chsp and calhen opioid adverse drug event prevention gap analysis: survey findings august 14, 2013,...
TRANSCRIPT
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CHSP and CalHEN Opioid Adverse Drug Event Prevention Gap Analysis: Survey Findings
August 14, 2013, 2013
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Welcome
Agenda
• Thank you for participating in the Opiate Adverse Drug Event Prevention Gap Analysis
• Review survey responses • Discussion and Questions
• Opportunities
• Participate in second gap analysis survey: hypoglycemia agents
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Survey SectionsSection Header Number of Section
QuestionsNumber of Sub-
section QuestionsI. Prevention and Mitigation Strategies
4 7
II. Assessment and Detection Strategies
1 2
III. Therapeutic Strategies 2 2
IV. Critical Thinking and Knowledge Strategies
1 1
V. Patient Education 1 1
VI. Survey Evaluation 1 1
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I. Prevention and Mitigation Strategies
# Sub-section Questions Total Number of Questions
7 31
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Number who responded to question= 56 Number who skipped the question= 0
# 1. The facility has process in place to eliminate errors in opioid storage, preparation and dispensing, which include:
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# 2. A pharmacist or pain provider provides oversight for all dosing of:
1h) Methadone. 1i) Fentanyl patches (at med-ication initiation only).
1j) Transmucosal immediate release fentanyl patches
(TIRFs) (at medication initia-tion only).
0
10
20
30
40
50
60
26
5
24
28
4924
Yes
No
Number who responded to question= 56 Number who skipped the question= 0
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# 3. The facility’s opioid practices clearly specify the following:
Number who responded to question= 53 Number who skipped the question= 3
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# 4. The facility has opioid administration and monitoring practice guidelines in place, which include:
Number who responded to question= 48 Number who skipped the question= 8
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# 5. The facility has safety mechanisms in place for epidural opioid infusion processes which ensure:
4a) Epidural pumps are used only for epidural infusion
therapy.
4b) Epidural tubing is pre-connected in pharmacy when possible, and is incompatible
with non-epidural pumps.
4c) Epidural bags and bottles are clearly differentiated from IV infusions or piggybacks.
0
5
10
15
20
25
30
35
40
45
7
28
7
34
13
33
Yes
No
Number who responded to question= 44 Number who skipped the question= 12
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# 6. The facility uses smart infusion pumps with drug libraries for the IV administration of all opioids (including PCA and epidural infusions), with functionality employed to:
4d) Intercept and prevent wrong dose errors 4e) Intercept and prevent wrong infusion rate errors.
0
5
10
15
20
25
30
35
40
45
50
9 9
35 34
Yes
No
Number who responded to question= 44 Number who skipped the question= 12
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# 7. The facility’s nursing practice includes a process to double check opioid pump programming:
4f) At the start of their shift. 4g) With new narcotic infusion and PCA starts.
4h) With setting changes – ini-tiation of bag, bag change, and
shift change.
0
5
10
15
20
25
30
35
40
45
92 5
3140 35
Yes
No
Number who responded to question= 44 Number who skipped the question= 12
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II. Assessment and Detection Strategies
# Sub-section Questions Total Number of Questions
2 12
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# 8. The facility has a PACU discharge process in place to ensure patient is stable upon transfer which includes:
5a) Holding patients in PACU for at least 15 minutes following narcotic dose.
5b) Holding patients until safely cleared for transport ( at least 30 additional minutes) if
naloxone administered in OR or PACU.
0
5
10
15
20
25
30
35
40
45
711
3230
Yes
No
Number who responded to question= 42 Number who skipped the question= 14
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# 9. A standard hand-off/transition communication process is in place for all patients receiving opioids which includes the following information, at minimum:
Number who responded to question= 42 Number who skipped the question= 14
5c) History of snoring, obesity & sleep apnea. 5d) Drug and dose history for the previous shift.0
5
10
15
20
25
30
35
40
45
19
8
1833
Yes
No
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# 10. A protocol is followed which guides the reversal of opioids and includes the following:
6a) Reversal protocols are active on all pa-
tients’ MARs if there is an active order for a
narcotic.
6b) Nurses are allowed to administer reversal agents without prior
physician order.
6c) Strategies are in place to guard against
dose stacking.
6d) The facility utilizes a rapid response team to assist with possible narcotic oversedation
events.
05
10152025303540
17 2113
2
20 1623
36
Yes
No
Number who responded to question= 40 Number who skipped the question= 16
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# 11. If an over sedation event occurs, the facility has a learning process in place which includes:
6e) All oversedation events are reviewed by expert staff and analyzed to identify improvement oppor-
tunities.
6f) A root cause anal-ysis is completed any time the use of a re-
versal agent results in a transfer to a higher
level of care.
6g) Data are collected and widely available on the rate of nalox-
one-reversal coded as an adverse drug
event.
6h) Collecting and reviewing data to as-sess compliance with dose guidelines and monitoring require-
ments.
05
10152025303540
6
17
6 9
31
20
31 27Yes
No
Number who responded to question= 40 Number who skipped the question= 16
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III. Therapeutic Strategies
# Sub-section Questions Total Number of Questions
2 22
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# 12. The facility has standard policies and practices in place for managing the initiation and maintenance of opioid therapy which include:
Number who responded to question= 34Number who skipped the question= 22
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# 13. Practice guidelines for morphine include:
7j) Starting doses of IV push morphine do not exceed 2 mg IV morphine equivalent in the
opiate naïve adult patient.
7k) Titration guidelines for appropriate and safe clinical response.
0
5
10
15
20
25
30
35
18
10
15
20Yes
No
Number who responded to question= 34Number who skipped the question= 22
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# 14. Practice guidelines for hydromorphone include:
7l) Starting doses of IV push hydromorphone do not exceed 0.4 mg
in the opiate naïve adult patient.
7m) Titration guide-lines for appropriate and safe clinical re-
sponse.
7n) Pharmacy repackages hydro-morphone into 0.2, 0.4, or 0.5 mg sy-
ringes.
7o) The facility’s renal opioid dosing program
includes morphine, meperidine (if used)
and oxycodone.
0
5
10
15
20
25
30
35
22
10
23
15
9
20
9
14Yes
No
Number who responded to question= 34Number who skipped the question= 22
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# 15. The facility has a pain management process in place, which includes:
Number who responded to question= 32Number who skipped the question= 24
8a) A pain management specialist is available for consultation, ei-ther onsite or external, which provides mentoring as well as
specific consults.
8b) A pain medication steward-ship program is in place (e.g.
processes for identification and implementation of best practices, daily monitoring of adherence to best practices, plan for interven-tion of deviation from best prac-tices, processes for monitorin
8c) Standardized pain assess-ment scales are used throughout
the facility.
05
101520253035
Yes
No
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# 16. 8.d .There is a process in place to discuss and agree upon specific pain goals and strategies with the patient prior to a surgical procedure.
Number who responded to question= 32Number who skipped the question= 24
56.3%
43.8%
Yes
No
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# 17. The facility has practice guidelines in place for appropriate use of tactics to reduce opioid use, which include:
8e) Non-narcotic medications (e.g., NSAIDs, acetaminophen,
regional infusions of local anesthetics, steroids,
gabapentinoids, etc.) are rou-tinely used as a tactic to re-
duce opioid administration on the patient care units.
8f) Non-narcotic medications (e.g., NSAIDs, acetaminophen,
regional infusions of local anesthetics, etc.) are routinely
used as a tactic to reduce opioid administration in the
operating room.
8g) Non-pharmacologic ther-apy (e.g., healing touch,
massage, music, guided im-agery, aromatherapy, etc) is offered and maximized when possible, as tactics to reduce
opioid administration.
0
5
10
15
20
25
30
35
511
17
2619
13Yes
No
Number who responded to question= 32Number who skipped the question= 24
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IV. Critical Thinking and Knowledge Strategies
# Sub-section Questions Total Number of Questions
1 4
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# 18. The facility provides interdisciplinary education on opioid therapy, which includes:
9a) Initial training for new hires and existing staff, including proto-cols and guidelines.
9b) Post test incorporat-ing a case-study ap-
proach to demonstrate proficiency; covers top-ics such as dose stack-ing, dose equivalency, interpretation of vital signs and monitoring
equipment.
9c) Plan for targeting gaps in knowledge.
9d) Ongoing opioid education is provided when new relevant in-formation is available.
0
5
10
15
20
25
30
35
6
2016
10
25
10 1520 Yes
No
Number who responded to question= 32Number who skipped the question= 24
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V. Patient Education
# Sub-section Questions Total Number of Questions
1 7
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# 19. When initiating opioid therapy, patients/caregivers receive verbal and written information on purpose, action, side effects, and monitoring, including:
Number who responded to question= 31Number who skipped the question= 25
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# 20. Is your organization a member of the California Hospital Engagement Network?
60.0%
40.0%Yes
No
Number who responded to question= 25Number who skipped the question= 31
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Contact Information Provided
Number who responded to question= 12
Number who skipped the question= 44
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Discussion and Questions
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Next Steps
Survey Topic
Survey Date Distribution
Completed Survey Due
Date
30 min Sharing Call Scheduled
Hypoglycemic Agent Adverse Drug Event GAP Analysis
August 19th
August 30th
September 11th