Transcript An Interprofessional Approach to Improved Patient Outcomes for

Medication Safety – An Interprofessional
Approach to Improved Patient Outcomes for
Undergraduate Nursing Student Learning
Indiana State Nurses Association Convention
Indiana University Kokomo, Indiana
September 16th, 2016
Linda Wallace, EdD, RN, CNE, NEA-BC
Pamela M. Karagory, MBA, MSN, MSB, RN, CNE
Special Thanks to:
Marlene Heeg, M.Ed.
Lynda Narwold, MA, RN
Dan Degnan, PharmD, MS, CPPS, CPHQ
Disclosure Statement
• None of the presenters have actual or
potential conflicts of interest in relation to this
presentation
Learning Objectives
• Define the term “medication safety”
• Describe the importance of coordinated efforts
among healthcare disciplines with regard to
medication safety education
• Describe a process for developing educational
collaboration in an academic environment
The Participants
What is medication safety?
Procuring
Prescribing
Monitoring
Administering
Transcribing
Dispensing
Assuring the 5 (or 6) components of the medication use process
provide the most benefit to the patient with the least risk of harm
What is medication safety?
Med Use Process
Safety
• Conditions of
being safe
• Preventing hurt,
injury or loss
Definition of Medication Safety
• “Preventing errors or mistakes in the medication use
process”
http://www.merriam-webster.com/dictionary/. Accessed September 4th, 2013
Medication Safety
Institute of Medicine (IOM)
• “To Err is Human” November 1st, 1999
– Chapter 8 covers medication errors exclusively
• “Crossing the Quality Chasm: A new health system
for the 21st century”, 2001
– Suggests accountability with improvement in quality
• “Preventing Medication Errors: Quality Chasm Series”,
2006
– ~480 page report on preventing medication errors
Medication Errors continue to occur
Interprofessional Approach to Solutions
"Alone we can do so little; together we can do so much."
- Helen Keller
"Many ideas grow better when transplanted into another
mind than the one where they sprang up.“
- Oliver Wendell Holmes
“The health care we want to provide for the people we
serve – safe, high-quality, accessible, person centered –
must be a team effort…..”
- Carol Aschenbrener, MD
Formation of Medication Safety Essentials
• Medication Safety Essentials (MSE)
– Conducted a literature review
– Completed interdisciplinary focus group (physician,
nurse and pharmacist attendees)
– Identified potential topics for inclusion
• Three iterations of current program
– MSE 1.0 and 2.0 are webinar programs
– MSE 3.0 is competency based certificate program
Medication Safety Essentials 1.0
Medication Errors and Safety Practices
Errors in Prescribing and Transcribing
Errors in Dispensing
Errors in Administration and Monitoring
Continuous Quality Improvement
Metrics, Scoreboards and Dashboards
Leading for Safety
Formation of Medication Safety Essentials
• Medication Safety Essentials 1.0
– Completed by hundreds of healthcare practitioners
– Targeted in 4 states
– Feedback used to improve new offerings
• Medication Safety Essentials 2.0
– Advanced offerings with new topics
– Similar development process
– National Action Plan for Adverse Drug Event
Prevention
http://www.health.gov/hcq/pdfs/ADE-Action-Plan-508c.pdf. Accessed August 7th, 2015
Medication Safety Essentials 2.0
Effective Interprofessional Education
Establishing a Culture of Safety
Technology
Medication Transitions of Care
Storytelling
Anticoagulation
Safety of Antihyperglycemics
Opioids and Pain Management
Formation of Medication Safety Essentials
• Medication Safety Essentials 3.0
– Next step in the evolution of series
– Competency based with formative and summative
feedback
• Two components to Certificate
– Case review with narrative submission
– Presentation development
– Faculty review of submissions
http://www.health.gov/hcq/pdfs/ADE-Action-Plan-508c.pdf. Accessed August 7th, 2015
Partnership with Indiana University
Kokomo School of Nursing
• IUK SON learned about Medication Safety Essentials
through participation in Indiana Hospital Association
Eastern Indiana Patient Safety Coalition
• Discussed opportunity with senior II nursing
management instructor & Assistant Dean Lynda Narwold
• Attractive to us as a School of Nursing because it was
created by an interprofessional/interdisciplinary
collaboration of pharmacists, nurses and physicians
Partnership (cont.)
• Contacted Purdue University College of
Pharmacy Continuing Education and
Professional Development program
• Piloted the first 7 modules of the Essentials with
our senior II nursing students (fall 2014)
• Provided feedback and was permitted to offer
all 15 modules to senior II nursing students
(spring 2015)
• Continue to collaborate with Purdue University
College of Pharmacy Continuing Education and
Professional Development to enhance
usefulness of Essentials to schools of nursing
Results (Spring 2016)
• % of participants indicated Essentials enhanced
their ability to:
•
•
•
•
•
•
•
100%
100%
100%
92%
92%
83%
83%
Provide patient-centered care
Work in interdisciplinary teams
Apply quality improvement
Professionally/effectively treat patients
Change practice behavior
Employ evidence-based practice
Utilize informatics
Results (cont.)
• Still notable even though not totally related to
participation in the Essentials:
• Class of December 2014 87% first time NCLEX
pass rate (MSE 7 modules)
• 2015 94% first time pass rate however 2 still
have not taken NCLEX (MSE 15 modules)
Results (cont.)
NCLEX Program Reports:
(National Council of State Boards of Nursing, 2016, p. 4.1)
Management of Care:
“Providing and directing nursing care that enhances the care delivery
setting in order to protect clients, family/significant others and
health care personnel.”
Pharmacological and Parenteral Therapies:
“Providing care related to the administration of medications and
parenteral therapies.”
Reduction of Risk Potential:
“Reducing the likelihood that clients will develop complications or
health problems related to existing conditions, treatments or
procedures.”
CLIENT NEEDS
NCLEX PROGRAM REPORT
Percentile Ranks of IU Kokomo BSN Graduates
Compared to National Population of Graduates
80
72
68
70
60
59
57
48
50
42
2015
40
2016
30
20
10
0
Management of Care
Pharmacological and Parenteral Therapies
Reduction of Risk Potential
Student Comments
• I felt this was a comprehensive series that was beneficial
in raising awareness and knowledge pertaining to safe
medication.
• These modules were very helpful! They helped clarify a
lot of information associated with medication and errors
surrounding medications.
• I felt more informed after going through these
modules. Some of the material was a repeat, but most of
it enhanced my critical thinking and ways of
implementation. I believe this course is good for
students and helps increase knowledge, competence,
and performance and patient outcomes.
Analogy to Soccer
• Soccer
Lessons from Soccer
Team Emphasis
• Analogy to soccer team with med safety as the goal, i.e. no one
discipline owns med safety
• Hand-offs are extremely important
• Importance of interprofessional/interdisciplinary collaboration
in the process
• Each player has a role, some have different strategies and different
tools but all work together to make the goal of safe, appropriate
medication administration
– Create the prescription (MDs, pharmacists, NPs)
– Receive the prescription (nurses, unit secretaries, pharmacy techs)
– Anticipate and overcome the hazards along the way-clarifying
prescription, appropriateness in this situation for this patient
– Importance of hand offs along the way and ultimately to the one
administering the medication (nurse, pharmacist, MD)