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Reducing Adverse Drug Events Reducing Adverse Drug Events
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Through Collaboration, Learning, Action and Sharing
Objectives
1. Role of the QIO in supporting the three broad aims of the National Quality Strategy
2 Risk factors impact and consequences2. Risk factors, impact and consequences of adverse drug events
3. National PSPC 4.0 Collaborative
4. Opportunities for nursing homes to participate in medication safety initiatives including PSPC 4.0
Objectives
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Quality Improvement Organizations
• Required under Section1152-1154 of the Social Security Act
• Network of 53 QIOs-one in each state, Di t i t f C l bi P t Ri Vi iDistrict of Columbia, Puerto Rico, Virgin Islands
• Contracts with Centers for Medicare & Medicaid Services for a 3 year scope of work (SOW)
Mission
•Effectiveness
•Efficiency•Efficiency
•Economy
Better Health forthe Population
National Quality Strategy
Better Carefor Individuals
Lower CostThrough
Improvement
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Improving Individual Patient Care
• Reduction of Healthcare-Associated Infections (HAI)
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• Reduction of Healthcare-Associated Conditions (HAC) by 40%
• Reduction of Adverse Drug Events (ADE)
Institute of Medicine Findings
•Medication Errors are Most Common
• Injure 1.5 Million People Annually
•Cost Billions Annually
“… for every dollar spent on ambulatory medications, another dollar is spent to treat new health problems caused by the medication.”
• 72% of ADE-related visits occur in outpatient settings Age 65 and older have highest rate: 3.8 ADE’s per 1,000 persons
• 86% of transfers (to or from SNF/hospital) a
Impact
86% of transfers (to or from SNF/hospital), a medication error occurs
• 30% of patients discharged from the hospital (to any location) have at least one medication discrepancy
Adverse Drug Events in U.S. Adult Ambulatory Medical Care Urmimala Sarkar, Andrea Lopez, Judith H. Maselli and Ralph Gonzales. Article first published on line: 9 MAY 2011 | DOI: 10.1111fj.14756773.2011.01269.x Arch Intern Med. 2004;164:545-50) Ann Pharmacother 2008;42:1373-9
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Chronic Illness Connection
• More than 133 million Americans live with chronic illnesses1
• 91% of all prescriptions filled for a chronic condition2
1 5 illi l i j d h lt f• 1.5 million people are injured each year as a result of medication3
• Uncoordinated care costs an estimated $240Billion/year 4
1. CDC National Center for Chronic Disease Prevention and Health Promotion: Chronic Disease Prevention http://www.cdc.gov/nccdphp/overview.htm2. American Heart Association. Heart Disease and Stroke Statistics–2008 Update. Dallas, Texas: American Heart Association; 2008.http://www.americanheart.org3. Institute of Medicine (IOM), To Err Is Human: Building a Safer Health System, Washington, DC: National Academy Press; 20004. Owens, MK “The Health Care imperative: Lowering Costs and Improving Outcomes”, The Institute of Medicine, 2010
• 770,000 injured or die each year
• ADE’s lead to ER visits – Higher rates of
hospitalizations (1 in 3)
– and death (1 in 5)
Consequences
• 8 - 12 days longer hospitalizations
• $16,000 - $24,000 more in hospital bills per patient
• $1.56 - $5.6 billion to treat annually
http://www.ahrq.gov/qual/aderia/aderia.htm
• Warfarin
• Insulin
Budnitz DS, Shehab N, Kegler SR, Richards CL. Medication use leading to emergency department visits for adverse drug events in
older adults. Ann Intern Med. 2007;147:755-765.
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PSPC 4.0
Patient Safety and Clinical Pharmacy Services Collaborative
PSPC 4.0
How?
• Seven community-based teams statewide
• Each team supporting no fewer than 50 M di /d l li ibl b fi i iMedicare /dual eligible beneficiaries
• Partnerships- statewide and nationally• Evidenced-based interventions drawn
from PSPC 4.0 Change Package
Leading the Way
Fair Haven
Arbor Springs
St. Martin’s in the Pines
Wesley Manor
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Team Fair Haven
What Do We Want To Achieve?
• Improve medication safety and health outcomes for high risk patients
• Minimize harm related to adverse drug events
• Enhance care coordination/transitions • Increase cost-effective clinical pharmacy
services• Foster a multidisciplinary approach to care
Key Attributes
• Patient-centered and multi-disciplinary
• Three year collaborative experience
• Cross-organizational
• Systems approach
• All Teach, All Learn
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Resources and Benefits
• QIO on-site technical support• Healthcare Communities Web-site• Data collection tools and analysis• National faculty coachy• List-serv, tools and resources• Learning sessions• National and local sharing• Improved care transitions• Jump start on QAPI
PSPC Model
PDSA=Plan, Do, Study, Act
LS= Learning Session
AP=Action PeriodEnroll Team
PreworkPrework
LS 1
P
S
A D
P
S
A D
LS 3LS 2AP1 AP2
The Population of Focus (PoF)
• Panel of patients whose care is tracked and managed by the team
T ll ti t ith l t• Teams enroll patients with select condition(s) into the PoF
• PSPC teams serve high-risk patients
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High Risk Patients
► Five or more concurrent chronic conditions
► Eight or more medications on at least a weekly basis
► Evaluated by two or more providers► Evaluated by two or more providers
► Warfarin on at least weekly or for three months or more basis
► Short / long acting antipsychotics
► Hypoglycemic meds for diabetes
Measures
Adverse drug events (ADEs)Events that result in harm or injury to the patient
Examples of ADEs:
• INR out of range and patient has bleed or clot; • Patient has allergic reaction due to wrong drug or
wrong dose prescribed; • Drug-drug interaction causes patient to have CNS
side effects
Measures
Potential adverse drug events (pADEs):Medication errors that were identified and stopped with appropriate interventionsstopped with appropriate interventions before harming the patientExamples of pADEs:
• Duplication of therapy • Incorrect dose• Drug-drug interaction • Inappropriate medication prescribed for indication
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Measuring Performance
• Number of ER visits, hospitalizations and/or hospital readmissions related to ADE
• Number of patients prescribed potentially inappropriate medications
• Clinical indicators for PoF
Improving Health and Safety
Three year collaborative goal:
Improve the health of patients in their PoF andPoF, and
Reduce rate of ADEs and rate of pADEsmoving toward zero
Collecting and Sharing Data
Platform for Results Sharing
Monthly status updates on system
Monthly quantitative data on improvements in patient health and safety
Rapid Polling Assessments
PSPC Progress Report
Monthly status updates on system changes the team is implementing to better serve patients
Quick feedback from teams on topics of interest
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PSPC 4.0 Participation Process
1. Read PSPC Info Packet2. Leadership commitment3. Identify collaborative partners4 Contact QIO for assistance and4. Contact QIO for assistance and
resources2. Charter team3. Complete participation packet and enroll4. ID number is assigned upon approval by
HRSA
To Learn More
Visit
www.hrsa.gov/patientsafety
www.healthcarecommunities.org
Congratulations to Our ANHA Members !
• Fair Haven
• Arbor Springs• Arbor Springs
• Wesley Manor
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PSPC Change Strategies
Leadership Commitment
Achieving goals using data-driven improvements
Integrated Care Delivery
Safe Medication Use Systems
Patient-centered Care- Patient Engagement
INTERACT
Interventions to Reduce Acute Care Transitions
• Communication
Cli i l C P th• Clinical Care Paths
• Advance Care Planning
http://interact.geriu.org
MATCH
Medications at Transitions
and
Clinical Handoffs
www.ahrq.gov/qual/match
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“I did then what I knew then.
When I knewWhen I knew better, I did
better.”Maya Angelou
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Advancing Excellence in America’s Nursing Homes Making Nursing Homes Better Places
to Live, Work and Visit!
What’s New in 2012 ? Advancing Excellence
www.nhqualitycampaign.org
Campaign in America’s Nursing Homes
Campaign Website:
www.nhqualitycampaign.org
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Campaign Overview
• Voluntary
• Largest national coalition (30 organizations) of nursing home stakeholders working together to help nursing homes improve care
www.nhqualitycampaign.org
• Over 53% (8300 Nursing Homes) registered
• Based on measurement of meaningful goals
• Initially a two-year campaign started in 2006
• The data show that it works!
Board of Directors / National Stakeholders
• CMS
• Other Government –AOA, AHRQ, CDC, more
• Funders
• Culture Change Association
• Medical Directorsmore
• Consumer Associations
• Ombudsmen
• Provider Associations
• Administrator Groups
• Medical Directors
• Surveyors
• Union Representative
• Geriatric Nursing Groups
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Purpose
Help make nursing homes better places to live
www.nhqualitycampaign.org
better places to live,
to work, and to visit.
Mission
Helping those we serve achieve the
www.nhqualitycampaign.org
Helping those we serve achieve the highest practicable level of
physical, mental, and psychosocial well-being.
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How?
• Provides free, practical and evidence-based QA/PI resources through the AE Website
• Commits support to those on the frontlines of nursing home care and encourages
www.nhqualitycampaign.org
nursing home care and encourages engagement of frontline staff
• Promotes open communication and transparency among families, residents, and nursing home staff.
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Campaign Design
• Clinical and cultural/organizational focus
• Links staff retention/stability to quality
• Engages consumers and frontline caregivers
• Easy accessibility to free resources
www.nhqualitycampaign.org
• Easy accessibility to free resources
• Prepares for Pay-for-Performance
• Gets nursing homes ready for QAPI
• Aligns with other national initiatives and priorities
Looking Forward - 2012
• AE Campaign Board established a slate of nine new and updated goals
• Person centered care focused
www.nhqualitycampaign.org
• Tools and resources should be posted on website by late spring 2012
• Full implementation by October 2012
Phase Two Goals
Resident Satisfaction
Physical Restraints
P UlPressure Ulcers
Pain
Advanced Care Planning
Staff Turnover
Consistent Assignment
Staff Satisfaction
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New Goals for 2012
High Quality
Person-Centered
Care
Pressure Ulcers
Pain
Infections
Mobility
Reduce hospitalizations
Medication Safety
Staff Stability
Consistent Assignment
Mobility
Person-Centered Care
Pressure
MedicationsConsistent Assignment
Staff Stability
Reduce Hospitalizations
PainInfections
National Integration9 New Advancing Excellence Goals for 2012
Ulcers
INTERACT
AHCA Quality
Initiative
PioneerNetwork – MDS Project
QAPI
QIO’s10th
Scope of Work Initiative
CMS Anti-
psychotic
Initiative
MedicaidP 4 P
These National Quality Initiatives Tie Into Advancing Excellence
How It Works
• Register (organization, consumers, staff)
• Select at least three goals
one clinical, one organizational & one of your
www.nhqualitycampaign.org
choice
• Set targets
• Use the resources and tools
• Track and trend your data – Share the results
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Quality - Not Just An Extra Thing To Do
Cultivate a culture of quality
• It can make your job easier (better surveys, less staff turnover, happier
www.nhqualitycampaign.org
y , , ppresidents)
• Use AE tools to simplify the process at your nursing home
G t th C i W b it
www.nhqualitycampaign.org
Go to the Campaign Website:
www.nhqualitycampaign.org
How to Register
• First time registrants
Make sure you have your Medicare Provider Number handy
www.nhqualitycampaign.org
y
• Re-Registrants – Need assistance resetting your password …..
Contact AQAF
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Advancing Excellence Front Page
Find out your registration status by selecting Find Participants
Determine if you are a new
www.nhqualitycampaign.org
are a new registrant or re-enrollee
Registering for the First time
www.nhqualitycampaign.org
Profileand first screen for new Participants
www.nhqualitycampaign.org
Have your Provider Number in hand
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Update Profile
www.nhqualitycampaign.org
Option to share goalswith LANEs
Option to participate In pilot projects
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Advancing Excellence
Re-enrollees
www.nhqualitycampaign.org
Re-enrollees
Login Page
To Re-enroll-
www.nhqualitycampaign.org
Have your Username and Password In HandThe QIO in your state can Reset this for you
Find your QIO Contact Here
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Select Your Goals
Remember:•1 Clinical•1 Organizational•1 of Your Choice
Pick Meaningful Goals
Move the mouse
www.nhqualitycampaign.org
Move the mouse cursor on the goal to see its description
View NH data to review trend and current score based on CMS Quality Measures
www.nhqualitycampaign.org
Look to see whatresourcesavailableto assist the NH
www.nhqualitycampaign.org
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Set Targets for the Clinical Goals
Click on Edit to start the Target Setting Process
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Track your Progress
Resources
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Advancing Excellence Tools
•Staff Turnover Calculator•Consistent Assignment Calculator•Pressure Ulcer Monitoring Tool•Restraint Monitoring Tool
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•Pain Monitoring Tool•Advance Care Plan Monitoring ToolSuggested tools for measuring Staff Satisfaction and Resident/Family Satisfaction
Pressure Ulcer Tool
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Develop a HABIT of tracking key quality information MONTHLY!!
www.nhqualitycampaign.org
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LANE Participation in Advancing Excellence Campaign
More than 50% nursing home participationCritical Access Nursing Home States
Accelerating LANE Performance State
Board of
Directors• Sets Goals
Statewide LANES• Recruit nursing
NURSING HOME• Registers for the
Campaign Organization
• Sets Goals• Develops
Resources• Provides Support
ghomes
• Coordinates statewide activities
• Provides support
gCampaign and selects three goals
• Uses Campaign method for QA/PI
Core LANE Members
• AQAF
• State Survey Agency
St t O b d
www.nhqualitycampaign.org
• State Ombudsman
• Alabama Nursing Home Association
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QA/PI
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QA/PI
Quality Assurance / Performance Improvement
QAPI Key Elements
1. Design and scope
2. Governance and leadership
3. Feedback, data systems and monitoring
www.nhqualitycampaign.org
monitoring
4. Performance improvement projects (PIPs)
5. Systematic analysis & systemic action
Quality Assurance
• Reactive
• Single episode
• Organizational mistake
P hi f
Quality Improvement
• Proactive
• Aggregate Data
• Organizational process
I ll
www.nhqualitycampaign.org
• Prevents something from happening again
• Sometimes anecdotal
• Retrospective
• Monitoring based on audit
• Sometimes punitive
• Improves overall performance
• Always measureable
• Concurrent
• Monitoring is continuous
• Positive change
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Quality Improvement Steps
• Identify meaningful area for improvement (Things people care about!)
• Benchmark/measure the starting point • Establish a target
P f t l i
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• Perform root cause analysis • Choose an intervention that makes sense • Implement the intervention• Use “Plan-Do-Study-Act Cycle” for improvement• Monitor
www.nhqualitycampaign.org
RECIPE FOR SUCCESS
PLAN-DO-STUDY-ACT
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Campaign Outcomes
• Campaign participants have improved faster than non-participants in all things measured.
• Campaign participants improved faster in the goals they selected to work on in every case.
• Campaign participants that set targets improved the most
Alabama
Phase 2 October 2009 – Dec. 2011
Alabama Nation
Participating Nursing Homes
157 8432
Percentage of ParticipatingNursing Homes
68.9% 53.8%
Participating ConsumersParticipating NH Staff
3234
32322480
Alabama
Quarter 3 2010 AlabamaParticipating NH
Nation
Physical Restraints 1 8% 3 6%Physical Restraints 1.8% 3.6%
Pressure Ulcers 9.8% 10.4 %
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Summary
• AE has demonstrated the ability to help NHs make real improvement in quality
• AE's mission and goals align with CMS l d ll j ti l NH i iti ti
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goals and all major national NH initiatives
• Registering for the Campaign now will help position your nursing home well for QAPI
• Don’t wait for the new 2012 goals!
www.nhqualitycampaign.org
“I think health care is more about love than about most other things. If there isn't at the core of this two human b i h h d t b ibeings who have agreed to be in a relationship where one is trying to help relieve the suffering of another, which is love, you can't get to the right answer here.” Donald Berwick
Liz Prosch, RN, BSN, MSHA, LNHAVice President Quality
AQAFTwo Perimeter Park Southo e e e a Sou
Suite 200 WestBirmingham, AL 35243
[email protected] ext. 3314
4/23/2012
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Peggy Braden RN, BSNPerformance Improvement Advisor
PSPC 4.0 CollaborativeAQAFAQAF
Two Perimeter Park SouthSuite 200 West
Birmingham, AL [email protected] ext. 3233
This material was prepared by AQAF, the Medicare Quality Improvement Organization for Alabama, under a contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S.
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( ), g yDepartment of Health and Human Services. Contents
do not necessarily reflect CMS policy.
10SOW-AL-C7-12-23
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