Transcript Slide 1

Improving Patient Safety through Informed
Medication Prescribing and Disposal Practices
Fifth Annual Maine Benzodiazepine Study Group
Conference & Fourth Annual Unused Drug Return
Conference
Track A: Safe Drug Return
Get Rid of Unused Pharmaceuticals
(GROUP) Campaign
Speakers:
Elizabeth A. Smith, Ph.D.
Matthew C. Mireles, Ph.D., M.P.H.
Community Medical Foundation for Patient Safety
November 1, 2007
10:30 am – 11:15 am
Get Rid of Unused Pharmaceuticals
(GROUP) Campaign
Learning Objectives
1. Dangers of unused and expired medicines
(UEM)
2. Community of Competence™: a method
and framework to study UEM
3. History and evolution of GROUP
4. Standardized data collection and
methodology
5. Current status and results of GROUP
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO1
Too Many Medications!
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135 million use prescription meds monthly1
4 billion prescriptions each year2
90% seniors use at least one med3
40% used 5 or more meds weekly3
Average person over 65 take 2 to 7 meds
daily (30% of meds prescribed)4
15 million misuse meds5
4 out 5 patients leave doc’s office with 1 or
more prescriptions6
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO1
Dangers of UEM
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Non-adherence to prescription and therapy
Med error causes 700,000 ER visits yearly7
36% of poisoning among kids happens at
grandparents’ homes4; pets get poisoned
19% (4.5 million) teenagers abuse
prescription meds8— “pharming”
Meds stolen and sold on the streets
Improper disposal contaminates water
Possible “dumping” of UEM overseas
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO2
Communities of Competence™ (CC)
Not just any group, committee, or
coalition...but a true community of
individuals based on knowledge,
skills, expertise, experience,
motivation, and competency
Copyright 2007 Community Medical
Foundation for Patient Safety
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Community of Competence™
for Patient Safety
Culture
Nurses
Others
Educators
Oslerians
Engineers
PATIENT
Interns
Volunteers
Env. Sc.
Partners
Info Sc.
Ethicists
Environment
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO2
Theories and Driving Forces
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Globalization—cultural diversity, politics,
distance, continuous production,
communication, etc.
Complexity of work itself—numerous disciplines,
experience levels, e-work, growing number of
products and services
Organizations are becoming flatter, virtual and
boundaryless
Turbulent external environment--limited
resources
Challenges in behaving, learning, adapting, and
surviving
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO2
Operational Definition of CC
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A new framework to first visualize what type of
group exists and what type of group should be
created to do a specific task or job
A methodology to describe, assess, and
combine separate strengths and core
competencies of individuals, groups, and
organizations into a meaningful, goal-oriented
whole--synergy
A team of highly skilled, specialized people with
proven competencies
A flexible, learning organization; network of
organizations or systems
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO2
General Tasks of CC Members
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Do specific tasks or jobs for which they are most
qualified or competent
Engage in continual learning and improving skills
Work together cooperatively and recognize
expertise of their members and of other individuals
Rotate leadership based on unique competencies
and expertise
Make maximum use of tacit knowledge based on
common sense and information sharing
Communicate openly and share skills, abilities,
knowledge, unique expertise, and lessons learned
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO2
Organization-Driven Tasks of Members
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Identify and address a complex problem—high
national…international concern and impact
Recognize oneself as part of a problem-solving
community
Understand the forces driving the problem and
solutions
Know one’s own skills, abilities, knowledge, and
unique professional responsibilities and resources
Acknowledge and value the individual and
collective competencies of others needed to solve
the problem
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO2
Action-Driven Tasks of Members
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Develop ways to meet in formal, informal, and/or
virtual groups or networks to solve the problem
Divide tasks, assignments, and responsibilities
based on expertise and competencies
Create a way to share information across disciplines
and organizations (boundary expanding)
Share data, information, and knowledge from one’s
own discipline and experience with members
Evaluate efforts and outcomes to stay on target
toward a solution
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO2
Community of Competence™ for UEM
Environmental
Protection
Patient Safety
Drug/Law
Enforcement
UEM
Medical
Practice
Public Safety
and Policy
Consumer
Protection
Academia and
Research
Others
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO2
Benefits of CC in Studying UEM
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UEM problem is large and too complex
UEM problem is relatively unknown and has
enormous impact
Problem requires diverse expertise, authority,
and intra-organizational involvement
Experts often work together at great distances
Experts must address current legal and political
barriers and technology
Problem requires complex solutions that are
both short-term and long-term
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO3
History and Evolution of GROUP
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Developed as part of patient safety education
and outreach in safe medication practices
Focus on building awareness and the CC to
address issues of UEM
Created the UEM Registry in 2004 to
systematically collect and analyze data
Collaborated with partners to standardized data
collection (anonymous with only 5 basic
variables: drug name, strength, quantity
returned, reason for return, and zip code)
Published the GROUP Manual of Procedures
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO3
History and Evolution of GROUP (Cont.)
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Continue to collect data from various sources
and locations
Standardized classification based Drug Abuse
Warning Network (DAWN) of DHHS Substance
Abuse & Mental Health Services Administration
(SAMHSA)
Data from UEM Registry requested and used for
research and policy (State of ME, ONDCP)
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO4
Methods to Standardize Data Collection
Research Rationale (Questions)
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What kinds of medicines prescribed and not used?
Why medicines not taken as prescribed?
Why people keep UEM in homes?
Why people stop taking medicines?
Which UEM are controlled substances?
What is the cost of UEM?
What is the environmental impact of UEM?
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO4
Methods to Standardize Data Collection
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Establish consensus on the variables and why
we are collecting them
Develop standardized data collection instrument
Implement use of standardized instrument
Evaluate and modify instrument if needed
Encourage wide use of instrument to collect
data the same way
Use CC as a model and framework for
promoting standardized data collection
Report usage of instrument
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO4
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO5
Current Status and Results
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GROUP Manual of Procedures completed and
now available
US EPA has included GROUP Manual into its
Resource Kit for Drug Disposal
Proposed service: designated data repository
and analysis of UEM nationally…internationally
GROUP Campaign to support other projects and
programs (e.g. Green Pharmacy and Maine Safe
Drug Disposal Project)
Ongoing study to evaluate GROUP Campaign
and data collection for the UEM Registry
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO5
Current Status and Results
Pilot study of GROUP Campaign in Houston, TX
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Aims: estimate response rate for participation;
evaluate education materials; study the utility of
self-administered returned drug form
Population: senior adults at a local church
Methods: 3-part educational workshop with a drug
(UEM) inventory and collection at the end
Results:
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Response rate = 18% based on enrollment in
workshop (8 participants of 45 enrolled)
Educational materials (slide presentation)
increase awareness of danger of UEM
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign—LO5
Current Status and Results
Pilot study of GROUP Campaign in Houston, TX
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Results (cont.):
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Participants rated the presentation very useful
and important, and they learned something new
Participants filled out drug return form without
any problem
Discussion and Conclusions:
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Pilot study is small; population is unique
Response (participation) rate can be increased
with addition promotion and publicity
Participants have no problem filling out forms
Copyright 2007 Community Medical
Foundation for Patient Safety
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Get Rid of Unused Pharmaceuticals
(GROUP) Campaign
Challenges and Opportunities
 Need leaders and champions to promote public
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awareness of the problem and widely adopt the
UEM Registry
Need funding to support and expand the Registry
and personnel
Integrate the Registry with collection and disposal
systems
Develop standard process for reports
Identify other uses of the Registry
Reinforce the values and principles of CC to
strengthen collaboration and actions
Copyright 2007 Community Medical
Foundation for Patient Safety
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Acknowledgements
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Anita Hampton, MS, Fellow
Jerry Miller, Ph.D.
Racheal Johnson, BS, Graduate Intern
John Sullivan
Cheenu Srinivasan
Hari Ayyer
Sonali Patel
Ye Sun
Faye Wang
Copyright 2007 Community Medical
Foundation for Patient Safety
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For more information
Community Medical Foundation
For Patient Safety
6800 West South Loop, Suite 190
Bellaire, Texas 77401
832-778-7777
www.comofcom.com
Copyright 2007 Community Medical
Foundation for Patient Safety
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References
1. Center for Disease Control. (2006). Therapeutic Drug Use.
National Center for Health Statistics,
http://www..cdc.gov/nchs/fastats/drugs.htm, p.1.
2. Garey, K.W. et al. (2004). “Economic consequences of unused
medications in Houston, Texas.” The Annals of
Pharmacotherapy, July/August; 38: 165-1168.
3. Smith, S.R. and Clancy, C.M. (2006). “Medication therapy
management: A new opportunity to optimize therapeutic
outcomes in medicare,” Patient Safety & Quality Healthcare,
September-October, p. 12.
4. Minnesota Poison Control System, Hennepin County Medical
Center, “Seniors and Medication Safety”.
www.mnpoison.org/index.asp?pageID=198
5. Maine Benzodiazepine Study Group, University of Maine, Center
on Aging (2006). Conference Proposal for a National Unused
Drug, Nov. 22, 2006.
Copyright 2007 Community Medical
Foundation for Patient Safety
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References (cont.)
6. Testimony before the House Government Reform Committee
Subcommittee on Criminal Justice, Drug Policy, and Human
Resources. Joseph T. Rannazzisi, Deputy Assistant
Administrator, Office of Diversion Control, July 26, 2006.
7. Houston Chronicle. (2006). “Everyday medicines, big risks”.
October 19, 2006, B2.
8. The Partnership for a Drug-Free America. (2005). “Latest teen
drug trends”.
www.drugfree/org/Portal/DrugIssue/Research/Teens_2005/Gen
eration_Rx_Study-…
Copyright 2007 Community Medical
Foundation for Patient Safety
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