Improving Safety in the Geriatric Patient By Reducing...
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Improving Safety in the Geriatric Patient By Reducing Potential Harm from High-Risk Medication Use A NICHE Initiative Kristin Miller, Pharm. D., Erin Kohler, Pharm. D., BCPS, Marketa Friel, MS, RN-BC, CEN, Dr. Steve Montamat, Rob Wills, Pharm. D., BCPS, St. Luke’s Health System – Boise, Idaho Preparing for the Silver Sunami o 28% of all hospitalizations in the elderly are from adverse drug reactions (ADR’s) o By 2020, on average, an elderly patient will require $25,000 worth of health care costs per year. o The average elderly patient takes 14 different medications NICHE Medication Team o Consists of 1 geriatric physician, 2 pharmacists, 2 geriatric resource nurses, and 2 nurse educators. Input was also received by other internal medicine physicians, pharmacists, educators, and nurses. o GOALS consisted of: o Developing ways to decrease the usage of PIM’s, as defined by the Beers list oImproving patient safety o Educating other health care members on the potential harm medications can cause to elderly patients Importance of Staff Education o The biggest impact of the study was involving other disciplines during the education component. o Physicians became aware of the dangers of PIM and of the amount they were prescribing o Change of practice was noted before the study was started based on physician feedback o Nurses gave smaller doses of PIM’s when ordered as a dosage range in hopes of decreasing the risk of ADR’s. Results NURSES IMPROVING CARE FOR HEALTHSYSTEM ELDERS o National organization designed to help hospitals improve the care of older adults, greater than 65 years if age. o NICHE is unlike other programs in that it does not prescribe how institutions should modify geriatric care; rather, it provides the materials and services necessary to stimulate and support the planning and implementation process. o St. Luke’s participated in the NICHE Leadership Program and has applied to become a certified provider in 2012. o Originally designed as a nursing program, the local NICHE committee has input from physicians, pharmacists, nurses, nurse educators, and clinical administrators. Objectives Retrospective • Identify which PIM are being used most frequently by collecting data on administered medications • Develop a system to decrease usage of those medications identified by data collection Prospective • Determine effectiveness of a pharmacists-driven communication system that would notify a physician when they prescribe a PIM to an elderly patient • Identify barriers to implementing a system-wide communication tool and ways in which pharmacists can intervene on behalf of the elderly patient that may be at risk of developing an ADR Implementation • Take the results of the retrospective and prospective study and implement a process change on all medical units • Provide necessary staff education to other health-care providers • Develop measurable endpoints to determine if patient safety is improving PIMS & Safer Alternatives Diphenhydramine • Itching: cetirizine • Sleep: behavioral modification or low-dose doxepin • Anti-emetic: ondansetron Promethazine • Anti-emetic: Ondansetron Hydroxyzine • Itching: cetirizine • Sleep: behavioral modification or low-dose doxepin • Anti-emetic: ondansetron Benzodiazepines • Anxiety: Lorazepam is preferred • Any other indication: Not recommended Citalopram • Doses > 20 mg no longer recommended by the FDA. Use alternative agent or decrease dose Escitalopram • Doses > 10 mg no longer recommended by the FDA. Use alternative agent or decrease dose Next Steps o St. Luke’s has now taken the steps to roll out NICHE Medication Review o Throughout Treasure Valley o Eventually System Wide o Initial rollout includes a Boise Pilot o Targeting Critical Care and Cardioloty/Telemetry Units o Interventions include o Daily trigger report of patients > 64 years of age o Patient Profile Review of Potentially Inappropriate Medications o Pharmacy to Physician Communication Forms specific to the NICHE initiative with areas for prescriber feedback o Expected System Wide Rollout - 2015
Transcript of Improving Safety in the Geriatric Patient By Reducing...
Improving Safety in the Geriatric Patient By Reducing
Potential Harm from High-Risk Medication Use
A NICHE InitiativeKristin Miller, Pharm. D., Erin Kohler, Pharm. D., BCPS, Marketa Friel, MS, RN-BC, CEN,
Dr. Steve Montamat, Rob Wills, Pharm. D., BCPS, St. Luke’s Health System – Boise, Idaho
Preparing for the Silver Sunami
o 28% of all hospitalizations in the elderly are
from adverse drug reactions (ADR’s)
o By 2020, on average, an elderly patient will
require $25,000 worth of health care costs per
year.
o The average elderly patient takes 14
different medications
NICHE Medication Team
o Consists of 1 geriatric physician, 2
pharmacists, 2 geriatric resource nurses, and 2
nurse educators. Input was also received by
other internal medicine physicians,
pharmacists, educators, and nurses.
o GOALS consisted of:
o Developing ways to decrease the usage of
PIM’s, as defined by the Beers list
oImproving patient safety
o Educating other health care members on
the potential harm medications can cause to
elderly patients
Importance of Staff Education
o The biggest impact of the study was
involving other disciplines during the
education component.
o Physicians became aware of the
dangers of PIM and of the amount they
were prescribing
o Change of practice was noted before
the study was started based on physician
feedback
o Nurses gave smaller doses of PIM’s
when ordered as a dosage range in
hopes of decreasing the risk of ADR’s.
Results
NURSES IMPROVING CARE FOR
HEALTHSYSTEM ELDERSo National organization designed to help
hospitals improve the care of older adults,
greater than 65 years if age.
o NICHE is unlike other programs in that
it does not prescribe how institutions
should modify geriatric care; rather, it
provides the materials and services
necessary to stimulate and support the
planning and implementation process.
o St. Luke’s participated in the NICHE
Leadership Program and has applied to
become a certified provider in 2012.
o Originally designed as a nursing
program, the local NICHE committee has
input from physicians, pharmacists,
nurses, nurse educators, and clinical
administrators.
Objectives
Retrospective
• Identify which PIM are being used most frequently by collecting data on administered medications
• Develop a system to decrease usage of those medications identified by data collection
Prospective
• Determine effectiveness of a pharmacists-driven communication system that would notify a physician when they prescribe a PIM to an elderly patient
• Identify barriers to implementing a system-wide communication tool and ways in which pharmacists can intervene on behalf of the elderly patient that may be at risk of developing an ADR
Implementation
• Take the results of the retrospective and prospective study and implement a process change on all medical units
• Provide necessary staff education to other health-care providers
• Develop measurable endpoints to determine if patient safety is improving
PIMS & Safer Alternatives
Diphenhydramine
• Itching: cetirizine
• Sleep: behavioral modification or low-dose doxepin
• Anti-emetic: ondansetron
Promethazine
• Anti-emetic: Ondansetron
Hydroxyzine
• Itching: cetirizine
• Sleep: behavioral modification or low-dose doxepin
• Anti-emetic: ondansetron
Benzodiazepines
• Anxiety: Lorazepam is preferred
• Any other indication: Not recommended
Citalopram
• Doses > 20 mg no longer recommended by the FDA. Use alternative agent or decrease dose
Escitalopram
• Doses > 10 mg no longer recommended by the FDA. Use alternative agent or decrease dose
Next Steps
o St. Luke’s has now taken the steps to
roll out NICHE Medication Review
o Throughout Treasure Valley
o Eventually System Wide
o Initial rollout includes a Boise Pilot
o Targeting Critical Care and
Cardioloty/Telemetry Units
o Interventions include
o Daily trigger report of patients > 64
years of age
o Patient Profile Review of Potentially
Inappropriate Medications
o Pharmacy to Physician
Communication Forms specific to the
NICHE initiative with areas for
prescriber feedback
o Expected System Wide Rollout - 2015
