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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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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 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


Four-Pillared Approach

• Surveillance

• Prevention

• Incentives and Oversight

• Research

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High Impact Targets and Populations

• Common

• Clinically significant

• Preventable

• Measurable

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3 targeted drug classes



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The most vulnerable

• Elderly

• Low health literacy

• Limited access to health care service

• Low socioeconomic status

• Certain minority and ethnic groups



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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?


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?


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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ADE Surveillance

Barriers

• Active

Coding not designed for ADE

Cause and effect

• Passive

Manual

Sampling

Voluntary – underreporting

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ADE Surveillance

Additional considerations

• Reporting Requirements

• Severity

• Settings

• Timeliness

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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

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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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



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Answers to Run With



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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

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