Term
|
Definition
| “I will hold as my primary responsibility the health, safety, welfare and dignity of all human beings.” |
|
|
Term
| Patient Adherence 3 factors |
|
Definition
• Psychosocial
– Hope and reasons for healthy life – Stigma of medication or diagnosis
• Contextual
– Access! To medication, to food, to urgent care, to support
• Cognitive
– Understanding of medication needs – Health literacy |
|
|
Term
| WHO identified five dimensions of adherence: |
|
Definition
– Social and economic factors: age, race, sex, and socioeconomic and educational status
– Patient-related factors including readiness to change, locus of control and self-efficacy, future discounting, health beliefs, health literacy, lack of knowledge, forgetfulness, and fear of dependence
– Therapy-related factors including the complexity and cost of treatment, especially out-of-pocket costs, and adverse effects
– Comorbid conditions, such as drug and/or alcohol abuse, depression, psychosis, impaired mental status, number of chronic medical conditions, and severity of symptoms
– Health care system factors, such as the patient-provider relationship, provider workload and burnout, misaligned and absent incentives, and absent or limited care coordination and car integration |
|
|
Term
| WHO dimensions simplified |
|
Definition
– SES and demographics
– Readiness to change
– Complexity of treatment
– Comorbidities
– Provider influence |
|
|
Term
| Addressing Adherence, 3 basic questions |
|
Definition
– Do you feel this medication is important?
– Do you think this medication could harm you?
– Do you think this medication is financially burdensome?
Remember to always set your baseline. |
|
|
Term
|
Definition
• The National Coordinating Council for Medication Error Reporting and Prevention defines a medication error as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.”
• Estimated 7000+ medication errors each year |
|
|
Term
| what has the FDA done about medication errors |
|
Definition
– Barcode label rule:
• Bar codes are required on certain drug and biological product labels
• Must be scanned to ensure the right dose, at the right time, to the right patient
– Drug name confusion:
• About 1/3 of proposed drug names are rejected |
|
|
Term
| what are there medication errors? points of confusion? |
|
Definition
– Serzone for depression vs Seqoquel for schizophrenia
– Lamictal for epilepsy vs Lamisil for nail infections vs Ludiomil for depression vs Lomotil for diarrhea
– Taxotere vs Taxol both for chemotherapy
– Zantac for heartburn vs Zyrtec for allergies vs Zyprexa for schizophrenia and BPD
– Celebrex for arthritis vs Celexa for depression |
|
|
Term
| FDA requirements for drug labels |
|
Definition
| FDA requires drug facts label to appear on more than 100,000 OTC drugs |
|
|
Term
| institutefor safe medicaiton practices findings |
|
Definition
• Institute for Safe Medication Practices (ISMP) found that more frequent reporting internally to hospital systems than externally to FDA
– Found difference linked to lack of knowledge on external reporting programs |
|
|
Term
| Hospital Strategies for medication errors |
|
Definition
– Pharmacist review medications with patient prior to surgery then consult surgeon
– Computerized Physician Order Entry (CPOE) – Smart pumps for IV administration |
|
|
Term
| High Risk settings for medication errors |
|
Definition
| – Adverse drug events are most commonly reported from the ICU and during off hours (nights and weekends) |
|
|
Term
| ProviderStrategies for medication errors |
|
Definition
– Review the drug list (yourself!) at ever appointment – Be vigilant of high risk drugs
– Discontinue unnecessary drugs
– Don’t treat side effects of one drug with another drug (ie: opioid induced pruritus to be treated with addition of hydroxyzine)
– Verify drug-drug interactions
– Adjust doses for age and creatinine clearance – Discuss strategies for adherence
– Computerized physician order entry**
– Questions? Call the pharmacist |
|
|
Term
| Consumer responsibilities for medication errors |
|
Definition
– Know what kind of errors occur
• Wrong dose, medication, or route of administration
– Older people at higher risk because multiple medicationsset up a system
– Ask for the purpose to be included on the script if taking multiple medications (or write it on the bottle for the patient)
– Keep list of medications
Is this too much to ask? Remember health literacy? |
|
|
Term
| IOM: Promoting Health Care Quality |
|
Definition
Safe
• Avoiding harm
Effective
• Scientific-based knowledge
Patient-centered
• Individually respectful and responsive
Timely
• Reducing waits or harmful delays
Efficient
• Avoiding waste
Equitable
• Quality care for all |
|
|
Term
| Healthcare Associated Infections |
|
Definition
• HAIs are a leading concern for hospitalized patients
– 1 out of every 25 hospitalized patients at any given time
– ~1 million per year -> billions in health care costs |
|
|
Term
| Process Improvement Define, Measure, Analyze, Improve, Control (DMAIC) |
|
Definition
– Define: translate voice of customer into measurable response variables
– Measure: (see above)
– Analyze: causal factors with greatest influence on response variable
– Improve: most difficult because involve changing human behavior
– Control: also difficult, reproducibility |
|
|
Term
|
Definition
|
|
Term
| Plan, Do, Study, Act (PDSA) |
|
Definition
– Done for each step of a larger goal
– Keep them brief, study often
– Small sample size (1-2 providers in each)
[image] |
|
|
Term
|
Definition
| event that may have resulted in error but did not reach patient due to intervention |
|
|
Term
|
Definition
| injury resulting in prolonged hospitalization, disability or death |
|
|
Term
|
Definition
|
|
Term
|
Definition
| occur at point of contact between human and larger system |
|
|
Term
|
Definition
| systemic approach, improvement of the whole system |
|
|
Term
|
Definition
| proactive and reactively work to prevent or minimize damages |
|
|
Term
|
Definition
| error analysis tool, identify underlying problem that increase likelihood of errors |
|
|
Term
| American Recovery and Revision Act of 2009 |
|
Definition
| Beginning FY 2015: 25% reduction in annual CMS reimbursement if all Hospital Inpatient Quality Reporting Program requirements not met |
|
|
Term
|
Definition
– Part of the CMS Hospital Quality Initiative, targeted at stimulating and supporting improvements in hospital care
– Objectives delivered to hospital systems
– Awarded up to 5 stars for each of the 11 provided measures
– See attachment for specific measures |
|
|
Term
|
Definition
• Reimbursement contracts are based on quality, patient satisfaction, and utilization of services->higher for those who achieve set objectives
– Think health homes, ACOs
• Value-based evolution of fee for service where reimbursement is based on each billed service |
|
|
Term
| Pay For Performance Challenges |
|
Definition
– Patients receive care from many providers and facilities, who gets credit for successes? Failures?
– Process measures are more physician- centric, outcome measures rely a lot more on the patient
– No risk adjustment protocol in place
– Administrative burden
– Provider buy in -> why change? |
|
|
Term
| See Something, Say Something |
|
Definition
Occupational Safety and Health Administration (OSHA)
[image]
• Consumers and health professionals can submit reports to the FDA for any regulated product
-report by hone or online |
|
|
Term
|
Definition
– Simply the facts
– 1999 IOM publication, To Err is Human: Building a Safer Health System
• Reported 44k-98k deaths in hospitals each year – Greater than MVAs, breast CA and AIDS
• Presented the idea that it is the system that is failing patients
– “This is not a ‘bad apple’ problem. More commonly, medical errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them.”
– Joint Commission standard states that, “Patients and, when appropriate, their families are informed about the outcomes of care, including unanticipated outcomes.”
• Involving both hospital and provider when in favor and when adverse
• DOES NOT require admission or apology |
|
|
Term
|
Definition
– Focus is on social interaction and relationships with patients and families
– Majority of apology laws cover empathetic statements but do not cover statements that include the admission of negligent actions
So I'm not saying don't apologize for it, but you have to be tactful. If there is an error that's occurred, think about it. Talk to someone else who's kind of been in this situation before you go to the patient if it's a big error.
Little things, where it's like, I ordered the wrong lab test. We're going to go ahead and order another one, that's fine. I'm talking bigger errors that are happening here, if something like that happens. If someone was given the wrong medication in a hospital, and they had an adverse event from it, make sure you talk to somebody before you just go in and start talking to the patient. Because you want to make sure that you're protected, and you're presenting that information in a very specific and deliberate way. |
|
|
