Transcript Medication Safety in the Primary Care Setting

Medication Safety in the
Primary Care Setting
Frank Federico
Executive Director
Institute for Healthcare Improvement
This project was supported by grant number R18HS019508 from the Agency for Healthcare Research and Quality (AHRQ).
The content is solely the responsibility of the authors and does not necessarily represent the official view of the AHRQ.
Learning Objectives
By the end of this module you will be able to:
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Describe the importance of medication safety
in the primary care setting
Identify areas in need of improvement
Use concepts described to begin to develop a
medication safety improvement project
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Concerns About Medication Safety
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More than half of American adults take at least
one prescription medication daily
Sources:
www.myhealthnewsdaily.com/3069-prescription-drugs-2011.html (4/9/2012)
Kaufman et al. 2002
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Concerns About Medication Safety
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More than half of American adults take at least
one prescription medication daily
About 4 billion prescriptions for medications
were written in 2011
Sources:
www.myhealthnewsdaily.com/3069-prescription-drugs-2011.html (4/9/2012)
Kaufman et al. 2002
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Concerns About Medication Safety
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More than half of American adults take at least
one prescription medication daily
About 4 billion prescriptions for medications
were written in 2011
Approximately two out of every three office
visits result in a prescription written
Sources:
www.myhealthnewsdaily.com/3069-prescription-drugs-2011.html (4/9/2012)
Kaufman et al. 2002
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Elderly and Their Medications
Sources:
www.myhealthnewsdaily.com/3069-prescription-drugs-2011.html (4/9/2012)
Kaufman et al. 2002
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Medication Errors: Ambulatory
Setting
Gurwitz JH, et. al. Incidence and Preventability of Adverse Drug
Events Among Older Persons in the Ambulatory Setting. JAMA. March
5, 2003;289(9):1107-1116.
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Evidence of Medication Errors
in the Primary Care Setting
• 25% (162/661) primary care patients had ADE
• Of those 162 patients
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13% (24) serious
11% (20) preventable
28% (51) ameliorable
06% (13) both serious &
preventable or ameliorable
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Gandhi TK, et al. NEJM April 2003
What Should We Worry About?
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“High-alert” medications
Out-of-date side effect & drug interaction info
Out-of-date medication and allergy lists
Therapeutic duplication
Adjustment for renal failure
and pregnancy
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Institute for Safe Medication Practices
www.ISMP.org
Accessed August 2013
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Situations Leading to Medication
Errors
Omitting a drug patient should be taking
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Example: Anticoagulant stopped for inpatient stay and not
restarted after surgery
Overlooking medications as cause of patient
problem
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Example: Patient prefers to color code her medication
Providing ineffective/incomplete instructions
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Example: Assuming patients understand the instructions or
warning labels on prescription bottles
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Situations Leading to Medication
Errors
Failing to ask if patients
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Are taking their medication at all
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Are taking their medication as prescribed
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Example: Patient stopped taking medication because of side effects,
but does not tell doctor.
Example: Patient is taking less medication to save money,
but does not tell doctor
Are taking medication from other doctors
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Example: Patient started new medication after visiting a specialist,
but does not tell doctor
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PROMISES Driver Diagram
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Useful Interventions
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Track patients on high-alert medications
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Monitor blood values
Monitor side effects
Ensure access to latest drug info database
Reduce “polypharmacy”
Apply lessons from follow up of lab results
to medication monitoring
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Useful Interventions
Implement a reliable medication follow-up
process to address knowing about:
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New prescriptions from other providers
Discontinued medications by other providers
Therapeutic duplication
Medications that may interact
Non-adherence by patients
Medications that require monitoring
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Useful Communication Interventions
Deliver instructions and materials in a patient
centered literacy appropriate level
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Examples: AHRQ website and Massachusetts
Coalition for the Prevention of Medical Errors
website
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Useful Communication Interventions
Engage patients/families/caregivers
when deciding therapeutic plans
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Example: Ask a patient:
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What is the matter with you?
What matters to you?
What will you be able to manage?
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What is the Patient Really Taking?
Problem:
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Patient has unexplained symptoms
Action:
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Patient asked to bring all medications in
Finding:
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Patient was arranging & taking pills by color!
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Test: Bring in all your Scripts!
Problem: Determine if patients with memory &
dementia issues are taking medications correctly
Action: Asked these vulnerable patients to bring
in all medications for a medication “check-up”
Finding: Provided opportunities to talk with patients
and test if using pillboxes made it easier to take
medications correctly
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Are Medication & Allergy Lists
Updated?
For 16 patients, Practice Manager checked
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Allergy lists, medication lists
Finding
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Only 3 medication lists
(19%) were updated
Only 6 allergy lists
(38%) were updated
None of the 16 had
both updated!
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Test: Medication List Review
Protocol
Change when the medication lists are reviewed
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Print medication list prior to patient visit (MA)
Review medication list prior to huddle (MD, MA)
Review list with patient
Make changes when provider indicates
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What Can You Do Today?
Check: Reliable process for updating patient
medication lists?
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What Can You Do Today?
Check: Reliable process for updating patient
medication lists?
Measurement strategy: Review medical records
 Was medication list reviewed and updated?
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What Can You Do Today?
Check: Reliable process for updating patient
medication lists?
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Measurement strategy: Review medical record
Was medication list reviewed and updated?
Check: Reliable process to update patient
allergies?
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What Can You Do Today?
Check: Reliable process for updating patient
medication lists
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Measurement strategy: Review medical record
Was medication list reviewed and updated?
Check: Reliable process to update patient
allergies
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Measurement strategy: Review medical records
Was allergy information reviewed & updated?
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Thank You!
Thank you
for your time
and attention today
A Few References
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Institute for Healthcare Improvement www.ihi.org
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Institute for Safe Medication Practices
http://ismp.org/
Massachusetts Coalition for the Prevention of
Medical Errors
http://www.macoalition.org/reducing_medication
_errors.shtml
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