IHI Expedition Expedition: Making Mental Health Care Safer in the - PDF document

4/27/2015 January 26, 2015 IHI Expedition Expedition: Making Mental Health Care Safer in the Hospital Setting Session 4: Medication Safety David Hall Brian Bjørn Loriann Rizzuto Kelly McCutcheon Adams Today’s Host 2 Dorian Burks, Project Coordinator, Institute for Healthcare Improvement, is a current coordinator for web-based Expeditions. He also contributes to the IHI work in the Triple Aim and Improvement Capability focus areas, as well as the Leading Quality Improvement series. Dorian is a member of the Diversity and Inclusion Council at IHI, where he and fellow staff members develop strategies to enhance IHI’s inclusive culture, both internally and externally. Dorian graduated from Massachusetts Institute of Technology in Cambridge, MA where he received his Bachelor of Science degree in Biology and humanities concentration in Anthropology. 1

4/27/2015 3 Audio Broadcast You will see a box in the top left hand corner labeled “ Audio broadcast .” If you are able to listen to the program using the speakers on your computer , you have connected successfully. 4 Phone Connection (Preferred) To join by phone : 1) Click on the “Participants” and “Chat” icon in the top, right hand side of your screen to open the necessary panels 2) Click the button on the right hand side of the screen. 3) A pop-up box will appear with the option “I will call in.” Click that option. 4) Please dial the phone number , the event number and your attendee ID to connect correctly . 2

4/27/2015 5 Audio Broadcast vs. Phone Connection If you using the audio broadcast (through your computer) you will not be able to speak during the WebEx to ask question. All questions will need to come through the chat. If you are using the phone connection (through your telephone) you will be able to raise your hand, be unmuted, and ask questions during the session. Phone connection is preferred if you have access to a phone. 6 WebEx Quick Reference • Please use chat to “All Participants” for questions • For technology Raise your hand issues only, please chat to “Host” • WebEx Technical Support: Select Chat recipient 866-569-3239 • Dial-in Info: Communicate / Audio Enter Text Conference (in menu) 3

4/27/2015 When Chatting… 7 Please send your message to All Participants 8 Expedition Director Kelly McCutcheon Adams, LICSW has been a Director at the Institute for Healthcare Improvement since 2004. Her primary areas of work with IHI have been in Critical Care and End of Life Care. She is an experienced medical social worker with experience in emergency department, ICU, nursing home, sub- acute rehabilitation, and hospice settings. Ms. McCutcheon Adams served on the faculty of the U.S. Department of Health and Human Services Organ Donation and Transplantation Collaboratives and serves on the faculty of the Gift of Life Institute in Philadelphia. She has a B.A. in Political Science from Wellesley College and an MSW from Boston College. 4

4/27/2015 Today’s Agenda 9 Welcome Action Period Assignment Debrief Medication Safety Action Period Assignment Closing 10 Expedition Objectives At the conclusion of this Expedition, participants will be able to: Explain the importance of partnering with patients and their families to improve safety for patients with mental health conditions Identify different areas to improve mental health care safety Describe examples of improvement efforts at other organizations Plan tests of change to begin or continue patient safety improvement 5

4/27/2015 11 Schedule of Calls Session 1 – Partnering with Patients and Families Date: Tuesday, December 2, 1:00 - 2:30 PM Eastern Time Session 2 – Making the Physical Environment Safer Date: Tuesday, December 16, 1:00 - 2:00 PM Eastern Time Session 3 – Why Flow Matters Date: Tuesday, January 13, 1:00 - 2:00 PM Eastern Time Session 4 – Medication Safety Date: Tuesday, January 27, 1:00 - 2:00 PM Eastern Time Session 5 – Ensuring Staff Preparedness Date: Tuesday, February 10, 1:00 - 2:00 PM Eastern Time Session 6 – Being Proactive and Avoiding Crises Date: Tuesday, February 24, 1:00 - 2:00 PM Eastern Time Action Period Assignment Debrief Sharing examples of changing hospital flow to improve mental health safety 6

4/27/2015 13 Medication Safety David Hall, Brian Bjørn, Loriann Rizzuto 14 Faculty David Hall has been a Consultant Psychiatrist and Clinical Director in South Scotland for over 20 years. His clinical work now focuses on Forensic and Rehabilitation Psychiatry. He has had a number of National and International roles, leading Scottish work to reduce psychiatric readmissions, and more recently Clinical Lead for the Scottish Patient Safety Programme in Mental Health. He is also IHI Faculty lead for the Danish Safer Hospitals Programme in Mental Health. 7

4/27/2015 15 Faculty Dr. Brian Bjørn is a physician and public health specialist. He is an independent quality improvement consultant and former Director of the Danish Patient Safety Program for Mental Health. Brian has served in different roles in collaboratives for perinatal, community and acute care quality improvement. He is a member of the Scientific Advisory Board for the Federal Quality Strategy for the Swiss Health Care System and an Assistant Lecturer on healthcare quality improvement at the University of Copenhagen Medical School. 16 Faculty Lori Ann Rizzuto, Director of Behavioral and Integrative Health Services, has 30 years of experience in behavioral health, twelve of which have been at Atlantic Health System developing cost-effective, quality behavioral health programs, and supervising operations and staff. Within the four hospital system, Lori has administrative oversight of daily operations of inpatient behavioral health units, Crisis Intervention Services in the ED and outpatient behavioral health services. This includes over 250 staff and 30 undergraduate and graduate interns. Before joining Atlantic Health System, Lori held Leadership positions at other hospitals, overseeing clinical and business development areas. Lori holds a Master of Social Work degree from Adelphi University School of Social Work and a Bachelor of Arts degree in Psychology from Queens College. 8

4/27/2015 The Scottish Patient Safety Programme- Mental Health Safer Medicine Management Workstream Staff feel and are safe, patients are and feel safe 9

4/27/2015 With a focus on adult psychiatric inpatient units, including admission and discharge processes Year Zero Year One Years Three Year Two and Four (Pre work) (Testing) Sep 13 – Sep 14 Sep 14 – Sep 16 Jan 12 – Aug 12 Aug 12- Sep 13 SPSP-MH Workstreams Safer Medicines Management Risk Assessment and Safety Planning Leadership and Culture Restraint and Seclusion Communication at Transitions 10

4/27/2015 Change Action Package Spread (Oct 2013) Risk Assessment and Restraint, Seclusion and Safety Planning – Emergency Sedation – 11 Boards 9 Boards 22 Wards 24 Wards Communications at Safer Medicines Transitions – Management – 9 Boards 12 Boards 23 Wards 30 Wards Safer Medicines Management • Error free prescribing • Management/ monitoring high risk medicines • Management/ monitoring ‘as required’ medicines • Medicines reconciliation 11

4/27/2015 Medicines reconciliation NHS Grampian Successful meds rec 90% 80% 70% 60% 50% 40% Successful meds rec 30% 20% 10% 0% May-13 Jan-14 Jun-14 Sep-14 Successful meds rec • Training • Communication • Training • New form • Training! 12

4/27/2015 Danish Patient Safety Program for Mental Health Workstreams • Clinical – Medicines – Physical comorbidity – Reduction in use of mechanical restraint – Suicide prevention • Organizational – Patient and carer engagement – Leadership for improvement 13

4/27/2015 7 psychiatric hospitals Percent patients with all elements of med rec bundle 14

4/27/2015 Friday afternoon coffee. Staff and patients discussing improvement work. Communication Transparency Visibility Keep it simple! 15

4/27/2015 Atlantic Behavioral Health Monitoring Metabolic Syndrome Lori Ann Rizzuto, L.C.S.W. Director, Behavioral & Integrative Health Services Why is it important to monitor second generation antipsychotics? Antipsychotic medications are an important part of the treatment of many psychotic conditions. Up to 83% of persons with serious mental illness in the US are overweight or obese. All atypical antipsychotics carry a risk of metabolic disturbance There are considerable benefits, but there are still some potential modifiable risks: • Overweight/obesity • Diabetes • Dyslipidemia • Cardiovascular disease 32 16

4/27/2015 Which medications are we talking about? Zyprexa (Olanzapine) Seroquel (Quetiapine) Geodon (Ziprasidone) Abilify (Aripiprazole) Risperdal (Risperidone) 33 Risk factors for developing Metabolic Syndrome  Weight (BMI > 25) High LDL (“bad cholesterol”) and Low HDL (“good  cholesterol”)  High blood pressure (above 120/80)  Family history of diabetes  Increased age  Tobacco use  Heavy alcohol use  Stress  Sedentary life-style  High fat diet And the use of atypical anti-psychotics increases the risk 34 17

4/27/2015 Where to start… Obtain baseline and periodic monitoring Weight Fasting plasma glucose Fasting lipids Cognitive restructuring Relapse management 35 36 Canadian Journal of Psychiatry, Vol.51, No 8, July 2006, p498 18