Jayme Steig, PharmD, RPh Quality Improvement Specialist -
Pharmacy
Sally May, RN, BSN, CH-GCN Senior Quality Improvement Specialist
Objectives
Review the National Action Plan (NAP) for Adverse Drug Event (ADE) Prevention
Identify and understand reasons for the three targeted drug classes in the NAP
Explain ADE surveillance opportunities and barriers
Discuss approaches to prevent ADEs
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Expectations
All teach, all learn
Active participation and discussion
Leave in action
Learn approaches and access resources to improve medication safety
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Questions to Run On
What medication safety efforts do you currently have in your setting?
What medication safety efforts are occurring in your community?
What are some ways your community can improve medication safety?
Who are your community partners to improve medication safety?
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The National Action Plan for Adverse Drug Event Prevention
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Adverse Drug Event (ADE)
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Source: National Action Plan for Adverse Drug Event Prevention
Definition
http://www.health.gov/hai/ade.asp#action-plan
National Action Plan - the need
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Source: National Action Plan for Adverse Drug Event Prevention
Nationally
http://www.health.gov/hai/ade.asp#action-plan
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 Health Care-Associated Infections
Federal interagency steering committee and workgroups
http://www.health.gov/hcq/ade.asp#overview
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http://www.health.gov/hcq/ade.asp#overviewhttp://www.health.gov/hcq/ade.asp#overview
National Action Plan for ADE Prevention
Four-Pillared Approach
• Surveillance
• Prevention
• Incentives and Oversight
• Research
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National Action Plan for ADE Prevention
High Impact Targets and Populations
• Common
• Clinically significant
• Preventable
• Measurable
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National Action Plan for ADE Prevention
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Source: National Action Plan for Adverse Drug Event Prevention
3 targeted drug classes
http://www.health.gov/hai/ade.asp#action-plan
National Action Plan for ADE Prevention
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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
http://www.health.gov/hai/ade.asp#action-plan
National Action Plan for ADE Prevention
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Source: National Action Plan for Adverse Drug Event Prevention
http://www.health.gov/hai/ade.asp#action-plan
National Action Plan – the Goal
Reduce preventable ADEs
The Triple Aim
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Questions to Run On
What medication safety efforts do you currently have in your practice setting?
What medication safety efforts are occurring in your community?
How do you track ADEs in your setting?
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Answers to Run With
What medication safety efforts do you currently have in your practice setting?
What medication safety efforts are occurring in your community?
How do you track ADEs in your setting?
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ADE Surveillance and Data
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ADE Surveillance
Types • Active – collects data from health records or
previously collected information Technology driven
Example – National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance Project (NEISS-CADES)
• 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
http://www.health.gov/hai/ade.asp#action-plan
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
http://www.health.gov/hai/ade.asp#action-plan
ADE Surveillance
Additional considerations
• Reporting Requirements
• Severity
• Settings
• Timeliness
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Source: National Action Plan for Adverse Drug Event Prevention
http://www.health.gov/hai/ade.asp#action-plan
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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Anticoagulant ADEs
Area
# of High-Risk Anticoagulant
Benes
# of Inpatient Bleed
Claims for HR Anticoag
Benes
# of HR Anticoag
Benes with Inpatient
Bleed Claims
% of HR Anticoag
Benes with Inpatient
Bleed Claims
State 7,230 467 393 5.44%
Bismarck 1,773 114 93 5.25%
Fargo 1,734 109 92 5.31%
Minot 939 61 52 5.54%
Other Communities 2,784 183 156 5.60%
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Source: 2014 Medicare Part D and Part A claims analysis
Community
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Minot Bismarck Grand Forks Fargo
Community Level
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0
0.5
1
1.5
2
2.5
3
3.5
Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15
# Order Clarifications/Admit
Orders per admit/readmit requiringclarification Total
Orders per admit requiring clarification - NewAdmit
Orders per readmit requiring clarification -Readmit
Linear (Orders per admit/readmit requiringclarification Total)
Facility Level
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0%
5%
10%
15%
20%
25%
30%
35%
Mar-15 Apr-15 May-15 Jun-15 Jul-15
Error Rate – Medication Reconciliation
Error Rate - TOTAL
ADE Prevention
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ADE Determinants
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Source: National Action Plan for Adverse Drug Event Prevention
http://www.health.gov/hai/ade.asp#action-plan
ADE Determinants
Underlying drivers
• Communication failures
• Suboptimal management systems
• Inadequate access to medication information
• Low patient activation
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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; 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 Access to Medication 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: Low Patient Activation
Teach-back
Patient and family education
Chronic disease self-management
Knowledge of medications
Medication planner
Medication adherence programs
Knowledge of “red flags”
Personal health record
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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
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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http://greatplainsqin.org/initiatives/medication-safety/http://greatplainsqin.org/initiatives/medication-safety/http://greatplainsqin.org/initiatives/medication-safety/http://greatplainsqin.org/initiatives/medication-safety/http://greatplainsqin.org/initiatives/coordination-care/http://greatplainsqin.org/initiatives/coordination-care/http://greatplainsqin.org/initiatives/coordination-care/http://greatplainsqin.org/initiatives/coordination-care/
Great Plain QIN/Quality Health Associates Care Coordination & Medication Safety Initiative
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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
Goal – reduce the incidence of adverse drug events by 35% by July 2019
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ADE 35% reduction
July 2019
Our Approach
Engaging all aspects of a local health reality • Encourages buy-in
• Establishes sustainability
• Enables efficient resource utilization
• Expands impact
Practitioners: multi-disciplinary • Pharmacies, hospitals, SNFs, home health, clinics, hospice, etc.
Community-based • Including practitioners, stakeholders,
LTSS, beneficiaries, etc
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
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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Commitment
Community Partners provide
• Collaborate to identify and develop interventions for medication safety barriers in the community
• Measurement of potential and actual ADE
• Share data with Great Plains QIN
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Questions to Run On
What are some ways your community can improve medication safety?
Who are your community partners to improve medication safety?
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Answers to Run With
What are some ways your community can improve medication safety?
Who are your community partners to improve medication safety?
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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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http://greatplainsqin.org/lan-signup-page/http://greatplainsqin.org/lan-signup-page/http://greatplainsqin.org/lan-signup-page/http://greatplainsqin.org/lan-signup-page/http://greatplainsqin.org/lan-signup-page/http://greatplainsqin.org/lan-signup-page/http://greatplainsqin.org/initiatives/coordination-care/http://greatplainsqin.org/initiatives/coordination-care/http://greatplainsqin.org/initiatives/coordination-care/http://greatplainsqin.org/initiatives/coordination-care/http://greatplainsqin.org/initiatives/coordination-care/http://greatplainsqin.org/initiatives/medication-safety/http://greatplainsqin.org/initiatives/medication-safety/http://greatplainsqin.org/initiatives/medication-safety/http://greatplainsqin.org/initiatives/medication-safety/http://greatplainsqin.org/initiatives/medication-safety/http://greatplainsqin.org/initiatives/medication-safety/https://www.surveymonkey.com/r/GPQINADE
Contact Information
Sally May, RN, BSN, CH-GCN Senior Quality Improvement
Specialist [email protected]
Jayme Steig, PharmD, RPh Quality Improvement Specialist-
Pharmacy [email protected]
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Quality Health Associates of North Dakota
3520 North Broadway Minot, ND 58703 P: 701.852.4231
www.greatplainsqin.org
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]://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-C3-28/0815