IHI Expedition Expedition: Making Mental Health Care Safer in the - - PDF document

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IHI Expedition

Expedition: Making Mental Health Care Safer in the Hospital Setting Session 4: Medication Safety January 26, 2015 David Hall Brian Bjørn Loriann Rizzuto Kelly McCutcheon Adams

Today’s Host

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Dorian Burks, Project Coordinator, Institute for Healthcare Improvement, is a current coordinator for web-based Expeditions. He also contributes to the IHI work in the Triple Aim and Improvement Capability focus areas, as well as the Leading Quality Improvement series. Dorian is a member of the Diversity and Inclusion Council at IHI, where he and fellow staff members develop strategies to enhance IHI’s inclusive culture, both internally and externally. Dorian graduated from Massachusetts Institute of Technology in Cambridge, MA where he received his Bachelor of Science degree in Biology and humanities concentration in Anthropology.

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Audio Broadcast

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Phone Connection (Preferred)

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To join by phone: 1) Click on the “Participants” and “Chat” icon in the top, right hand side of your screen to open the necessary panels 2) Click the button on the right hand side of the screen. 3) A pop-up box will appear with the option “I will call in.” Click that option. 4) Please dial the phone number, the event number and your attendee ID to connect correctly .

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Audio Broadcast vs. Phone Connection

If you using the audio broadcast (through your computer) you will not be able to speak during the WebEx to ask question. All questions will need to come through the chat. If you are using the phone connection (through your telephone) you will be able to raise your hand, be unmuted, and ask questions during the session. Phone connection is preferred if you have access to a phone.

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Expedition Director

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Kelly McCutcheon Adams, LICSW has been a Director at the Institute for Healthcare Improvement since 2004. Her primary areas of work with IHI have been in Critical Care and End of Life Care. She is an experienced medical social worker with experience in emergency department, ICU, nursing home, sub- acute rehabilitation, and hospice settings. Ms. McCutcheon Adams served on the faculty of the U.S. Department of Health and Human Services Organ Donation and Transplantation Collaboratives and serves on the faculty of the Gift of Life Institute in

• Philadelphia. She has a B.A. in Political Science from

Wellesley College and an MSW from Boston College.

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Today’s Agenda

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Welcome Action Period Assignment Debrief Medication Safety Action Period Assignment Closing

Expedition Objectives

At the conclusion of this Expedition, participants will be able to: Explain the importance of partnering with patients and their families to improve safety for patients with mental health conditions Identify different areas to improve mental health care safety Describe examples of improvement efforts at other

• rganizations

Plan tests of change to begin or continue patient safety improvement

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Schedule of Calls

Session 1 – Partnering with Patients and Families Date: Tuesday, December 2, 1:00 - 2:30 PM Eastern Time Session 2 – Making the Physical Environment Safer Date: Tuesday, December 16, 1:00 - 2:00 PM Eastern Time Session 3 – Why Flow Matters Date: Tuesday, January 13, 1:00 - 2:00 PM Eastern Time Session 4 – Medication Safety Date: Tuesday, January 27, 1:00 - 2:00 PM Eastern Time Session 5 – Ensuring Staff Preparedness Date: Tuesday, February 10, 1:00 - 2:00 PM Eastern Time Session 6 – Being Proactive and Avoiding Crises Date: Tuesday, February 24, 1:00 - 2:00 PM Eastern Time

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Action Period Assignment Debrief

Sharing examples of changing hospital flow to improve mental health safety

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Medication Safety

David Hall, Brian Bjørn, Loriann Rizzuto

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Faculty

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David Hall has been a Consultant Psychiatrist and Clinical Director in South Scotland for over 20 years. His clinical work now focuses on Forensic and Rehabilitation Psychiatry. He has had a number of National and International roles, leading Scottish work to reduce psychiatric readmissions, and more recently Clinical Lead for the Scottish Patient Safety Programme in Mental Health. He is also IHI Faculty lead for the Danish Safer Hospitals Programme in Mental Health.

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Faculty

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• Dr. Brian Bjørn is a physician and public

health specialist. He is an independent quality improvement consultant and former Director of the Danish Patient Safety Program for Mental

• Health. Brian has served in different roles in

collaboratives for perinatal, community and acute care quality improvement. He is a member of the Scientific Advisory Board for the Federal Quality Strategy for the Swiss Health Care System and an Assistant Lecturer on healthcare quality improvement at the University of Copenhagen Medical School.

Faculty

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Lori Ann Rizzuto, Director of Behavioral and Integrative Health Services, has 30 years of experience in behavioral health, twelve of which have been at Atlantic Health System developing cost-effective, quality behavioral health programs, and supervising operations and staff. Within the four hospital system, Lori has administrative oversight of daily operations of inpatient behavioral health units, Crisis Intervention Services in the ED and outpatient behavioral health services. This includes over 250 staff and 30 undergraduate and graduate interns. Before joining Atlantic Health System, Lori held Leadership positions at other hospitals, overseeing clinical and business development areas. Lori holds a Master of Social Work degree from Adelphi University School of Social Work and a Bachelor of Arts degree in Psychology from Queens College.

4/27/2015 9 The Scottish Patient Safety Programme- Mental Health Safer Medicine Management Workstream

Staff feel and are safe, patients are and feel safe

4/27/2015 10 With a focus on adult psychiatric inpatient units, including admission and discharge processes

Year Zero (Pre work)

Jan 12 – Aug 12

Year One (Testing)

Aug 12- Sep 13

Year Two

Sep 13 – Sep 14

Years Three and Four

Sep 14 – Sep 16

SPSP-MH Workstreams

Safer Medicines Management Risk Assessment and Safety Planning Restraint and Seclusion Communication at Transitions Leadership and Culture

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Change Action Package Spread

(Oct 2013)

Risk Assessment and Safety Planning – 11 Boards 22 Wards Restraint, Seclusion and Emergency Sedation – 9 Boards 24 Wards

Communications at Transitions – 9 Boards 23 Wards Safer Medicines Management – 12 Boards 30 Wards

Safer Medicines Management

• Error free prescribing
• Management/ monitoring high risk medicines
• Management/ monitoring ‘as required’

medicines

• Medicines reconciliation

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Medicines reconciliation NHS Grampian

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% May-13 Jan-14 Jun-14 Sep-14

Successful meds rec

Successful meds rec

Successful meds rec

• Training
• Communication
• Training
• New form
• Training!

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Danish Patient Safety Program for Mental Health

Workstreams

• Clinical

– Medicines – Physical comorbidity – Reduction in use of mechanical restraint – Suicide prevention

• Organizational

– Patient and carer engagement – Leadership for improvement

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7 psychiatric hospitals

Percent patients with all elements of med rec bundle

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Friday afternoon coffee. Staff and patients discussing improvement work.

Communication Transparency Visibility Keep it simple!

4/27/2015 16 Atlantic Behavioral Health Monitoring Metabolic Syndrome

Lori Ann Rizzuto, L.C.S.W. Director, Behavioral & Integrative Health Services

Why is it important to monitor second generation antipsychotics?

Antipsychotic medications are an important part of the treatment

• f many psychotic conditions.

Up to 83% of persons with serious mental illness in the US are

• verweight or obese.

All atypical antipsychotics carry a risk of metabolic disturbance There are considerable benefits, but there are still some potential modifiable risks:

• Overweight/obesity
• Diabetes
• Dyslipidemia
• Cardiovascular disease

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4/27/2015 17 Which medications are we talking about?

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Zyprexa (Olanzapine) Seroquel (Quetiapine) Geodon (Ziprasidone) Abilify (Aripiprazole) Risperdal (Risperidone)

Risk factors for developing Metabolic Syndrome

• Weight (BMI > 25)
• High LDL (“bad cholesterol”) and Low HDL (“good

cholesterol”)

• High blood pressure (above 120/80)
• Family history of diabetes
• Increased age
• Tobacco use
• Heavy alcohol use
• Stress
• Sedentary life-style
• High fat diet

And the use of atypical anti-psychotics increases the risk

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Obtain baseline and periodic monitoring Weight Fasting plasma glucose Fasting lipids Cognitive restructuring Relapse management

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Where to start…

Canadian Journal of Psychiatry, Vol.51, No 8, July 2006, p498 36

4/27/2015 19 What did we do

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What did we do?

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Plan

• Literature review
• Benchmarking
• Brainstormed
• Flow charted the process
• Forced field analysis to identify barriers to monitoring

Do

• Worked with medical staff to develop form
• Educated staff on form
• Implemented monitoring process
• Began monitoring compliance to process

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More of what we did…

Study & Act Compliance for completing the form and ordering blood work was excellent at one site but below acceptable level at another site Brainstormed #1 Idea -start with a pilot study

• We have control over the process for

patients being transferred from our inpatient programs to our outpatient programs

• Discharge information contains medication

information

• If needed, the doctor orders fasting lipid

levels while the patient is still an inpatient

• Lab work is either faxed to the outpatient

program or is available through the hospital database

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4/27/2015 21 Questions?

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Questions/Discussion

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Raise your hand Use the chat

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Action Period Assignment

Please think about times when you have made improvements to medication safety for patients with mental health issues

– Share via information about these efforts via the

listserv before next session: MentalHealthSafety@ls.ihi.org

Expedition Communications

Listserv for session communications: MentalHealthSafety@ls.ihi.org To add colleagues, email us at info@ihi.org Pose questions, share resources, discuss barriers or successes

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Next Session

Session 5 – Ensuring Staff Preparedness

Tuesday, February 10th, 1:00 – 2:00 EST

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