North Dakota Pharmacists Association - Medication Safety...

Medication Safety Quality Improvement: Collaboration to

Reduce Adverse Drug Events

Jayme Steig, PharmD, RPh Quality Improvement Specialist - Pharmacy Quality Health Associates of North Dakota

Disclosure

“I have had no financial relationship over the past 12 months with any commercial sponsor with a vested interest in this presentation.”

2

Objectives

Review the National Action Plan (NAP) for Adverse Drug Event (ADE) Prevention

Name the three drug classes targeted in NAP and explain the reasons for their inclusion

Compare ADE data at national, state and community level and identify strengths and areas for improvement in North Dakota

Review and discuss current collaborative approaches to prevent ADEs

Formulate opportunities to improve medication safety in your practice

3

Expectations

All teach, all learn

Active participation and discussion

Leave in action

Learn approaches to collaborate and improve medication safety in your practice

4

Background

5

The National Action Plan for Adverse Drug Event Prevention

6

Adverse Drug Event (ADE)

7

Source: National Action Plan for Adverse Drug Event Prevention

Definition

National Action Plan - The Need

8

Source: National Action Plan for Adverse Drug Event Prevention

Nationally

National Action Plan for ADE Prevention

Released in fall 2014 by US Department of Health and Human Services

Modeled after successful National Action Plan to Prevent Healthcare-Associated Infections

Federal interagency steering committee and workgroups

http://www.health.gov/hcq/ade.asp#overview

9

National Action Plan for ADE Prevention

Four-Pillared Approach

• Surveillance

• Prevention

• Incentives and Oversight

• Research

10

National Action Plan for ADE Prevention

High Impact Targets and Populations

• Common

• Clinically significant

• Preventable

• Measurable

11

National Action Plan for ADE Prevention

12

Source: National Action Plan for Adverse Drug Event Prevention

3 targeted drug classes

National Action Plan for ADE Prevention

13

Source: National Action Plan for Adverse Drug Event Prevention

The most vulnerable

• Elderly

• Low health literacy

• Limited access to health care service

• Low socioeconomic status

• Certain minority and ethnic groups

National Action Plan for ADE Prevention

14

Source: National Action Plan for Adverse Drug Event Prevention

National Action Plan – the Goal

Reduce preventable ADEs

The Triple Aim

15

Question to Run On

In what way(s) may the National Action Plan to Prevent ADEs impact your practice?

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Medication Safety Data

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18

240.00

250.00

260.00

270.00

280.00

290.00

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320.00

330.00

340.001

2/1

/20

09

2/1

/20

10

4/1

/20

10

6/1

/20

10

8/1

/20

10

10

/1/2

01

0

12

/1/2

01

0

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/20

11

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/20

11

6/1

/20

11

8/1

/20

11

10

/1/2

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1

12

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1

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/20

12

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12

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12

8/1

/20

12

10

/1/2

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2

12

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01

2

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/20

13

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13

8/1

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13

10

/1/2

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3

12

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01

3

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/20

14

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14

6/1

/20

14

8/1

/20

14

10

/1/2

01

4

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/1/2

01

4

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/20

15

Ad

mis

sio

ns

pe

r 1

00

0 M

ed

icar

e F

FS B

en

efi

ciar

ies

Year Ending

Hospital Admissions

Nation

ND

19

30.00

35.00

40.00

45.00

50.00

55.00

60.00

65.001

2/1

/20

09

2/1

/20

10

4/1

/20

10

6/1

/20

10

8/1

/20

10

10

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01

0

12

/1/2

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0

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/20

11

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11

8/1

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11

10

/1/2

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1

12

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1

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12

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12

6/1

/20

12

8/1

/20

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10

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2

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2

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/20

13

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Re

adm

issi

on

s p

er

10

00

Me

dic

are

FFS

Be

ne

fici

arie

s

Year Ending

Hospital Readmissions

Nation

ND

ADE Surveillance

Types

• Active – Collects data from health records or previously collected information

Technology driven

• Passive – Voluntary reporting to surveillance system

Manual

Example – FDA Adverse Event Reporting System

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Source: National Action Plan for Adverse Drug Event Prevention

ADE Surveillance

Barriers

• Active

Coding not designed for ADE

Cause and effect

• Passive

Manual

Sampling

Voluntary – Underreporting

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Source: National Action Plan for Adverse Drug Event Prevention

ADE Surveillance

Additional considerations

• Reporting requirements

• Severity

• Settings

• Timeliness

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Source: National Action Plan for Adverse Drug Event Prevention

ADE Data

National, Regional, State

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State Total Beneficiaries

% 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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25

263.49

416.32

694.96 741.32

287.46

495.31

872.8

715.67

0

100

200

300

400

500

600

700

800

900

1000

FFS Beneficiaries HRM Benes -Diabetic Agents

HRM Benes -Anticoagulants

HRM Benes - Opioids

Admissions per 1,000 FFS Beneficiaries by Drug Class (CY 2013)

North Dakota Nation

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41.21

80.18

128.83 147.93

51.86

106.18

192.39

158.29

0

50

100

150

200

250

FFS Beneficiaries HRM Benes -Diabetic Agents

HRM Benes -Anticoagulants

HRM Benes - Opioids

Readmissions per 1,000 FFS Beneficiaries by Drug Class (CY 2013)

North Dakota Nation

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The Good News (and the Bad)

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3

11

36

0

5

10

15

20

25

30

35

40

45

50

Diabetic agents Anticoagulants Opioids

Probably Adverse Drug Event Rates (CY 2013) ND’s National Rank (lower is better)

A Broader Picture

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Sources: http://www.cdc.gov/drugoverdose/data/statedeaths.html http://blogs.cdc.gov/nchs-data-visualization/drug-poisoning-mortality/

Community Level Data

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Minot Bismarck Grand Forks Fargo

Probable ADE Rates

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Source: QHA analysis of Medicare Part D and Part A claims 8/1/14 thru 7/31/2015

0.00

20.00

40.00

60.00

80.00

100.00

120.00

140.00

State Bismarck Minot Fargo Grand Forks Outside

Pro

bab

le A

DE

per

10

00

HR

Ben

efic

iari

es

Combined Anticoagulants Diabetic Agents Opioids

Questions to Run On

What are your thoughts after seeing this data?

Have you noticed similar data/trends in your practice?

What is your greatest area of concern in relation to the three targeted high-risk drug classes?

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ADE Prevention Approaches

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ADE Determinants

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Source: National Action Plan for Adverse Drug Event Prevention

ADE Determinants

Underlying drivers

• Communication failures

• Suboptimal management systems

• Inadequate access to medication information

• Low patient activation

What are drivers within your community?

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Source: IPRO. Parade: Preventing and Reducing Adverse Drug Events in Care Coordination Communities (webinar). January 6, 2015.

Improving Medication Safety

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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Example Interventions: Suboptimal Communication/Management

Nurse-to-nurse calls

SBAR

Follow-up MD appointments made before hospital discharge

Medication reconciliation by pharmacist

Readmission risk assessment

Post discharge telephone follow-up with high-risk patients

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Example Interventions: Inadequate Access to Medication Information

Communication between senders and receivers

Medication reconciliation

Patient and family involvement during transitions

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Example Interventions: Low Patient Activation

Teach-back

Patient and family education

Chronic disease self-management

Medication adherence programs

Personal health record

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Example Interventions: Multiple Drivers

INTERACT Quality Improvement Program

Cross-setting workgroups

Project RED (Re-engineered Discharge)

Advance care planning

Medication Therapy Management (MTM)

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Medication Safety Resources

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

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

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Resources and Assistance

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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Area Examples

Medication reconciliation

• Hospital-SNF: Organizational

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0.0

1.0

2.0

3.0

4.0

5.0

6.0

Pharmacist Inpatient Med Rec - Orders per SNF readmit requiring clarification

Orders per readmit requiring clarification - Readmit

Linear (Orders per readmit requiring clarification - Readmit )

Area Examples

Medication reconciliation

• Hospital-SNF: Collaborative

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0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15

SNF Cover Sheet - Orders per readmit requiring clarification

Orders per readmit requiring clarification - Readmit

Linear (Orders per readmit requiring clarification - Readmit)

Area Examples

More Hospital-SNF collaboration

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15.7% 15.2%

15.9%

13.9% 14.1% 13.2%

11.0% 10.7% 10.1%

11.3%

14.5% 14.2% 13.8%

14.0% 14.2% 14.3%

15.7% 15.8%

14.3% 13.9%

6%

8%

10%

12%

14%

16%

18%

Rea

dm

issi

on

Rat

e

1 - Year Period Ending

Readmission Trends - Workgroup SNFs vs. Other SNFs

Workgroup SNFs All Other SNFs

Area Examples

ADE screening as part of medication adherence program - Pilot

Improving anticoagulation education

Increasing awareness of community resources

HEN – Inpatient and admission ADE tracking

SD – PMP utilization

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Great Plains QIN ADE Environmental Scan

WHAT: A tool to collect information regarding current status of medication safety efforts to detect and prevent Adverse Drug Events (ADE) within the Great Plains Quality Innovation Network (QIN)

HOW: Link to environmental scan placed on the Great Plains QIN website during July and August 2015 and emails sent to providers and stakeholders

WHO: Distributed to providers and stakeholders within the Great Plains QIN (Kansas, Nebraska, North Dakota and South Dakota)

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Overview – Great Plains

48

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Electronic Manual Other

Most track ADEs via electronic records

Overview – all settings

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ND Responses

Use of data

• P&T/Medication safety committee review

• RCA on each event with aggregate reporting for trending

Barriers

• Time/resources

• Turnover

• Pharmacist availability (CAH, SNF)

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ND Responses

Current initiatives

• Increase med rec reviews

• Bar coding

• Anticoagulant (INR w/antibiotic starts)

• Opioids (staff training, Narcan availability)

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Question to Run On

What are some examples of your involvement in medication safety initiatives?

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Reflection & Action

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Learning Assessment

Which three drug classes are targeted in the NAP for ADE preventions?

Why were these 3 classes chosen?

Which drug class does ND have higher probable ADE rates than national average?

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Questions to Run On

What action will you take to reduce ADEs in your practice?

What will you do in the next seven days to start this effort?

Name one community partner you will contact in the next two weeks regarding collaborative efforts to improve medication safety.

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Action Plan Exercise

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Action Plan Example

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Leave in Action

Follow through on Action Plan

Sign up for the Learning and Action Network • http://greatplainsqin.org/lan-signup-page/

• Medication safety, care coordination, immunization, diabetes, and others

View website resources • Care Coordination

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

• Medication Safety

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

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Contact Information

Jayme Steig, PharmD, RPh Quality Improvement Specialist-Pharmacy

P: 701-240-8135 jayme.steig@area-a.hcqis.org

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Quality Health Associates of North Dakota 3520 North Broadway

Minot, ND 58703 P: 701.852.4231

www.greatplainsqin.org

Thank You!

This material was prepared by the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, 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. 11S0W-GPQIN-ND-C3-43/0216