Transcript Overdose Fatality Review – Haas

OVERDOSE FATALITY
REVIEW
A THOUGHTFUL APPROACH TO PAIN
MANAGEMENT
MAY 29-30, 2015
Erin Haas
Overdose Prevention
Local Programs Manager
OVERDOSE FATALITY
REVIEW
Modeled after other mortality review teams (CFR, FIMR, etc.)
Multi-agency/multi-disciplinary team assembled to conduct confidential
case reviews of overdose deaths
Goal to prevent future deaths by
Identifying missed opportunities for prevention and gaps in system
Building working relationships b/t local stakeholders on OD prevention
Recommending policies, programs, laws, etc. to prevent OD deaths
Informing local overdose prevention strategy
Department of Health and Mental Hygiene (DHMH) provides TA & death
records to teams
Team members bring info from respective agencies about decedents to
inform review
3 Pilot Teams → Baltimore City, Cecil County, Wicomico County
OVERDOSE FATALITY
REVIEW
Legal authority
• Pilot phase: medical review committees
• HB1282 passed and went into effect 10/1/14
OFR law (HB1282)
• gives structure and authority to the teams (membership, goals,
etc.)
• provides civil liability protection for team members and those that
provide information to the teams
• establishes confidentiality requirements
• establishes expectations and reporting requirement to DHMH
TA continues to new and existing teams
• 11 new teams have begun reviewing cases
• Attending all first meetings
• Bimonthly conference calls
“The open communication will help resolve the barriers that we face
in the community”
“The meetings were stilted at first, but have been improving- nearly
all members contribute to discussions, which are often lively, and we
spend enough time on cases to generate ideas”
“Its definitely helping us get to the story behind the numbers”
OPERATIONS
Three pilot teams
• Cecil, Wicomico, Baltimore
City
• Met at least quarterly,
reviewed 86 cases from
January – October 2014
Agencies involved:
•
•
•
•
EMS
Sheriff's Office
Detention Center
Court System
•
•
•
•
•
•
•
Mental Health Treatment
Social Services
Community Supervision
State's Attorney
SEP/Staying Alive
Pharmacy
Drug Treatment (Public and
Private)
• Hospital
• Board of Education
• Dept. Juvenile Services
DATA COLLECTION/REPORTING
Meetings
•
•
•
•
Demographics
Date of death
Cause of death
Indication of data
reviewed
• Key observations
• Trends, potential
recommendations at
policy, system and
program level
• Data challenges
Recommendation
tracking
• Updated quarterly
• Reported to DHMH
CASES REVIEWED
Total: 86
Pilot Phase: January – October 2014
Unkno
<18 18-24 25-34 35-44 45-54 55-64 65+
wn Total
Gender
Male
0
5
15
12
16
11
3
0
62
72%
Female
0
1
8
5
5
3
1
1
24
28%
African American
0
2
5
3
7
5
1
0
23
Hispanic
0
0
1
0
1
0
0
0
2
White
0
4
16
13
13
9
2
1
58
Unknown
0
0
1
1
0
0
1
0
3
Race/Ethnicity
AGENCY
INTERACTION
VA
EMS
Law Enforcement
Detention Center
Court System
Mental Health Tx
Social Services
Community Supervision
State's Attorney
SEP/Staying Alive
Pharmacy
Drug Tx (Public and Private)
Hospital
1
56
76
11
8
22
31
25
29
10
4
49
9
1
65%
88%
13%
9%
26%
36%
29%
34%
12%
5%
57%
10%
AGENCY
INTERACTION
<18
18-24
VA
0.00%
0.00%
EMS
0.00%
1.22%
Law Enforcement
0.00%
2.13%
4.88%
7.32%
Detention Center
0.00%
0.30%
Court System
0.00%
0.30%
Mental Health Tx
0.00%
0.61%
Social & Human Services
0.00%
0.61%
Community Supervision
0.00%
0.00%
1.83%
State's Attorney
0.00%
0.00%
SEP/Staying Alive
0.00%
Pharmacy
Unknow Total
n
Inter.
35-44
45-54
55-64
65+
0.00%
0.00%
0.00%
0.00%
0.00%
1
3.05%
4.27%
2.74%
0.61%
0.30%
56
4.27%
5.18%
3.66%
0.91%
0.30%
78
0.91%
0.61%
0.91%
0.30%
0.30%
0.00%
11
0.91%
0.30%
0.61%
0.30%
0.00%
0.00%
8
1.52%
0.91%
0.30%
0.00%
22
0.91%
1.22%
0.30%
0.00%
26
1.52%
2.13%
1.52%
0.30%
0.30%
25
2.44%
1.83%
2.44%
1.52%
0.61%
0.00%
29
0.00%
0.61%
0.61%
1.22%
0.30%
0.30%
0.00%
10
0.00%
0.30%
0.00%
0.30%
0.00%
0.30%
0.30%
0.00%
4
Drug Tx (Public and Private)
0.00%
0.61%
3.66%
3.35%
4.27%
1.52%
0.91%
0.61%
49
Hospital
0.00%
0.30%
0.91%
0.30%
0.61%
0.00%
0.61%
0.00%
9
0.30%
2.13% 1.22%
2.44% 2.44%
328
AGENCY
INTERACTION
<18
18-24
25-34
35-44
45-54
55-64
65+
Unknow
n
Total
Inter.
VA
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
0.00%
0.00%
100.00%
EMS
0.00%
7.14%
28.57%
17.86%
25.00%
16.07%
3.57%
1.79%
100.00%
Law Enforcement
Detention Center
0.00%
0.00%
8.97%
9.09%
30.77%
27.27%
17.95%
18.18%
21.79%
27.27%
15.38%
9.09%
3.85%
9.09%
1.28%
0.00%
100.00%
100.00%
Court System
0.00%
12.50%
37.50%
12.50%
25.00%
12.50%
0.00%
0.00%
100.00%
Mental Health Tx
0.00%
9.09%
31.82%
18.18%
22.73%
13.64%
4.55%
0.00%
100.00%
Social & Human Services
0.00%
7.69%
30.77% 30.77%
11.54%
15.38%
3.85%
0.00%
100.00%
Community Supervision
State's Attorney
0.00%
0.00%
0.00%
0.00%
24.00%
20.00%
20.69%
28.00%
27.59%
20.00%
17.24%
4.00%
6.90%
4.00%
0.00%
100.00%
100.00%
SEP/Staying Alive
Pharmacy
0.00%
0.00%
0.00%
25.00%
20.00%
0.00%
20.00%
25.00%
40.00%
0.00%
10.00%
25.00%
10.00%
25.00%
0.00%
0.00%
100.00%
100.00%
Drug Tx (Public and Private)
0.00%
4.08%
24.49%
22.45%
28.57%
10.20%
6.12%
4.08%
100.00%
Hospital
0.00%
11.11%
33.33%
11.11%
22.22%
0.00%
22.22%
0.00%
100.00%
27.59%
DATA CHALLENGES
AND LIMITATIONS
 Dependent on entity, agency, or organization’s record
keeping system and member attendance
• Time span of records
• Detail of medical history
• Veteran status/VA data
• Prescription data or PDMP
• Treatment data post-SMART
• Juvenile records
• Out of state records
NOTABLE TEAM MEMBER
OBSERVATIONS
• Sheer amount of interaction with systems
• Especially the criminal justice system in BC
• Role of alcohol in overdose deaths
• Older drug users are at risk, with many co-occurring
chronic health issues
• Care coordination in somatic health and after substance
use disorder treatment
• Occurrence of trauma just before death (loss of a loved
one, struggles with child custody, etc.)
TRENDS
• Deaths occurring in hotels and motels
• Recent release from jail; detoxification in jail system
before release
• Hispanic population and LGBT
• History of intimate partner violence
• Poly-pharmacy
• Previous overdose
• Pain management
• noted in 7/86 (8%) pilot cases
IMPACTS/OUTCOMES ON
PARTICIPATING AGENCIES
Increase in number and improved the quality of the referral
system
Training of staff to use naloxone
Educated and increased the awareness of staff of overdose
related issues
• Promoting substance use disorder education and assessment at
all levels of the organization
Broader understanding of overdose in the community
More direct outreach to families on overdose prevention and
wraparound services by those that serve people at risk of
overdose
Changes to intake questionnaires to include questions about
overdose history
OUTCOMES SYSTEM
LEVEL
Collaboration among partner agencies to strengthen
outreach: BHSB and EMS
Improvement to Treatment Referral Line in Baltimore City,
collaboration between HCAM and BHSB
Collaboration between local health department and EMS to
follow up with overdose survivors
Changes proposed to PDMP law to allow for data sharing
with review teams
MOVING FORWARD
 Continue the momentum with existing teams to build upon
observations and potential recommendations
 Capacity building of teams
Conference calls/collaborative learning for coordinators
Build team membership; improve attendence
 Continue support and technical assistance to new teams,
ensure understanding of program goals and
confidentiality
 Turn observations and recommendations into bigger
action steps, further tracking those developments
CONTACT
INFORMATION
Erin Haas, MPH
Maryland Department of Health and Mental Hygiene
Behavioral Health Administration
Overdose Prevention Office
[email protected]
​Office: 410-402-8574
Cell: 443-827-0735