Post on 08-Jan-2016
description
Medication Safety in thePrimary Care Setting
Frank Federico
Executive Director
Institute for Healthcare Improvement
This project was supported by grant number R18HS019508 from the Agency for Healthcare Research and Quality (AHRQ). The content is solely the responsibility of the authors and does not necessarily represent the official view of the AHRQ.
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Learning Objectives
By the end of this module you will be able to: Describe the importance of medication safety in the primary care setting Identify areas in need of improvement Use concepts described to begin to develop a medication safety improvement project
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Concerns About Medication Safety
More than half of American adults take at least one prescription medication daily
Sources:
www.myhealthnewsdaily.com/3069-prescription-drugs-2011.html (4/9/2012)
Kaufman et al. 2002
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Concerns About Medication Safety
More than half of American adults take at least one prescription medication daily
About 4 billion prescriptions for medications were written in 2011
Sources:
www.myhealthnewsdaily.com/3069-prescription-drugs-2011.html (4/9/2012)
Kaufman et al. 2002
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Concerns About Medication Safety
More than half of American adults take at least one prescription medication daily
About 4 billion prescriptions for medications were written in 2011
Approximately two out of every three office visits result in a prescription written
Sources:
www.myhealthnewsdaily.com/3069-prescription-drugs-2011.html (4/9/2012)
Kaufman et al. 2002
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Elderly and Their Medications
6Sources:
www.myhealthnewsdaily.com/3069-prescription-drugs-2011.html (4/9/2012)
Kaufman et al. 2002
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Medication Errors: Ambulatory Setting
7Gurwitz JH, et. al. Incidence and Preventability of Adverse Drug Events Among Older Persons in the Ambulatory Setting. JAMA. March 5, 2003;289(9):1107-1116.
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Evidence of Medication Errorsin the Primary Care Setting
• 25% (162/661) primary care patients had ADE• Of those 162 patients
• 13% (24) serious• 11% (20) preventable• 28% (51) ameliorable• 06% (13) both serious &
preventable or ameliorable
Gandhi TK, et al. NEJM April 2003
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What Should We Worry About?
“High-alert” medications Out-of-date side effect & drug interaction info Out-of-date medication and allergy lists Therapeutic duplication Adjustment for renal failure
and pregnancy
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Institute for Safe Medication Practices
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www.ISMP.orgAccessed August 2013
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Situations Leading to Medication Errors
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Situations Leading to Medication Errors
PROMISES Driver Diagram
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Useful Interventions
Track patients on high-alert medications Monitor blood values Monitor side effects
Ensure access to latest drug info database Reduce “polypharmacy” Apply lessons from follow up of lab results
to medication monitoring
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Useful Interventions
Implement a reliable medication follow-up process to address knowing about: New prescriptions from other providers Discontinued medications by other providers Therapeutic duplication Medications that may interact Non-adherence by patients Medications that require monitoring
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Useful Communication Interventions
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Useful Communication InterventionsEngage patients/families/caregivers
when deciding therapeutic plans Example: Ask a patient:
What is the matter with you? What matters to you? What will you be able to manage?
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Problem: Patient has unexplained symptoms
Action: Patient asked to bring all medications in
Finding: Patient was arranging & taking pills by color!
What is the Patient Really Taking?
Problem: Determine if patients with memory & dementia issues are taking medications correctly
Action: Asked these vulnerable patients to bring
in all medications for a medication “check-up”
Finding: Provided opportunities to talk with patients and test if using pillboxes made it easier to take medications correctly
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Test: Bring in all your Scripts!
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Are Medication & Allergy Lists Updated? For 16 patients, Practice Manager checked Allergy lists, medication lists
Finding Only 3 medication lists
(19%) were updated Only 6 allergy lists
(38%) were updated None of the 16 had
both updated!
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Test: Medication List Review Protocol
Change when the medication lists are reviewed Print medication list prior to patient visit (MA) Review medication list prior to huddle (MD, MA) Review list with patient Make changes when provider indicates
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What Can You Do Today?
Check: Reliable process for updating patient medication lists?
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What Can You Do Today?
Check: Reliable process for updating patient medication lists? Measurement strategy: Review medical records Was medication list reviewed and updated?
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What Can You Do Today?
Check: Reliable process for updating patient medication lists? Measurement strategy: Review medical record Was medication list reviewed and updated?
Check: Reliable process to update patient allergies?
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What Can You Do Today?
Check: Reliable process for updating patient medication lists Measurement strategy: Review medical record Was medication list reviewed and updated?
Check: Reliable process to update patient allergies Measurement strategy: Review medical records Was allergy information reviewed & updated?
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Thank You!
Thank you
for your time
and attention today
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A Few References
Institute for Healthcare Improvement www.ihi.org
Institute for Safe Medication Practices http://ismp.org/
Massachusetts Coalition for the Prevention of Medical Errors http://www.macoalition.org/reducing_medication_errors.shtml
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