HRSA PATIENT SAFETY AND HRSA PATIENT SAFETY AND CLINICAL PHARMACY CLINICAL PHARMACY

SERVICES COLLABORATIVESERVICES COLLABORATIVE

OVERVIEWOVERVIEW

Safere Diawara, MPHSafere Diawara, MPHQuality Management CoordinatorQuality Management Coordinator

WHY THE PATIENT SAFETY WHY THE PATIENT SAFETY AND CLINICAL PHARMACY AND CLINICAL PHARMACY

SERVICES COLLABORATIVE?SERVICES COLLABORATIVE?

Why are we doing this work?Why are we doing this work?

Increase in multiple chronic conditionsIncrease in multiple chronic conditions

Alignment with HRSA Core MeasuresAlignment with HRSA Core Measures

ADEs leading cause of death and injury – IOM ADEs leading cause of death and injury – IOM ReportReport

Aging population - polypharmacyAging population - polypharmacy

Lack of integration of clinical pharmacy Lack of integration of clinical pharmacy servicesservices

Why a Patient Safety & Clinical Why a Patient Safety & Clinical Pharmacy Collaborative?Pharmacy Collaborative?

““The [Senate Appropriations] Committee The [Senate Appropriations] Committee further encourages HRSA to establish a further encourages HRSA to establish a pharmacy collaborative to identify and pharmacy collaborative to identify and implement best practices, which may implement best practices, which may improve patient care by establishing the improve patient care by establishing the pharmacist as an integral part of a pharmacist as an integral part of a patient-centered, interprofessional health patient-centered, interprofessional health care team.”care team.” 2007 & 2008 Senate Appropriations Committee Reports 2007 & 2008 Senate Appropriations Committee Reports Encourage Pharmacy Collaborative.Encourage Pharmacy Collaborative.

Institute of Medicine Findings on Institute of Medicine Findings on Patient Safety and ErrorsPatient Safety and Errors

Medication Errors are Most Medication Errors are Most CommonCommon

Injure 1.5 Million People Injure 1.5 Million People

AnnuallyAnnually

Cost Billions AnnuallyCost Billions Annually

“…“…for every dollar spent on for every dollar spent on ambulatory medications, ambulatory medications, another dollar is spent to treat another dollar is spent to treat new health problems caused new health problems caused by the medication.”by the medication.”

GOALS AND AIMS OF THE GOALS AND AIMS OF THE PATIENT SAFETY AND PATIENT SAFETY AND CLINICAL PHARMACY CLINICAL PHARMACY SERVICES COLLABORATIVE?SERVICES COLLABORATIVE?

Improve Health Outcomes by implementing effective Improve Health Outcomes by implementing effective patient safety principles and clinical pharmacy patient safety principles and clinical pharmacy servicesservices

Improve Patient SafetyImprove Patient Safety• Fewer errors, fewer injuries, less harmFewer errors, fewer injuries, less harm

Increase High Quality, Cost-Effective Pharmacy Increase High Quality, Cost-Effective Pharmacy ServicesServices

• Maximizing and enhancing medication use Maximizing and enhancing medication use managementmanagement

Patient Safety & Clinical Pharmacy Collaborative Goals

Emerging AimsEmerging AimsClinical Pharmacy Services and Clinical Pharmacy Services and

Patient SafetyPatient Safety

More clinical pharmacy for complex patientsMore clinical pharmacy for complex patients More management of high risk medicationsMore management of high risk medications Fewer drug-drug interactionsFewer drug-drug interactions Fewer potentially inappropriate medicationsFewer potentially inappropriate medications Medication reconciliation for 100% of patientsMedication reconciliation for 100% of patients Healthcare organizations develop and sustain Healthcare organizations develop and sustain

a culture of medication safetya culture of medication safety

Value PropositionValue Proposition

Organizations can achieve better health Organizations can achieve better health outcomes for patients through safer, integrated outcomes for patients through safer, integrated clinical pharmacy services.clinical pharmacy services.

WHAT IS THE PATIENT WHAT IS THE PATIENT SAFETY AND CLINICAL SAFETY AND CLINICAL PHARMACY SERVICES PHARMACY SERVICES

COLLABORATIVE?COLLABORATIVE?

What are clinical pharmacy What are clinical pharmacy services?services?

Patient-centered services that promote the Patient-centered services that promote the appropriate selection and utilization of appropriate selection and utilization of medications to optimize individualized therapeutic medications to optimize individualized therapeutic outcomesoutcomes

Provided by an inter-disciplinary healthcare team Provided by an inter-disciplinary healthcare team through individualized patient assessment and through individualized patient assessment and managementmanagement

Services best provided by a pharmacist or by Services best provided by a pharmacist or by another healthcare professional in collaboration another healthcare professional in collaboration with a pharmacistwith a pharmacist

What is the Patient Safety & What is the Patient Safety & Clinical Pharmacy Collaborative?Clinical Pharmacy Collaborative?

18 month rapid learning model that creates a community of 18 month rapid learning model that creates a community of learning, bringing together interdisciplinary teams from learning, bringing together interdisciplinary teams from multiple types of organizations focused on improving multiple types of organizations focused on improving health outcomes by focusing on improved patient safety health outcomes by focusing on improved patient safety and clinical pharmacy services.and clinical pharmacy services.

Collaborative learning is accomplished by using learning Collaborative learning is accomplished by using learning sessions, action periods, Web training and listservs to sessions, action periods, Web training and listservs to measure, report and track improvement. Led by an expert measure, report and track improvement. Led by an expert faculty poised to help test and implement successful faculty poised to help test and implement successful practices.practices.

Care Transitions and HandoffsCare Transitions and Handoffs

Specialist

PatientMultiple Conditions

Primary Care Home(s)

Hospital ED

Hospital Inpatient

Pharmacy Services Specialist

Care Transitions and HandoffsCare Transitions and Handoffs

PatientMultiple Conditions

Conditions For A Disaster

Hospital Inpatient

Primary Care Home(s)

Hospital ED

Hospital Inpatient

Hospital ED

Primary Care Home(s)

Specialist

Patient Self- Management

Care Transitions and HandoffsCare Transitions and Handoffs

Pharmacy Services

ClinicalPharmacy Services

PatientMultiple Conditions

Clinical Pharmacy Services

Integrated Patient Care

Optimum Health

Outcomes

No Adverse Events

Patient

Patient Safety Pharmacy Collaborative

Learning Collaborative EngineLearning Collaborative Engine

S

DP

A S

DP

A

Adapted from IHI Breakthrough Series Collaboratives IHI.org

Select Topic

Planning Group

Identify Change

Concepts

Enroll Participants

Prework

LS1 LS3LS2

Supports

Listserv Site Visits & Filming

Conference Calls Rapid Sharing

Team Reporting Web site

Leadership Coordinating Council

LS 4LS4AP1 AP3AP2

PDSA=Plan, Do, Study, Act

LS= Learning Session

AP=Action Period

S

DP

A

Patient Safety & Clinical Pharmacy Patient Safety & Clinical Pharmacy Collaborative – Next StepsCollaborative – Next Steps

Share the information with potential partnersShare the information with potential partners Engage with community partnersEngage with community partners Engage senior leaders in the visionEngage senior leaders in the vision Secure support for participationSecure support for participation Review participation package on: Review participation package on:

http://www.hrsa.gov/patientsafety Submit Team Participation PackageSubmit Team Participation Package

19

Patient Safety & Clinical Pharmacy Patient Safety & Clinical Pharmacy Collaborative (PSPC)Collaborative (PSPC)

Participation RequirementsParticipation Requirements

State Based Organization PartnersState Based Organization Partners

State Primary Care AssociationsState Primary Care Associations State Primary Care OfficesState Primary Care Offices State Offices of Rural HealthState Offices of Rural Health State Hospital AssociationsState Hospital Associations State Pharmacy Associations State Pharmacy Associations State AIDS DirectorsState AIDS Directors Quality Improvement OrganizationsQuality Improvement Organizations FoundationsFoundations Institute for Healthcare Improvement (IHI) Campaign Institute for Healthcare Improvement (IHI) Campaign

NodesNodes Health Center Network LeadersHealth Center Network Leaders Area Health Education CentersArea Health Education Centers Others Who Want to Help Enroll and Support Others Who Want to Help Enroll and Support

Collaborative TeamsCollaborative Teams

Teams of providers from multiple caregiver organizations in a community who want to improve the quality and safety of care for a defined patient population they together serve:

Health Centers

Rural Health Clinics

Critical Access Hospitals

Disproportionate Share Hospitals

HIV AIDS Clinics

Others (inclusivity is encouraged)

Who will join?

Key Benefits of Participation in the Key Benefits of Participation in the PSPCPSPC

It’s the Right Thing to Do for the Patients We ServeIt’s the Right Thing to Do for the Patients We Serve• SaferSafer• More, Better Pharmacy ServicesMore, Better Pharmacy Services• Improved Health OutcomesImproved Health Outcomes

Reduces/Manages Risk – and Risk is IncreasingReduces/Manages Risk – and Risk is Increasing

Builds on and Takes Prior Experience to a New LevelBuilds on and Takes Prior Experience to a New Level• IntegratedIntegrated• Takes HRSA Collaborative Experiences to the Next Takes HRSA Collaborative Experiences to the Next

PowerPower

What will the teams do?

Commit to Collaborative aims

Commit time and effort

Designate consistent members to attend all 4 Learning Sessions and support travel

Measure and track progress

Share activities and results

Align with team around continuity of care

Bring their organizations’ senior leader(s) to Learning Sessions

THANKSTHANKS

EVMS PSPC TEAM

Working together to improve Services, Safety and Quality of Care for all our consumers!

Basic Facts on the EVMS Patient Safety & Clinical Basic Facts on the EVMS Patient Safety & Clinical Pharmacy Services CollaborativePharmacy Services Collaborative

Primary Health Care Home OrganizationPrimary Health Care Home Organization::Eastern Virginia Medical School, Norfolk, Virginia Eastern Virginia Medical School, Norfolk, Virginia

Team Name:Team Name:Eastern Virginia Medical School Patient Safety & Clinical Pharmacy Eastern Virginia Medical School Patient Safety & Clinical Pharmacy Services CollaborativeServices Collaborative

MottoMotto::Communication, Collaboration and CommitmentCommunication, Collaboration and Commitment

Team LeaderTeam Leader::Judy Wessell, Nurse PractitionerJudy Wessell, Nurse PractitionerThe collaborative is composed of staff from EVMS, peer educator The collaborative is composed of staff from EVMS, peer educator consultants, the Gloucester County Health Dept, and an independent consultants, the Gloucester County Health Dept, and an independent PharmD.PharmD.

Thanks to VDH Thanks to VDH for for

the financial and technical the financial and technical assistance to the Eastern’s assistance to the Eastern’s

EVMS PSPC team.EVMS PSPC team.

HRSA Five StrategiesHRSA Five Strategies

Leadership CommitmentLeadership Commitment

Measurable ImprovementMeasurable Improvement

Integrated Care DeliveryIntegrated Care Delivery

Safe Medication Use SystemSafe Medication Use System

Patient Centered CarePatient Centered Care

PDSA-Worksheet for PDSA-Worksheet for Testing ChangeTesting Change

Aim:Aim: (overall goal you wish to achieve) (overall goal you wish to achieve)Every goal will require multiple smaller tests of Every goal will require multiple smaller tests of changechange

PlanPlan List the tasks needed to set up this test of change: Person responsible, List the tasks needed to set up this test of change: Person responsible,

When to be done, Where to be doneWhen to be done, Where to be done Predict what will happen when the test is carried outPredict what will happen when the test is carried out Measures to determine if prediction succeedsMeasures to determine if prediction succeeds Do Do Describe what actually happened when you ran the testDescribe what actually happened when you ran the test StudyStudy Describe the measured results and how they compared to the predictionsDescribe the measured results and how they compared to the predictions Act Act Describe what modifications to the plan will be made for the next cycle Describe what modifications to the plan will be made for the next cycle

from what you learnedfrom what you learned

EVMS Change PackageEVMS Change Package

Clinical Pharmacy ServicesClinical Pharmacy Services

The following are core elements of CPS which patients areThe following are core elements of CPS which patients arecurrently receiving at the Gloucester County care site:currently receiving at the Gloucester County care site:

Patient counselingPatient counseling Preventive care programs (smoking cessation)Preventive care programs (smoking cessation) Retrospective Drug Utilization Review (ADE/ADR)Retrospective Drug Utilization Review (ADE/ADR) Medication Therapy Management (Med reconciliation, Medication Therapy Management (Med reconciliation,

Triple HAART, hepatic/renal evaluation)Triple HAART, hepatic/renal evaluation) Disease State Management (Viral Load/CD4, Disease State Management (Viral Load/CD4,

Lipid/metabolic evaluation)Lipid/metabolic evaluation) Prospective chart review (co-morbid disease)Prospective chart review (co-morbid disease)

Pharm Dand

RN Educator

Pharm Dand

RN Educator

PharmacyAccess

PharmacyAccess

MedicalCase Management

at GloucesterHealth Department

MedicalCase Management

at GloucesterHealth Department

LocalLocal

P A T I E N TP A T I E N T

Mail OrderMail Order

ADAPADAP

EVMS HIV Treatment at Gloucester

Health Department

OralHealth

OralHealth

EVMSUrgent HIV

Careat Norfolk

EVMSUrgent HIV

Careat Norfolk

SocialCase Mgt. and

Ancillary Support

SocialCase Mgt. and

Ancillary Support

Patient’sP.C.P.

orSpecialty

CareSite

Patient’sP.C.P.

orSpecialty

CareSite

Local Hospitals

for Diagnostics

and Treatment

Local Hospitals

for Diagnostics

and Treatment

Sites of Clinical Pharmacy Services

Local Service Providers

Non-medical Sites

EVMS PSPSC: Patient Flow Across Providers

EVMS PSPSC: Patient Flow Across Providers

An example in improvements in An example in improvements in health outcomeshealth outcomes

Cohort: Entire Population of Focus Safety Measure: Establishment of, or collaborating with, a patient-centered health care home.

Measure Improvement:Measure Improvement: The process of consultation with a patient’s PCP or other provider in order to The process of consultation with a patient’s PCP or other provider in order to do a medicine reconciliation establishes the need for, or number of, changes do a medicine reconciliation establishes the need for, or number of, changes from baseline. from baseline.

Display:Display: Electronic medical record medicine list from EVMS.Electronic medical record medicine list from EVMS.

Use:Use: CPS will verify record at each encounter, thereby, CPS will verify record at each encounter, thereby, • Promoting patient health literacy and self care involvementPromoting patient health literacy and self care involvement• Developing a protocol communication between participants in the Developing a protocol communication between participants in the

healthcare processhealthcare process• Establishing and maintaining responsive linkages between local service Establishing and maintaining responsive linkages between local service

providers and the delivery of patient care -- addressing the unique needs providers and the delivery of patient care -- addressing the unique needs of an HIV+ population.of an HIV+ population.

EVMS PSPSC: WE’RE GROWING AND EVMS PSPSC: WE’RE GROWING AND WE’RE DIVERSE!!WE’RE DIVERSE!!

Cindy Lewis, EVMS

RN Educator

Judy Wessell, EVMS

Nurse Practitioner

Tanya Kearney, Dir.

AIDS Resource Center

Fred Casey, Project Off.

Ryan White Part B

Allison Gray, RN

Clinical Quality Coord.

Janet Hall

Consumer, Ryan White Part B

Pierre Diaz

Consumer, Ryan White Part A

Dr. Virginia Walker

Contract Pharm D

Rick Hall , Health Counselor

Three Rivers Health Dept.MOST OF OUR HAPPY FAMILY