Monthly Medication Safety Webinar:
All lines will be muted during the presentation and unmuted during questions. If you do not have a
question to ask, please mute your phone. If you do not have a mute button on your phone you can
press *6 to mute your line. Please do not put the conference on hold. If you would like to ask a
question during the webinar please enter the question into the question box.
OPIOIDS: Embedding Safety Science in Medication
Management System
Jocasta N. Gee, Pharm.D.
Hospital Corporation of America (HCA) University
of Tennessee College of Pharmacy
Nashville, Tennessee
Jason Wright, Pharm.D.
TriStar Centennial Medical Center
Nashville, Tennessee
L. Hayley Burgess, Pharm.D.
Hospital Corporation of America (HCA)
Nashville, Tennessee
Jennifer Higdon, Pharm.D., BCPS
HCA-TriStar Division
Chattanooga, Tennessee
2
Joint Commission Sentinel Event Alert
Effective processes
Safe technology
Appropriate education
and training
Effective tools
Med Man System Topic
• Effective processes
– Ordering
– Procurement
• Safe technology
–
–
–
–
Transcribing
Administration
Storage
Preparing and Dispensing
• Appropriate education and training
– Patient Monitoring and Metrics
– Patient Education
– Training
• Effective tools
– Process Mapping
– FMEA
– Action Plan
4
Effective Processes
5
5
ORDERING
6
Initial Assessment
• Screen patients for respiratory depression risk factors
• Assess the patient’s previous history of analgesic use
– abuse, duration and possible side effects to identify potential opioid
tolerance or intolerance.
• Conduct a full body skin assessment of patients prior to
administering a new opioid to rule out
– an applied fentanyl patch
– implanted drug delivery system
– infusion pump
Jarzyna D, Pain Management Nursing. 2011.
Dahan A. Anesthesiology, 2010.
American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons.Journal of the American Geriatrics Society. 2009.
7
Treatment
• Use an individualized, multimodal treatment plan to manage pain.
–
–
–
–
Psychosocial support
Coordination of care
Nonpharmacologic approaches
Non-opioid pain medications
• Treatment Approaches
– Avoid rapid dose escalation of opioid analgesia
– Take extra precautions when
• Transferring patients between care units
• Transferring patients between facilities
• Discharging patients to their home.
– Consider that drug levels may reach peak concentrations during transport.
– Avoid using opioids to meet an arbitrary pain rating or a planned discharge
date.
– Dosing should be based on the individual patient’s need and condition.
Jarzyna D, Pain Management Nursing. 2011.
Dahan A. Anesthesiology, 2010.
American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons.Journal of the American Geriatrics Society. 2009.
8
Effectiveness
• Assess the pain using a standardized pain scale
– Ask the patient
– If the patient is unable to communicate, assess pain
based on behavioral cues
• Frequency of assessment should be:
– Initial
– Every 8 hours for mild to moderate pain
– Every 2 hours for severe pain
• Standardized tools can be used to screen patients for
undersedation, oversedation and respiratory
depression
– Pasero Opioid-Induced Sedation Scale (POSS)
– Richmond Agitation-Sedation Scale (RASS)
9
Objective Pain Scales
10
Subjective Pain Evaluation
• Most common determination of pain in the ICU due to
sedation and/or cognitive impairment
• Need a patient-specific strategy
• Assess patient movement, facial expression, and posturing
• Physiologic manifestation of pain:
–
–
–
–
–
Tachycardia
HTN
Increased RR
Diaphoresis
Mydriasis
11
Assessment of Pain (FLACC Pain Scale)
12
Assessment of Neuropathic Pain
• Neuropathic Pain questionnaire – Short Form
• Rate the following aspects of your pain (0‐10 scale):
– Tingling pain
– Numbness of pain
– Increased pain due to touch
Backonja M, Krause SJ. Neuropathic Pain Questionnaire – Short Form.
Clin J Pain 2003;1995)L315-316.
13
Strategies to Reduce Errors with Ordering
Assess if patient
is a candidate
for opioid
therapy
• Conduct a psychology screening to obtain realistic expectations about pain
management
• Review concomitant medications prior to prescribing opioids
• Collect a history of snoring, obesity and sleep apnea
• Dose and frequency of opioids in procedural areas such as endoscopy
The facility’s
opioid practices
clearly specify
the following:
• Opioids are not used to treat anxiety
• Meperidine use is minimized or eliminated
• Opioid administration is not routinely accompanied by sedatives or
anticholinergic drugs such as hydroxyzine
• Opioid dose ranges do not exceed 4x (four times) the original dose (Consider
limiting to 2x the original dose)
• Intramuscular (IM) opioid use is minimized
• Oxygen is used only if therapeutically necessary and only upon a physician order
Minnesota Hospital Association. The Road Map to a Medication Safety Program. 2012.
http://www.mnhospitals.org/Portals/0/Documents/ptsafety/ade/Medication-SafetyRoadmap.pdf
14
Strategies to Reduce Errors with Ordering (cont.)
The facility
has practice
guidelines in
place for
appropriate
use of tactics
to reduce
opioid use,
which include:
• Non-narcotic medications (e.g., NSAIDs,
acetaminophen, regional infusions of local
anesthetics, steroids, gabapentinoids, etc.) are
routinely used as a tactic to reduce opioid
administration on the patient care units
• Non-narcotic medications (e.g., NSAIDs,
acetaminophen, regional infusions of local
anesthetics, etc.) are routinely used as a tactic to
reduce opioid administration in the operating room
• Non-pharmacologic therapy (e.g., healing touch,
massage, music, guided imagery, aromatherapy, etc) is
offered and maximized when possible, as tactics to
reduce opioid administration
Minnesota Hospital Association. The Road Map to a Medication Safety Program. 2012.
http://www.mnhospitals.org/Portals/0/Documents/ptsafety/ade/Medication-SafetyRoadmap.pdf
15
PROCUREMENT
16
Strategies to Reduce Errors with Procurement
• The facility has a pain management process in place, which
includes:
– Pain management specialist available for consultation, either onsite or
external, which provides mentoring as well as specific consults
– High-Alert medication policy and formulary review
– Pain medication stewardship program in place
•
•
•
•
Processes for identification and implementation of best practices
Daily monitoring of adherence to best practices
Plan for intervention of deviation from best practices
Processes for monitoring patient pain management satisfaction scores
– Standardized pain assessment scales are used throughout the facility
– Process in place to discuss and agree upon specific pain goals and
strategies with the patient prior to a surgical procedure
Minnesota Hospital Association. The Road Map to a Medication Safety Program. 2012.
http://www.mnhospitals.org/Portals/0/Documents/ptsafety/ade/Medication-SafetyRoadmap.pdf
17
Safe Technology
18
TRANSCRIBING
19
Equianalgesic Conversion Process
Total the 24-hour
dose of current
drug, including all
breakthrough
doses
Convert 24-hour
dose to new drug
and/or route using
an equianalgesic
conversion table
In opioid-tolerant
patients, consider
reducing calculated
dose of the new
drug by 25 to 50%
to account for
incomplete crosstolerance
McPherson M. Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing. 2010.
McPherson M. 2011 Update to Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing.
McNicol E. Opioid Analgesics: Administration issues, Side-effect management, and Equianalgesic Conversion. 2008;5(1):16-25.
Divide the total
dose of new drug
by the schedule of
the new drug
Calculate a
breakthrough dose
– either 5% - 15%
of the total daily
opioid dose or 25 –
30% of the single
standing dose
20
Analgesic Equivalencies
Opioid Agonist
Parenteral (mg)
Oral (mg)
Morphine
10
30
Oxycodone
NA
20
Hydromorphone
1.5
7.5
Fentanyl
0.1
NA
Codeine
130
200
Hydrocodone
NA
30
Meperidine (not preferred)
75
300
McPherson M. Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing. 2010.
McPherson M. 2011 Update to Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing.
McNicol E. Opioid Analgesics: Administration issues, Side-effect management, and Equianalgesic Conversion. 2008;5(1):16-25.
21
Clinical Pharmacology Opioid Calculator
22
FENTANYL PATCHES
When to use fentanyl patches?
• Opioid Tolerance-Adaptation to a drug which results in
decreased effects over time
• Opioid Tolerance can be defined as taking one of the below for a week
or longer
•
•
•
•
60mg of oral morphine per day
30mg of oral oxycodone per day
8mg of oral hydromorphone per day
OR an equianalgesic dose of another opioid
Barr J, Fraser G, Puntillo K, et al. Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult
Patients in the Intensive Care Unit. Critical Care Medicine. 2013:41(1);263 – 306.
Mularski R. Pain Management in the intensive care unit. Crit Care Clin. 2004:20;381 – 401.
Opioid Dosing: Focus on Safety. Pharmacist’s Letter. 2010:26;260712.
24
Converting to Transdermal Fentanyl
• Determine the 24 hour parenteral morphine equivalent
• Dose patch at 50 – 75% of the previous 24 hours opioid use
• Prescribe short acting opioids for breakthrough pain (5 – 15%) of 24 hour
dose every 3 hours
• Patch duration is 72 hours
– Increase the patch dose based on the average amount of additional short
acting opioid required in the previous 72 hours
– Wait at least 48 hours before adjusting the dose
• It may take up to 6 days for fentanyl levels to reach equilibrium on a new
dose
– Wait two 3-day applications before any further increase in dosage is made
• For doses greater than 100 mcg/hr multiple patches can be used
25
Converting from Transdermal Fentanyl
• Remove fentanyl patch
• Approximate transdermal T1/2 of 17 hrs
– 50% decrease in plasma levels
• Typically Start Long-acting opioid at least 18 hours after
removal
– Titrate short-acting opioids for breakthrough pain until LAO is initiated
• Common to use 2:1 method (i.e. 2 mg PO morphine/day = 1
mcg/hr fentanyl)
– Wait 8 – 12 hours before starting 50% of equianalgesic regimen
– Wait 24 hours before increasing to 100%
26
Equianalgesic Conversion Process
• Equianalgesic data is approximate!
–
–
–
–
Many different tables available
Mostly based on single-dose, cross-over studies
Mostly studied in cancer patients
Patient specific factors
• Age, organ function, genetics, co-morbidities, medications
• Use clinical judgment
– Start low and go slow!
McPherson M. Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing. 2010.
McPherson M. 2011 Update to Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing.
McNicol E. Opioid Analgesics: Administration issues, Side-effect management, and Equianalgesic Conversion. 2008;5(1):16-25.
27
Strategies to Reduce Errors with Transcribing
A pharmacist or pain
provider provides
oversight for all dosing
of:
• Methadone
• Fentanyl patches
• Transmucosal immediate release fentanyl patches (TIRFs)
The facility has
standard policies and
practices in place for
managing the initiation
and maintenance of
opioid therapy which
include:
• Identifying the need for a consultative pain assessment by a
qualified pain practitioner (e.g., pain management physician, nurse
practitioner, clinical pharmacy specialist or CNS focused on pain)
• Standardized pain order sets within clinical practices/ specialties
(e.g., orthopedics, vascular surgery, oncology, labor and delivery,
etc.)
• PCA and PCEA orders prohibit the routine use of basal dosing in the
opiate naïve patient
Minnesota Hospital Association. The Road Map to a Medication Safety Program. 2012.
http://www.mnhospitals.org/Portals/0/Documents/ptsafety/ade/Medication-SafetyRoadmap.pdf
28
ADMINISTRATION
29
Pain Guidelines
• Titrate the opioid dose at least every 24 hours and as often as
every 2 hours when the pain is severe
– Increase the dose by 25-50% or by 50-100% with severe pain
– Do not use range orders
• Manage breakthrough pain with short acting opioids using 1/3
of the single dose amount or 5-15% of the total daily dose
– Use around the clock pain medication not PRN for ongoing pain
– Use the KISS principle – Keep It Same and Simple (i.e. use the same opioid for
short and long term pain control)
Barr J, Fraser G, Puntillo K, et al. Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult
Patients in the Intensive Care Unit. Critical Care Medicine. 2013:41(1);263 – 306.
Mularski R. Pain Management in the intensive care unit. Crit Care Clin. 2004:20;381 – 401.
Opioid Dosing: Focus on Safety. Pharmacist’s Letter. 2010:26;260712.
30
Administration: Patient Controlled Analgesia
Patient Controlled Analgesia
Medication
Dose
Lock-out Interval
Fentanyl
Max: 50mcg
(Range: 10-50mcg)
5-8 minutes
Hydromorphone
Max: 0.4mg
(Range: 0.05-0.4mg)
5-10 minutes
Morphine
Max: 2.5mg
(Range: 0.5-2.5mg)
5-10 minutes
1Lexi-Comp OnlineTM , Lexi-Drugs OnlineTM , Hudson, Ohio: Lexi-Comp, Inc.; February 13, 2014.
Hicks R, Sikirica V, Nelson W, Schein J, Cousins D. Medication errors involving patient-controlled analgesia. Am J Health-Syst Pharm.
2008; 65:429-40.
Cohen MR, Weber RJ, Moss J. Patient-controlled analgesia: Making it safer for patient. Institute for Safe Medication Practices. April 1,
2006.
31
Strategies to Reduce Errors with Administration
New opioid administration
The facility’s nursing practice
includes a process to double
check opioid pump
programming:
The facility uses smart infusion
pumps with drug libraries for
the IV administration of all
opioids (including PCA and
epidural infusions), with
functionality employed to:
• Conduct a full body skin assessment of patients prior to
administering a new opioid to rule out the possibility
that the patient has an applied fentanyl patch or
implanted drug delivery system or infusion pump
• At the start of their shift
• With new narcotic infusion and PCA starts
• With setting changes – initiation of bag, bag change,
and shift change
• Intercept and prevent wrong dose errors
• Intercept and prevent wrong infusion rate errors
Minnesota Hospital Association. The Road Map to a Medication Safety Program. 2012.
http://www.mnhospitals.org/Portals/0/Documents/ptsafety/ade/Medication-SafetyRoadmap.pdf
32
STORAGE
33
Storage: Fentanyl Drip & Epidurals
34
Strategies to Reduce Errors with Storage
Automated Dispensing
Cabinets (ADC)
The facility has safety
mechanisms in place for
epidural opioid infusion
processes which ensure:
Storage of controlled
substances
• Where appropriate, only dose forms that are needed for starting
doses are available as override items in automated dispensing
cabinets (e.g., morphine 2 mg syringes are available but 4 mg
syringes are not available on override)
• Epidural pumps are used only for epidural infusion therapy
• Epidural tubing is pre-connected in pharmacy when possible, and is
incompatible with non-epidural pumps
• Epidural bags and bottles are clearly differentiated from IV infusions
or piggybacks
• Procedures in place to prevent diversion
Minnesota Hospital Association. The Road Map to a Medication Safety Program. 2012.
http://www.mnhospitals.org/Portals/0/Documents/ptsafety/ade/Medication-SafetyRoadmap.pdf
35
PREPARING AND DISPENSING
36
Strategies to Reduce Errors with Preparing/Dispensing
The facility has
processes in
place to
eliminate
errors in
opioid storage,
preparation,
and
dispensing,
which include:
• Strategies to prevent errors caused by mixing up concentrated
and dilute oral liquid narcotics
• Standardizing the choices of epidural infusions per
organization/service line and minimizing the formulary
• Established dose equivalency conversion tools are readily
available and utilized
• Guidelines to address how and when to supplement opioid
doses when range orders are used
• Established pediatric dose guidelines are widely available and
utilized
• Pediatric dose guidelines are incorporated into the electronic
health record
• Pediatric dosage forms are separated from adult dosage forms
• An independent double check (two licensed providers) is
performed for all narcotic infusions prepared in the pharmacy
Minnesota Hospital Association. The Road Map to a Medication Safety Program. 2012.
http://www.mnhospitals.org/Portals/0/Documents/ptsafety/ade/Medication-SafetyRoadmap.pdf
37
Appropriate Education and Training
38
PATIENT MONITORING
39
Patient Monitoring: Effectiveness
• Opioid analgesics rank among the drugs most frequently
associated with adverse drug events.
• The literature provides numerous studies of the adverse
events associated with opioids.
• The incidence of respiratory depression among post-operative
patients is reported to average about 0.5 percent.
• Some of the causes for adverse events associated with opioid
use are:
– Lack of knowledge about potency differences among opioids.
– Improper prescribing and administration of multiple opioids and
modalities of opioid administration (i.e., oral, parenteral and
transdermal patches).
– Inadequate monitoring of patients on opioids.
Swegle J, Logemann C. Management of Common Opioid-Induced Adverse Effecs. American Family Physician
2006:74(8);1347 – 1354.
McNicol E. Opioid Analgesics: Administration issues, Side-effect management, and Equianalgesic Conversion.
2008;5(1):16-25
40
Patient Monitoring: Adverse Events
• Educate and assess the staff understanding of potential adverse effects of
opioid therapy.
• Educate and provide written instructions to patients who are on opioids
(and to the patient’s family or caregiver).
• Common Adverse Events:
–
–
–
–
–
–
Sedation
Nausea/Vomiting
Constipation
Pruritis
Respiratory Depression
Confusion/Mental clouding
• Less Common Adverse Events:
– Euphoria or dysphoria
– Dependence
– Withdrawal
• Can occur within 12 hours of discontinuation
• Sweating, agitation, diarrhea, tachycardia, rebound pain
Swegle J, Logemann C. Management of Common Opioid-Induced Adverse Effecs. American Family Physician
2006:74(8);1347 – 1354.
McNicol E. Opioid Analgesics: Administration issues, Side-effect management, and Equianalgesic Conversion.
2008;5(1):16-25
41
Monitoring Makes a Difference
• Study Design
• The Committee for Safe Medication Practice at Wesley Medical Center in
Wichita, KS, has improved patient-controlled analgesia (PCA) outcomes by
developing and implementing:
• A sleep apnea risk assessment model
• Evaluates all adult patients
• Uses modified STOP-Bang scoring system
• Risk documented in electronic health record
• Dosing parameters
• Robust monitoring
• The consistent use of capnography to monitor respiratory status.
• Results
• Decreasing the percentage of moderate and severe patient-controlled analgesia
adverse events progressing to code blue from 13 percent to zero percent.
Strategies to Reduce Errors with Monitoring
The facility has opioid
administration and
monitoring practice
guidelines in place,
which include:
• Vital signs monitoring, including pain, is defined for all clinical
situations (oral narcotics, PCA, epidural, IV injection)
• Continuous pulse oximetry for all patients (excluding end of life
patients) receiving IV narcotics
• Capnography monitors are used when patient is receiving
supplemental oxygen (excluding end of life patients) and receiving
IV narcotic infusion, epidural, PCA, or frequent IV narcotic
injections
• Monitor alarms can be heard at the nursing station for pulse
oximetry and capnography and cannot be turned “off”
• Monitor alarms automatically default to hospital-defined
thresholds
• Nursing practice guidelines address how and when to transition
opioid therapy (e.g., PCA to oral: If patient is not NPO and is able to
tolerate, oral pain medications are utilized)
A protocol is followed
which guides the
reversal of opioids and
includes the following:
• Reversal protocols are active on all patients’ MARs if there is an
active order for a narcotic
• Nurses are allowed to administer reversal agents without prior
physician order
• Strategies are in place to guard against dose stacking
• The facility utilizes a rapid response team to assist with
possible narcotic oversedation
Minnesota Hospital Association. The Road Map to a Medication Safety Program. 2012.
http://www.mnhospitals.org/Portals/0/Documents/ptsafety/ade/Medication-SafetyRoadmap.pdf
43
TRAINING
44
Training
• Assess your organization’s need for training based on:
– Analysis of reported adverse events
– Near misses
– Staff observations
• Training Examples
– Initial training for new hires and existing staff, including protocols,
guidelines, onboarding materials
– Post-test incorporating a case-study approach to demonstrate
proficiency covers topics such as dose stacking, dose equivalency,
interpretation of vital signs and monitoring equipment
– Identify knowledge gaps and develop improvement strategies to
reduce recurrences
– Ongoing opioid education is provided when new relevant information
is available
45
Effective Tools
46
PROCESS MAPPING
47
Opioid Use Process
48
FMEA
49
Top 8 Failure Modes Identified
Potential
Effect
Severity
13- Nurse
Acknowledge too
Acknowledge soon and medication
s the order
is discontinued
ADR
10
7
16- Nurse The nurse does not
Scan Patient
scan the patient
Barcode
barcode
ADR
10
22- Nurse
performs
pain
assessment
Inappropriate
assessment
ADR
19- Nurse
waste with
witness
Diversion
Inadequate
control
Step
Failure Mode
Occurrence Detection
RPN
Rank
10
700
1
7
9
630
2
10
8
7
560
3
7
8
8
448
4
50
Top 8 Failure Modes Identified (cont)
Step
Failure
Mode
Potential
Effect
Severity
Occurrence
Detection
26- Patient
transitioning
care
PACU orders still on
profile causing
duplicate
therapy/orders
ADR
10
7
5
350
5
6- Pharmacist
DUR not performed
Approves the
properly
order
ADR
10
5
6
300
7
2- Decided the
Not using a proper
appropriatenes
assessment
s of Opioids
Oversedation
10
6
4
240
8
Unrealistic
1- Teach Pain
expectation of
Education to No Pain Education the effects of
Patient
the pain
medication
4
7
7
196
9
RPN Rank
51
ACTION PLAN
52
Action Plans/Next Steps
Step #
Top Failure Mode(s)
RPN
Action Plan
Assess patients for risk
factors associated with
oversedation and respiratory
depression.
22- Nurse performs
pain assessment
Inappropriate
Assessment
560
Assess patients for
inadequate pain control.
Next Steps
Establish guidelines for appropriate frequency of
monitoring and provide standardized patient monitoring
tools:
• Acute care: Pasero Opioid-Induced Sedation Scale
(POSS) and the Richmond Agitation Sedation Scale
(RASS).
• Ambulatory: Screener and Opioid Assessment for
Patients with Pain (SOAPP & SOAPP-R), the Opioid Risk
Tool (ORT), and the Screening instrument for Substance
Abuse Potential (SISAP).
• Ensure that the oversedation and respiratory
depression assessment is properly documented on the
patient’s profile and electronic medical record.
Provide standardized tools:
• Ensure that the pain assessment is properly
documented on the patient’s profile and electronic
medical record.
• Implement a hard stop that prompts nursing staff to
enter the pain scale number before administering an
opioid.
• Add an opioid conversion /equivalences chart on
meditech
53
Other Action Plans/Next Steps
Step #
21- Nurse
Administer the Dose
Top Failure Mode(s)
Dose Not
Administered to
Patient
RPN
350
Action Plan
Ensure patient receives medication in a
timely manner.
Educate and provide written instruction to
patients who are on opioids (and to
family/caregivers).
1- Teach Pain
Education to Patient
No Pain Education
Next Steps
Establish a lock out time frame:
• Opioid medications cannot be retrieved
30 minutes before the medication is due.
• Must be administered 15 minutes after
removal from Pyxis. After retrieving the
medication from pyxis to when it is
actually administered.
Ensure that the education session is
properly documented on the patient’s
profile and electronic medical record..
196
Assess if patient is a poor candidate for
opioid therapy
Conduct a psychology screening to obtain
realistic expectations about pain
management
54
Rank Order of Error Reduction Strategies
- Ensure patient
receives
medication in a
timely manner.
Forcing Functions & Constraints
Automation & Computerization
Standardization & Protocols
-
Educate and provide
written instruction to
patients who are on
opioids (and to
family/caregivers).
-
Checklists & Double-Checks
-
Policies & Procedures
Assess patients for risk
factors associated with
oversedation and
respiratory depression.
Assess patients for
inadequate pain control.
Education & Information
- Educate and assess the
understanding of staff.
55
OPIOIDS: Embedding Safety Science in Medication
Management System
Hayley Burgess, Pharm.D., Director of Medication Safety and System Innovations, Hospital Corporation of
America, Hayley.Burgess@hcahealthcare.com
Jocasta N. Gee, Pharm.D., PGY1 Managed Care Resident, Hospital Corporation of America/University of
Tennessee College of Pharmacy, Jocasta.Gee@hcahealthcare.com
Jason Wright, Pharm.D., PGY1 Pharmacy Practice Resident, TriStar Centennial Medical Center,
Jason.Wright3@hcahealthcare.com
Jennifer Higdon, Pharm.D.,BSCP, Division Director Clinical Pharmacy Services, HCA-TriStar Division,
Jennifer.Higdon@Parallon.com
56
Next Steps
Monitor and update best practices
Identify new projects for next cycle
Decision support
Smart Pumps
Adopt ASHP strategy for volunteer groups
Spring call for volunteers via TPA/THA
Seat membership for next cycle
Begin next cycle in August
Submit your name and contact information to Jackie
Moreland @ jmoreland@tha.com
Identified ADE Measures by TPC
Opioids Outcome Measure:
Total # doses of Narcan dispensed
Total # doses of Opioids dispensed
Identified ADE Measures by TPC
Anticoagulants Outcome Measure:
Total # patients with an INR > or equal to 4.0
Total # doses of Warfarin or Coumadin dispensed
Identified ADE Measures by TPC
Hypoglycemic Agents Outcome Measure:
Total # patients with a blood glucose equal to or
less than 70
Total # doses of Insulin dispensed
Tennessee Pharmacists Coalition
Mark Sullivan, Pharm.D., MBA, BCPS, Chairman, Tennessee Pharmacists Taskforce & Director, VUH
Pharmacy Operations, Vanderbilt University Hospital
Chris Clarke, RN, BSN, Senior Vice President, Clinical and Professional Practices, Tennessee Hospital
Association
Jackie Moreland, RN, BSN, MS, Clinical Quality Improvement Specialist, Tennessee Center for Patient
Safety, Tennessee Hospital Association
Todd Bess, Pharm.D., BCPS, Assistant Dean for Middle Tennessee, Director, Nashville Clinical
Education Center & Statewide Community Pharmacy Residency Program, University of Tennessee
College of Pharmacy
Jeff Binkley, Pharm.D, BCNSP, FASHP, Director of Pharmacy, Maury Regional Medical Center
Baeteena Black, D.Ph., Executive Director, Tennessee Pharmacists Association
Hayley Burgess, Pharm.D., Director of Medication Safety and System Innovations, Clinical Services
Group/HCA
Jason Carter, Pharm.D., Chief Pharmacist TN Dept. of Mental Health and Substance Abuse Services,
TN State Opioid Treatment Authority, Associate Professor, University of Tennessee College of
Pharmacy
Tennessee Pharmacists Coalition
Micah Cost, Pharm.D., Director of Professional Affairs, Tennessee Pharmacist Association
Brian Esters, Pharm.D., CPPS, Assistant Professor of Pharmacy Practice, South College School of
Pharmacy
Carly Feldott, Pharm.D., Medication Safety Program Director, LifePoint Healthcare
Brandy Greene, Pharm.D., Clinical Pharmacy Manager, Saint Thomas at Midtown
Leah Ingram, Pharm.D., Director of Pharmacy, Cookeville Regional Medical Center
Keith Kuboske, D.Ph., Pharm.D., Director of Pharmacy, NorthCrest Medical Center
Susan Morley, Pharm.D, Assistant Professor, Lipscomb University College of Pharmacy
David Mulherin, Pharm.D., BCPS, Informatics Pharmacist, Vanderbilt
Sherry Osborne, D.Ph., Executive Director of Pharmacy, Jackson-Madison County General Hospital;
Faculty Union University School of Pharmacy
Calita Richards, Pharm.D., MPH, Director of Pharmacy, Tennessee Department of Health
Kay Ryan, D.Ph., MS, MBA, Certified L/S Green Belt, Pharmacy Director, Regional Medical Center at
Memphis
http://tnpatientsafety.com/SafetyQualityInitiatives/AdverseDrugEventsADE/PharmacyResources/tabid/312/Default.aspx
IHI Open School 2014
• THA is providing free access to the IHI Open School curriculum to employees
and trustees of our safety partner hospitals.
• 22 online, self-paced courses including 73 lessons and corresponding
resources—videos, case studies, podcasts, featured articles, exercises,
networking
• Free app for the iPhone and iPad by logging onto iTunes
• Over 25 contact hours available for CME, CNE, CPHQ and ACPE credit
• Certificate of completion
• Register using instructions. Type “Tennessee Hospital Association” as your
facility to receive free membership.
• Once registered, go to the course page: www.ihi.org/lms
• Click the online learning tab and choose a lesson
• Click Begin Lesson
• Contact Patrice Mayo at pmayo@tha.com 615-401-7434 for more
information.
65
Upcoming Events
Antimicrobial Stewardship Collaborative Webinar – Tuesday June
17th 10am CT/11am ET.
Dr. Ashley Tyler, PharmD, BCPS, Infectious Disease Pharmacist at
Saint Thomas Midtown will present on “De-Escalation”.
Webinar link:
https://stateoftennessee.adobeconnect.com/antimicrobialstewardship/
Bridge Line: 1-888-757-2790 | Passcode: 848713
July ADE webinar – Date/time TBD
TPA’s 127th Annual Convention—July 21-24th, Hilton Head
Marriott, Hilton Head, S.C. Register @ http://www.tnpharm.org/
Upcoming Events
TCPS Monthly Webinar on Readmissions—June 27; Time TBD
TCPS Regional Meetings
Knoxville—Tuesday, August 19th
Nashville—Thursday, August 21st
Memphis—Tuesday, August 26th
THA Leadership Summit—November 5, Opryland Hotel and
Convention Center, Nashville, TN
Other Reminders
Webinar Evaluation: Earn contact hours for webinar participation after
completing
TCPS Newsletter: Sent every Tuesday afternoon
IHI Open School: THA is providing free access to the IHI Open School
curriculum for 2014 to employees and trustees of our safety partner
hospitals.
AHRQ Hospital Survey on Patient Safety (HSOPS): The Tennessee Center for
Patient Safety offers the survey to all safety partners at NO COST. Go to
www.tnpatientsafety.comTools and Resources AHRQ Culture Survey for
more information.