Reducing Medication Errors in the LongTerm Care Setting - PowerPoint PPT Presentation

Loading...

PPT – Reducing Medication Errors in the LongTerm Care Setting PowerPoint presentation | free to download - id: 1d3312-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Reducing Medication Errors in the LongTerm Care Setting

Description:

Key Points. Prescribing errors account for the majority of preventable ADE ... Flow Diagram. Checklist of process. Change of condition form. Tab 4: Prescribing ... – PowerPoint PPT presentation

Number of Views:146
Avg rating:3.0/5.0
Slides: 36
Provided by: SDPS
Learn more at: http://www.ahqa.org
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Reducing Medication Errors in the LongTerm Care Setting


1
Reducing Medication Errors in the Long-Term Care
Setting
Patrick OReilly, MPH, PhD MassPRO
2
AIM of the Project
  • Develop and pilot tools needed by staff in
    long-term care to assess change and monitor
    medication systems
  • 22 Nursing homes have been recruited

3
Stakeholders
Steering Committee
Consensus Group
Advisory Panel
LTC Experts Multi-disciplinary Geriatric
Specialists Researchers
Betsy Lehman MA Coalition MassPRO MECF Geriatric
Specialists
Nursing Home Leaders Innovators
4
Adverse Drug Events are Accidents in the
Healthcare System
  • Accidents are a form of information about a
    system.
  • They represent places in which the system failed.

To Err Is Human Building a Safer Health System.
Institute of Medicine. 2000.
5
To Err Is Human Building a Safer Health System.
Institute of Medicine. 2000.
Ensuring Patient Safety
  • Human beings, in all lines of work, make errors.
  • People working in health care are among the most
    educated and dedicated workforce in any industry.
    The problem is not bad people the problem is
    that the system needs to be made safer.
  • Errors can be prevented by designing systems that
    make it hard for people to do the wrong thing and
    easy for people to do the right thing.

6
The Medication Use Process is adapted with
permission from US Pharmacopeia.
7
Adverse Drug Events Injury resulting from a
medical intervention related to a drug
8
ADEs in the Long-term Care Setting Rates
  • 2 studies set in nursing homes 18 community-based
    homes in MA, 2 large, academically-based in CT
    and CA
  • For all ADEs, rates from 1.9 to 9.3 per 100
    resident months For preventable ADEs, rates from
    1.0 to 3.8 per 100 resident months

Gurwitz JH et al Am J Med 200010987-94
2005118251-8
9
ADEs in the Long-term Care Setting Severity
18 community-based nursing homes
2 academically-based nursing homes
10
ADEs in the Long-term Care Setting Severity
Preventability
  • Among fatal, life-threatening and serious events,
    60 to 72 preventable
  • Among less serious events, 34 to 40 preventable

11
ADEs in the Long-term Care Setting Errors
  • Occurred during
  • Ordering stage 40 to 68
  • Monitoring stage 50 to 70
  • Administration, transcription 4 to 10
  • Ordering errors tended to be
  • too high dose
  • drug interaction
  • poor choice for the residents condition

12
ADEs in the Long-term Care Setting Drugs
Involved in ADEs
Community homes
Academic homes
  • Antipsychotics 26
  • Antidepressants 18
  • Sedatives/hypnotics 18
  • Anticoagulants 13
  • Anti-epileptics 10
  • Cardiovascular 9
  • Hypoglycemics 5
  • Anti-infectives 5
  • Analgesics 5

Sedatives/hypnotics 14 Antipsychotics 13 Anticoa
gulants 11 Antidepressants 11 Analgesics 10 Car
diovascular 9 Diuretics 8 Hypoglycemics 7 Anti
-epileptics 6
13
ADEs in the Long-term Care Setting Residents at
Highest Risk
  • Age, gender, comorbidity, functional status NOT
    associated with high risk
  • Medications associated with high risk of having a
    PREVENTABLE ADE anticoagulants, antibiotics,
    anti-epileptics, antipsychotics, diuretics
  • Conclusion prevention efforts must focus on
    improving medication systems that apply to all
    residents

14
ADEs in the Long-term Care Setting
Implications for Interventions
MD
Pharmacy
Patient
Nurse
Lab
Nursing Homes
15
ADEs in the Long-term Care Setting Summary
  • ADEs are VERY common and often preventable
  • More serious ADEs are more likely to be
    preventable
  • Psychoactive drugs and anticoagulants are most
    often involved
  • Prescribing and monitoring are important stages
    for inclusion in prevention efforts

16
Possible Interventions Low Tech
  • Enhance communication
  • Standardize, use protocols
  • Reduce reliance on memory
  • Ensure access to information at the time it is
    needed
  • Optimize work hours, staffing-ratios
  • Reduction of distractions
  • Use tested tailored systems

17
Possible Interventions High Tech
  • Bar-coding
  • Automated dispensing
  • Computerized medication administration records
  • Computerized provider order entry (CPOE)
  • Clinical decision support systems

18
Reducing Medication Errors in the Long-Term Care
Setting
Safe Medication Practices Workbook
19
Issues to Consider in a Systems Approach
  • System changes involve a series of steps
  • Change agents need tools to effect change
  • Learning process should be simple
  • Minimize the skills needed for change
  • Learning takes place individually and in groups

20
Issues to Consider in a Systems Approach
  • Leadership/organization with strong QI commitment
    presence
  • Education on clinical domain, across
    disciplines
  • Practice and protocols are consistent with
    current clinical practices
  • Ensure protocols are followed accountability
  • QI Processes are integrated into programs,
    clinical areas

21
Changing Systems of Care
TRACKING
EDUCATION
ASSESSMENT/ PROCEDURES
  • Break the process into key steps or components
  • Identify best practice examples
  • Bring together the tools
  • Provide a step-by-step guide

POLICY
22
Previous Experience Workbooks and Interventions
  • A Systems Approach to Quality Improvement in
    Long-Term Care
  • Increasing Immunizations
  • Pain Management
  • Pressure Ulcer Prevention and Management

23
Proven Design Tab Pages
1. Organizational Commitment
2. Medication Management Policies
3. Educating Staff
4. Prescribing
5. Documenting/Transcribing
6. Dispensing
7. Administering
24
Tab Pages (continued)
8. Monitoring
9. Error Tracking Analysis
10. Quality Improvement
11. Warfarin
12. Reconciliation
13. Educating Residents Families
14. Regulations Resources
25
  • Layout of Tabs

26
Tab 3 Educating Staff
  • Key Points
  • Determine proficiency
  • Conduct learning needs assessment
  • Provide education
  • Tools Checklists
  • Assessing staff knowledge
  • Medication administration observation
  • Skills and Experience

27
Tab 4 Prescribing
  • The Prescribing Process
  • Key Points
  • Prescribing errors account for the majority of
    preventable ADE
  • Modifying current processes offers potential to
    decrease ADEs
  • Tools
  • Flow Diagram
  • Checklist of process
  • Change of condition form

28
Inappropriate Prescribing in 12 Nursing Homes in
California
Create your homes Most Common Types List
Avorn, J. et. al. Ann Intern Med 1995123195-204
29
Tab 3 Reconciliation
  • Description of Process
  • Tools
  • Flow chart
  • Incident reporting form
  • Medication reconciliation at admission

30
Reconciling process Admission to hospital
1 Intake Medication History
2 Admission Orders
3 Reconcile
31
Impact
  • Rate of medication errors reduced 70 in short
    seven month period
  • ADEs reduced by over 15
  • Significant efficiency gains Time saved
  • At admission (nurse) 20-25 min.
  • Transfer from CCU 25-45 min.
  • At discharge (pharmacist) 35-50 min.
  • Source Luther Midelfort
  • Rozich, Resar JCOM Oct. 2001

32
Medication Reconciliation in Long-Term Care
Setting
Source of Admission
Healthcare Institution Tertiary/SNF
Community Home/Assisted Living
MD/NP/PA
HHA
MD/NP/PA
Pharmacist
Discharge Summary
Page 1 Referral
Review
Review
Resident/Family
No
No
Reconciliation
Yes
MD/NP/PA
33
Barriers
  • Not an easy process to implement 
  • Obtaining buy-in from staff and physicians/NPs
  • Unable to obtain medication history
  • Placement of worksheet in the chart
  • Frequent modification of the Policy Procedure
  • Duplication of documentation

34
Timetable
  • November Workshop for participants
  • December-
  • February On-site meetings/conference calls
  • February Preliminary review and
    adjustments
  • March On-site visits
  • April Final review
  • May ??

35
Reducing Medication Errors in the Long-Term Care
Setting
Patrick OReilly, Poreilly_at_maqio.sdps.org
About PowerShow.com