Completing a Medication Management Assessment:

Getting Started

Ettie Lande, MS, RN Associate Director, Care Coordination

Health Services Advisory Group (HSAG) July 30, 2015

Why Are we Here?

Adverse Drug Events (ADEs) account for

In older adults ADEs account for

of emergency hospitalizationsor readmissions

Medicare population

Medication safety isessential to improve care

coordination in all settings

Visitingmultipleproviders

out of

of all hospital adverse events

Prolong hospital stays by

to days hospital stays affected

Sources: Institute of Medicine, Agency for Healthcare Research and Quality and the National Institute of Health 2

No Place Like Home, Phase 2: A Pledge Agreement by Providers

Arizona providers who are No Place Like Home partners pledge to the following actions: • Conduct three medication management performance

improvement projects (PIPs) over the next four years (January1, 2015–December 31, 2018).

• Designate two staff members: (1) a team leader and (2) a pharmacy or physician champion for your facility.

• Conduct a medication management assessment (MMA) bySeptember 30, 2015.

• Develop an action plan that addresses the items identified in the MMA.

• Collect and analyze data to monitor the effectiveness of theaction plan through monthly process measures that support the Quality Assessment and Performance Improvement(QAPI) process.

3

A Focused Approach to Improvement

• Reviewed evidence-based literature and best practices to select structured MMA tools for organizational use.

• Identified the Road Map to a Medication Safety Program tools as best practice that has been embraced by hospitals in Minnesota.

• These tools are endorsed by HSAG and can be found on the No Place Like Home website.

• Communicated to hospitals, nursing homes, home health agencies, and hospice providers that tools are available that will help providers to evaluate gap opportunities for future improvement.

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Assess Your Organization: Medication Management Assessment Tools

5

Online Toolkit at hsag.com/noplacelikehomeaz

• Begin with a structured assessment – Leadership and safety

culture infrastructure – Topics common to all

medications • Find great resources in a

web-based toolkit – Assessment tools – Articles – External resources – Glossary of terms,

acronyms, definitions

6

Next: Evaluate Adverse Drug Event (ADE) Gap Analyses Structure

• Complete the ADE gap analysis assessment components specific to – Opioids – Hypoglycemic agents – Anticoagulants

• Strategies: – Assessment and detection – Prevention and mitigation – Therapeutic strategies – Critical thinking and knowledge – Medication-specific patient and family

education

7

Getting Started: Step 1

• Convene an interdisciplinary team or workgroup. • Consider incorporating this work into an

established team or workgroup that is addressing readmissions or other quality/safety improvement initiatives.

• Involve those who work directly with and are knowledgeable of your organization’s medication processes and practices.

• Completing this medication safety program assessment may take two to three meetings of approximately one hour each.

8

Getting Started: Step 2

• Team members review the tools. • Assign team members with direct knowledge and

expertise in the high-risk medication categories. • These experts follow up on items needing further

review and/or validation before completing the assessment. For example: – Create an anticoagulation therapy subgroup of

interdisciplinary team members. – Have the “expert” interview various key stakeholder

group members regarding current practices.

9

Getting Started: Step 3

• Select the assessment tool you want and save the file toyour computer and/or print paper copies.

• Answer YES or NO to each item. • Checking NO should have a corresponding note with a

specific action plan. • Notes can be added electronically-click on the right

column and start typing. • Examples of specific action plans:

– CEO to communicate overall medication goals at AugustLeadership meeting

– Nurse managers to schedule all RNs for ADE-prevention training 8/15

– Medication Safety Team has first meeting on 8/15

10

Getting Started: Step 4

• Team members come together to review the assessment results.

• Review the items checked as NO and added comments. • Identify “low hanging fruit” that can be easily remedied

and consider addressing these items first while reducing and/or eliminating actual or potential barriers that exist with more complex items.

• Look for common themes or trends that exist across each of the gap analysis tools, for example: – No ADE reporting – Health literacy and teach back – Patient and caregiver engagement

11

Getting Started: Step 5

• Workgroup members collectively prioritize the identified gap opportunities based on those that: – Have the greatest impact on preventing adverse

drug events or reducing avoidable hospital readmission rates

– Are within team or facility control – Are aligned with the organization’s current

process and outcome measures

12

Getting Started: Step 6

• Workgroup members: – Create the action plan for improvement – Communicate the action plan for improvement – Set reasonable timeframes for completion

• Review and update the plan at regular intervals. • Use available evidence-based resources and

toolkits. • Many medication management resources can be

found on the No Place Like Home website: http://www.hsag.com/noplacelikehomeaz

13

Getting Started: Step 7

• Complete the Medication ManagementAssessment Organizational Summary and share with HSAG. – Identify top five focus areas for medication safety

improvement in order of priority. – Indicate what tools and resources would be most

helpful to assist in improvement efforts. – Share best practices that have been implemented to

improve medication safety in your organization orpromising practices being considering forimplementation.

Email form to Ettie Lande: elande@hsag.com or fax to 602.801.6051.

14

Medication Management Assessment: Complete the Organizational Summary

Completing and sharing this allows HSAG to target efforts in providing resources, tools, and webinars you need to be successful!

15

Medication Management Assessment Organizational Summary (cont.)

Examples of additional resource needs and best practice from your facility you may want to share with your community.

16

Then What?

• Prioritize gap opportunities and break them down to incorporate improvement into other teams or meetings, as needed.

• Develop an action plan and identify reasonable time frames for implementation.

• Track progress. • Review and analyze the data. • Share data on a regular basis

and communicate the learnings.

17

Examples of Action Plan items Related to Facility Expectations

• Follow standardized practices. • Establish and communicate clear expectations. • Educate staff members. • Establish a structured

communication process. • Establish an effective

medication reconciliation process.

• Disclose unanticipated events.

18

Example of an Action Plan to Improve Patient and Family Engagement

• Educate and empower patients/families – Their role in medication safety – Remove barriers to understanding:

cultural, language, hearing impairment, health literacy

– Assess understanding (e.g., teach back)

– Expectations regarding safe behaviors of staff members

– Encourage “speaking up”

19

Quotes from Hospitals There were many things we weren’t

aware of that these tools drew to our

attention

Using the roadmap to ID priority topics was

beneficial

Keep at it!

HSAG Home Page: Navigating to Tools and Resources

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Questions? Thank you!

Ettie Lande, MS, RN Associate Director, Care Transitions

602.801.6912 elande@hsag.com

This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Arizona, 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. Publication No. AZ-11SOW-C.3-07272015-01