Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
1
We Heal, We Teach, We Discover, We Care
Developing a Medication Safety Strategic Plan
Marc R. SummerfieldDirector of PharmacyUniversity of Maryland Medical CenterTimothy J. Babineau MDSenior Vice-President, Chief Medical OfficerUniversity of Maryland Medical Center
Maryland Patient Safety Center Fourth Annual Confer enceBaltimore, Maryland Thursday, March 20, 2008
Outline
• Overview of the Medical Center
• Overview of Pharmacy
• Why do a Strategic Plan?
• Assessing Current State
• Developing a Strategic Plan
• Execution
2
University of Maryland Medical System
University of Maryland, BaltimoreUniversity of Maryland, Baltimore
School of LawSchool of Law
School of Social WorkSchool of Social Work
School of DentistrySchool of Dentistry
School of PharmacySchool of Pharmacy
School of NursingSchool of Nursing
School of MedicineSchool of Medicine
Professional Schools
University Physicians, Inc.Faculty Practice Plan
University Physicians, Inc.Faculty Practice Plan
University of Maryland Medical System
UMMS Board of DirectorsUMMS Board of Directors
University of Maryland Medical Center
University of Maryland Medical Center
University Hospital
Greenebaum Cancer Center
Shock Trauma Center
Programmatic Joint Ventures
UniversityCARE, LLCUniversityCARE, LLC
The University of Maryland Medical System (UMMS) is governed by a board of directors and is neither owned by the State of Maryland nor governed by the University of Maryland. The University of Maryland Medical Center (UMMC) is a private, not-for-profit hospital,
serving the State of Maryland and Baltimore City with a full continuum of services. UniversityCARE is a partnership between UMMC and University Physicians, Inc. operating primary care centers in West Baltimore and multispecialty satellites.
6,031 Employees
689 Licensed Beds
32,278 admissions
551 ADC
5.6 ALOS
155,000 outpatient visits
18,095 Surgeries
64,458 ER Visits
General
Founded in 1823 as the Baltimore Infirmary, the University of Maryland Medical Center is one
of the nation's oldest teaching hospitals. Located on the west side of downtown Baltimore, the Medical Center provides highly specialized tertiary and quaternary care for the entire state
and region and comprehensive care for the West Baltimore community. UMMC provides a
broad range of inpatient and outpatient services and functions as the primary teaching
hospital for five professional/graduate schools of the University of Maryland.
Medical Staff
All members of the medical staff at UMMC are members of the faculty of the School of Medicine or the School of Dentistry. The majority of the active admitters to UMMC are
salaried full-time faculty of these schools. As of January, 2008, there were 1,071 clinical
faculty on the medical staff.
Services Provided
UMMC offers a broad range of primary, secondary, tertiary and quaternary services
complemented by extensive education and research activities. In addition to meeting the medical needs of its immediate service area, UMMC serves as a tertiary and quaternary
referral center for the State and Mid-Atlantic region and considers itself a national leader in
the following specialties: solid organ transplantation, bone marrow transplantation, trauma
care, cardiac care, oncology, neonatal and high risk obstetrics, and innovative laparoscopic
surgery.
University of Maryland Medical Center
3
Pharmacy Overview:
• Pharmacist FTEs (including managers and clinical specialists): 83
• Technician FTEs: 105
• Support Personnel FTEs: 12
• Number of Unit Doses Per Day: ~15,000
• Number of IV Admixtures Per Day (including first do ses manually picked): ~900
• Omnicell® Doses Per Day: ~11,200
• Robot Picks Per Day: ~4000
• Number of TPNs Per Day: ~ 50
• Drug Cost Per Day: ~ $170,000
Pharmacy Overview: Centralized/Decentralized Model
– Centralized Operations:
• IV Admixture (Intellifill®);
• 24-hour cartfill (McKesson Robot-Rx®);
• Compounding/Repackaging
– Decentralized Satellites:
•Women’s & Children’s (“Peds”); Greenebaum Cancer Center (2); Gudelsky; Weinberg; Shock/Trauma; O.R. Pharmacy
– Omnicell® unit-based cabinets:
• 144 cabinets including Anesthesia Carts for O.R.’s
4
Pharmacy Overview: Heavy Focus on Technology
• Cerner PharmNet Millennium®: CPMOE*CPMOE*
• Omincell® Unit-Based Cabinets with Safety StockSafety Stock ®®**
• Omnicell® Anesthesia WorkStations
•• McKesson RobotMcKesson Robot --RxRx®®** and Intellifill®
• TUGs®
•• IV TrackIV Track ®®:: bar-coded matching of patient label with pre-mixed IVs
• QS/1 NRx® Ambulatory Care Software
•• ScriptProScriptPro ®® Ambulatory Care RobotAmbulatory Care Robot
• WebFormulary® and WebIDS®
• VasTech Scheduling Software®
• Medication Area Inspection Database: Medkeeper®
• Pharmacy OneSource® Quantifi®
• Valimed® controlled substances waste verification
Why do a Strategic plan?
• Improves organizational focus among all stakeholders
• Promotes collaboration across the entire organization
• Defines measures of success and failures
• Translates strategies into programs, projects and products
• Fosters accountability among participants.
5
To Err is Human: Building a Safer Health System
• IOM releases report : 11/99
• Deaths due to medical errors are between the 4th an d 8th leading cause of death in the United States.
• Medication errors account for > 7000 deaths/year(incorrect prescribing or dispensing of drugs)
• Almost 2% of admissions experience adverse drug event
• Increased hospital cost of $4,700 per ADE.
Medication Safety will remain one of the majorpatient safety challenges of the next decade
The Five Tasks of Strategic Planning
• Developing a Vision and a Mission
• Setting Objectives
• Crafting a Strategy
• Implementing and Executing Strategy
• Evaluating Performance, Reviewing the Situation and Initiating Corrective Action
6
Three Big Strategic Questions
• Where Are We Now?
• Where Do we Want to Go?
• How Will We Get There?
Or . . . What is the “goal”?
Strategic Planning
•A vision with a task is but a dream
•A task without a vision is drudgery
•A vision and a task can change the world.
From a church in Sussex, England. C. 1730.
7
What is the goal? What is our Mission and Vision?
• Mission: To provide standard-setting, proficient, and compassionate pharmaceutical care services to the patients, health care professionals, and employees of the University of Maryland Medical Center.
• Vision: To become a national leader in developing innovative methods for ensuring the safest medication practices anywhere.
Nine priority areas of focus that contribute to our mission• Create, communicate and demonstrate a leadership-dr iven
culture of safety.
• Improve error detection and reporting and use of th e informationto improve medication safety.
• Optimize control and storage of medications for med ication safety (including purchasing).
• Design and execute the Prescribing function to opti mize medication safety.
• Design and execute purchasing and Dispensing (inclu ding delivery process to optimize medication safety).
8
• Design Medication Administration process to optimiz e medication safety.
• Enhance the quality and accessibility of medication -related information and the communication of information to optimize medication safety.
• Standardize protocols and processes to optimize saf ety. Optimize medication safety for special patient popu lations (pediatrics/oncology).
• Maintain and improve existing processes and program s that contribute significantly to medication safety.
Nine priority areas of focus that contribute to our mission
Planning a Strategic Planning Retreat
• Multidisciplinary
• Off-site
• All Day
• Guest Speaker
9
Program: December 15, 2006• Welcome and Purpose: Marc Summerfield
• Building a Culture of Safety: Dr. Tim Babineau
• Medication Errors: a Review: Kasey Thompson, ASHP
• Applying Automation for a Safer Medication Use Process:
Mark Neuenschwander
• Models and Principles of Medication Safety: Marc
Summerfield
• Role of Human Factors in Patient Safety: Jake Seagull, PhD
• CPMOE: Update
• MEADE: Three Years of Accomplishments and Lessons
Learned
• Work sessions throughout the day on the nine priority areas
University of Maryland Medical Center Pharmacy Department
Medication Safety
Strategic Plan
10
•Appoint a point-person (leader) for the Medication Safety Strategic Plan.Status: Done: Susan Carey, Professional Development Coordinator.
•Appoint a nurse medication safety champion; we have physician champions (CMO; Co-chair of MEADE) and a pharmacy and overall champion (MSO).Status: Done: Ronetta Lambert, RN.
Create, communicate, and demonstrate a leadership-driven Culture of Safety
1
Create, communicate, and demonstrate a leadership-driven Culture of Safety•Evaluate the hospital’s mission/vision/values statements to accurately reflect the strategic emphasis on patient safety, including medication safety.
Status: Done: Values statement is expressed by our “Commitment to Excellence”program—where ”Safety and Quality”is one of the five pillars.1
11
Create, communicate, and demonstrate a leadership-driven Culture of Safety•Disseminate the “Striking the Right Balance”model to depict the challenge in achieving the proper balance between Medication “Control”(Safety/Security/ Compliance) issues and “Access” (Timeliness/Convenience/Flexibility) issues.
1 Goal: To Achieve the desired level of Control of medications without sacrificing Access to medications.
Control
Compliance
Security
Safety
Access
Convenience
Timeliness
Flexibility
Achieve the desired level of Control of medications
without sacrificing Access to medications.
Striking the BALANCE in Medication Use
1
12
Improve Error Detection and Reporting and use of the information to improve
medication safety.
•Install an on-line medication error and adverse drug event reporting hospital-wide. Status: Done: RiskMaster® linked to MedMarx®.
2
Improve Error Detection and Reporting and use of the information to improve medication safety.
•Investigate use of the observational methodology to enhance medication error detection during drug administration and to establish a credible medication error rate for trending and benchmarking.Status: Pursuing AU Meds®.2
13
Optimize Control and Storage of medication safety (including purchasing).
•Implement barcode-based Omnicell Safety Stock®automation hospital-wide to improve accuracy of Omnicell® stocking and withdrawing and returning.Description: SafetyStock™—a patient safety feature for preventing restock, issue, and return errors; uses bar code scanning as a secondary checking methodology for tracking medication ingress and egress from the system. Status: Expanding PICU Pilot.3
Optimize Control and Storage of medication safety (including purchasing).
3
14
Design and execute the Prescribing function to optimize medication safety.
•Pursue e-prescribing for discharge and clinic-based at-home-use medications.
Status: The Epic® portfolio project is in final stages of purchase and integration of the Sure Scripts®product, which does e-prescribing. This is the solution for ambulatory care and the future solution for discharge. 4
Design and execute the Prescribing function to optimize medication safety.
•Implement Computerized Prescriber Medication Order Entry.
Status: Done!Fully-integrated/linked: universal access; prescriber order entry with electronic pharmacist order verification; access to lab data; access to non-medication orders (diet, wound care), and e-MAR.
4
15
Design and execute purchasing and preparation and Dispensing process (including delivery) to optimize
medication safety.
•Expand Robot-Rx® functionality to dispense 50% of all first doses from the Robot by July 2008.
Status: Pilot. Implement “forcing function.”5
Design and execute purchasing and preparation and Dispensing process (including delivery) to optimize
medication safety. •Install Carousel® or Intellishelf® technology to improve accuracy of selecting manual (non-Robot-Rx® selected) medications (inhalers; otics; ophthalmics) for the cartfill supply.
Status: Pursuing.5
16
Design and execute purchasing and preparation and Dispensing process (including delivery) to optimize medication safety.
5
Design Medication Administration process to optimize medication safety.
•Prepare for installation of Barcode Point-of-Care Medication Administration.(BPOC-MA).
Status: Preparations: On-going. Plan Pilot at University Specialty Hospital.
6
17
6
•Limit the number of locations that store medication for patient administration.
Status: Plan Six Sigma Exercise.Guiding through directional language in e-MAR (“Usually located in Omnicell®”).
Design Medication Administration process to optimize medication safety.
Enhance the quality and accessibility of Medication-Related Information and the communication of information to optimize medication safety. •Evaluate current situation regarding the provision of multi-lingual, patient-based medication instructions and information.
Status: Pursue QS/1 “add on” program, which allows the identification of Spanish-speaking patients and which produces patient instructions and drug monographs in Spanish.
7
18
7
Develop process to display patient-specific pregnancy and lactation information during prescribing.Status: Current state: Pregnancy and lactation status is documented electronically on admission on the Intake/Triage Form. Desired Future State: Pregnancy and lactation status would appear on each screen during prescribing and verifying of medication orders, so this information is easily accessible to those involved in medication management. Drugs with a category "X" classification would prompt an alert to prescribers and pharmacists.
Enhance the quality and accessibility of Medication-Related Information and the communication of information to
optimize medication safety.
Standardize protocols and processes to optimize medication safety. Optimize medication safety for special
patient populations (pediatrics/oncology).
Develop, maintain, monitor, and improve medication reconciliation process. Status:
Fully integrated into CPMOE.Able to electronically track compliance.Working to create electronic tools for prescribers, such as a computer-generated medication list upon discharge.
8
19
Standardize protocols and processes to optimize medication safety. Optimize medication safety for special
patient populations (pediatrics/oncology).
•Develop and perform medication safety assessment (gap analysis) of best practices versus actual for cancer chemotherapeutic and pediatric agents. Develop action plan.
Status: Completed gap analysis for cancer chemotherapeutic agents; assembling action plan.
8
Maintain and improve existing processes and programs that contribute significantly to medication safety.
•Standardize drug references in all patient care areas. Supply most recent editions. Replace manual versions with electronic versions if possible.
•Sustain an active and effective Medication Error and Adverse Drug Event (MEADE) committee.
•Sustain integrity of philosophy of using generic nomenclature as the preferred drug nomenclature.
9
20
Maintain and improve existing processes and programs that contribute significantly to medication safety.
•Continue to standardize and limit the number of intravenous and oral drug concentrations.
•Continue to promote pharmacy review of medication orders before administration.
•Sustain “Omnicell® philosophy”: Minimize storage of non-emergency floor stock medications on the patient care units.
9
“Whatever you are, be a good one.”
University of Maryland Medical Center