IHI Expedition Expedition: Improving Medication Safety from the - - PowerPoint PPT Presentation
February 26, 2015 These presenters have nothing to disclose IHI Expedition Expedition: Improving Medication Safety from the Patients Perspective Session 1: Improving Polypharmacy E. Robert Feroli Jr., PharmD, FASHP Amanda Brummel,
Expedition: Improving Medication Safety from the Patient’s Perspective Session 1: Improving Polypharmacy February 26, 2015
These presenters have nothing to disclose
PharmD, FASHP Amanda Brummel, PharmD, BCACP Frank Federico, RPh Joelle Baehrend
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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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Name and the Organization you represent Example: Sam Jones, Midwest Health
Please send your message to All Participants
Where are you joining from?
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For more information or to enroll, email Passport@ihi.org
By joining Passport, your entire staff gets access to a wide range of web-based tools to help prioritize, deploy, and accelerate your improvement initiatives without leaving your desks. Passport membership will:
multiple teams closest to the point of care as they make rapid improvements in the areas of greatest concern to hospitals today.
nurses, and pharmacists.
use of your resources.
renowned experts in the following topics
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Improvement Capability
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Patient Safety
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Person- and Family-Centered Care
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Triple Aim for Populations
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Quality, Cost, and Value
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Leadership
nurses, physicians, and pharmacists. NAHQ has also approved the courses for CPHQ CE credit.
completion of 16 foundational course.
Passport Members
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ex•pe•di•tion (noun)
purpose
Joelle Baehrend, Fellowship Director, IHI, is also a developer for IHI’s Patient Safety Focus Area. She was previously a project manager for the 100,000 Lives Campaign and platform lead for the 5 Million Lives
participation on IHI’s business team, product development, including the satellite broadcast of IHI’s National Forum on Quality Improvement in Health Care, as well as project management for the Improving Flow Through Acute Care Settings IMPACT Community. Baehrend received a Master of Arts in English literature from Indiana University of Pennsylvania in 1996 and served as adjunct faculty at Massasoit Community College before joining IHI in 2000.
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What is your goal for participating in this Expedition?
Please send your message to All Participants
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learn”
encouraged!
At the conclusion of this Expedition, participants will be able to:
Explain the importance of including patients and their families in efforts to improve medication safety Identify different approaches to improve medication safety Describe examples of medication safety improvement efforts at other organizations Plan tests of change to begin or continue medication safety improvement
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Session 1 – Improving Polypharmacy Date: Thursday, February 26, 1:00 – 2:30 PM Eastern Time Session 2 – Health Literacy and Medication Safety Date: Thursday, March 12, 1:00 – 2:00 PM Eastern Time Session 3 – Improving Medication Adherence Date: Thursday, March 26, 1:00 – 2:00 PM Eastern Time Session 4 – Medication Reconciliation Date: Thursday, April 9, 1:00 – 2:00 PM Eastern Time Session 5 – Safe Management of Newly Released Anticoagulants and High-Alert Medications Date: Thursday, April 23, 1:00 – 2:00 PM Eastern Time
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Model For Improvement: Your Engine for Change
Safety from the Patient’s Perspective Pre- Survey
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Top three barriers to improving medication safety:
resolving discrepancies; identifying the most reliable list)
Top two barriers to engaging patients in this work:
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Points of pride in improving medication safety:
pumps CPOE, barcoding
What are you hoping to learn in this Expedition?:
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My hospital has a process to address medication management and reduce polypharmacy where appropriate.
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Frank Federico, RPh, Executive Director, Strategic Partners, Institute for Healthcare Improvement (IHI), works in the areas of patient safety, application of reliability principles in health care, preventing surgical complications, and improving perinatal care. He is faculty for the IHI Patient Safety Executive Training Program and co-chaired a number of Patient Safety
Director of the Office Practice Evaluation Program and a Loss Prevention/Patient Safety Specialist at Risk Management Foundation of the Harvard Affiliated Institutions, and Director of Pharmacy at Children's Hospital, Boston. He has authored numerous patient safety articles, co-authored a book chapter in Achieving Safe and Reliable Healthcare: Strategies and Solutions, and is an Executive Producer of "First, Do No Harm, Part 2: T aking the Lead." Mr. Federico serves as Vice Chair of the National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP). He coaches teams and lectures extensively, nationally and internationally, on patient safety.
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pharmacist at Johns Hopkins Hospital for 36 years and has served as a Medication Safety Officer for the past 11 years. He established a Medication Use Safety Pharmacy Residency (accredited by ASHP). Dr. Feroli teaches on topics
and has faculty appointments at the Johns Hopkins University Schools of Medicine and Nursing, and the University Of Maryland School Of Pharmacy. Dr. Feroli also participates in error prevention efforts, investigations of errors, and serves as chairman of the Medication Error Reduction Implementation T eam (MERIT). He also works with 12 international hospitals that have formed affiliations with Johns Hopkins on using the medication use system to improve safety, efficiency, therapeutic appropriateness, and compliance with Joint Commission International (JCI) standards.
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Amanda Brummel, PharmD, BCACP serves as the Director of Clinical Ambulatory Pharmacy Services. Dr. Brummel has been employed by Fairview Pharmacy Services since 1999 when she graduated from the University of Minnesota. While at Fairview, she has built and practiced Medication Therapy Management (MTM) in multiple clinic locations, was the clinical supervisor for the MTM department, the MTM Operations & Program Manager. Currently Dr. Brummel has responsibility for the MTM program, the clinical development and integration of pharmacy services in the Fairview Health Network including our transitions of care approach and our retail clinical services. She works closely with the Fairview Medical Group and the Fairview Network in our population health approach and new payer product development. Dr. Brummel is also an Adjunct Associate Professor at the University of MN. She has published multiple articles on MTM and pharmacy’s role in the care team. She has chaired and served on multiple committees and is a current member of the Minnesota Pharmacists Association, the American Society of Health-System Pharmacists, the American College of Clinical Pharmacy and Pharmacy Quality Alliance (PQA).
Medication Safety Officer Department of Pharmacy Johns Hopkins Hospital
National Center for Health Statistics Data Brief No.42 Sept 2010
clinically appropriate medications generally goes up.
related problems go up
– Adverse drug effects – Drug – Drug interactions – Drug – Disease interactions – Possibility of medication errors – Poor adherence – Cost of therapy – Poor quality of life (e.g., pill burden)
Homoeopathy Polypharmacy - A prescription of many drugs in one compound
Illinois and Indiana Medical and Surgical Journal, Volume 1, Issue 1 (1846) Reform Practical Therapeutics Agenda item #6 – “To endeavor to substitute for the monstrous system of Polypharmacy now universally prevalent, one that is, at least, vastly more simple, more intelligible …”
I take aspirin for the headache caused by the Zyrtec I take for the hayfever I got from Relenza from the uneasy stomach from the Ritalin I take for the short attention span caused by the Scopederm Ts I take for the motion sickness I got from the Lomotil I take for the diarrhea caused by the Zenikal for the uncontrolled weight gain from the Paxil I take for the anxiety from the Zocor I take for my high cholesterol because exercise, a good diet, and regular chiropractic care are just too much trouble.
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Image reproduced with permission
I take aspirin for the headache caused by the Zyrtec I take for the hayfever I got from Relenza from the uneasy stomach from the Ritalin I take for the short attention span caused by the Scopederm Ts I take for the motion sickness I got from the Lomotil I take for the diarrhea caused by the Zenikal for the uncontrolled weight gain from the Paxil I take for the anxiety from the Zocor I take for my high cholesterol because exercise, a good diet, and regular chiropractic care are just too much trouble.
.C.)
Image reproduced with permission
Bushart RL, Massey EB, et.al., Polypharmacy; Misleading, but manageable. Clinical Interventions in Aging 2008:3(2) 383-389 Review of literature Jan 1997 – May 2007
– Potentially Inappropriate
Bushart RL, Massey EB, et.al., Polypharmacy; Misleading, but manageable. Clinical Interventions in Aging 2008:3(2) 383-389 Review of literature Jan 1997 – May 2007
– Potentially Inappropriate
Bushart RL, Massey EB, et.al., Polypharmacy; Misleading, but manageable. Clinical Interventions in Aging 2008:3(2) 383-389 Review of literature Jan 1997 – May 2007
Potentially Inappropriate
Potentially Inappropriate
Potentially Inappropriate
Potentially Inappropriate?
Potentially Inappropriate?
– Therapeutically appropriate therapy vs. patient's ability to adhere to therapeutic regimen
Potentially Inappropriate?
– Therapeutically appropriate therapy vs. patient's ability to adhere to therapeutic regimen » The simplest most appropriate therapeutic regimen for a particular patient may be too complex for them to follow.
Potentially Inappropriate?
– Therapeutically appropriate therapy vs. patient's ability to adhere to therapeutic regimen » The simplest most appropriate therapeutic regimen for a particular patient may be too complex for them to follow. » We must use a risk : benefit approach to find the most appropriate therapy given the patient’s values and ability to adhere to the chosen regimen.
– Clinical Appropriateness – Safety – Affordability – Ease of use – Patient’s ability & willingness to adhere
– Reconciliation: Based on the response from medications taken “yesterday.” What, if any, changes are appropriate going forward.
– Polypharmacy (e.g., patient on more than x drugs) – IHI trigger tool – Beer’s criteria – STOPP (Screening Tool of Older People’s Prescriptions) – START (Screening Tool to Alert to Right Treatment)
Seek the “sweet spot”
Amanda Brummel PharmD, BCACP Director, Clinical Ambulatory Services Fairview Pharmacy Services
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February 26, 2015
Practitioners’ responsibilities:
to meet those needs
appropriately indicated, the most effective, the safest and the patient is compliant
patient’s care team
Pharmacy Strategies
Built upon the philosophy and process of “pharmaceutical care practice”
ASSESSMENT CARE PLAN EVALUATION
indicated, effective, safe and convenient
problems
problems
problems
meeting therapeutic goals
Continuous Follow-up
Working in collaboration with all members of the healthcare team
therapy
Meet the patient
experience, clinical information
Elicit relevant information
convenience
Make drug therapy decisions
INDICATION
EFFICACY
SAFETY
COMPLIANCE
Establish goals of therapy
Interventions: DTP resolutions, achieving goals of therapy, achieving patient goals prevention of DTP
appropriate
Schedule follow-up evaluation
therapy
Compare actual patient outcomes to goals
to adhere to therapy
Monitor for adverse effects and compliance
status and drug therapy
Assess for new drug therapy problems
Schedule next follow-up
2014
Dosage Too Low 31 % Needs Additional Drug Therapy 21 % Noncompliance 15 % Adverse Drug Reaction 11 % Dosage Too High 10 % Unnecessary Drug Therapy 8 % Ineffective Drug 6 %
health-care costs, documented in “Clinical and Economic Outcomes
Experience” (Isetts, et al., J Am Pharm Assoc. 2008;48(2):203-211)
documented in “Optimal Diabetes Care Outcomes Following Face- to-Face Medication Therapy Management Services” (Brummel A.R. et al, Population Health Management: 2012)
integrated health care system. (Ramalho de Oliveira, D., Journal of Managed Care Pharmacy : JMCP, 16(3), 185-195.)
$0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000
Facilities (-57.9%) Professional (-11.1%) Prescriptions (+ 19.5%) Total Cost (-31.5%)
1 Year before MTM 1 Year after MTM
Isetts, et al., J Am Pharm Assoc. 2008;48(2):203-211
2006 Pre-MTM, 2007 MTM, 2008 Post-MTM
“Optimal Diabetes Care Outcomes Following Face-to-Face Medication Therapy Management Services” (Brummel A.R. et al, Population Health Management: 2012)
Measure of patient’s knowledge, skills, and ability to manage their health
Steps patients take on their own Combines ‘activation’ with interventions
Patient’s condition, treatment options, the medical evidence behind treatment options, risks and benefits, and patients’ preferences, arrive at treatment plan
Robert Wood Johnson Foundation. Patient Engagement. February 14, 2013. http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_86.pdf. Accessed September 5, 2014.
Patients who had decision-making support
costs were 5.3% lower
fewer hospital admissions
fewer preference-sensitive heart surgeries
the greatest gains
than patients with Level 2-4
Some variance by condition
higher than Level 4
than Level 4 Caveat: Predicted costs were no different for patients at Level 2-4
Health Affairs, 32, no.2, 2013. Judith H. Hibbard. Patients With Lower Activation Associated With Higher Costs. http://content.healthaffairs.org/content/32/2/216.full.html. Accessed September 7, 2014.
Look to make sure each medication is
choosing their medication therapy
drug therapy problems
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Raise your hand Use the chat
Research and consider what your facility has in place to optimize medication use and minimize polypharmacy.
– Please be prepared to share on our next session
MedicationSafety@ls.ihi.org
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Thursday, March 12, 1:00 PM ET
Health Literacy and Medication Safety
Gail Nielsen, BSHCA, FAHRA Fellow and Patient Safety Scholar at IHI
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Joelle Baehrend jbaehrend@ihi.org Dorian Burks dburks@IHI.org
Please let us know if you have any questions or feedback following today’s Expedition webinar.
Improvement in Health Care http://www.ihi.org/resources/Pages/AudioandVideo/MikeEv ansVideoQIHealthCare.aspx
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What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement?
Model for Improvement
Act Plan Study Do
Aim of Improvement Measurement
Improvement Developing a Change Testing a Change
Adapted from Langley, G. J., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. The Improvement Guide: A Practical Approach to Enhancing Organizational
Medical Model Collect signs and symptoms Develop a treatment plan Prescribe the plan Collect signs and symptoms to determine if there is improvement Model for Improvement Collect pre-data to understand the extent of the problem Select process changes to be tested Test the changes Collect post-data to determine if there is improvement
improvement
expected from the change
the local environment
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Hunches Theories Ideas Changes that Result in Improvement
A P S D A P S D
Very Small Scale Test Follow-up Tests Wide-Scale Tests
Implementation of Change Sequential building of knowledge under a wide range
Spread
Transfusion Administration Safety Communication and Awareness Strategies Engaging with Leadership
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Implementing Transfusion Guidelines
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Raise your hand Use the chat