Post on 31-Mar-2015
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Resolving Patient Safety Issues Related to Methadone Maintenance Clinics
Resolving Patient Safety Issues Related to Methadone Maintenance Clinics
Shirley Lesieur and Nancy R. SmestadPharmacist Consultants
OHI IT Patient SafetyApril 27, 2010
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ObjectivesObjectives
Identify the importance of methadone treatment medication orders as a component of CPRS
Define the methodologies utilized to notify health care staff of methadone treatment enrolled patients
Discuss the importance of a VistA interface between methadone COTS software and CPRS
Share topics for discussion and a few lessons learned
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Initial ReportInitial Report
Methadone Treatment Clinic and Reported Scenario
Overview of the event
How did this occur?
Why did this occur?
Role of Technology in the solution
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Areas of ConcernAreas of Concern
Methadone COTS software – Interface with CPRS
Medication Reconciliation
Accurate Medication Management for methadone treatment patients
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Preliminary ScreeningPreliminary Screening Type of methadone software
Utilization of the methadone software
Documentation of methadone clinic patient in CPRS
Methadone clinic medication documentation in CPRS
• Copays ?
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Methadone Maintenance ClinicsMethadone Maintenance Clinics
Number of Clinics
VA Clinic versus Contracted Clinic
Clinic Design
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QuestionnaireQuestionnaire
Development of Questionnaire
Types of information gathering questions
Request for screen captures and/or station guidelines
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Methadone Clinic Setup
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Case StudyCase Study
Opioid Treatment Program and TJC
Recommendation for Improvement (RFI)
Addiction Management System(AMS)
Local Policy
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PRO’s and CON’sPRO’s and CON’s
Outpatient Prescription
CPRS Order with Priority = DONE
Non-VA Meds
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Facility VisitFacility Visit
Team Members
IT Patient Safety Role
Visit Objective
Visit Synopsis
Vulnerabilities Identified
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Facility Visit RecommendationsFacility Visit Recommendations
NCPS Alert
Mental Health Software and Hardware
CPRS documentation
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Post Methadone Clinic Visit Action ItemsPost Methadone Clinic Visit Action Items
Best practice recommendation to inform practitioner’s of Veteran’s active enrollment in the methadone clinic in a readily noticeable way
Best practice recommendation for entry of methadone clinic orders into CPRS
Best practice recommendation for sequence of order placement and appropriate personnel roles
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NCPS Notification: Patient IdentificationNCPS Notification: Patient Identification
Use of Clinical Reminder
Category II Patient Record Flags
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NCPS Notification: Medication EntryNCPS Notification: Medication Entry
Inpatient Meds for Outpatient (Clinic Orders)
Outpatient Prescription
Non-VA Meds
Documentation Responsibility & Timeliness
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Methadone Clinic Order Documentation OptionsMethadone Clinic Order Documentation Options
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Methadone Medication ManagementMethadone Medication Management
Opioid Medication Accountability
Medication Reconciliation
Patient Safety Caveats
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Patient Safety Alert Documentation ResultsPatient Safety Alert Documentation Results
Clinical Warning PRF Cat II Problem List Reminder Dialog CPRS Coversheet
Med List
2 8 1 1 3
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Patient Safety Alert Medication Compliance ResultsPatient Safety Alert Medication Compliance Results
Outpatient Prescription
Inpatient Meds for Outpatient
Non-VA Meds
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QuestionsQuestions