Transcript Improving Patient Safety Using HIT

Improving Patient Safety
Using Health Information
Technology
Eric G. Gayle, MD F.A.A.F.P
IFH-Bronx Regional Medical Director
and
Regina Ginzburg, Pharm.D.
Clinical Pharmacy Faculty, BI Family Medicine
Associate Clinical Professor, St. Johns University
Medication Errors &
Preventable Adverse Drug Events
 At
least 1.5 million preventable ADEs
occur each year in the United States

~1/3 occur in the outpatient setting
 Cost
per preventable ADE: ~$2,000
 National annual cost: $887 million
 The numbers above are likely an
underestimation!
Preventing Medication Errors: Quality Chasm Series
http://www.nap.edu/catalog/11623.html
Electronic patient records and patient safety
legibility
communication
Point of
care
interactions
EHR
“Electronic
pharmacy”
capabilities
Effective Error-Prevention Strategies

Improving Patient-Provider communication
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Verify active medication list with each encounter
Review the name and purpose of the selected
medication.
Discuss when and how to take the medication.
Discuss important and likely side effects and what to
do about them.
Discuss drug-drug, drug-food, and drug-disease
interactions.
Review the patient’s role in achieving appropriate
medication use
Improving patient safety using
Health Information Technology
Eliminates
transcription
errors
Point of care
checks and
reviews
“Electronic
Pharmacy”
within the EHR
Electronic
prescribing
Improves patient
medication history
documentation
Effective Error-Prevention Strategies
 Electronic
prescribing
Ways to Improve
Medication Errors Using HIT
 Auto-calculated
dosing for special
populations
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Weight-based formula incorporated for certain
medications
Correct dosage should appear in the
directions field for specified patient
weight must be documented in current
encounter
Auto-calculated dosing:
Impact of Intervention
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Retrospective chart review looking rate of
medication errors in our pediatric patients who
were prescribed this medication before and after
intervention
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N=316 (Pre) and 224 (Post)
Number of medication errors
• Pre: 103 (32.7%)
• Post: 46 (20.6%)
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p=0.002
Significantly fewer strength overdosing errors in
postintervention group
• OR 0.431 (95% CI: 0.175-0.964) [p=0.028]
Ginzburg et al. Am J Health-Syst Pharm—Vol 66 Nov 15, 2009
Effective Error-Prevention Strategies

Access to evidence-based references
Patient Safety Management
Review new
drug
information
from FDA
Develop
medicationrelated policies
Pharmacy and
Therapeutics
Committee
Review and
update
medication
formulary
Build
“smartsets”
within EHR to
reflect policies
P&T Committee
 Monitor
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medication effects and risk for use
FDA warnings, latest guidelines/position
statements, new major RCTs
Committee’s decision based on levels
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Level 0 – no action
Level 1 – “Inbasket” to all providers
Level 2 - Inbasket + BPA
Level 3 – advise HCP to cease prescribing
Monitoring Adverse Drug Reactions
Provider detects an ADR event
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ADR diagnosis is entered during encounter
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Patient chart is flagged and sent to P&T
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Pharmacist reviews chart and determines if
ADR needs to be submitted to Medwatch
Impact of Best Practice Alerts
(BPAs)
 Effort
to decrease prescribing teratogenic
medications to women of reproductive age

Phase I:
• chart review determining the degree of need
• 679 electronic charts reviewed
• Primary outcome measure
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absence of a documented contraception plan
or
documentation that patient is low risk for pregnancy
• Exclusion: Active contraceptive on medication list,
IUD documented under procedure section,
hysterectomy documented in surgical history
Results of Phase I
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51.3% of women were prescribed a
potential teratogen and were considered
high risk for pregnancy
 No
easy way to see if discussion took
place with patient regarding potential
teratogenicity
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Implementation of BPA
 BPA
will alert providers that they are
ordering a potential teratogen for a women
who is b/w 14-49 y/o
 Exclusion criteria:
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Active contraceptive on medication list
Has IUD documented under procedure
Has hysterectomy documented in surgical
history
Has pregnancy or abortion diagnosis
BPA link to “smartset”
 Progress
note to blow in. Provider can
choose 1 of 3 notes
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Discussed risk and benefits.
• Patient is sexually active, current method of
contraception is document.
• Patient understands risk if becomes pregnant.
Patient is not currently sexually active.
• Patient understands risk if becomes pregnant.
Patient is only sexually active with women.
 Link
to contraceptive management
diagnosis
Future needs to improve safety
 How
to improve integration of OTC meds/
supplements with the Patient’s EHR
 Two way communication between
providers and hospitals- Bronx RHIO
project ongoing.
 One patient one chart concept
The Unmarked Territory…
 More
research is needed for
ambulatory care areas using HIT!!
Questions???