Medication Safety LAN Event Promising Interventions to Improve Safety and Reduce Opioid Adverse Events. Thursday, January 26, :00 4:30 PM ET

Transcription

1 Medication Safety LAN Event Promising Interventions to Improve Safety and Reduce Opioid Adverse Events Thursday, January 26, :00 4:30 PM ET 1

2 Welcome and Reminders Amanda Ryan, PharmD, CGP Qsource Chat Manager Rachel Digmann, PharmD, BCPS QIN NCC Facilitator Please be prepared for sharing and open discussion Slides and a recording from today s session can be found on: 2

3 Agenda Continuing Education Details Speaker Presentations Jen Thomas, Delmarva, DC (AQIN) Cheryl Anderson, CCME, SC (AQIN) Anne Myrka, IPRO, New York (AQIN) Marghie Giuliano, Healthcentric Advisors & The Connecticut Pharmacists Association Tom Kowalski, BCBSMA Facilitated Discussion Wrap-up 3

4 Things to Think About Will you commit to being Attentive Active participant Actionable Show your commitment by clicking the green checkmark! 4

5 Now Offering Continuing Education Credit Continuing education credit is available for: Physicians & Physician Assistants Registered Nurses & Nurse Practitioners Dieticians Pharmacists Certified Professionals in Healthcare Quality Certificate of Attendance 5

6 Instructions for Obtaining CE Attend the entire event Complete the evaluation that will pop up at the conclusion of the event There is a separate evaluation required for CE that will load in your browser following completion of the general evaluation Once you submit your CE evaluation, you will be provided with a certificate to retain for your records For technical assistance, please Nikki Racelis (nikki.racelis@qinncc.hcqis.org) 6

7 CE Information Physicians: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare, CRW & Associates and Telligen. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians. AKH Inc., Advancing Knowledge in Healthcare designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physician Assistants: NCCPA accepts AMA PRA Category 1 Credit from organizations accredited by ACCME. Pharmacists: AKH Inc., Advancing Knowledge in Healthcare is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. AKH Inc., Advancing Knowledge in Healthcare approves this knowledge-based activity for 1.0 contact hour (0.1 CEU). UAN L01-P; UAN L01-T. Initial Release Date: 1/26/2017 7

8 CE Information, Continued Registered Nurses: AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. This activity is awarded 1.0 contact hour. Nurse Practitioners: AKH Inc., Advancing Knowledge in Healthcare is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider Number: This program is accredited for 1.0 contact hour which includes 0 hours of pharmacology. Program ID # This program was planned in accordance with AANP CE Standards and Policies. Dietitians: AKH Inc., Advancing Knowledge in Healthcare is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 1.0 continuing professional education unit (CPEU) for completion of this program/material. CDR Accredited Provider #AN008. The focus of this activity is rated Level 2. Learners may submit evaluations of program/materials quality to the CDR at 8

9 Disclosure of Financial Relationships & Commercial Support The planners and faculty do not have any relevant financial relationships to disclose. AKH Inc., CRW & Associates, and Telligen do not have any relevant financial relationships to disclose. No commercial support was received for this activity. 9

10 Disclosure of Financial Relationships & Commercial Support Disclosures It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review. Disclosure of Unlabeled Use and Investigational Product This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Disclaimer This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant's misunderstanding of the content. 10

11 Method of Participation You must participate in the entire activity to receive credit. A statement of credit will be available upon completion of an online evaluation/claimed credit form. The link to the online evaluation will be provided after completion of the activity. If you have questions about this CME/CE activity, please contact AKH Inc. at service@akhcme.com. 11

12 Who s in the Room? What entity or type of organization do you represent? CMS Home Health Agency Hospital Nursing Home/Skilled Nursing Facility Patient, Family, or Caregiver Representative Pharmacy/Pharmacist Provider/Practice QIN-QIO Other (please specify in the comments field) 12

13 Session Goals By the end of today s call you will be able to describe the breadth and depth of the current opioid epidemic, explain how collaboration with a quality improvement organization (QIO) may improve outcomes for Medicare beneficiaries and patients, and implement possible interventions to reduce adverse events associated with opioids and/or understand who to contact to assist in creating interventions to improve opioid safety. 13

14 Let s Hear From You in Chat! Think about a time when you played an active role in your healthcare decision making process. What were the factors that contributed to the outcome? 14

15 Framing 15

16 AQIN - Delmarva Foundation, CCME, & IPRO Jennifer Thomas, PharmD Sr. Pharmacist Medication Quality/Safety Delmarva Foundation Cheryl Anderson, BS, RPh Medication Safety Pharmacist The Carolinas Center for Medical Excellence Anne Myrka, BS Pharm, MAT Director, Drug Safety IPRO 16

17 Atlantic Quality Innovation Network Opioid Safety Strategies District of Columbia - Delmarva South Carolina - CCME New York - IPRO Medication Safety Learning and Action Network (LAN) January 26, 2017

18 Opioid Use and Safety in the District of Columbia Jennifer Thomas, PharmD Medication Safety Learning and Action Network (LAN) January 26, 2017

19 Start With Measurement (Data)

20 Start With Measurement (Data)

21

22 Provide Education

23 Provide Education

24 Provide Education

25 Medicine Disposal Take Back Sites

26 District of Columbia Laws BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this act may be cited as the Substance Abuse and Opioid Overdose Prevention Amendment Act of 2016 To allow physicians and pharmacists to prescribe an opioid antagonist such as Naloxone, to a person at risk for experiencing an opioid-related overdose Regulations in draft/review Prescription Drug Monitoring Program Operational October 2016

27 Initiatives, Guidelines, Resources A large health system has created a team of healthcare providers to address the use and dosing of opiates within their system (hospital, clinics, providers practices, ED). November 2016 The Goals and Objectives of the team include: To provide optimal analgesia To discuss opioid use/misuse/abuse To assess opiate ordering habits within the hospital To assess and determine risk vs. benefits of using opioid analgesics To develop policies and procedures for opiate use within the hospital Develop order sets, educational modules (CBO) and training classes (grand rounds) on appropriate opiate use. Large health system and insurer Clinical practice guidelines, Pain Management guidelines recently reviewed/updated in Oct Prescribing Naloxone in Outpatient Settings, last reviewed Oct DCHA D.C. ED Guide Opioid Prescribing Guidelines

28 South Carolina s Approach to the Opioid Epidemic - Medication Safety Matters Cheryl A Anderson, BS, RPh Medication Safety Learning and Action Network (LAN) January 26, 2017

29 Statewide Approach Governor s Prescription Drug Abuse Prevention Council Implementation: Executive Order by Governor Haley Initiated: May 14, 2014 Composition of Council: Representatives from each agency with a regulatory, enforcement or treatment role Role of Council: analyze available data; develop a comprehensive state plan; assist and encourage local communities to engage existing coalitions or to establish new coalitions; and, continue to meet as a Council and at least annually Final Report of Council: December

30 30

31 Medication Safety Matters South Carolina Pharmacy Association (SCPhA) applied for a grant through the BlueCross BlueShield Foundation for $500,000 for a campaign on safe prescribing of controlled substances. May 2016: Grant Approved May 2016 April

32 Medication Safety Matters - Goals Increased enrollment in: Prescription monitoring program (PMP), SCRIPTS Opioid treatment programs and substance use disorder treatment Establishment of and increased use of safe and approved drug collection disposal programs Decrease in: Emergency department admissions and deaths related to opioid use Incarceration rates related to the violation of laws prohibiting the production, distribution or use of controlled substances 32

33 Governance structure Clinical Data Team SC Pharmacy Assoc. Academic Detailing Team Clinical Advisory Team Medication Safety Matters Marketing & Social Media Team Grant, Program Manager Patient Advisory Council

34 Stakeholders South Carolina Department of Alcohol and Other Drug Abuse Services Department of Health and Environmental Control's Bureau of Drug Control The Carolinas Center for Medical Excellence South Carolina Medical Association South Carolina Hospital Association South Carolina Department of Health and Human Services South Carolinas Society of Health-System Pharmacists South Carolina Colleges of Pharmacy Alliance for a Healthier South Carolina US Department of Justice Drug Enforcement Administration

35 Medication Safety Matters - Approach Provider Education Healthier South Carolina Public Health Awareness

36 Medication Safety Matters - Provider Education Campaign Academic Detailing Approach: Provider site visits Evidence-Based Toolkit Education and training on proper use of the SCRIPTS program Gold Standard prescribing practices Risk assessments for substance use disorders Urine drug screenings Opiate agreements

37 Medication Safety Matters Next Steps Expand the clinical academic detailing team Finalize training of clinical academic detailers Target initial academic detailing on high opioid use areas of the state Developing unique app that will provide all of the approved tools and resources for both prescribers and patients Roll out of prescriber/dispenser, youth social media, and influencers campaigns Collaborating with state agencies on grants recently awarded aimed at education 37

38 New York State Pain Management Coalition Anne Myrka, BSPharm, RPh, MAT Medication Safety Learning and Action Network (LAN) January 26, 2017

39 Source: CDC, NCHS, Multiple Cause of Death on CDC WONDER Online Database, released Accessed at 39

40 Pain Management Coalition Multidisciplinary group of subject matter experts (SMEs) Seeks to increase awareness of pain management priorities Align existing improvement efforts Develop and disseminate educational resources and clinical tools Promote clinical research and publications relating to opiate analgesics Task Force structure accomplishes tangible, short-term goals 40

41 Pain Management Coalition Stakeholders Albany College of Pharmacy and Health Sciences Albany Medical College Bassett Healthcare Network Capital Care Primary Care Centers for Disease Control and Prevention Emblem Health Harm Reduction Coalition MVP Health Plan New York City Dept. of Health New York State Dept. of Health New York University Langone South Carolina Dept. of Health and Environmental Control State University of New York at Buffalo St. John Fisher College of Pharmacy University of Maryland University of Rhode Island Veterans Administration Medical Center 41

42 Pain Management Discharge Communication (PMDC) Task Force Work centers on opioid safety during care transitions Establishing through expert consensus the essential pain management elements that should be communicated to subsequent providers upon patient transfer/discharge from any care setting/facility to another. Consensus completed for communication elements Community implementation of audit tool based on PMDC consensus began October 2016 Manuscript in development for peer-reviewed publication 42

43 Pain Management Discharge Communication Elements 43

44 PMDC Audit Measure & Goals Measure: % Adherence to communication elements Goals: Measureable and sustained improvement from baseline Standardization of high risk medication management communication across care transition communities 44

45 New York State Bureau of Narcotic Enforcement Regulations Relating to Opioids Prescribers must review the NYS Prescription Drug Monitoring database for patient opioid prescription history prior to issuing a new prescription All prescriptions must be transmitted electronically to pharmacies as of March 2016, with few exceptions Initial opioid prescribing for acute pain is limited to a 7 day supply as of July 2016 Refills on opioid prescriptions are prohibited NYS Pharmacists may dispense naloxone through a patient-specific or non-patient-specific prescription 45

46 For more information Jennifer Thomas, PharmD Medication Quality/Safety Task Lead (410) Cheryl A Anderson, BS, RPh Medication Safety Pharmacist (803) canderson@thecarolinascenter.org Anne Myrka, BS, RPh, MAT IPRO, Director, Drug Safety (518) anne.myrka@area-i.hcqis.org This material was prepared by the Atlantic Quality Innovation Network (AQIN), the Medicare Quality Innovation Network - Quality Improvement Organization for New York State, South Carolina, and the District of Columbia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy.11sow-aqin3- TskC Template 9/23/14

47 Facilitated Discussion Chat in your questions and comments. Press *1 on your telephone key pad to enter the teleconference queue. 47

48 Healthcentric Advisors & Connecticut Pharmacists Association Margherita Giuliano, RPh, CAE Regional Medication Safety Lead Executive Vice President 48

49 STRATEGIES TO MANAGE PATIENTS ON OPIOIDS ACROSS THE CARE CONTINUUM ~ Highlights of a few New England efforts~ MARGHERITA R. GIULIANO, R.PH., CAE REGIONAL LEAD MEDICATION SAFETY NEW ENGLAND QIN-QIO

50 New England QIN-QIO Led and administered by Healthcentric Advisors in partnership with Qualidigm In state teams Healthcentric Advisors: MA, ME, RI Qualidigm: CT, NH, VT 1/24/

51 Discussion Discuss how the prescription drug monitoring program can assist in identifying best practices for opioid prescribing and management Identify one strategy to improve opioid prescribing for patients on discharge Engage the community pharmacist to monitor patients on opioids 1/24/

52 Utilizing Data: The Prescription Drug Monitoring Program A systems approach to improve prescriber and pharmacist engagement to monitor opioids Goals: Decrease opioid abuse and misuse Raise awareness and provide education to pharmacists and prescribers at a community level Decrease adverse drug events and reduce hospital admissions/readmissions in patients utilizing opioids

53 Initiate Change Collaboration with Uconn School of Pharmacy Academic detailing to prescribers and pharmacies by pharmacists Spread across New England Goals: Increase utilization of the PDMP Assess the impact of academic detailing in communities with high prescribing rates

54 Desired Outcomes Total morphine milliequivalents Tablet strength prescribed Day s supply Prescriber/Pharmacy PDMP lookups Number of opioids prescribed in area Quantity of pills supplied

55 Changing Post Surgical Prescribing Process Goal: Restructure the opioid prescribing procedure in the surgical ward Before: - No pain assessments prior to opioid prescriptions - All patients received standard pain regimens - No pharmacists education/ intervention - OVER- PRESCRIBING OF OPIOIDS After: - Opioid risk assessment by PCP prior to admission - Pain assessment prior to discharge - Patient receives opioid prescription based on their personal needs - Pharmacist education at bedside - Culture change around opioid prescribing - REDUCTION IN OPIOID PRESCRIPTIONS

56

57 To know if you are making a difference you need to measure impact! # of pain assessments completed # of surgeries completed # of automatic prescriptions written # of surgeries given # of MME prescribed before implementation # of MME prescribed after implementation # of prescribers accessing PMP before implementation # of prescribers accessing PMP after implementation

58 Engaging Community Pharmacists Goal: Guide community pharmacists to assess opioid utilization, consultation information, and recommendations to ultimately reduce adverse drug reactions in patients taking opioids. Assess patients knowledge/experience Based on the results of the assessment tool, the pharmacist will educate the patient on possible adverse effects and how to manage them, proper use, and alternatives to opioid pain management.

59 Workflow tools - New Prescriptions - Maintenance - Role base activities - Clinical support

60 Role based: Technicians Screen Do you know what this medication is for? In the past week, what was your pain on average? 0 = no pain, 10 = pain as bad as you can imagine In the past week, how much has pain interfered with your general activity? 0 = no interference, 10 = Unable to complete activity Do you know what to do if your pain is not managed after taking the medication? Have you had a hospitalization since your last pharmacy visit? Note to Technician: Provide this assessment tool to the pharmacist for evaluation

61 Role based: Pharmacist Clinical Support Key Points... Assess Consult Recommend

62 Measures To know if you are making a difference you need to measure impact! # of patients hospitalized while enrolled Time to graduate the program % of enrolled patients who switched to an alternative treatment Improved pain scores over time Decrease overall MME use

63 Questions, Comments, Recommendations We d Love to hear from you!

64 Facilitated Discussion Chat in your questions and comments. Press *1 on your telephone key pad to enter the teleconference queue. 64

65 Blue Cross Blue Shield of Massachusetts Thomas J. Kowalski, RPh Clinical Pharmacy Director 65

66 Opioid Crisis, Our Response Medication Safety Learning and Action Network January 26, 2017

67 Our Population Data Approximately 11% of members with a pharmacy benefit filled a prescription 11% for a short-acting opioid 85% of these received one prescription for less than 30 days of treatment the average prescribed treatment duration was 7 days 15% of members received prescriptions for greater than 30 days, exposing them to the risks of addiction. 1% 1% of members with a pharmacy benefit had a prescription for a long-acting opioid Approximately 15% of these had one prescription for less than 30 days the average prescribed treatment duration in this group was for 15 days It appears these members were being initially treated for acute pain with long-acting opioids, exacerbating their risks of falls and other accidents. 28% 28% of members with Suboxone prescriptions were receiving these prescriptions from multiple prescribers, raising the possibility of fragmented care and possible medication misuse or abuse. Blue Cross Blue Shield of Massachusetts 67

68 Our Multipronged Approach Short-acting opioids require prior authorization after three 7-day** fills within 60 days of the original fill Long-acting opioids for new starts require prior approval Outlier reports for individual and group practices Internal cross-functional team review of outliers. Addictionologist on staff Buprenorphine and combination products limited to /16mgday, prior approval required for greater doses Acetaminophen (APAP) 3g/day Rx limit* Block opioids from mail order Blue Cross Blue Shield of Massachusetts 68

69 Prescription Pain Medication Safety Program: Results Reduced the average monthly prescription rate of opioids like OxyContin by 15 percent Decreased the number of members using prescription opioids by 6 9 percent Wrote 14,000 fewer prescriptions for these drugs per month Eliminated an estimated 21.5 million doses of opioid-based medications in the community over a three year period Reduced claims for short-acting opioid painkillers such as Vicodin and Percocet by approximately 25 percent Reduced claims for long-acting opioids such as OxyContin by approximately 50 percent by switching patients to shortacting pain treatments Stopped 62,000 members from receiving inappropriate levels of acetaminophen Provided members who receive large amounts of narcotic medications with access to pain management experts and nonnarcotic methods of pain control Improved care coordination for members with painmanagement needs, especially for members with more than one provider-prescribed medication Blue Cross Blue Shield of Massachusetts 69

70 Strategies Substance Use Case Management Partnerships with detox facilities Partnerships with local police departments Suboxone consulting by in-house board-certified addictionologist Serves as internal consultant to our case managers and utilization managers Serves as external consultant to our provider partners and members Removed pre-authorization requirements from ER to detox Improved access for members seeking detox, removing administrative barriers Increased support for methadone availability and affordability Removing prior authorization requirements Removing majority of member cost share Education and prevention Presentations to external audiences by addictionologist Participating in external forums Blue Cross Blue Shield of Massachusetts 70

71 Individual Reflection What are your key takeaways? Did you hear any tactics that you could apply to your efforts around addressing opioid adverse events? 71

72 Facilitated Discussion All Speakers Chat in your questions and comments. Press *1 on your telephone key pad to enter the teleconference queue. 72

73 Call to Action 1. Reach out to your state QIN-QIO for assistance 2. Consider who you can partner with to implement interventions and reduce the likelihood of opioid misuse 3. Implement processes to utilize the PDMP 4. Be transparent and share what works and what opportunities for improvement you have witnessed so others can learn from you 73

74 Call For Future Topics We want to hear from you! Do you have a need or desire to hear about a certain topic? Submit your ideas in chat or us at QINNCC@area-d.hcqis.org 74

75 4/27- Save the Date! Join us for the next Medication Safety LAN Event! Thursday, April 27, :00-4:30pm ET Registration is required! Register at 6ebf851454c41f964baba2b6b

76 Thank you! This material was prepared by Telligen, the Quality Innovation Network National Coordinating Center, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-QINNCC /12/17 77