S AN F RANCISCO C OUNTY : I MPROVING THE S AFETY OF S EDATIVE -H YPNOTIC P RESCRIBING Michelle Geier, PharmD Psychiatric and Substance Use Disorders Clinical.

Slides:



Advertisements
Similar presentations
Implementing NICE guidance
Advertisements

Depression in adults with a chronic physical health problem
Mental Health is Integral to Overall Health. Health Issues Related to People with Serious Mental Illness People with SMI who receive services in the public.
1 Resolving Patient Safety Issues Related to Methadone Maintenance Clinics Shirley Lesieur and Nancy R. Smestad Pharmacist Consultants OHI IT Patient Safety.
Effective Risk Management Strategies in Outpatient Methadone Treatment: Clinical Guidelines and Liability Prevention Curriculum Module 9 Special Populations.
Role of the Pharmacist in Collaborative Care for Mental Health and Addiction Treatment in Medically Underserved Appalachia Sarah T. Melton, PharmD,BCPP,CGP.
Youth Mental Health April 9, Overview History Current Youth Mental Health Resources – Wraparound Orange Youth Mental Health Proposal Action item.
JSNA Schizophrenia progress report Martina Pickin Locum Consultant in Public Health.
Behavioral Health Overview Welcome New Team Member!
Mental Health Needs: Meeting the Challenge Marsha G. Ansel, LCSW-C Howard County Mental Health Authority.
{ Bay Area Prescription Drug Abuse Summit: Pharmacist Perspective Lori Reisner, Pharm.D. Health Sciences Professor of Clinical Pharmacy University of California.
2.11 Conduct Medication Management University Medical Center Health System Lubbock, TX Jason Mills, PharmD, RPh Assistant Director of Pharmacy.
Opioid Safety Phillip Coffin, MD, MIA Director of Substance Use Research San Francisco Dept. of Public Health Assistant Clinical Professor University of.
Sublingual Buprenorphine and Pain
Emergency Unit Management: a guide to better practice Basil Bonner Head: Emergency Unit Milnerton Medi-Clinic.
Psychiatric Mental Health Nursing in Acute Care Settings.
SFGH- Department of Psychiatry Emergency Department Case Management Program (EDCM) September 24, 2012 Kathy O’Brien, LCSW Program Coordinator
Psychiatric Services in an Emergency Department Prepared by: Kathleen Crapanzano, MD DHH, OMH Medical Director Presented by: Patricia Gonzales, LCSW Acting.
ESRD Network 6 5 Diamond Patient Safety Program Taking Time Out: Working with Non-Compliant Patients Updated 2/5/09.
Criteria and Standard.
Recommended by the Sentinel Event Alert Advisory Group NATIONAL PATIENT SAFETY GOALS FY 2009.
The Role of Clinical Pharmacists in Outpatient Psychiatric Clinics Mary A. Gutierrez, Pharm.D., BCPP Associate Professor of Clinical Pharmacy University.
1 Advancing Recovery: Baltimore Buprenorphine Initiative Tucson Presentation July 29, 2009 Baltimore Substance Abuse Systems.
January 25, 2011 Georgia Behavioral Health Caucus Community Care Joseph Bona, MD, MBA Chief Medical Officer DeKalb Community Service Board.
Module 3. Session DCST Clinical governance
Summer Savon, MD, PhD, James Dilley, MD, Christina Mangurian, MD, Emily Martin, BA, Jaspreet Uppal, BS, Richard Patel, MD, Richard Oliva, MD, Martha Shumway,
Introducing the Medication Recording System Schedule Ed Castagna Mom & Pop’s Small Business Services.
Pharmacist Assisted Management of Complex Psychiatric Patients in Primary Care Casey Gallimore, PharmD, Assistant Professor of Pharmacy Ken Kushner, M.A.,
Respect and Advocacy Sabato A. Stile M.D.. Worldwide, Complex, Public Health Problem affects people from all demographic and social groups and economic.
Integrating Behavioral Health and Medical Health Care.
Client Centred Practice and Management of Risk Falls Prevention Forum for People with Dementia in Gippsland Monday 15 th September 2014 Nicole Tierney.
Continuity of Care / SPOE October 24, Arthur Ashe What is the secret to becoming a Great Tennis Player ? What is the secret to becoming a Great.
Applying Science to Transform Lives TREATMENT RESEARCH INSTITUTE TRI science addiction Mady Chalk, Ph.D Treatment Research Institute CADPAAC Conference.
An integrated approach to addressing opiate abuse in Maine Debra L. Brucker, MPA, PhD State of Maine Office of Substance Abuse October 2009.
Origin and Process of Utah Guidelines Anna Fondario, MPH Utah Department of Health Violence and Injury Prevention Program.
Implementing NICE guidance 2011 NICE clinical guideline 113 Generalised anxiety disorder in adults.
Medication Error Reduction Principles in Practice Copyright © – Academy of Managed Care Pharmacy (AMCP)Slide 1.
11 Mayview Regional Service Area Plan (MRSAP) Tracking: Supporting Individuals in the Community June 18, 2008.
Nursing Process: The Foundation for Safe and Effective Care Chapter 5.
Using drug use evaluation (DUE) to optimise analgesic prescribing in emergency departments (EDs) Karen Kaye, Susie Welch. NSW Therapeutic Advisory Group*
O. A. S. I. S. January 30 – 31, 2007 FSP Presentation The OASIS Program, College Community Services is supported by the Orange County Health Care Agency.
Sedative-hypnotic guideline, BHS
Bringing Hepatitis C Treatment into the Medical Home A Pilot Program for Drug Users Dr. Joanna Eveland MS, MD, Clinical Chief for Special Populations Mission.
Working with the Impaired Nurse Sharon S. Parker ONA convention, 2015.
Practice Key Driver Diagram. Chapter Quality Network ADHD Project Jeff Epstein PhD CQN ADHD National Expert/CQN Data Analyst The mehealth Portal and CQN.
Using Outcomes and other Assessment Tools to Improve Quality Quality Improvement.
California Department of Public Health Office of AIDS HIV CARE and PREVENTION 2009: You Need to Know.
National Patient Safety Goals 2008 T he University of Toledo Medical Center Toledo, Ohio.
Risk Management of Modified- Release Opiate Analgesics: Palladone Sharon Hertz, M.D. Medical Team Leader, Analgesics Division of Anesthetic, Critical Care,
An unpleasant sensory or emotional experience associated with actual or potential tissue damage The World Health Organization (WHO) has stated that pain.
1 Cognitive Impairment and Dementia: What You Need to Know about Alzheimer's Disease and Related Disorders Part 2 – Clinical focus Susan Rowlett, LICSW.
ANTHROPOLOGY IN APPLIED CLINICAL MENTAL HEALTH RESEARCH Sheila A.M. Rauch, Ph.D. Clinical Director Emory Healthcare Veterans Program Emory University School.
Provider Initiated HIV Counseling and Testing Unit 2: Introduction and Rational for PIHCT.
Clear the Clutter: Sage Advice on De-Prescribing Kimberly Wintemute MD CCFP FCFP National Primary Care Co-Lead Annual Clinic Day in Family Medicine, London.
Sarah Thompson, PharmD, CDOE Director of Clinical Services, Coastal Medical.
ABCs of Interprofessional Education in a teaching PCMH FQHC STFM Annual Conference ~ May 1, 2016 A. Ildiko Martonffy, MD Meghan Fondow, PhD Nora Groeschel,
PRESCRITION DRUG ABUSE and the ELDERLY GREGORY BUNT, M.D. Clinical Assistant Professor of Psychiatry NYU School of Medicine Interim Medical Director Samaritan.
Prepared by Dr. Ramin Safakish, MD, FRCPC – March 2016.
Opioid Prescribing CAPT Thomas Weiser, MD, MPH Medical Epidemiologist
Opioids in chronic pain
OPIOID SAFETY. Indiana Statistics In Summary… About 100 Hoosiers die from drug overdoses every month, many from opioids such as heroin and prescription.
Opioid Prescribing & Monitoring
EDC ©2016. All rights reserved.
Appropriate Opiate Prescribing: Managing Chronic Pain in a FQHC
What Works? Evidence-Based Practices for Treating Opioid Use Disorder
Information for Network Providers
Welcome Peer Support Main title slide page Suicide Prevention
Essentials of Good Pain Care: A Team-Based Approach
Welcome Peer Support Main title slide page Suicide Prevention
Tapering and Discontinuing Chronic Opioid Therapy
Presentation transcript:

S AN F RANCISCO C OUNTY : I MPROVING THE S AFETY OF S EDATIVE -H YPNOTIC P RESCRIBING Michelle Geier, PharmD Psychiatric and Substance Use Disorders Clinical Pharmacist Behavioral Health Services, San Francisco Health Network

D ISCLOSURES The presenter has no conflicts of interest

C REATING A P ERFORMANCE I MPROVEMENT P ROJECT

J AN 2014: BHS DECIDED TO TAKE ON S AFER S EDATIVE - H YPNOTICS AS A P ERFORMANCE I MPROVEMENT P ROJECT Large population effected The potential for unsafe sedative-hypnotics prescribing exists for all BHS consumers Increased patient safety Consistent with the Wellness and Recovery Model Cognitive dysfunction and impaired memory are barriers for client’s wellness and recovery Consumer demand Consumers request both providers and clients receive more education on sedative-hypnotics

UNSAFE SEDATIVE- HYPNOTIC RX PATIENTS Benzodiazepine use disorder Lack of education re: risks Attachment/preferenc e to current regimen EQUIPMENT Medical record not integrated across system Cumbersome to obtain CURES access PROCEDURES Poor coordination between care settings Poor documentation of rationale for ongoing use POLICIES No policy requiring risk assessment No policy requiring documentation for ongoing use PRESCRIBERS Policy may limit appropriate treatment Inherited patient on regimen NON-MEDICAL PROVIDERS Lack of commitment or experience with non- pharmacologic treatment Home environment not conducive for sleep Lack of education re: risks Lack of support for non- pharmacologic treatment UNSAFE SEDATIVE-HYPNOTIC PRESCRIBING ROOT CAUSE ANALYSIS

S TUDY Q UESTION If we formulate and implement Safer Prescribing of Sedative- Hypnotic Guidelines, then we will reduce the long-term use of sedative-hypnotics?

S TUDY P OPULATION Includes all adults (18+) with billed services in the BHS electronic health record Total of 11,921 clients in Did not include <18 years – sedative-hypnotics accounted for <1% of total number of prescriptions in this group in FY Excluded clients who only receive services in locations where they do not use the BHS prescribing software Excluded inpatient, crisis stabilization, long-term care, private provider network Also Evaluated High Risk Subpopulations: Older adults (age 60+): 2752 clients Methadone maintenance: 542 clients

S TUDY I NDICATOR Indicator: Number of chronic (≥60 days) prescriptions during a quarter for sedative-hypnotics Reasoning: Decreasing sedative-hypnotic use could improve health status and functional status of our clients Sedative-hypnotic prescribing was identified as a problem in our system Did not include short-term use due to treatment guideline recommendations Considered number of sedative-hypnotics related deaths Due to low incidence it is difficult to detect change, therefore not selected

B ASELINE D ATA FOR BHS –

B ASELINE D ATA – # Performance Indicator # Patients with Prescriptions for a Sedative-Hypnotic* (Numerator) # Patients with a Billed Mental Health Service* (Denominator) Baseline Performance Indicator Goal 1 Percent of clients (age 18+) receiving a sedative-hypnotic %20% reduction from baseline (12%) 2 Percent of older adult clients (age 60+) receiving a sedative- hypnotic %20% reduction from baseline (12%) 3 Percent of methadone maintenance clients receiving a sedative-hypnotic %30% reduction from baseline (24%) * Determined by a mean of the 8 quarters in

I MPLEMENTATION

I MPLEMENTATION C HALLENGES Technical Staff Client

T ECHNICAL C HALLENGES Access to CURES and interpreting CURES reports Methadone maintenance not on CURES reports Distributing guideline to staff Educating staff about the new guideline Do we have adequate staff to provide non-pharmacologic interventions?

S TAFF C HALLENGES “I’ve been told we have to take you off this medication…by our very mean pharmacist” Caught in the middle of administrative goals and patient demands Prescriber hands feeling tied with few pharmacologic options Difficult to tolerate patient push-back Time concerns

P ATIENT C HALLENGES Lack of education about risks Client fears of change Denial of risk – “This will never happen to me” “I take my medicine as prescribed”

C LINIC I MPLEMENTATION

C LINIC S TAFF AND A DMINISTRATIVE I MPLEMENTATION Prescriber meeting to discuss cases and peer review Clients taking concomitant opioids or over 60 years Challenging cases Any new, changed, or requested sedative-hypnotic Frequency: every 1 – 4 weeks Internally auditing and following medication list, doses, and ages for all clients on sedative-hypnotics

P ATIENT E DUCATION Welcome letter for new clients that informs them of Behavioral Health’s status on sedative-hypnotics Safety concerns and long-term treatment is not recommended Offering EMPOWER handout to those asking about sedative-hypnotics Sedative-hypnotic patient agreement Reviews risks Sets expectations for both prescriber and patient Patient education visits with clinical pharmacist to discuss risks and benefits Consistent message across medical team

1 1/2 Y EARS OF F OLLOW - UP D ATA

P RE - AND P OST -I MPLEMENTATION S UMMARY 1. All Medical Staff Meeting Reviewing MMT Death Data 2. Registering Medical Staff with CURES 3. Form MUIC Subcommittee to Create a Sedative-Hypnotic Guideline Disseminate and Implement the Sedative-Hypnotic Guideline Disseminate Guideline to SFGH psychiatry

BHS P LANS FOR 2015 Continue quarterly measurements and analysis by MUIC Joint education with primary care and mental health providers Develop a non-pharmacologic treatment of insomnia toolkit Sleep hygiene patient education handouts Focus on older adults Patient education materials Assist providers with identifying patients Shift to non-medication treatments and team approach

Q UESTIONS ?