Raising the Bar On Infusion Therapy Safety: A Patient Safety Program

at Catholic Health Initiatives

Friday, June 24, 2016

AAMI FoundationVision: To drive the safe adoption and safe use of healthcare technology

• National Coalition for Infusion Therapy Safety

• National Coalition to Promote Continuous Monitoring of Patients on Opioids

• NEW Compendium: Opioid Safety & Patient Monitoring

• National Coalition for Alarm Management Safety

• NEW Compendium: AAMI Foundation Management of Clinical Alarm

Please Consider Making a Donation!

Contact Marilyn Flack at mflack@aami.org

A Special Thanks

Thank You to Our PremiereIndustry Partners

Without the generous support of our industry partners, we would not be able to produce the many tools and deliverables created by the coalition to help you improve infusion therapy safety.

The AAMI Foundation is managing all costs for the series. The seminar does not contain commercial content.

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Nursing Continuing Education Disclosure Statement• This seminar is jointly provided today with our co-provider, the National Association of

Clinical Nurse Specialists (NACNS).

• 1.0 contact hour will be awarded for this seminar. This seminar may be accessed online at the AAMI Foundation website for nursing CE up to two years from today’s date.

• This continuing nursing education activity was approved by the Alabama State Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation (ANCC).

• Criteria for successful completion includes attendance at the session and submission of a completed evaluation form. You can submit the fee for the CE credit by going to the AAMI store at http://my.aami.org/store/detail.aspx?id=INTRUSIONSEM A link to the evaluation form will be sent to you for completion and a certificate sent to you upon completion of the evaluation.

• The planning committee members have declared no conflict of interest along with our faculty for today’s session.

• Contributions to the AAMI Foundation have been received from the identified sponsors to support program initiatives and projects. However, the program content for today’s seminar has been planned independently by AAMI staff with the seminar presenters.

• Approval of the continuing education activity does not imply endorsement by the provider, ANCC or the Alabama State Nurses Association.

Polling Questions

Speaker Introductions

Mary Kane, RN, MS

Vice President

Regional Chief Nursing Informatics Officer

Catholic Health Initiatives

Improving Financial and Safety Outcomes

via Standardization

At A Glance: Catholic Health Initiatives

• Operates in 19 states

• 90,000+ employees

• 105 hospitals including:

4 academic health centers and major teaching hospitals

30 critical access hospitals 13 clinically integrated networks10 insurance plans

About 54 million people – or nearly 17% of the U.S. population –live within a 60-mile radius of a CHI hospital.

Financial Highlights

• $21.8 billion in assets

• $13.9 billion in total annual operating revenue

• $910 million in total annual contributions to charity care and community benefit

Mission and Ministry FundMore than $55 million in grants for building healthycommunities

Catholic HealthInitiatives Today

Electronic Record Platforms

• Outpatient

• Allscripts

• Inpatient

• Meditech Magic and 6 x

• Cerner

• Epic

Inpatient platforms used by over 70,000 clinicians and staff within the Catholic Health Care System

9/25/2013 13

Device Strategy

• Three major manufacturers make up 80% of infusion devices within CHI

• CHI has made several acquisitions in the last five years accounting for a number of disparate devices

• Goal is to achieve standardization in both the device strategy as well as software (drug library) content build wherever possible

9/25/2013 14

Implementation Process

9/25/2013 15

Build a bridge that can withstand any Tornado/Hurricane we can get.

Worst Hurricane in 200 years. Bridge still standing.

Success!

OOPS!........ River moved.

How We Got Here

2008 Begin implementation

2009 Refine approach

2010 Implement

2011 Implement……etc.

10 year, 60+ Million dollar journey.

Implementation

• Multidisciplinary AND Nationally funded

• National-Local partnership

• CHI-Vendor partnership

• Gap Analysis, Clinical Assessment part of the process

• ~12 week process

• IT, Nursing, Pharmacy, Providers, Informatics, Clinical Engineering, Supply Chain Quality at the table.

Implementations led by Clinical at the National Level. More specifically Clinical Informatics. Stakeholder engagement must include clinical end users of the system.

9/25/2013 19

The Data: Who is analyzing it?

Library Compliance

“You cannot improve outcomes if you are not accessing the library in the first place.”

2012 64.2%

Root Cause: No one knew how to access their own data.

Library Compliance

“You cannot improve outcomes if you are not accessing the library in the first place.”

2012 64.2%

2013 76.1%

Root Cause: No one thought it mattered

Board of Directors

• Made the target 85% compliance a line item under quality metrics enterprise-wide

• Tied it to executive compensation (bonus)

Result…..compliance now 87.9%

What is the Data Telling Us

Current State of Library

• Thirty-four different builds.

• No standardized use of Tallman naming convention

• Trade and generic drug names in use

• No consistency in the formatting of common infusion

concentrations

• Inconsistent application of evidence-based infusion rate

recommendations for specific drugs

• Inconsistency in Upper and Lower Soft and Hard Parameters

and in some situations no parameters are set

- Many are ISMP high risk med

Drug LibraryStandardization

Why is Standardization of Drug Libraries Desirable?

• Everyone “talking the same language”

• Allows for truly comparable data between facilities

• Represents opportunity to improve patient safety=improved financial

outcomes

Drug LibraryReview Process

Purpose: Maintaining the Integrity of our Drug LibrariesChange Management process is necessary to assure that our Drug Libraries remain synched, able to address change needs and remain relevant.

Pilot

Roll-Out

Change REQ

Process

Update & Maintain

Creation of

Standard

Analysis of data

Use of Tallman

UHL

Limit AnalysisLHL, LSL, USL,

UHL

Review of Database

Parameters

Override vs. Edit

Overrides are situations where the clinician exceeded an upper or lower soft limit and confirmed their intent to exceed the limit.

• Overrides can only occur with drug library soft limits. • Soft limit overrides indicate variation exists between clinical

practice and drug library parameters. • The source of the variation maybe in physician prescribing or

medication administration practice.

Edits are situations where the clinician indicated intent to change their entry in response to the alerts.

• Edits may occur with soft or hard limits.

Soft LimitSoft limit - like a speed bump requires you to slow down and take an extra step to overcome it

Hard limitLike a brick wall…..cannot get through the wall…. you must EDIT

Results(What we Learned)

Financial - CHI ROI

Sources

• ADE will cost $8,750 in 2006 Dollars Preventing Medication Errors: Quality Chasm Series. Committee on Identifying and

Preventing Medication Errors. Eds. Aspden P. Wolcott J, et al. Institute of Medicine, 2006

• 7% of ADE’s cause harm based on the Barker Study Barker KN, et al. Arch Int Med. 2002;162:1897-1903

• CHI’s internal cost figure for an ADE is $2,200

Financial

Appropriate edits leads to avoidance of adverse drug events (ADE’s)

Financial

Clinical Efficiencies

1. Alerts. System is becoming more responsive2. Overrides. Overridden prone medications have been addressed3. Edits. There is an increased effectiveness of the drug library

in changing clinician programming behavior.

Alert Rates

9/25/2013 37

1. Decreases alert fatigue2. Takes the noise out of the system3. Clinician satisfier

Conclusion

• Performance excellence is the goal

• Increase awareness in your clinicians and leadership

• Joint effort between nursing and pharmacy

• Appropriate change management process

• Educate and informLarge forumsSmall groupsIndividual

Approach

• Report out and remediate system-wide any inconsistencies in alerts, overrides, poor use of limits. Done at the executive leadership level.

Done quarterly

• Report out facility-wide inconsistencies in limits, overrides, alerts

Done monthly

• Provide education both locally and nationally to improve access to local portal

On an as needed basis

Next Steps

• Continue migrations to CHI standard for devices

• Drug library content optimization to be a national initiative

• National governance

• SME work group

• Drive standardization across all platforms

• EMR integration

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Lessons Learned• Standardization the rule, but will always be exceptions

• Never discount the wants, needs, desires of individual practices/hospitals/markets

• Governance must include end users to make change permanent

• Partnership for change control of the drug library worked best when nursing and pharmacy was hand in hand

• Change management processes are like numbers…..they just go on and on and on and on…….to infinity and beyond!

9/25/2013 41

Future/Ongoing Initiatives

9/25/2013 42

CE Credit

• http://my.aami.org/store/detail.aspx?id=INTRUSIONSEM

9/25/2013 43

Mark Your Calendars!July 18, 2016; 12pm to 1pm

Another in our series: Raising the Bar on Infusion Therapy Safety --A Systematic Approach To Improving Infusion Pump Safety

Molly A. Hicks, RN, MSN

Director of Patient Safety,

Baylor Scott & White Health

Jason Trahan, PharmD

Pharmacy Director – Medication Safety,

Baylor Scott & White Health

Register: https://attendee.gotowebinar.com/register/8325915835043571458

CE credit of 1 hour has been approved for this seminar

Complimentary Resources� Safety Innovations Series

� Alarms Management Patient Safety Seminars • Seminar Recordings

• Webinar Slides

• Key Points Checklists

NEW Opioid Safety & Patient

Monitoring

NEW AAMI FoundationAlarm Compendium

Thank You to Our PremiereIndustry Partners

Without the generous support of our industry partners, we would not be able to produce the many tools and deliverables created by the coalition to help you improve infusion therapy safety.

The AAMI Foundation is managing all costs for the series. The seminar does not contain commercial content.

PlatinumDiamond Gold

Questions?• Post a question on AAMI

Foundation’s LinkedIn

• Type your question in the “Question” box on your webinar dashboard

• Or you can email your question to: mflack@aami.org.

Consider Making a Donation to the AAMI Foundation Today!

Making Healthcare Technology Safer, Together

Thank you for your support!

http://my.aami.org/store/donation.aspx

Thank you for attending!

You will receive a follow-up email in a week that will have the link to the on-line slides and the full seminar – share with your colleagues!