Preventing and Reducing Adverse Drug Events in Care Coordination Communities: Cycle 1 Results - PowerPoint PPT Presentation

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Preventing and Reducing Adverse Drug Events in Care Coordination Communities: Cycle 1 Results


* Coordination of Care Task Goals Promote Effective Communication ... Audit Methods Additional Ad Hoc Anticoagulation Measure- Warfarin Time in Therapeutic ... – PowerPoint PPT presentation

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Title: Preventing and Reducing Adverse Drug Events in Care Coordination Communities: Cycle 1 Results

Preventing and Reducing Adverse Drug Events in
Care Coordination CommunitiesCycle 1 Results
Anne Myrka, RPh, MAT IPRO July 30, 2015
  • Describe IPROs CMS 11th Scope of Work Priorities
    and Goals
  • IPRO Drug Safety work overview
  • Describe the Preventing and Reducing Adverse Drug
    Events (PARADE) initiative Objectives and
  • Provide Cycle 1 (January June) results
  • Highlight facility specific interventions and
    experiences guest speakers
  • Next Steps, Q A

  • Thank You!!!

Coordination of Care Task Goals
  • Promote Effective Communication and
    Coordination of Care
  • Reduce hospital readmission rates in the Medicare
    program by 20 by 2019
  • Reduce hospital admissions rates in the Medicare
    program by 20 by 2019
  • Increase community tenure, as evidenced by
    increased number of nights spent at home, for
    Medicare beneficiaries by 10 by 2019
  • Reduce the prevalence of adverse drug events
    (ADEs) that contribute to significant patient
    harm, emergency department visits, observation
    stays, hospital admissions or readmissions
    occurring as a result of the care transitions
  • Anticoagulants
  • Hypoglycemic Agents
  • Opioids

IPRO Drug Safety overview
  • NYS Anticoagulation Coalition
  • Appropriate DOAC use included in utilization
  • Effective EHR utilization manuscript published
  • Peri-procedural utilization of all anticoagulants
    MAP tool (app under development)
  • Pain Management Task Force
  • Reducing opioid-related adverse drug events
  • Hypoglycemia agent Task Force
  • Reducing hypoglycemia-related ADEs

  • What is IPROs PARADE Initiative?

PARADE Initiative 2014 Pilot study and results
  • Evidence-based system improvements were applied
    to Anticoagulation Discharge Communication and
    Med Rec on Admission according to site-specific
    baseline results
  • Significant improvement in communication of
    requisite anticoagulation-related elements to
    subsequent provider upon transfer/discharge
  • All facilities (16, 95 CI 11.6-20.3)
  • Hospitals (8, 95 CI 1.2-15.2)
  • SNFs (19, 95 CI 12.7- 25.8)
  • Significant improvement in completion of
    medication reconciliation processes upon
    admission in SNFs (21.2,
    95 CI 9.6- 31.9)

PARADE Initiative
  • QIOs are directed by CMS in the 11th Statement of
    Work (11SoW- 2015-2019) to
  • Establish relationships and collaborations in the
    community to coordinate provider communication
    and medication management across care settings
    with a patient centered focus
  • Help providers utilize new or existing
    evidence-based tools and practices to improve the
    care of those prescribed high risk medications,
    specifically anticoagulants, diabetic agents and
  • Use health information technology to screen for
    and prevent ADEs in Medicare beneficiaries

  • PARADE Objectives and Strategy

PARADE Objectives
  • To identify patients at risk of experiencing ADEs
    due to high risk medication use following
    hospital discharge
  • To identify hospital readmissions and emergency
    department visits associated with high risk drug
  • To evaluate the post-discharge medication use
    system across care settings and identify
    opportunities for system improvements
  • To facilitate the implementation and serial
    evaluation of evidence-based intervention

PARADE Strategy
  • Process measures All facilities/healthcare
  • Small, low-impact audits of medication
    reconciliation processes and high risk drug
    discharge communication (5-10 charts,
  • Serial evaluation to guide improvements
  • Goal measureable improvement in adherence to
    audit criteria
  • Interventions
  • Evidence based interventions according to
    site-specific results
  • Outcome measures Hospitals only
  • Readmissions due to ADEs using data from
    electronic health record data (hospital) and
    claims data (IPRO)
  • Serial evaluation to identify improvements
  • Goal Demonstrate measureable improvement over 5
    year scope of work

PARADE Strategy
  • Based on ?6 month improvement cycles
  • Cross setting work will be achieved within each
    care transition coalition Medication Management
    Committee monthly meetings
  • Eligible facilities hospitals, skilled nursing
    facilities (SNF), rehabilitation facilities, home
    healthcare services/agencies (HHA), residential
    facilities, adult homes, pharmacies (hospital,
    community, SNF vendors, etc.)
  • Participating individuals are administrators,
    physicians, nurses, pharmacists (including SNF
    consultant pharmacists), quality improvement
    professionals, discharge planners, HHA hospital
    liaisons, etc.
  • Cycle 1 was January 6, 2015 June 30, 2015
  • All facilities focused on Medication
    Reconciliation and Anticoagulation Discharge

PARADE Strategy
  • Cycle 2 is September 2015 February 2016
  • Continue to work on ADE hospital readmission
    measure, high risk drug discharge communication
    and med rec improvement processes (expanding to
  • Expand to medication management of hypoglycemics,
    opioids, other (e.g. antibiotics)
  • IPRO is currently convening subject matter
    experts to provide guidance on best practices for
    management across care settings during
  • Subsequent Cycle work will focus on continued
    evidence based improvements, sustainability and
    applicable cross-setting emerging measures

  • PARADE Process Measures Audit Methods

PARADE Process Measures Audit Methods
  • Medication Reconciliation on Admission Audit
  • Medication Discrepancy Tool
  • Anticoagulation Discharge Communication Audit
  • Anticoagulation Information Discovery Tool

Additional Ad Hoc Anticoagulation Measure-
Warfarin Time in Therapeutic Range?
  • Designed for skilled nursing facilities,
    outpatient clinics and others that serve
    population over long term
  • For more information http//

TTR Rosendaals method
  • Cycle 1 Results

Anticoagulation Discharge Communication
Medication Reconciliation
Outcomes ADE Surveillance Process - Hospitals
  • Remeasure quarterly after baseline is completed
  • Secure data transfer protocol utilized

ADE Surveillance Hospital Engagement
  • Total hospitals engaged 27
  • Already sharing complete data 6
  • Represents 22,380 unique Medicare Fee for Service
    Beneficiaries discharged from participating
    hospitals on 1 high risk drug and screened for
  • Anticoagulant potential ADEs - 104
  • Opioid potential ADEs - 55
  • Hypoglycemic potential ADEs - 9
  • Beginning test data query 4
  • Agreed to share data 17
  • ?Hospitals currently participating in CT

  • PARADE Interventions

Medication Reconciliation Improvement Tools
Anticoagulation Improvement Tools
  • Facility Specific Interventions

HealthAlliance of the Hudson Valley, Kingston, NY
  • Medication Reconciliation Risk Reduction
    Strategies Identified
  • ASU staff were provided additional training on
    how to enter home medications in the EMR to
    generate a clean medication reconciliation. No
    free texting!
  • Orthopedics -aggressive education with Medical
    Staff on steps to complete medication
    reconciliation utilizing the EMR. Informatics
    staff assisted MD with 11 concurrent training
  • Set up touch points with MD to address any
    concerns identified with use of medication
    reconciliation process
  • Sole use of the EMR for medication
    reconciliation. No more paper!

HealthAlliance of the Hudson Valley, Kingston, NY
  • Medication Reconciliation Risk Reduction
    Strategies Identified continued
  • The Emergency Department created dedicated
    resource called Clinical Data Specialist
  • This position is staffed with an a Pharmacy Tech
    or LPN. They are required to enter into the
    hospital EMR all of the Home Medications for
    all patients admitted.
  • Two sources must be utilized to reconcile the
    list of home medications
  • The patients list
  • Call pharmacy
  • Calling the patients MD
  • Reviewing the list from the ER EMR

HealthAlliance of the Hudson Valley, Kingston, NY
  • Medication Reconciliation Opportunities for
  • CHF patient post discharge phone calls
    identified need for clearer patient instructions
    on home medication resumption or discontinuation.
    Not always evident in the medical record.
  • Pharmacy medical record application does not
    allow pharmacist to view MD reason for
    stopping/discontinuing medications.

HealthAlliance of the Hudson Valley, Kingston, NY
  • Blood Thinner Adverse Events Risk Reduction
    Strategies Identified
  • Orthopedics physicians managing post operative
    course of blood thinner or conferring with
    patients cardiologist.
  • Orthopedics - plan to pilot a sequential
    compression biomechanical device (SCBD) replacing
    the use of utilizing blood thinner medications

HealthAlliance of the Hudson Valley, Kingston, NY
  • Blood Thinner Adverse Events Opportunities for
  • Multiple places in EMR where information
    regarding high risk blood thinner medication may
    be documented.
  • Auditing difficult due to inconsistent
    documentation. Sub-group identified location of
    possible documentation evaluating possibility
    of creating a blood thinner tab in EMR for
    centralized documentation.
  • Information needed for transition of care not

HealthAlliance of the Hudson Valley, Kingston, NY
  • Medication Reconciliation High Risk Medication
    Discharge Process Audit
  • Audit 35 charts utilizing IPRO medication
    reconciliation discharge tool to obtain baseline.
  • Audits to be completed no later than July 31,
  • Charts to be audited by discharge location
  • 5 - SNF, Rehab, Acute Care
  • 5 ED
  • 5 Orthopedics
  • 5 General Home
  • 5 Endo
  • 5 Hypoglycemic agents
  • 5 CHF

Albany Memorial Hospital, Albany, NY
  • Anticoagulant-related high priority elements
    highlighted for hospitalists in real time during
    discharge summary dictation facilitated by case
    management at time of discharge
  • Kaizen done regarding standardization of
    discharge practices
  • Patient teach back
  • Identifying high risk patients
  • ED med rec by pharmacist
  • Contact PCP on admit
  • Identify caregiver/family by day 2
  • Rapid summaries for high risk drugs

Evergreen Commons, East Greenbush, NY
  • Initiated the Blood Thinner Safety Plan  
  • Complete med list printed from Omniview
    indicating drug, dosage and time of next dose due
  • Most recent fall risk assessment faxed to
    community PCP
  • Resident PT/INR flow sheet faxed to community PCP
  • Medication Reconciliation home meds
  • Developed a discharge check list

Home Healthcare
  • Dominican Sisters Family Health Services
  • Multiple PDSAs and PARADE huddles weekly
  • Business Development Managers and Liaison
  • Standardized New Electronic Referral which
    includes  mandatory fields to capture
    Anticoagulant high priority elements
  • Collaboration with hospital readmission teams
  • Access to hospital electronic medical record
  • Nurse education
  • Cross-setting pilot of Blood Thinner Safety Plan
    - planning for next cycle.

Home Healthcare
  • VNA of the Hudson Valley
  • Evidence Based Patient Education Protocols and
    Materials including BTSP, INR Worksheet, RN Pt.
    Teaching Plan Checklist, Guidelines for Lovenox
    Administration/Precautions Patient self-test re
    learning achieved
  • Guidelines for  Home Health Intake Coordinators
    Baseline transfer information
  • Anticoagulation information to be sent  to PCP
    upon discharge from homecare Transfer summaries
    to reflect status of anticoagulation therapy
  • Nurse education

Home Healthcare
  • VNS Westchester Putnam Branch
  • Implementing intake template revision to capture
    salient anticoagulation information for use by
    Home Health Intake Coordinators and Liaisons
  • Piloting Blood Thinner Safety Plan and Warfarin
    Dose and INR flow sheet
  • Developing Discharge Summary Form for patients on
    AC therapy to be sent to the PCP or other
    provider upon discharge from home care services
    to include diagnosis requiring need for AC
    therapy, flow sheet account of past INR readings,
    corresponding AC medication changes, s/s
    bleeding, related teaching, etc.
  • Working with local hospital readmission task
    force for access to patient portal and other
    options to obtain most current accurate discharge
    medication and other pertinent data related to AC
    therapy last 3 INRs, reason for AC therapy,
    identification of patients new to AC therapy,
    therapeutic level, etc.
  • Working with Director of Pharmacy at local
    hospital for identification of patients on AC
    therapy at risk for complications and in need of
    home care follow-up.
  • Developing process for standardized, mandatory
    clinician education on the assessment and
    pharmacology aspects of the anticoagulated

Next Steps
  • Webinar PARADE Cycle 2 Launch
  • Wednesday, September 9, 2015 200pm 300pm
  • This webinar will serve as an introduction to
    IPROs Preventing and Reducing Adverse Drug
    Events (PARADE) initiative for new communities
    and provide information for those communities
    entering PARADE Cycle 2.
  • Click or Copy and Paste this URL to your web
    browser https//
  • Password IPRO
  • Dial in number is 866-209-5917. The access code

  • Questions / Feedback

For more information
  • Anne Myrka
  • Pharmacist Drug Safety
  • (518) 320-3591

Sara Butterfield Senior Director Care
Coordination (518) 320-3504 Sara.Butterfield_at_area-
Darren Triller Senior Director Drug
Safety (518) 320-3525 Darren.Triller_at_area-i.hcqis.
IPRO Care Transitions Web Site http//qio.ipro.or
g/care-transitions/overview IPRO Drug Safety Web
Site http//
Avenue Lake Success, NY 11042-1002 IPRO REGIONAL
OFFICE 20 Corporate Woods Boulevard Albany, NY
This material was prepared by the Atlantic
Quality Innovation Network/IPRO, the Medicare
Quality Innovation Network Quality Improvement
Organization for New York State, South Carolina,
and the District of Columbia, under contract with
the Centers for Medicare Medicaid Services
(CMS), an agency of the U.S. Department of Health
and Human Services. The contents do not
necessarily reflect CMS policy.
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