January 26, 2015
IHI Expedition
Expedition: Making Mental Health Care Safer in the Hospital Setting
Session 4: Medication Safety
David Hall
Brian Bjørn
Loriann Rizzuto
Kelly McCutcheon Adams
Today’s Host
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Dorian Burks, Project Coordinator, Institute for
Healthcare Improvement, is a current coordinator for
web-based Expeditions. He also contributes to the IHI
work in the Triple Aim and Improvement Capability
focus areas, as well as the Leading Quality
Improvement series. Dorian is a member of the
Diversity and Inclusion Council at IHI, where he and
fellow staff members develop strategies to enhance
IHI’s inclusive culture, both internally and externally.
Dorian graduated from Massachusetts Institute of
Technology in Cambridge, MA where he received his
Bachelor of Science degree in Biology and humanities
concentration in Anthropology.
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Expedition Director
Kelly McCutcheon Adams, LICSW has been a
Director at the Institute for Healthcare Improvement
since 2004. Her primary areas of work with IHI have
been in Critical Care and End of Life Care. She is an
experienced medical social worker with experience in
emergency department, ICU, nursing home, subacute rehabilitation, and hospice settings. Ms.
McCutcheon Adams served on the faculty of the U.S.
Department of Health and Human Services Organ
Donation and Transplantation Collaboratives and
serves on the faculty of the Gift of Life Institute in
Philadelphia. She has a B.A. in Political Science from
Wellesley College and an MSW from Boston College.
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Today’s Agenda
Welcome
Action Period Assignment
Debrief
Medication Safety
Action Period Assignment
Closing
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Expedition Objectives
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At the conclusion of this Expedition, participants will be
able to:
Explain the importance of partnering with patients
and their families to improve safety for patients with
mental health conditions
Identify different areas to improve mental health
care safety
Describe examples of improvement efforts at other
organizations
Plan tests of change to begin or continue patient
safety improvement
Schedule of Calls
Session 1 – Partnering with Patients and Families
Date: Tuesday, December 2, 1:00 - 2:30 PM Eastern Time
Session 2 – Making the Physical Environment Safer
Date: Tuesday, December 16, 1:00 - 2:00 PM Eastern Time
Session 3 – Why Flow Matters
Date: Tuesday, January 13, 1:00 - 2:00 PM Eastern Time
Session 4 – Medication Safety
Date: Tuesday, January 27, 1:00 - 2:00 PM Eastern Time
Session 5 – Ensuring Staff Preparedness
Date: Tuesday, February 10, 1:00 - 2:00 PM Eastern Time
Session 6 – Being Proactive and Avoiding Crises
Date: Tuesday, February 24, 1:00 - 2:00 PM Eastern Time
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Action Period Assignment Debrief
Sharing examples of changing hospital flow to
improve mental health safety
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Medication Safety
David Hall, Brian Bjørn, Loriann Rizzuto
Faculty
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David Hall has been a Consultant
Psychiatrist and Clinical Director in South
Scotland for over 20 years. His clinical
work now focuses on Forensic and
Rehabilitation Psychiatry. He has had a
number of National and International roles,
leading Scottish work to reduce psychiatric
readmissions, and more recently Clinical
Lead for the Scottish Patient Safety
Programme in Mental Health. He is also
IHI Faculty lead for the Danish Safer
Hospitals Programme in Mental Health.
Faculty
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Dr. Brian Bjørn is a physician and public
health specialist. He is an independent quality
improvement consultant and former Director of
the Danish Patient Safety Program for Mental
Health. Brian has served in different roles in
collaboratives for perinatal, community and
acute care quality improvement. He is a
member of the Scientific Advisory Board for the
Federal Quality Strategy for the Swiss Health
Care System and an Assistant Lecturer on
healthcare quality improvement at the
University of Copenhagen Medical School.
Faculty
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Lori Ann Rizzuto, Director of Behavioral and
Integrative Health Services, has 30 years of
experience in behavioral health, twelve of which
have been at Atlantic Health System developing
cost-effective, quality behavioral health programs,
and supervising operations and staff. Within the four
hospital system, Lori has administrative oversight of
daily operations of inpatient behavioral health units,
Crisis Intervention Services in the ED and outpatient
behavioral health services. This includes over 250
staff and 30 undergraduate and graduate interns.
Before joining Atlantic Health System, Lori held
Leadership positions at other hospitals, overseeing
clinical and business development areas. Lori holds
a Master of Social Work degree from Adelphi
University School of Social Work and a Bachelor of
Arts degree in Psychology from Queens College.
The Scottish Patient Safety ProgrammeMental Health
Safer Medicine Management
Workstream
Staff feel and are safe,
patients are and feel safe
With a focus on adult psychiatric inpatient units,
including admission and discharge processes
Year Zero
(Pre work)
Year One
(Testing)
Jan 12 – Aug 12
Aug 12- Sep 13
Year Two
Sep 13 – Sep 14
Years Three
and Four
Sep 14 – Sep 16
SPSP-MH Workstreams
Safer Medicines Management
Risk Assessment and Safety Planning
Leadership and
Culture
Restraint and Seclusion
Communication at Transitions
Change Action
Package Spread
(Oct 2013)
Risk Assessment and
Safety Planning –
11 Boards
22 Wards
Restraint, Seclusion and
Emergency Sedation –
9 Boards
24 Wards
Communications at
Transitions –
9 Boards
23 Wards
Safer Medicines
Management –
12 Boards
30 Wards
Safer Medicines Management
• Error free prescribing
• Management/ monitoring high risk medicines
• Management/ monitoring ‘as required’
medicines
• Medicines reconciliation
Medicines reconciliation NHS
Grampian
Successful meds rec
90%
80%
70%
60%
50%
40%
Successful meds rec
30%
20%
10%
0%
May-13
Jan-14
Jun-14
Sep-14
Successful meds rec
•
•
•
•
•
Training
Communication
Training
New form
Training!
Danish Patient Safety
Program for Mental
Health
Workstreams
• Clinical
– Medicines
– Physical comorbidity
– Reduction in use of mechanical restraint
– Suicide prevention
• Organizational
– Patient and carer engagement
– Leadership for improvement
7 psychiatric hospitals
Percent patients with all elements of
med rec bundle
Friday afternoon coffee. Staff and patients discussing improvement work.
Communication
Transparency
Visibility
Keep it simple!
Atlantic Behavioral Health
Monitoring Metabolic
Syndrome
Lori Ann Rizzuto, L.C.S.W.
Director,
Behavioral & Integrative Health Services
Why is it important to monitor second generation
antipsychotics?
Antipsychotic medications are an important part of the treatment
of many psychotic conditions.
Up to 83% of persons with serious mental illness in the US are
overweight or obese.
All atypical antipsychotics carry a risk of metabolic disturbance
There are considerable benefits, but there are still some potential
modifiable risks:
• Overweight/obesity
• Diabetes
• Dyslipidemia
• Cardiovascular disease
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Which medications are we talking about?
Zyprexa (Olanzapine)
Seroquel (Quetiapine)
Geodon (Ziprasidone)
Abilify (Aripiprazole)
Risperdal (Risperidone)
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Risk factors for developing Metabolic Syndrome

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

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
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

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Weight (BMI > 25)
High LDL (“bad cholesterol”) and Low HDL (“good
cholesterol”)
High blood pressure (above 120/80)
Family history of diabetes
Increased age
Tobacco use
Heavy alcohol use
Stress
Sedentary life-style
High fat diet
And the use of atypical anti-psychotics increases the
risk
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Where to start…
Obtain baseline and periodic monitoring
Weight
Fasting plasma glucose
Fasting lipids
Cognitive restructuring
Relapse management
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Canadian Journal of Psychiatry, Vol.51, No 8, July 2006, p498
What did we do
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What did we do?
Plan
 Literature review
 Benchmarking
 Brainstormed
 Flow charted the process
 Forced field analysis to identify barriers to monitoring
Do




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Worked with medical staff to develop form
Educated staff on form
Implemented monitoring process
Began monitoring compliance to process
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More of what we did…
Study & Act
Compliance for completing the form and ordering blood work
was excellent at one site but below acceptable level at another
site
Brainstormed #1 Idea -start with a pilot study
• We have control over the process for
patients being transferred from our
inpatient programs to our outpatient
programs
• Discharge information contains medication
information
• If needed, the doctor orders fasting lipid
levels while the patient is still an inpatient
• Lab work is either faxed to the outpatient
program or is available through the hospital
database
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Questions?
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Questions/Discussion
Raise your hand
Use the chat
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Action Period Assignment
Please think about times when you have made
improvements to medication safety for patients
with mental health issues
– Share via information about these efforts via the
listserv before next session:
MentalHealthSafety@ls.ihi.org
Expedition Communications
Listserv for session communications:
MentalHealthSafety@ls.ihi.org
To add colleagues, email us at info@ihi.org
Pose questions, share resources, discuss barriers or
successes
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Next Session
Session 5 – Ensuring Staff Preparedness
Tuesday, February 10th, 1:00 – 2:00 EST
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