Transcript Medication Management - Jason Mills

2.11 Conduct Medication
Management
University Medical Center Health System
Lubbock, TX
Jason Mills, PharmD, RPh
Assistant Director of Pharmacy
Project Options
• 2.11.2 Evidence-base interventions that put in place the teams,
technology and processes to avoid medication errors. This project
option could include one or more of the following components:
• a) Implement a medication management program that serves
the patient across the continuum of care targeting one or more
chronic disease patient populations
• b) Implement Computerized Physician Order Entry (CPOE)
• c) Implement pharmacist-led chronic disease medication
management services in collaboration with primary care and
other health care providers
• d) Conduct quality improvement for project using methods such
as rapid cycle improvement.
Rationale
• Approximately 1.5 million preventable ADEs occur annually as a
result of medication errors
• Cost more than 3 billion per year
• 1 in 5 patients discharged from hospitals suffers an adverse event
• 72% are related to medications
• 76% of Medicare readmissions in 2007 were potentially preventable
• 13-15 billion in readmission costs may be preventable
• Pharmacist-provided medication therapy review and consultation in
various settings resulted in reductions in physician visits, ER visits,
hospital days, and overall health care costs
• Uniquely positioned to help increase medication safety and
compliance in patients across the continuum of care
Rationale
• Diabetes is a complex, increasingly common chronic condition that
remains one of the most serious health problems in Lubbock County
and Texas
• 6th leading cause of death in Texas
• 21.9% of adult diabetics do not have health insurance in Texas
• Lubbock BRFSS data indicate that 10.7% have diagnosed diabetes
• Death rate from diabetes in Lubbock is 38.6/100,000 compared to
26.5/100,000 in Texas
• Approximately 1.8 million adult Texans have type 2 diabetes and
460,000 are undiagnosed
• 4th leading cause of death for African Americans and Hispanics
• One study found that a decrease in diabetes medication adherence
resulted in a 58% increase in hospitalizations and 81% increase in allcause mortality
Project Description
• Provide medication management for adult diabetes mellitus patients across the
continuum of care
• Age 18 and older
• Approximately 5000 total patient visits per year with about 1000 visits being
Medicaid or uninsured
• Establish a patient-centric medication management program that includes the
following components:
• Written medication management plan focused on medication safety
• Clearly defined roles for interdisciplinary participants
• Process and criteria to screen for adult diabetic patients
• Standardized medication reconciliation process and counseling by a pharmacist
• Utilization of patient friendly education and medication management tools
• Patient access to outpatient prescriptions on site at UMC Outpatient Pharmacy
• Targeted post-discharge follow-up
Project Process
• Population-based screening
• Identify targeted adult diabetic population
• Admission assessment
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Best Possible Medication History (BPMH)
Compliance
Lack of efficacy
Adverse drug effects
• Discharge counseling
• Comprehensive review of discharge medication list and counseling by a
pharmacist
• Individualized patient education
• Comprehension of medication instructions and therapy plan
• Coordinate the filling and delivery of discharge prescriptions to the patient’s
room
• Post-discharge Follow-up
• Phone call by a pharmacist
• Assess compliance, identify ADEs, and answering any patient questions
Project Goals
• Project Goals
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Reduce medication errors and adverse drug events
Increase adherence to an appropriate medication regimen
Cost saving to the health system
Provide access to outpatient medications
Decrease unplanned visits to the ER
Decrease hospital’s diabetes 30 day readmission rate (IT-3.3)
Improve patient satisfaction regarding issues and questions about
their medications
• Regional Goals
• Improve access to care and medications
• Address the high incidence of diabetes mellitus
• Provide a specialist to assist in the treatment of diabetes mellitus
Expected Outcomes
• DY2 (10/1/12 – 9/30/13)
• Develop criteria and identify targeted patient populations
• Develop written medication management plan
• Implement an evidence based program based on best practices for
medication reconciliation to improve medication management and
continuity between acute care and ambulatory setting
• DY3 (10/1/13 – 9/30/14)
• 20% or about 1000 patients receive medication management therapy
• DY4 (10/1/14 – 9/30/15)
• 40% or about 2000 patients receive medication management therapy
• DY5 (10/1/15 – 9/30/16)
• 60% or about 3000 patients receive medication management therapy
Challenges
• Complex disease state and co-morbidites
• Engagement and education of patients
• History of poor medication compliance
• Lack of understanding of the severity of their disease state
• Collaboration with other services and departments
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Case Management
Social Services
Nursing
Physicians
• Pharmacist education and training
• Pharmacist staffing
• Hospital census
CQI
• Pharmacy medication management team meets internally at
least every two weeks
• Lessons learned
• Project impacts
• Challenges
• Pharmacy medication management team meets with IT
monthly to discuss issues and improvements
• Pharmacy medication management team meets routinely
with case management, social services, and nursing
• Medication errors, ADEs, and compliance are continuously
monitored for trends and areas of improvement
June 1, 2013- March 22, 2014
Yes
No
Admission
Assessment
2,245
2,012
Discharge
Counseling
1,890
1,147
Follow Up
Phone Call
1,406
1,879
Success at all
three
markers
1,239
3,018
Not
Indicated
Total
%
4,257
52.72%
1,219
4,256
44.40%
971
4,256
33.03%
4,257
29.11%
October 1, 2013-March 22, 2014
Yes
No
Admission
Assessment
1,324
1,231
Discharge
Counseling
1,171
682
Follow Up
Phone Call
971
989
Success at
all three
markers
896
1,659
Not
Indicated
Total
%
2,555
51.82%
702
2,555
45.83%
595
2,555
38.00%
2,555
35.07%
Readmissions
Total
Patients
Total
Readmissions
Readmission
Rate
Decrease from
Previous Year
2012
568
106
18.66%
2013
552
81
14.67%
21.37%
2014
88
8
9.09%
38.04%