Improving Medication Errors and Near Miss Reporting Without Spending Money
We are all trying to do more with less. Pharmacy departments are looked to be leaders in ensuring medication safety in our health systems. Pharmacists need to be leaders by tracking, creating, and implementing safe medication-use systems at their facilities. To lead improvement efforts, pharmacists must collect information to then act upon. It is challenging to put systems in place to collect and analyze medication errors and near misses. Jacob Thompson, PharmD, MS discussed efforts made at the UHS system to improve medication errors and near miss reporting without busting the budget. By taking some simple steps, UHS has engaged its employees to be active and ongoing in creating a safe medication use system.
Implementation of Risk Evaluation and Mitigation Strategy Programs in a Health System
The Food and Drug Administration (FDA) received authority to require manufacturers to develop Risk Evaluation and Mitigation Strategy (REMS) programs from the Food and Drug Administration Amendments Act (FDAAA) of 2007. Since FDAAA 2007, the number of REMS programs that require elements to assure safe use (ETASU) has increased. The pharmacy leadership team of a ten hospital health system identified the need for a pharmacist to be responsible for the implementation and standardization of REMS programs for the health system. Mandy Leonard, PharmD, BCPS and Katie Stabi, PharmD, BCPS discussed the background of the position approval, the process for REMS programs implementation and standardization, as well as some common challenges.
Pharmacists have a crucial role in providing extemporaneously compounded sterile preparations (CSPs) to patients and for ensuring the sterility, safety, and efficacy of these preparations. Very effective standards are outlined in the United States Pharmacopeia (USP, Chapter 797) that serve as the foundation for sterile admixture programs; yet we know from two recent surveys of USP Chapter 797 compliance that the need for ongoing education and general acceptance of these standards remains significant. Eric S. Kastango, MBA, RPh, FASHP reviewed lessons still being learned from the tragic 2012 fungal meningitis outbreak, associated with thousands of vials of methylprednisolone that were compounded by a Massachusetts-based New England Compounding Pharmacy (NECC).
CMS and NHSN - What's New for Infection Preventionists in 2013?
Joan Hebden, RN, MS, CIC provided information on the new CMS requirement of LabID Event reporting and changes to the NHSN definitions for healthcare-associated infections. Case studies based on realistic clinical scenarios were used to aid learning.
Outsourced Medications: How Can You Know They are Safe?
The recent national outbreak of fungal meningitis has led to 354 cases of infection and 25 deaths. This outbreak has been linked to contaminated injection drugs compounded by an outsourced pharmacy. Since the outbreak occurred, the public has increased scrutiny on the quality of medications coming from these compounding pharmacies. In this webinar, Eric S. Kastango, MBA, RPh, FASHP explored the core quality standards that your outsourcer should be doing to ensure safe medications.
An Update on Medicare's Value-based Purchasing and Readmissions Reduction Programs: Positioning Pharmacy as Team Leaders
The Patient Protection and Affordable Care Act (aka Health Care Reform) has taken a bumpy ride, but with approval from the US Supreme Court the journey continues. Two key programs of the Act that fell under the responsibility of CMS, the Value-based Purchasing and the Hospital Readmissions Reduction Programs, officially went into full operation as of October 1st, 2012 and hospitals were provided the first definitive information on reimbursement penalties for FFY2013. The fiscal impact of the program will be notable for poor performers and hospital leadership are looking for answers. These programs provide tremendous opportunity for pharmacists and pharmacy departments to take leadership roles in improving care quality and efficiency. Alignment of pharmacy department goals and activities with the organizational mission is critical to ensure clinical services are well supported.
During this presentation, Steve Riddle, PharmD, BCPS, FASHP reviewed the key components of the VBP and HRRP, including the alterations and adjustments made by CMS in the last year that may shift for some hospital strategic improvement plans. The role of the pharmacist was examined across the specific measures and examples of care services as well as business plan strategies related to the VBP and readmissions programs will be discussed.
Building Ambulatory Pharmacy Clinical Services: Demonstrating Value
As the debate for how to handle the healthcare crisis in America rages on, pharmacists and other healthcare professionals are left to try to improve the quality of care they provide for patients with shrinking reimbursement for their services. Justification of innovative pharmacist services based on improved clinical outcomes, cost avoidance and cost savings used to be a common method to create or expand services. However, in the current economic climate, administrators are now often asking for revenue generation and return on investment figures prior to approving service creation or expansion.
Amy Stump, PharmD, BCPS reviewed how to develop a list of outcomes that could be used to justify the benefit of a pharmacist service, showed how to determine how to calculate return-on-investment for a pharmacist service, and introduced innovative options for services that improve quality and may also generate revenue.
Prioritizing National Patient Safety Initiatives -- Institution Assessment and a Medication Safety Culture
Healthcare organizations are challenged with accomplishing numerous patient safety and quality initiatives under each national authority: healthcare reform, meaningful use, the Joint Commission, CMS, FDA, ISMP and others. Limited resources and the lengthy list of projects create the need for standardized processes for managing the competing priorities. Application of subjective, prioritization criteria offer an improved method to rank importance, resource time, automation requirements, and the development of effective timelines to support efficiency and completion of each initiative.
Marie Link, PharmD described national patient safety initiatives and their impact on healthcare organizations, proposed practical methods for managing competing priorities with limited resources and explained the role and importance of having a medication safety culture.
Steve Carlson, Director of Pharmacy at Northeast Georgia Health System, and Andrew Corsaro, Director of Security at Northeast Georgia Health System, helped attendees: understand the prevalence of drug abuse in healthcare, learn how to develop a drug diversion program, detect drug diversion, learn helpful interviewing methodology and understand reporting requirements.
Case Study of an Active Surveillance Program
Lillian A. Burns, MT, MPH, CIC gave an overview of active surveillance testing for the past 10 year, discussed some of the controversy about active surveillance testing, and provided a case study of an active surveillance program at a healthcare system hospital.
How Maryland Increased Infection Prevention and Control Activities in Long Term Care Facilities
Brenda Roup, PhD, RN, CIC outlined how the Maryland State Department of Health and Mental Hygiene increased infection prevention and control activities in long term care facilities (nursing homes) over an eight year span, from 2003 to 2010, using regulatory, educational, and financial approaches. Data was presented that supports the efficacy of these approaches.
Rebroadcast: Maximizing the Use of Single-Dose Vials
Recently, Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) published documents discussing the proper use and handling of single-dose vials (SDVs). Eric S. Kastango, MBA, RPh, FASHP will review those positions and frame the discussion in context of USP Chapter <797>. This webinar is a rebroadcast of the webinar presented on August 8, 2012.
Antibiotic Stewardship: Implementation of a Program in a Hospital Setting
Antibiotic stewardship is the careful and responsible use of antimicrobials, and this concept has been present since the inception of antibiotics. However, some estimate that up to 50% of antibiotics are used in an inappropriate fashion. Furthermore, there are few new antibiotics or new classes of antibiotics in development, leading to an unfortunate situation of bad bugs with no drugs. It is recommended that every hospital in the United States develop an antimicrobial stewardship program to limit patient exposure and reduce resistance and cost. Davey Legendre, PharmD, BCPS-AQID reviewed antibiotic stewardship and to explore strategies to successful implementation in a hospital setting.
Best Practices in MDRO Screening and Control
Infections caused by multidrug-resistant organisms are perceived to be serious problems in the management of infectious diseases. There are proven ways to prevent and control the spread of these infections. Addressing the challenge of multidrug-resistant organisms in healthcare requires collaboration between the laboratory and infection prevention department. Richard A. Van Enk, Ph.D., CIC will review these best practices.
Recently, Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) published documents discussing the proper use and handling of single-dose vials (SDVs). Eric S. Kastango, MBA, RPh, FASHP reviewed those positions and frame the discussion in context of USP Chapter <797>.
As the demand for compounded medications has increased, the pharmaceutical profession observed a requirement of a system of standards by which each compounding pharmacy can adhere to. Compounding pharmacists also wanted a mechanism to enable them to know that they are producing the highest quality compound preparations for their patients. Pharmacy Compounding Accreditation Board (PCAB) Accreditation gives patients, prescribers and payers a way to select a pharmacy that meets or exceeds USPís high quality standards.
PCAB accreditation improves the quality of compounding to better service the practice of pharmacy. Accreditation provides a competitive edge in the marketplace to enable the pharmacy to secure future business with providers and institutions. By meeting national standards, developed by a large number of stakeholders, this endorsement will augment and strengthen your community confidence. William Stuart, RPh reviewed PCAB accreditation and how it impacts pharmacies.
Infection Prevention With Human Factors and Systems Engineering
Errors in complex systems invariably have multiple embedded causes at a variety of levels. Understanding error causality is essential for design improvement. Although human factors experts can produce diagnoses of error causality, there is little guidance for health care professionals on how to diagnosis errors and understand failures in safety-critical systems.
Carla Alvarado, PhD provided an understanding of human factors and systems engineering and how this approach to infection prevention and patient safety can improve performance, prevent harm when error occurs, and help systems recover from error, mitigating further harm.
Preventing MDROs Transmission: Navigating Technologies, Processes, and Measurement of Cleaning and Disinfection of Environmental Surfaces
Salah Qutaishat, PhD, CIC, FSHEA reviewed the existing CDC recommendations for cleaning and disinfection of environmental surfaces. He discussed methods to improve processes, including options available to measure effectiveness of cleaning and disinfection. In addition, the most recent "supplemental" or "no-touch" technologies were discussed.
Outbreaks Associated with Unsafe Injection and Medication Practices -- and How We Can Prevent Them
Since 2007, multiple outbreaks associated with improper injection and medication handling practices have occurred in the United States. These breaches have resulted in the transmission of a variety of bacterial and viral pathogens and in patients developing viral hepatitis, meningitis, bloodstream infections, skin abscesses, and skin, soft tissue and joint infections. They have also resulted in the notification of tens of thousands of patients that they were possibly exposed to bloodborne pathogens, and the screening of thousands of patients for infection with hepatitis B and C viruses and HIV.
Although these events are preventable, why do they continue to occur? Kathleen Arias, MS, MT(ASCP), CIC answered this question by identifying the unsafe injection and medication handling practices associated with disease transmission in these outbreaks; discussed recommendations for safe injection and medication handling practices developed by a variety of organizations; and identified resources that can be used to promote adherence to proper infection prevention protocols in our healthcare organizations.
Sean Patrick Nordt, MD, PharmD discussed some of the newer specific therapies for the acutely poisoned patient. There were case discussions followed by brief review of pharmacology and targeted antidotal therapies.
Parenteral Nutrition in the Pediatric Patient
Hospitalized pediatric patients sometimes require nutrition support. Parenteral nutrition (PN), the delivery of nutrients into the circulatory system, is often used to maximize caloric intake while oral feedings or enteral feedings are established. Shamim Tejani, PharmD discussed the assessment and prescription of PN for the hospitalized pediatric patient.
Decreasing Costs in your Sterile Compounding Operation without Sacrificing Quality
There is a tremendous amount of pressure on pharmacy leadership to cut operating costs in their departments and many compliance elements of USP 797 are viewed as expensive and ripe for replacing or ripping out. Eric S. Kastango, MBA, RPh, FASHP provided actionable ideas that will improve the efficiency of your sterile compounding operation which will result in decreased costs without sacrificing quality.
A mistake-proofing device is any mechanism that either prevents a mistake from being made or makes the mistake obvious at a glance. The ability to find mistakes at a glance is essential because, as Shingo writes, "The causes of defects lie in worker errors, and defects are the results of neglecting those errors. It follows that mistakes will not turn into defects if worker errors are discovered and eliminated beforehand." Most mistake-proofing devices are physical objects which can be photographed.
Dr. John Grout has been researching, documenting and teaching Mistake-proofing for 20 years. Learn about this technique for eliminating defects, improving quality, and streamlining work. He discussed mistake-proofing within the specific context of health care, including lots of examples.
A Multidisciplinary Approach to Preventing Catheter Associated Urinary Tract Infections
The Indiana Heart Hospital in Indianapolis, Indiana decided to tackle Catheter Associated Urinary Tract Infections (CAUTIs) using multiple strategies. Establishing objective, straightforward criteria for insertion was one of the first steps of the journey. For years, hospitals nationwide have relied on urinary catheters as a habitual part of daily practice. The Indiana Heart Hospital leadership and staff spoke loudly and clearly that existing habits had to go and "catheter apathy" stops now.
Kelly Manning, RN, BSN, CIC reviewed their approach: The hospital formed a multidisciplinary CAUTI team, and then reclaimed and polished an old UTI Bundle formulated years earlier. Starting in the Intensive Care Unit and Emergency Department, specific plans set the course. Multiple strategies were implemented that led to heightened awareness of the seriousness of a catheter associated urinary tract infection, decreased catheter days and the frequency of catheter associated urinary tract infections.
Putting Pharmacogenomics into Practice Strategies for Successful Implementation
Leslie Mackowiak, RPh, MS briefly introduced pharmacogenomics and some standard terminology. She reviewed the experience of the pharmacists in supporting the practical application of pharmacogenomics into clinical practice using computer tools. This will involve describing the role of electronic health records and clinical decision support in facilitating drug management using pharmacogenomics. She identified strategies and techniques for pharmacists to lead the introduction of pharmacogenomics at their practice site.
Pharmacogenetic information is currently included in more than 200 drug labels in the United States and the field continues to grow rapidly. There has not been a commensurate effort to establish the resources, methods, and infrastructure, which would allow the translation of such evidence, representing a major obstacle in the application of testing.
Mackowiak described how Vanderbilt University Medical Center assembled a multidisciplinary, multidepartment team consisting of pathology, informatics, pharmacy, practicing clinicians, ethicists, and legal and regulatory administrators to oversee the implementation of pharmacogenetics.
Pharmacy Implications with Enteral Nutrition
Pharmacists must be knowledgeable about their patients' nutrition to provide complete care and maximize the efficacy and safety of concurrent medications. Many pharmacists are comfortable managing a patient's parenteral nutrition, but often are not involved in patient care relating to enteral nutrition, or "tube feeds." This includes the different components that constitute an enteral nutrition formulation, the interactions that may be present between enteral nutrition and pharmacotherapy, and managing side effects that arise from enteral nutrition.
Matthew Wanat, PharmD, BCPS provided a background on enteral nutrition for pharmacists, spoke about major drug-nutrition interactions and provided pharmacologic and non-pharmacologic interventions for managing side effects from enteral nutrition.
The Evidence Behind Extended-Infusion Piperacillin/Tazobactam
Bacteria are a common source of community- and hospital-acquired infections. Many bacteria are becoming increasingly resistant to current antimicrobial agents and this increase in resistance is outpacing discovery of novel antimicrobial agents. As a result, clinicians are challenged to make the best use of available antimicrobials to not only treat infections, but preserve the life-span of current agents.
Timothy Reilly, PharmD reviewed the current status of multi-drug resistant bacteria and the pharmacokinetic and pharmacodynamic principles that govern extended infusions of beta lactam antibiotics. He also described the available literature supporting the use of extended infusions of pipacillin/tazobactam and describe a community-based teaching hospital's experience with this treatment modality.
Drug shortages have become one of the most serious, potentially life-threatening issues in health-system pharmacy practice. Today, the incidence of drug shortages has risen to critical levels, as of December 2011, there were over 250 documented shortages. To further compound the problem the shortage landscape is not expected to change for at least 3 years.
Shortages adversely affect drug therapy, compromise or delay treatment, and can even result in failure to properly treat disease and the consequent progression of disease. With so many current shortages--and new ones occurring daily--facilities with well-developed programs and active committees designed to address these issues are at a distinct advantage. Paul Arpino, PharmD, BCPS reviewed drug shortage programs, which should be designed to mitigate the impact of these events on patient care.
An Infection Control Risk Assessment is required by The Joint Commission (standard IC.01.03.01, EP 1 - 5). This assessment must include Geographic location, Community assessment, population served, care, treatment and services provided, analysis of surveillance activities, annual review and, prioritization. Patricia Keenan, RN, MSN, CPHQ, HACP provided information, tools and case studies to enable the practitioner to successfully navigate this standard.
Clinical Decision Support Options in a CPOE System
Clinical decision support is an essential feature in a CPOE system. Creating and maintaining the balance between ensuring patient safety, providing safe prescribing guidelines, while at the same time avoiding alert fatigue is a complex task. Lolita G. White, PharmD reviewed clinical decision support options and provide information needed to promote safe practices. An evaluation model for assessing and avoiding alert fatigue was also be presented.
Six Sigma and the GEMBA's Use in Prevention of HAIs
With the increasing emphasis on prevention of Healthcare-Associated Infections (HAIs), Infection Preventionists are being challenged to ensure evidence-based practice is at the bedside. Utilization of the Lean Six Sigma tools, specifically GEMBA, assists in understanding the delivery of healthcare at the patient level.
GEMBA has been utilized in the Manufacturing System prior to being introduced into healthcare. GEMBA allows one to "walk the process" to determine current state. The view is observed at the level of the healthcare worker and not from the 30,000-foot level. Kathy Ward, RN, MPH, CIC, described how using GEMBA can facilitate Infection Prevention at the staff level.
Quality in Compounding: QA, QC, CQI with USP and Practical Applications
The need for compounded products is increasing with personalized medicine. Ensuring the quality of a compounded preparation through verification includes: process, procedures and personnel. With continuous litigation and regulatory involvement it is necessary to have a quality assurance and quality control systems in place. This can help mitigate liability and ensure the overall safety of the patient by delivering accurate compounded preparations.
Thomas Kupiec, PhD reviewed the differences between quality control, quality assurance and continuous quality improvement; identified continuous quality improvement techniques that hospital pharmacists can use in their compounding processes; assessed the reasonable and appropriate quality control testing frequency based on specific compounding process; and gave examples of continuous quality improvement techniques for hospital pharmacies.
Michael Olesen looked at infectious diseases that are increasingly likely to require reporting or could pose a problem for managing them in the health care setting. He looked at diseases that are on our borders, that have been eradicated in the US but could easily come back, and some ecological conditions that could drive a higher prevalence of currently rare pathogens.
Top USP 797 Gaps: Results from the 2011 Compliance Survey
Eric S. Kastango, MBA, RPh, FASHP, and Kate Douglass, MS, RN, APN,C, CRNI, reviewed the findings from the first of its kind national survey of USP 797 compliance. Overall compliance scores for the hospital pharmacy industry were reviewed along with the top areas for improvement.
Measuring Medication Harm: Advantages of Using a Trigger Tool
Adverse drug events continue to be the single most frequent source of healthcare mishaps, continually placing patients at risk of injury. This is not unexpected, given that drug treatment is the most common medical intervention and medication use is a highly complex, multidisciplinary, and largely manual process. Assessing the actual safety of drug use has been historically difficult, mainly because traditional methods such as chart audits and voluntary reporting of data have been shown to be expensive, insensitive, and largely ineffective for detecting mistakes in drug administration and drug-related adverse clinical events (ADEs). Computerized methods for detecting ADEs -- employing sentinel words or "triggers" in a patient's medical records -- are effective but expensive and require customized software linkage to pharmacy databases.
Frank Federico, R.Ph showed participants how to use the Institute for Healthcare Improvement (IHI) ADE Trigger Tool to measure harm, collect data and use the information to direct improvement projects within a hospital.
Medication Safety - Everyone's Responsibility, No One's Priority
Medication errors are a significant problem across disciplines and practice settings in healthcare. Efforts to reduce medication errors have placed the greatest emphasis on system changes. Strategies include using technology, improving processes, identifying high-risk medications and establishing safe practices for them, and building a culture of safety.
Zahra Khudeira, PharmD, Medication Safety Manager of Sinai Health System in Chicago, discussed the medication use process and vulnerabilities that exist within the process. She offered some practical interventions that can improve patient safety. The goal of this webinar was to assist those hospitals without a medication safety pharmacist in providing an action list of tasks.
Best Practices in Applying Standardized Definitions for NHSN Reporting
The valid and reliable detection of HAIs allow for facility-based identification of increases in endemic infection rates, the recognition of adverse trends and the assessment of performance improvement initiatives.
The primary goal of data transparency is the advancement of patient safety through the reduction of HAIs. However, recent assessments of the quality of central-line associated bloodstream infection (CLABSI) data has revealed a high degree of variability in reported surveillance practices by Infection Preventionists (IPs), with underreporting of cases and misinterpretation of case definition criteria. These findings raise the question: how accurate is the data being reported?
Joan Hebden, RN, MS, CIC, reviewed efforts to define the best practices for surveillance through state validation studies, qualitative research and educational initiatives to assist IPs with the application of National Healthcare Safety Network (NHSN) criteria.
Establishing and Advancing Clinical Pharmacy Services in Community Hospitals
Misty Boachie, Pharmacy Clinical Coordinator at Henry Medical Center, discussed strategies for establishing clinical pharmacy programs and ensuring their continued success. At a time when all hospitals are experiencing a financial crunch, relatively small community hospitals are especially hard hit. Hear about approaches for developing clinical services with minimal impact to the bottom line. Topics included creative methods for covering clinical shifts, motivating pharmacists, and staff development. A timeline of Henry's own clinical evolution was presented along with specific examples of implementation techniques and ideas for continued growth and progress.
Henry Medical Center is a 215-bed, non-teaching community hospital located in Stockbridge, Georgia -- 20 miles south of Atlanta.