1. CHSP and CalHEN Opioid Adverse Drug Event Prevention Gap Analysis: Survey Findings August 14, 2013, 2013

2. Welcome Agenda Thank you for participating in the Opiate Adverse Drug Event Prevention Gap Analysis Review survey responses Discussion and Questions Opportunities Participate in second gap analysis survey: hypoglycemia agents

3. Survey Sections Section HeaderNumber of Section Questions Number of Sub- section Questions I. Prevention and Mitigation Strategies 47 II. Assessment and Detection Strategies 12 III. Therapeutic Strategies22 IV. Critical Thinking and Knowledge Strategies 11 V. Patient Education11 VI. Survey Evaluation11

4. I. Prevention and Mitigation Strategies # Sub-section QuestionsTotal Number of Questions 731

5. Number who responded to question= 56 Number who skipped the question= 0 # 1. The facility has process in place to eliminate errors in opioid storage, preparation and dispensing, which include:

6. # 2. A pharmacist or pain provider provides oversight for all dosing of: Number who responded to question= 56 Number who skipped the question= 0

7. # 3. The facility’s opioid practices clearly specify the following: Number who responded to question= 53 Number who skipped the question= 3

8. # 4. The facility has opioid administration and monitoring practice guidelines in place, which include: Number who responded to question= 48 Number who skipped the question= 8

9. # 5. The facility has safety mechanisms in place for epidural opioid infusion processes which ensure: Number who responded to question= 44 Number who skipped the question= 12

10. # 6. 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: Number who responded to question= 44 Number who skipped the question= 12

11. # 7. The facility’s nursing practice includes a process to double check opioid pump programming: Number who responded to question= 44 Number who skipped the question= 12

12. II. Assessment and Detection Strategies # Sub-section QuestionsTotal Number of Questions 212

13. # 8. The facility has a PACU discharge process in place to ensure patient is stable upon transfer which includes: Number who responded to question= 42 Number who skipped the question= 14

14. # 9. A standard hand-off/transition communication process is in place for all patients receiving opioids which includes the following information, at minimum: Number who responded to question= 42 Number who skipped the question= 14

15. # 10. A protocol is followed which guides the reversal of opioids and includes the following: Number who responded to question= 40 Number who skipped the question= 16

16. # 11. If an over sedation event occurs, the facility has a learning process in place which includes: Number who responded to question= 40 Number who skipped the question= 16

17. III. Therapeutic Strategies # Sub-section QuestionsTotal Number of Questions 222

18. # 12. The facility has standard policies and practices in place for managing the initiation and maintenance of opioid therapy which include: Number who responded to question= 34 Number who skipped the question= 22

19. # 13. Practice guidelines for morphine include: Number who responded to question= 34 Number who skipped the question= 22

20. # 14. Practice guidelines for hydromorphone include: Number who responded to question= 34 Number who skipped the question= 22

21. # 15. The facility has a pain management process in place, which includes: Number who responded to question= 32 Number who skipped the question= 24

22. # 16. 8.d.There is a process in place to discuss and agree upon specific pain goals and strategies with the patient prior to a surgical procedure. Number who responded to question= 32 Number who skipped the question= 24

23. # 17. The facility has practice guidelines in place for appropriate use of tactics to reduce opioid use, which include: Number who responded to question= 32 Number who skipped the question= 24

24. IV. Critical Thinking and Knowledge Strategies # Sub-section QuestionsTotal Number of Questions 14

25. # 18. The facility provides interdisciplinary education on opioid therapy, which includes: Number who responded to question= 32 Number who skipped the question= 24

26. V. Patient Education # Sub-section QuestionsTotal Number of Questions 17

27. # 19. When initiating opioid therapy, patients/caregivers receive verbal and written information on purpose, action, side effects, and monitoring, including: Number who responded to question= 31 Number who skipped the question= 25

28. # 20. Is your organization a member of the California Hospital Engagement Network? Number who responded to question= 25 Number who skipped the question= 31

29. Contact Information Provided Number who responded to question= 12 Number who skipped the question= 44

30. Discussion and Questions

31. Next Steps Survey Topic Survey Date Distribution Completed Survey Due Date 30 min Sharing Call Scheduled Hypoglycemic Agent Adverse Drug Event GAP Analysis August 19 th August 30 th September 11 th