Operationalizing a Medication Safety Gap Assessment for a Large Health System.

Background: Medication errors continue to be a leading cause of medical errors. In the United States alone, 7000 to 9000 people die annually due to a medication error, and many more are harmed. Since 2014, the Institute for Safe Medication Practices (ISMP) has advocated for several best practices in acute care facilities derived from reports of patient harm. Methods: The medication safety best practices chosen for this assessment were based on the 2020 ISMP Targeted Medication Safety Best Practices (TMSBP) and health system-identified opportunities. Each month, for 9 months, select best practices were covered with associated tools to assess the current state, document the gap, and close identified gaps. Results: Overall, 121 acute care facilities participated in most safety best practice assessments. Of the best practices assessed, there were 8 practices that more than 20 hospitals documented as not implemented and 9 practices where more than 80 hospitals had fully implemented them. Conclusion: Full implementation of medication safety best practices is a resource-intensive process that requires strong change management leadership at a local level. As noted by the redundancy in published ISMP TMSBP, there is an opportunity to continue improving safety in acute care facilities across the United States.

A Comprehensive Analysis of Risk Factors Associated With Inpatient Falls.

OBJECTIVES: The primary objective of this study was to identify the relationship between rates of falls among hospitalized patients and the use of inpatient medications associated with falls. METHODS: This is a retrospective study on patients older than 60 years, hospitalized between January 1, 2021, and December 31, 2021. Ventilated patients and patients with a length of stay or fall less than 48 hours after admission were excluded. Falls were determined by assessing documented post fall assessments in the medical record. Patients who fell were matched 3:1 with control patients based on demographic data (age, sex, length of stay up to the fall time, and Elixhauser Comorbidity score). For controls, a pseudo time to fall was assigned based on matching. Medication information was gathered from barcode administration data. Statistical analysis was conducted using R and RStudio. RESULTS: A total of 6363 fall patients and 19,089 controls met the inclusion and exclusion criteria. Seven drug classes were identified as statistically significant ( P < 0.001) in increasing an inpatient's rate of falling: angiotensin-converting enzyme inhibitors (unadjusted odds ratio [OR], 1.22), antipsychotics (OR, 1.93), benzodiazepines (OR, 1.57), serotonin modulators (OR, 1.2), selective serotonin-reuptake inhibitors (OR, 1.26), tricyclics and norepinephrine reuptake inhibitors (OR, 1.45), and miscellaneous antidepressants (OR, 1.54). CONCLUSIONS: Hospitalized patients older than 60 years are more likely to fall while taking angiotensin-converting enzyme inhibitors, antipsychotics, benzodiazepines, serotonin modulators, selective serotonin-reuptake inhibitors, tricyclics, norepinephrine reuptake inhibitors, or miscellaneous antidepressants. Patients on opiates and diuretics had a significant decrease in rate of falls.

Implementation of Clinical Pharmacy Surveillance Technology and a Pharmacy Practice Model Re-Design Across a Multi-State Health System.

Background: Outcomes-directed pharmacy models are necessary to further comprehensive, patient-centric clinical care. This report describes the implementation of clinical surveillance technology and the development of clinical pharmacy metrics to measure outcomes that support return on investment. The overall goal of clinical surveillance technology implementation in this quality improvement project was to extend the pharmacists' reach and to improve patient safety and clinical outcomes with greater operational efficiencies. Methods: In 2013, a clinical pharmacy surveillance tool was piloted and expanded over the next 2 years to 154 hospitals across the health system. Over the next 6 years, the number of hospitals utilizing the technology, the number of drug therapy modifications, the time to pharmacist intervention, clinical pharmacy metric results, and return on investment were tracked. Results: From 2015 to 2021, the number of hospitals with clinical surveillance technology implemented grew to 177 hospitals. During this same time, the number of frontline clinical pharmacist drug therapy modifications more than doubled, and the time for pharmacists to respond to alerts decreased from 13.9 to 2.6 hours. Since 2015, the percentage of patients on vancomycin de-escalated by 3 days of therapy has increased by 12% and the percentage of patients with a UTI treated with fluoroquinolone decreased by 25%. Hard and soft dollar savings resulted in an annual return on investment of 1:12.9. Conclusion: After implementing the redesigned pharmacy services model, pharmacists were more efficient and patient outcomes improved.