of “red flags”
  • Personal health record

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Example Interventions: Lack of Standard, Known Process

  • Nurse-to-nurse calls; MD-to-MD calls
  • SBAR
  • Follow-up MD appointments made before

hospital discharge

  • Medication reconciliation by pharmacist
  • Medication education by pharmacist for patients

with high-risk medications

  • Readmission risk assessment
  • Post discharge telephone follow-up with high-risk

patients

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Example Interventions: Inadequate Transfer of Information

  • Communication between senders and

receivers

  • Medication reconciliation
  • Hospital discharge summary to PCP, SNF and

Home Health

  • Patient and family involvement during

transitions

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Example Interventions: Multiple Drivers

  • INTERACT Quality Improvement Program
  • Cross-setting workgroups
  • Home Health Quality Improvement (HHQI)

Best Practice Intervention Packages (BPIP)

  • Project RED (Re-engineered Discharge)
  • Care Transition Intervention(CTI)
  • Advance care planning

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Medication Safety

Jayme Steig, PharmD, RPh

Quality Improvement Specialist - Pharmacy Quality Health Associates

  • f North Dakota

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Medication Safety

17 Source: National Action Plan for Adverse Drug Event Prevention

  • The issue nationally:
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Medication Safety

  • The issue regionally

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State Total Medicare Consumers % at High Risk for ADE Anticoagulants Diabetic Agents Opioids Total Kansas 404,445 6.7% 13.7% 14.5% 25.1% Nebraska 260,660 8.1% 12.2% 11.3% 22.9% North Dakota 97,604 8.4% 14.9% 11.1% 25.6% South Dakota 125,298 7.6% 12.6% 10.6% 22.7% United States 37,079,097 5.8% 13.3% 13.2% 23.8%

Source: 2013 Medicare Part D claims analysis

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Medication Safety Goals

  • Aim - Improve medication safety to reduce

and prevent adverse drug events by implementing practices that align with the National Action Plan for Adverse Drug Event (ADE) Prevention

  • Goal – Reduce the incidence of adverse drug

events by 35% by July 2019

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ADE 35% reduction July 2019

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Medication Safety - Our Approach

  • Practitioners: Multi-disciplinary
  • Pharmacies, hospitals, SNFs, home health, clinics,

hospice, etc.

  • Community-based
  • Including practitioners, stakeholders,

LTSS, consumers & families, etc.

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Medication Safety – Commitment

  • Great Plains QIN provides:
  • Learning and Action Network
  • Facilitation
  • Technical assistance
  • Tools and best practices
  • Data analysis
  • Promote and share resources

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Medication Safety - Commitment

  • Community partners:
  • Collaborate to identify and develop interventions

for medication safety barriers in the community

  • Provide measurement of potential and actual ADE
  • Share data with Great Plains QIN

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Medication Safety Interventions

  • Examples include:
  • Coordinate communication and medication

therapy management

  • Medication reconciliation
  • Medication adherence
  • Consumer and family engagement
  • Use of HIT to screen for ADE
  • Implementation of treatment guidelines
  • Other community defined interventions

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Medication Safety – Immediate Opportunity

  • Complete the Adverse Drug Event

Environmental Scan

  • https://www.surveymonkey.com/r/GPQINADE

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Community Approach

Vanessa Lamoreaux, BA

Project Manager Kansas Foundation for Medical Care

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The Power of People

“I alone cannot change the world, but I can cast a stone across the waters to create many ripples.”

  • Mother Teresa
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Holistic Approach

  • Engaging all aspects of a

local health reality

  • Encourages buy-in
  • Establishes sustainability
  • Enables efficient

resource utilization

  • Expands impact
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Dare To Be Different!

  • Community engagement is:
  • Gaining momentum across a broad spectrum of issues and

funders

  • An opportunity to dive deep to creating lasting change
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Engaging A Community

  • Conduct an

environmental scan

  • Find a champion(s)
  • Define common goals

and vision

  • Build the group
  • Affirm and reaffirm

commitment through action

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Community Organizing as a Movement

A Movement In 3 Minutes

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“What To Expect”

Linda Penisten, RN, OTR/L

Program Manager South Dakota Foundation for Medical Care

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“What to Expect”

  • Exploring evidence-based interventions and

tools

  • Learning through shared “lessons learned”

and best practices

  • Celebrating successes
  • Working collaboratively
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Polling Question - 2

  • Which focus would be most helpful for your

community? (Answer all that apply.)

  • Conducting root cause analysis to better

understand drivers of readmissions

  • Data collection and quality improvement process
  • Improving care coordination
  • Reducing adverse drug events
  • Coalition building and development

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Leave in Action

  • Sign up for the Learning and Action Network
  • http://greatplainsqin.org/lan-signup-page/
  • View website resources
  • Care coordination

http://greatplainsqin.org/initiatives/coordination-care/

  • Medication Safety

http://greatplainsqin.org/initiatives/medication-safety/

  • Complete the Adverse Drug Event Environmental Scan
  • https://www.surveymonkey.com/r/GPQINADE

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Coming Events

August 4, 2015 2:00-3:00 p.m. CT

(1:00-2:00 p.m. MT)

National Benefits, Local Support The QIO Program in ACTION

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Coming Events . . .

October 2015 Webinar Topic: Immunizations Hosted by: CIMRO of Nebraska

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Questions?

Thank you!

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Contact Information

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Vanessa Lamoreaux

vlamoreaux@kfmc.org

Kansas Foundation for Medical Care 2947 SW Wanamaker Drive Topeka, KS 66614-4193 P: 785.271.4120

Paula Sitzman, RN, BSN

paula.sitzman@area-a.hcqis.org

CIMRO of Nebraska 1200 Libra Drive, Suite 102 Lincoln, Nebraska 68512 P: 402.476.1399, Ext. 512

Sally May

sally.may@area-a.hcqis.org

Jayme Steig

jayme.steig@area-a.hcqis.org

Quality Health Associates of North Dakota 3520 North Broadway Minot, ND 58703 P: 701.852.4231

Linda Penisten, RN, OTR/L

linda.penisten@area-a.hcqis.org

South Dakota Foundation for Medical Care 2600 West 49th Street, Suite 300 Sioux Falls, SD 57105 P: 605-444-4124