Health Information Technology Eric G Gayle MD FAAFP IFHBronx R egional Medical Director and Regina Ginzburg PharmD Clinical Pharmacy Faculty BI Family Medicine Associate Clinical Professor St Johns University ID: 731430
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Improving Patient Safety Using Health Information Technology
Eric G. Gayle, MD F.A.A.F.P
IFH-Bronx
R
egional Medical Director
and
Regina Ginzburg,
Pharm.D
.
Clinical Pharmacy Faculty, BI Family Medicine
Associate Clinical Professor, St. Johns UniversitySlide2
Medication Errors & Preventable Adverse Drug Events
At least 1.5 million preventable ADEs occur each year in the United States
~1/3 occur in the outpatient setting
Cost per preventable ADE: ~$2,000National annual cost: $887 millionThe numbers above are likely an underestimation!
Preventing Medication Errors: Quality Chasm Series
http://www.nap.edu/catalog/11623.htmlSlide3
Electronic patient records and patient safety
communication
“Electronic pharmacy”
capabilities
EHR
Point of care interactions
legibilitySlide4
Effective Error-Prevention Strategies
Improving Patient-Provider communication
Verify active medication list with each encounter
Review the name and purpose of the selected medication.Discuss when and how to take the medication.Discuss important and likely side effects and what to do about them.Discuss drug-drug, drug-food, and drug-disease interactions.
Review the patient’s role in achieving appropriate medication useSlide5Slide6Slide7
Improving patient safety using Health Information Technology
“Electronic Pharmacy” within the EHR
Eliminates transcription errors
Point of care checks and reviews
Electronic prescribing
Improves patient medication history documentationSlide8Slide9Slide10
Effective Error-Prevention Strategies
Electronic prescribingSlide11
Ways to Improve Medication Errors Using HIT
Auto-calculated dosing for special populations
Weight-based formula incorporated for certain medications
Correct dosage should appear in the directions field for specified patient weight must be documented in current encounterSlide12
Auto-calculated dosing: Impact of Intervention
Retrospective chart review looking rate of medication errors in our pediatric patients who were prescribed this medication before and after intervention
N=316 (Pre) and 224 (Post)
Number of medication errorsPre: 103 (32.7%)Post: 46 (20.6%) p=0.002
Significantly fewer strength overdosing errors in postintervention group
OR 0.431 (95% CI: 0.175-0.964) [p=0.028]
Ginzburg et al. Am J Health-Syst Pharm—Vol 66 Nov 15, 2009Slide13
Effective Error-Prevention Strategies
Access to evidence-based referencesSlide14
Patient Safety Management
Pharmacy and Therapeutics Committee
Develop medication-related policies
Review new drug information from FDA
Review and update medication formulary
Build “smartsets” within EHR to reflect policiesSlide15
P&T Committee
Monitor medication effects and risk for use
FDA warnings, latest guidelines/position statements, new major RCTs
Committee’s decision based on levelsLevel 0 – no actionLevel 1 – “Inbasket” to all providersLevel 2 - Inbasket + BPALevel 3 – advise HCP to cease prescribingSlide16
Monitoring Adverse Drug Reactions
Provider detects an ADR event
ADR diagnosis is entered during encounterPatient chart is flagged and sent to P&T
Pharmacist reviews chart and determines if ADR needs to be submitted to MedwatchSlide17
Impact of Best Practice Alerts (BPAs)
Effort to decrease prescribing teratogenic medications to women of reproductive age
Phase I
: chart review determining the degree of need679 electronic charts reviewedPrimary outcome measureabsence of a documented contraception plan
or
documentation that patient is low risk for pregnancy
Exclusion
: Active contraceptive on medication list, IUD documented under procedure section, hysterectomy documented in surgical historySlide18
Results of Phase I
51.3% of women were prescribed a potential teratogen and were considered high risk for pregnancy
No easy way to see if discussion took place with patient regarding potential teratogenicity
Slide19
Implementation of BPA
BPA will alert providers that they are ordering a potential teratogen for a women who is b/w 14-49 y/o
Exclusion criteria
:Active contraceptive on medication listHas IUD documented under procedureHas hysterectomy documented in surgical historyHas pregnancy or abortion diagnosis Slide20
BPA link to “smartset”
Progress note to blow in. Provider can choose 1 of 3 notes
Discussed risk and benefits.
Patient is sexually active, current method of contraception is document.Patient understands risk if becomes pregnant. Patient is not currently sexually active. Patient understands risk if becomes pregnant. Patient is only sexually active with women.Link to contraceptive management diagnosisSlide21
Future needs to improve safety
How to improve integration of OTC meds/ supplements with the Patient’s EHR
Two way communication between providers and hospitals- Bronx RHIO project ongoing.
One patient one chart conceptSlide22
The Unmarked Territory…
More research is needed for ambulatory care areas using HIT!!Slide23
Questions???