Health Indicators in Action (Examples of Indicator Projects) - Module 4
Executive Management: Examples of Data and Indicators
description
Transcript of Executive Management: Examples of Data and Indicators
![Page 1: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/1.jpg)
Engaging the C-suite to Advance Pharmacy PracticeProviding quality patient care throughprogressive pharmacy practice
Executive Management: Examples of Data and IndicatorsRita Shane, Pharm.D., FASHP, FCSHPChief Pharmacy Officer Cedars-Sinai Medical CenterAssistant Dean, Clinical Pharmacy Services, at the University of California, San Francisco, School of Pharmacy
![Page 2: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/2.jpg)
Pharmacy Core Functions: Safe, Effective, Efficient Medication
Use
Patient Care and Risk Reduction
Resource Management
Transitions of Care
Medication Management and Regulatory Compliance
![Page 3: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/3.jpg)
Drug Expenditures
FY 09 FY 10 FY 11 FY 12
Inpatient Drug Expenditures Outpatient Drug Expenditures
![Page 4: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/4.jpg)
Transp
lant
Oncology
Heart
Shorta
ge
Inflammato
ry Bowel D
isease
Anti-snak
e venom
Vaccine
Orphan Drug
Heparin In
duced Thrombocyt
openiaStr
oke -
200,000 400,000 600,000 800,000
1,000,000 1,200,000 1,400,000 1,600,000
Total Variance $6,915,000
Drug Expense Variance FY11 Year to Date
![Page 5: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/5.jpg)
Drug Cost Summary – 2011 Price Increases
Drug Price↑ Primary UsePorfimer sodium 624% Photodynamic therapy of tumors; Barrett’s
esophagusFactor VII 33% Cardiac surgery, liver pts, factor deficiencyAlteplase 11% StrokeInfliximab 21% Rheumatoid Arthritis, Crohn’s, Ulcerative ColitisBasiliximab 66% Kidney transplant induction
Bortezomib 53% Transplant desensitization/rejection, multiple myeloma
Aldesleukin 38% Renal Cell Carcinoma, Metastatic MelanomaNesiritide 78% Acute decompensated heart failureFilgrastim 13% Chemo-induced neutropenia
Mycophenolate IV 1560% Heart, lung, kidney transplant immunosuppression
![Page 6: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/6.jpg)
Inpatient Drug Expenditures and Transplant Volumes
Heart Transplant ↑ 230%, Allogenic BMT ↑ 81% from FY09 to FY12
FY09 FY10 FY11 FY120
50100150200250300350400450500
$0 $5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000 $30,000,000 $35,000,000 $40,000,000 $45,000,000 $50,000,000
Total BMT Total Solid Inpatient Drug Expenditures
![Page 7: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/7.jpg)
Epoetin (000)
FY11 FY12 FY13 FY14$0
$200
$400
$600
$800
$1,000
$1,200
$998
$731
$534
$389
Pharmacy Protocol to start medication on day #8 and reduce standard dose to 50 units/Kg three times/week
Pharmacy Protocol to limit dose to 10,000 units
![Page 8: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/8.jpg)
Hepatitis B Immune Globulin (both inpatient and outpatient)
FY13 FY14$0
$50
$100
$150
$200
$250
$300
$350
$400 $337,000
$95,000
Based on UHC data, reduced # doses/pt.
6.2 Doses/Pt
2.2 Doses/Pt
(000)
![Page 9: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/9.jpg)
Value ExamplesMedication Opportunity Identified and Pharmacist Intervention Cost
SavingsCMV-IVIG
Pt with CMV viremia who had response to change in antiviral from ganciclovir to foscarnet. Intervention: Discontinued CMV-IVIG
$75,000
Glucarpidase Pt with methotrexate toxicity. Intervention: Dose rounding
$24,805
Panhemitin
Pt without lab confirmation of acute intermittent porphyria. Intervention: Hold therapy pending lab results. Labs returned negative.
$24,984
IVIG Pt with HIV, hepatitis C, ITP; received 3 doses of IVIG as outpatient. Admitted with bruising and headache, platelet count of 9000/µL. MD ordered 2 more doses, however platelets were increasing.Intervention: Discontinue IVIG order
$15,074
Idursulfase Pt with VP shunt malfunction repair. Receives idursulfase weekly as an outpatient.Intervention: Contacted patient’s medical geneticist to administer dose post-discharge.
$10,500
![Page 10: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/10.jpg)
MedicationsPrior to Admit Medication ListAs well as new
ordersDrug
IndicationDoseRoute
FrequencyDosage form
Duration
Patient Characteristics
Age-Pediatrics-Geriatrics
GenderHeight/Weight
AllergiesKidney/Liver
FunctionCurrent labs
Previous admissions
Special ConsiderationsHigh risk patients or therapies such
as: Chemotherapy
Blood thinners
AntibioticsDrugs with narrow therapeutic index
ICU
Pharmacist’s Role in Evaluating Medications
![Page 11: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/11.jpg)
Prescribing Errors Intercepted September ‘11 – June ’13
Septem
ber '11
October
'11
November
'11
December
'11
January
'12
Febru
ary '1
2
March '1
2
April '12
May '1
2
June '12
July '12
August
'12
Septem
ber '12
October
'12
November
'12
December
'12
January
'13
Febru
ary '1
3
March '1
3
April '13
May '1
3
June '13
0
500
1000
1500
2000
2500
3000
3500CPOE Implementation
Sept - Feb Average/Month: 1633
(76.6/1,000 pt days)
Prescribing Errors Intercepted/1,000 OrdersIOM: 2.87
CSMC: 10.4 (pre-CPOE)
Prescribing Errors Intercepted/1,000 OrdersIOM: 2.87
CSMC: 15.6 (post-CPOE)
May ‘12-June’13 Average/Month:2431
(116/1,000 pt days)49% Increase
![Page 12: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/12.jpg)
Methodology
Low Capacity for Harm
Serious/Significant
Life Threatening
![Page 13: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/13.jpg)
Prescribing Errors Intercepted by Pharmacists ORDER RECEIVED ACTION TAKEN OUTCOME AVOIDED SEVERITY
RATINGHYDROmorphone PCA dose 2.4mg q8 minutes. Current dose= 0.2mg
Recommended 0.3mg Narcotic overdose, leading to respiratory failure and possible death.
Life Threatening
MD note included plan to start antibiotics for R/O meningitis. No antibiotics ordered.
Recommended to start antibiotics at meningitis dosing.
Potential undertreatment of meningitis
Life Threatening
Methotrexate 10mg daily and patient on weekly dose for RA.
Recommended continuing weekly dose.
Potential antineoplastic overdose and possible death.
Life Threatening
Fentanyl patch ordered upon admission. Per SNF, patient was not on fentanyl patch
Recommended discontinuing.
Potential narcotic overdose, leading to respiratory failure and possible death.
Life Threatening
![Page 14: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/14.jpg)
Medication Reconciliation Across Transitions of Care
Changing clinical conditions require continually evaluating the medication lists at each transition
![Page 15: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/15.jpg)
15
40% of resolved DRPs were classified as life-threatening or serious/significant
7.4 Drug-Related Problems Identified Per Patient Based on Medication History
21% of inpatient orders were changed due to DRPs identified
Resolution of Drug-Related Problems (DRPs) in
High-Risk Hospitalized Patients
![Page 16: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/16.jpg)
PTA Drug-Related Problems (DRPs)
16
Medication on PTA List Drug-Related Problem DRP Type Capacity for
Harm
Flecainide PTA List: Med not listed on PTA med listFinding: Pt reports taking flecainide 50 mg BID
Omission of Medication Life-Threatening
Plavix PTA List: Med not listed on PTA med listFinding: Pt reports taking Plavix 75 mg daily
Omission of Medication Serious/Significant
Prednisone PTA List: Prednisone 20 mg dailyFinding: Pt reports it was d/ced by MD 6 months ago
Extraneous Medication Serious/Significant
Furosemide PTA List: Furosemide 40 mg BID Finding: Pt reports taking 60 mg BID (CHF pt)
Wrong Dose Serious/Significant
Mycophenolate PTA List: Mycophenolate 360 mg BIDFinding: Pt reports taking 720 mg BID Wrong Dose Serious/Significant
Midodrine PTA List: Midodrine 100 mg TIDFinding: Pt reports taking 30 mg TID Wrong Dose Life-Threatening
![Page 17: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/17.jpg)
Hospitalist-Pharmacist Transitions of Care Collaboration
![Page 18: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/18.jpg)
Evaluation of Medication List Accuracy, Adherence, and Literacy
Identify High- Risk Patients
Validate Medication
History∙∙∙∙
Assess Adherence
and Literacy∙∙∙∙
Educate Patient
Notify MD Regarding
DRPs Identified along with Recommen
d-ations
Post-Discharge Follow-Up within 72
Hrs:-Med Rec
-Adherence & Literacy
Reinforcement
-Education
Additional Calls up to
30 Days Based on
Risk Assessment
![Page 19: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/19.jpg)
Criteria to Determine Need for Post-Discharge Follow-Up Medication Adherence and Literacy
Literacy
AdherenceHigh literacy Intermediate
literacy Low literacy
High adherence No post-DC f/u needed
Educate pt. No post-DC f/u
neededPost-DC f/u needed
Intermediate adherence
Educate pt. No post-DC f/u
needed
Educate pt. No post-DC f/u needed?
vs. Post-DC f/u needed?
Use clinical judgment
Post-DC f/u needed
Low adherence Post-DC f/u needed Post-DC f/u needed Post-DC f/u needed
![Page 20: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/20.jpg)
Post-Discharge Metrics
20
Post-DC f/u Call Completed
Readmissions Prevented*
# of Patients 207 16%
Average DRPs/Pt 2.9
*Validated by MD Review
Post-Discharge Findings• 58% of pts had discrepancies between their discharge medication
list and what they were taking• 33% of pts were taking more medications than were prescribed
(excludes vitamins, herbals, etc)
![Page 21: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/21.jpg)
Examples of Post-Discharge Follow-up
21
Reason for Admission Drug-Related Problems Identified Post-Discharge and Pharmacist Intervention
Adverse Outcome Prevented
54 y/o w/ HTN & DVT admitted for sickle cell crisis & left parietal stroke
Issue discovered: Pt had self-d/ced warfarin, amlodipine, and carvedilol
Intervention: Contacted MD and confirmed that warfarin and anti-hypertensives should be re-started. Pharmacist contacted pt and instructed to take all meds as was prescribed at d/c; do not self-start, self-d/c, self-dose, or adjust any med w/o speaking to MD first; educated pt on the importance of compliance to avoid complications
Avoided potential occurrence of thromboembolism, readmission, and/or death
92 y/o w/ altered mental status found to have a UTI & toxic digoxin level, also w/ arrhythmias & low blood pressure
Issue discovered: Pt had continued taking medications that had been stopped, including digoxin, metoprolol, and zolpidem
Intervention: Instructed patient to d/c these medications
Avoided potential drug toxicity, life- threatening arrhythmias, recurrence of confusion, and/or death
![Page 22: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/22.jpg)
Enhanced Care Program forSkilled Nursing Facilities (SNF)
![Page 23: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/23.jpg)
Identification of Patients Discharged
to SNF
Medication Reconciliation:
Discharge Medication List vs
SNF MAR-
Pharmacist Clinical Evaluation
-NP consults
Drug-Related Problems
Communicated to NP for Follow Up
SNF Post-Discharge Follow-Up
![Page 24: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/24.jpg)
Data Period: 1/22/13 -6/30/14
ECP Pharmacy Data Summary
2013 1st Quarter2014
2nd Quarter2014
Total
# of Patients 708 241 223 1172
# of Serious/ Significant Drug-Related Problems (DRPs) Identified
560 275 2451080
(14 were life- threatening)
% of Patients Requiring Intervention
41%(293/708)
56%(134/241)
54% (120/223)
47%(547/1172)
![Page 25: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/25.jpg)
25
Reason for Hospital Admission
Drug-Related Problems Identified Post-Discharge and Pharmacist Intervention
Adverse Outcome Prevented
98 y/o M from home w/ hip fracture and multiple medical issues.
Issue discovered: Pt was a new start on fentanyl 25mcg in house. Dose was increased to 50mcg 1 hour prior to discharge. Intervention: Called SNF to d/c fentanyl 50mcg order. Informed SNF RN that the patch was already placed on the pt. SNF RN was unaware.
Avoided severe respiratory depression or death due to potential supra-therapeutic dose of fentanyl.
79 y/o M w/ ESRD - HD on TuThSat - with catheter-related S. aureus bacteremia.
Issue discovered: Per ID, vancomycin after dialysis to be continued after d/c and was on discharge medication list. There was an order at the SNF for vancomycin but not at the dialysis center. Pt dialyzed on Sat after d/c but did not receive vancomycin.
Intervention: Ensured vancomycin administration occurred.
Avoided progression of bacteremia and catheter re-infection d/t missed doses of antibiotics.
89 y/o F w/multiple medical problems including pulmonary hypertension.
Issue discovered: Sildenafil 25mg PO TID was listed on discharge medication list but not continued at the SNF.
Intervention: Pharmacist recommended re-initiation of medication for the pt, who also required an oxygen mask at the SNF.
Avoided worsening of respiratory status and potential progression of condition and organ damage.
Examples of ECP Pharmacist Post-Discharge Follow-Up
![Page 26: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/26.jpg)
Readmissions Dashboard
26
Baseline Jan 2013 Feb 2013 Mar 2013
SNF
30-day All-Cause Readmissions Rate
20% 17% 21% 12%
6SE Heart Failure
30-day All-Cause Readmissions Rate
21% 22% 18% 15%
Interdisciplinary Team Results
![Page 27: Executive Management: Examples of Data and Indicators](https://reader036.fdocuments.in/reader036/viewer/2022081512/56816924550346895de05bb4/html5/thumbnails/27.jpg)
QUESTIONS