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Presentation on theme: "Monthly Medication Safety Webinar: All lines will be muted during the presentation and unmuted during questions. If you do not have a question to ask,"— Presentation transcript:

1 Monthly Medication Safety Webinar: All lines will be muted during the presentation and unmuted during questions. If you do not have a question to ask, please mute your phone. If you do not have a mute button on your phone you can press *6 to mute your line. Please do not put the conference on hold. If you would like to ask a question during the webinar please enter the question into the question box.

2 2 OPIOIDS: Embedding Safety Science in Medication Management System Jocasta N. Gee, Pharm.D. Hospital Corporation of America (HCA) University of Tennessee College of Pharmacy Nashville, Tennessee Jason Wright, Pharm.D. TriStar Centennial Medical Center Nashville, Tennessee L. Hayley Burgess, Pharm.D. Hospital Corporation of America (HCA) Nashville, Tennessee Jennifer Higdon, Pharm.D., BCPS HCA-TriStar Division Chattanooga, Tennessee

3 Effective processesSafe technology Appropriate education and training Effective tools Joint Commission Sentinel Event Alert

4 4 Med Man System Topic Effective processes – Ordering – Procurement Safe technology – Transcribing – Administration – Storage – Preparing and Dispensing Appropriate education and training – Patient Monitoring and Metrics – Patient Education – Training Effective tools – Process Mapping – FMEA – Action Plan

5 5 Effective Processes 5

6 ORDERING 6

7 7 Initial Assessment Screen patients for respiratory depression risk factors Assess the patient’s previous history of analgesic use – abuse, duration and possible side effects to identify potential opioid tolerance or intolerance. Conduct a full body skin assessment of patients prior to administering a new opioid to rule out – an applied fentanyl patch – implanted drug delivery system – infusion pump Jarzyna D, Pain Management Nursing Dahan A. Anesthesiology, American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons.Journal of the American Geriatrics Society

8 8 Treatment Use an individualized, multimodal treatment plan to manage pain. – Psychosocial support – Coordination of care – Nonpharmacologic approaches – Non-opioid pain medications Treatment Approaches – Avoid rapid dose escalation of opioid analgesia – Take extra precautions when Transferring patients between care units Transferring patients between facilities Discharging patients to their home. – Consider that drug levels may reach peak concentrations during transport. – Avoid using opioids to meet an arbitrary pain rating or a planned discharge date. – Dosing should be based on the individual patient’s need and condition. Jarzyna D, Pain Management Nursing Dahan A. Anesthesiology, American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons.Journal of the American Geriatrics Society

9 9 Effectiveness Assess the pain using a standardized pain scale – Ask the patient – If the patient is unable to communicate, assess pain based on behavioral cues Frequency of assessment should be: – Initial – Every 8 hours for mild to moderate pain – Every 2 hours for severe pain Standardized tools can be used to screen patients for undersedation, oversedation and respiratory depression – Pasero Opioid-Induced Sedation Scale (POSS) – Richmond Agitation-Sedation Scale (RASS)

10 10 Objective Pain Scales

11 11 Subjective Pain Evaluation Most common determination of pain in the ICU due to sedation and/or cognitive impairment Need a patient-specific strategy Assess patient movement, facial expression, and posturing Physiologic manifestation of pain: – Tachycardia – HTN – Increased RR – Diaphoresis – Mydriasis

12 12 Assessment of Pain (FLACC Pain Scale)

13 13 Assessment of Neuropathic Pain Neuropathic Pain questionnaire – Short Form Rate the following aspects of your pain (0‐10 scale): – Tingling pain – Numbness of pain – Increased pain due to touch Backonja M, Krause SJ. Neuropathic Pain Questionnaire – Short Form. Clin J Pain 2003;1995)L

14 14 Strategies to Reduce Errors with Ordering Conduct a psychology screening to obtain realistic expectations about pain management Review concomitant medications prior to prescribing opioids Collect a history of snoring, obesity and sleep apnea Dose and frequency of opioids in procedural areas such as endoscopy Assess if patient is a candidate for opioid therapy Opioids are not used to treat anxiety Meperidine use is minimized or eliminated Opioid administration is not routinely accompanied by sedatives or anticholinergic drugs such as hydroxyzine Opioid dose ranges do not exceed 4x (four times) the original dose (Consider limiting to 2x the original dose) Intramuscular (IM) opioid use is minimized Oxygen is used only if therapeutically necessary and only upon a physician order The facility’s opioid practices clearly specify the following: Minnesota Hospital Association. The Road Map to a Medication Safety Program Roadmap.pdf

15 15 Strategies to Reduce Errors with Ordering (cont.) Non-­narcotic medications (e.g., NSAIDs, acetaminophen, regional infusions of local anesthetics, steroids, gabapentinoids, etc.) are routinely used as a tactic to reduce opioid administration on the patient care units Non-­narcotic medications (e.g., NSAIDs, acetaminophen, regional infusions of local anesthetics, etc.) are routinely used as a tactic to reduce opioid administration in the operating room Non-­pharmacologic therapy (e.g., healing touch, massage, music, guided imagery, aromatherapy, etc) is offered and maximized when possible, as tactics to reduce opioid administration The facility has practice guidelines in place for appropriate use of tactics to reduce opioid use, which include: Minnesota Hospital Association. The Road Map to a Medication Safety Program Roadmap.pdf

16 PROCUREMENT 16

17 17 Strategies to Reduce Errors with Procurement The facility has a pain management process in place, which includes: – Pain management specialist available for consultation, either onsite or external, which provides mentoring as well as specific consults – High-Alert medication policy and formulary review – Pain medication stewardship program in place Processes for identification and implementation of best practices Daily monitoring of adherence to best practices Plan for intervention of deviation from best practices Processes for monitoring patient pain management satisfaction scores – Standardized pain assessment scales are used throughout the facility – Process in place to discuss and agree upon specific pain goals and strategies with the patient prior to a surgical procedure Minnesota Hospital Association. The Road Map to a Medication Safety Program Roadmap.pdf

18 18 Safe Technology

19 TRANSCRIBING 19

20 20 Equianalgesic Conversion Process Total the 24-hour dose of current drug, including all breakthrough doses Convert 24-hour dose to new drug and/or route using an equianalgesic conversion table In opioid-tolerant patients, consider reducing calculated dose of the new drug by 25 to 50% to account for incomplete cross- tolerance Divide the total dose of new drug by the schedule of the new drug Calculate a breakthrough dose – either 5% - 15% of the total daily opioid dose or 25 – 30% of the single standing dose McPherson M. Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing McPherson M Update to Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing. McNicol E. Opioid Analgesics: Administration issues, Side-effect management, and Equianalgesic Conversion. 2008;5(1):16-25.

21 21 Analgesic Equivalencies Opioid AgonistParenteral (mg)Oral (mg) Morphine1030 OxycodoneNA20 Hydromorphone Fentanyl0.1NA Codeine HydrocodoneNA30 Meperidine (not preferred)75300 McPherson M. Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing McPherson M Update to Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing. McNicol E. Opioid Analgesics: Administration issues, Side-effect management, and Equianalgesic Conversion. 2008;5(1):16-25.

22 22 Clinical Pharmacology Opioid Calculator

23 FENTANYL PATCHES

24 24 When to use fentanyl patches? Opioid Tolerance-Adaptation to a drug which results in decreased effects over time Opioid Tolerance can be defined as taking one of the below for a week or longer 60mg of oral morphine per day 30mg of oral oxycodone per day 8mg of oral hydromorphone per day OR an equianalgesic dose of another opioid Barr J, Fraser G, Puntillo K, et al. Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit. Critical Care Medicine. 2013:41(1);263 – 306. Mularski R. Pain Management in the intensive care unit. Crit Care Clin. 2004:20;381 – 401. Opioid Dosing: Focus on Safety. Pharmacist’s Letter. 2010:26;

25 25 Converting to Transdermal Fentanyl Determine the 24 hour parenteral morphine equivalent Dose patch at 50 – 75% of the previous 24 hours opioid use Prescribe short acting opioids for breakthrough pain (5 – 15%) of 24 hour dose every 3 hours Patch duration is 72 hours – Increase the patch dose based on the average amount of additional short acting opioid required in the previous 72 hours – Wait at least 48 hours before adjusting the dose It may take up to 6 days for fentanyl levels to reach equilibrium on a new dose – Wait two 3-day applications before any further increase in dosage is made For doses greater than 100 mcg/hr multiple patches can be used

26 26 Converting from Transdermal Fentanyl Remove fentanyl patch Approximate transdermal T 1/2 of 17 hrs – 50% decrease in plasma levels Typically Start Long-acting opioid at least 18 hours after removal – Titrate short-acting opioids for breakthrough pain until LAO is initiated Common to use 2:1 method (i.e. 2 mg PO morphine/day = 1 mcg/hr fentanyl) – Wait 8 – 12 hours before starting 50% of equianalgesic regimen – Wait 24 hours before increasing to 100%

27 27 Equianalgesic Conversion Process Equianalgesic data is approximate! – Many different tables available – Mostly based on single-dose, cross-over studies – Mostly studied in cancer patients – Patient specific factors Age, organ function, genetics, co-morbidities, medications Use clinical judgment – Start low and go slow! McPherson M. Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing McPherson M Update to Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing. McNicol E. Opioid Analgesics: Administration issues, Side-effect management, and Equianalgesic Conversion. 2008;5(1):16-25.

28 28 Strategies to Reduce Errors with Transcribing Methadone Fentanyl patches Transmucosal immediate release fentanyl patches (TIRFs) A pharmacist or pain provider provides oversight for all dosing of: Identifying the need for a consultative pain assessment by a qualified pain practitioner (e.g., pain management physician, nurse practitioner, clinical pharmacy specialist or CNS focused on pain) Standardized pain order sets within clinical practices/ specialties (e.g., orthopedics, vascular surgery, oncology, labor and delivery, etc.) PCA and PCEA orders prohibit the routine use of basal dosing in the opiate naïve patient The facility has standard policies and practices in place for managing the initiation and maintenance of opioid therapy which include: Minnesota Hospital Association. The Road Map to a Medication Safety Program Roadmap.pdf

29 ADMINISTRATION 29

30 30 Pain Guidelines Titrate the opioid dose at least every 24 hours and as often as every 2 hours when the pain is severe – Increase the dose by 25-50% or by % with severe pain – Do not use range orders Manage breakthrough pain with short acting opioids using 1/3 of the single dose amount or 5-15% of the total daily dose – Use around the clock pain medication not PRN for ongoing pain – Use the KISS principle – Keep It Same and Simple (i.e. use the same opioid for short and long term pain control) Barr J, Fraser G, Puntillo K, et al. Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit. Critical Care Medicine. 2013:41(1);263 – 306. Mularski R. Pain Management in the intensive care unit. Crit Care Clin. 2004:20;381 – 401. Opioid Dosing: Focus on Safety. Pharmacist’s Letter. 2010:26;

31 31 Administration: Patient Controlled Analgesia 1Lexi-Comp OnlineTM, Lexi-Drugs OnlineTM, Hudson, Ohio: Lexi-Comp, Inc.; February 13, Hicks R, Sikirica V, Nelson W, Schein J, Cousins D. Medication errors involving patient-controlled analgesia. Am J Health-Syst Pharm. 2008; 65: Cohen MR, Weber RJ, Moss J. Patient-controlled analgesia: Making it safer for patient. Institute for Safe Medication Practices. April 1, 2006.

32 32 Strategies to Reduce Errors with Administration Conduct a full body skin assessment of patients prior to administering a new opioid to rule out the possibility that the patient has an applied fentanyl patch or implanted drug delivery system or infusion pump New opioid administration At the start of their shift With new narcotic infusion and PCA starts With setting changes – initiation of bag, bag change, and shift change The facility’s nursing practice includes a process to double check opioid pump programming: Intercept and prevent wrong dose errors Intercept and prevent wrong infusion rate errors 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: Minnesota Hospital Association. The Road Map to a Medication Safety Program Roadmap.pdf

33 STORAGE 33

34 34 Storage: Fentanyl Drip & Epidurals

35 35 Strategies to Reduce Errors with Storage Where appropriate, only dose forms that are needed for starting doses are available as override items in automated dispensing cabinets (e.g., morphine 2 mg syringes are available but 4 mg syringes are not available on override) Automated Dispensing Cabinets (ADC) Epidural pumps are used only for epidural infusion therapy Epidural tubing is pre-­connected in pharmacy when possible, and is incompatible with non-­epidural pumps Epidural bags and bottles are clearly differentiated from IV infusions or piggybacks The facility has safety mechanisms in place for epidural opioid infusion processes which ensure: Procedures in place to prevent diversion Storage of controlled substances Minnesota Hospital Association. The Road Map to a Medication Safety Program Roadmap.pdf

36 PREPARING AND DISPENSING 36

37 37 Strategies to Reduce Errors with Preparing/Dispensing Strategies to prevent errors caused by mixing up concentrated and dilute oral liquid narcotics Standardizing the choices of epidural infusions per organization/service line and minimizing the formulary Established dose equivalency conversion tools are readily available and utilized Guidelines to address how and when to supplement opioid doses when range orders are used Established pediatric dose guidelines are widely available and utilized Pediatric dose guidelines are incorporated into the electronic health record Pediatric dosage forms are separated from adult dosage forms An independent double check (two licensed providers) is performed for all narcotic infusions prepared in the pharmacy The facility has processes in place to eliminate errors in opioid storage, preparation, and dispensing, which include: Minnesota Hospital Association. The Road Map to a Medication Safety Program Roadmap.pdf

38 38 Appropriate Education and Training

39 PATIENT MONITORING 39

40 40 Patient Monitoring: Effectiveness Swegle J, Logemann C. Management of Common Opioid-Induced Adverse Effecs. American Family Physician 2006:74(8);1347 – McNicol E. Opioid Analgesics: Administration issues, Side-effect management, and Equianalgesic Conversion. 2008;5(1):16-25 Opioid analgesics rank among the drugs most frequently associated with adverse drug events. The literature provides numerous studies of the adverse events associated with opioids. The incidence of respiratory depression among post-operative patients is reported to average about 0.5 percent. Some of the causes for adverse events associated with opioid use are: – Lack of knowledge about potency differences among opioids. – Improper prescribing and administration of multiple opioids and modalities of opioid administration (i.e., oral, parenteral and transdermal patches). – Inadequate monitoring of patients on opioids.

41 41 Patient Monitoring: Adverse Events Educate and assess the staff understanding of potential adverse effects of opioid therapy. Educate and provide written instructions to patients who are on opioids (and to the patient’s family or caregiver). Common Adverse Events: – Sedation – Nausea/Vomiting – Constipation – Pruritis – Respiratory Depression – Confusion/Mental clouding Less Common Adverse Events: – Euphoria or dysphoria – Dependence – Withdrawal Can occur within 12 hours of discontinuation Sweating, agitation, diarrhea, tachycardia, rebound pain Swegle J, Logemann C. Management of Common Opioid-Induced Adverse Effecs. American Family Physician 2006:74(8);1347 – McNicol E. Opioid Analgesics: Administration issues, Side-effect management, and Equianalgesic Conversion. 2008;5(1):16-25

42 Study Design The Committee for Safe Medication Practice at Wesley Medical Center in Wichita, KS, has improved patient-controlled analgesia (PCA) outcomes by developing and implementing: A sleep apnea risk assessment model Evaluates all adult patients Uses modified STOP-Bang scoring system Risk documented in electronic health record Dosing parameters Robust monitoring The consistent use of capnography to monitor respiratory status. Results Decreasing the percentage of moderate and severe patient-controlled analgesia adverse events progressing to code blue from 13 percent to zero percent. Monitoring Makes a Difference

43 43 Strategies to Reduce Errors with Monitoring Vital signs monitoring, including pain, is defined for all clinical situations (oral narcotics, PCA, epidural, IV injection) Continuous pulse oximetry for all patients (excluding end of life patients) receiving IV narcotics Capnography monitors are used when patient is receiving supplemental oxygen (excluding end of life patients) and receiving IV narcotic infusion, epidural, PCA, or frequent IV narcotic injections Monitor alarms can be heard at the nursing station for pulse oximetry and capnography and cannot be turned “off” Monitor alarms automatically default to hospital-defined thresholds Nursing practice guidelines address how and when to transition opioid therapy (e.g., PCA to oral: If patient is not NPO and is able to tolerate, oral pain medications are utilized) The facility has opioid administration and monitoring practice guidelines in place, which include: Reversal protocols are active on all patients’ MARs if there is an active order for a narcotic Nurses are allowed to administer reversal agents without prior physician order Strategies are in place to guard against dose stacking The facility utilizes a rapid response team to assist with possible narcotic oversedation A protocol is followed which guides the reversal of opioids and includes the following: Minnesota Hospital Association. The Road Map to a Medication Safety Program Roadmap.pdf

44 TRAINING 44

45 45 Training Assess your organization’s need for training based on: – Analysis of reported adverse events – Near misses – Staff observations Training Examples – Initial training for new hires and existing staff, including protocols, guidelines, onboarding materials – Post-test incorporating a case-­study approach to demonstrate proficiency covers topics such as dose stacking, dose equivalency, interpretation of vital signs and monitoring equipment – Identify knowledge gaps and develop improvement strategies to reduce recurrences – Ongoing opioid education is provided when new relevant information is available

46 46 Effective Tools

47 PROCESS MAPPING 47

48 48 Opioid Use Process

49 FMEA 49

50 50 Top 8 Failure Modes Identified

51 51 Top 8 Failure Modes Identified (cont)

52 ACTION PLAN 52

53 53 Action Plans/Next Steps Step #Top Failure Mode(s)RPNAction PlanNext Steps 22- Nurse performs pain assessment Inappropriate Assessment 560 Assess patients for risk factors associated with oversedation and respiratory depression. Establish guidelines for appropriate frequency of monitoring and provide standardized patient monitoring tools: Acute care: Pasero Opioid-Induced Sedation Scale (POSS) and the Richmond Agitation Sedation Scale (RASS). Ambulatory: Screener and Opioid Assessment for Patients with Pain (SOAPP & SOAPP-R), the Opioid Risk Tool (ORT), and the Screening instrument for Substance Abuse Potential (SISAP). Ensure that the oversedation and respiratory depression assessment is properly documented on the patient’s profile and electronic medical record. Assess patients for inadequate pain control. Provide standardized tools: Ensure that the pain assessment is properly documented on the patient’s profile and electronic medical record. Implement a hard stop that prompts nursing staff to enter the pain scale number before administering an opioid. Add an opioid conversion /equivalences chart on meditech

54 54 Other Action Plans/Next Steps Step #Top Failure Mode(s)RPNAction PlanNext Steps 21- Nurse Administer the Dose Dose Not Administered to Patient 350 Ensure patient receives medication in a timely manner. Establish a lock out time frame: Opioid medications cannot be retrieved 30 minutes before the medication is due. Must be administered 15 minutes after removal from Pyxis. After retrieving the medication from pyxis to when it is actually administered. 1- Teach Pain Education to Patient No Pain Education196 Educate and provide written instruction to patients who are on opioids (and to family/caregivers). Ensure that the education session is properly documented on the patient’s profile and electronic medical record.. Assess if patient is a poor candidate for opioid therapy Conduct a psychology screening to obtain realistic expectations about pain management

55 55 Rank Order of Error Reduction Strategies Forcing Functions & Constraints Automation & Computerization Standardization & Protocols Checklists & Double-Checks Policies & Procedures Education & Information -Educate and provide written instruction to patients who are on opioids (and to family/caregivers). -Ensure patient receives medication in a timely manner. -Educate and assess the understanding of staff. -Assess patients for risk factors associated with oversedation and respiratory depression. -Assess patients for inadequate pain control.

56 56 OPIOIDS: Embedding Safety Science in Medication Management System Hayley Burgess, Pharm.D., Director of Medication Safety and System Innovations, Hospital Corporation of America, Jocasta N. Gee, Pharm.D., PGY1 Managed Care Resident, Hospital Corporation of America/University of Tennessee College of Pharmacy, Jason Wright, Pharm.D., PGY1 Pharmacy Practice Resident, TriStar Centennial Medical Center, Jennifer Higdon, Pharm.D.,BSCP, Division Director Clinical Pharmacy Services, HCA-TriStar Division,

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58 Monitor and update best practices Identify new projects for next cycle Decision support Smart Pumps Adopt ASHP strategy for volunteer groups Spring call for volunteers via TPA/THA Seat membership for next cycle Begin next cycle in August Submit your name and contact information to Jackie Next Steps

59 Opioids Outcome Measure: Total # doses of Narcan dispensed Total # doses of Opioids dispensed Identified ADE Measures by TPC

60 Anticoagulants Outcome Measure: Total # patients with an INR > or equal to 4.0 Total # doses of Warfarin or Coumadin dispensed Identified ADE Measures by TPC

61 Hypoglycemic Agents Outcome Measure: Total # patients with a blood glucose equal to or less than 70 Total # doses of Insulin dispensed Identified ADE Measures by TPC

62 Mark Sullivan, Pharm.D., MBA, BCPS, Chairman, Tennessee Pharmacists Taskforce & Director, VUH Pharmacy Operations, Vanderbilt University Hospital Chris Clarke, RN, BSN, Senior Vice President, Clinical and Professional Practices, Tennessee Hospital Association Jackie Moreland, RN, BSN, MS, Clinical Quality Improvement Specialist, Tennessee Center for Patient Safety, Tennessee Hospital Association Todd Bess, Pharm.D., BCPS, Assistant Dean for Middle Tennessee, Director, Nashville Clinical Education Center & Statewide Community Pharmacy Residency Program, University of Tennessee College of Pharmacy Jeff Binkley, Pharm.D, BCNSP, FASHP, Director of Pharmacy, Maury Regional Medical Center Baeteena Black, D.Ph., Executive Director, Tennessee Pharmacists Association Hayley Burgess, Pharm.D., Director of Medication Safety and System Innovations, Clinical Services Group/HCA Jason Carter, Pharm.D., Chief Pharmacist TN Dept. of Mental Health and Substance Abuse Services, TN State Opioid Treatment Authority, Associate Professor, University of Tennessee College of Pharmacy Tennessee Pharmacists Coalition

63 Micah Cost, Pharm.D., Director of Professional Affairs, Tennessee Pharmacist Association Brian Esters, Pharm.D., CPPS, Assistant Professor of Pharmacy Practice, South College School of Pharmacy Carly Feldott, Pharm.D., Medication Safety Program Director, LifePoint Healthcare Brandy Greene, Pharm.D., Clinical Pharmacy Manager, Saint Thomas at Midtown Leah Ingram, Pharm.D., Director of Pharmacy, Cookeville Regional Medical Center Keith Kuboske, D.Ph., Pharm.D., Director of Pharmacy, NorthCrest Medical Center Susan Morley, Pharm.D, Assistant Professor, Lipscomb University College of Pharmacy David Mulherin, Pharm.D., BCPS, Informatics Pharmacist, Vanderbilt Sherry Osborne, D.Ph., Executive Director of Pharmacy, Jackson-Madison County General Hospital; Faculty Union University School of Pharmacy Calita Richards, Pharm.D., MPH, Director of Pharmacy, Tennessee Department of Health Kay Ryan, D.Ph., MS, MBA, Certified L/S Green Belt, Pharmacy Director, Regional Medical Center at Memphis Tennessee Pharmacists Coalition

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65 IHI Open School 2014 THA is providing free access to the IHI Open School curriculum to employees and trustees of our safety partner hospitals. 22 online, self-paced courses including 73 lessons and corresponding resources—videos, case studies, podcasts, featured articles, exercises, networking Free app for the iPhone and iPad by logging onto iTunes Over 25 contact hours available for CME, CNE, CPHQ and ACPE credit Certificate of completion Register using instructions. Type “Tennessee Hospital Association” as your facility to receive free membership. Once registered, go to the course page: Click the online learning tab and choose a lesson Click Begin Lesson Contact Patrice Mayo at for more 65

66 Antimicrobial Stewardship Collaborative Webinar – Tuesday June 17 th 10am CT/11am ET. Dr. Ashley Tyler, PharmD, BCPS, Infectious Disease Pharmacist at Saint Thomas Midtown will present on “De-Escalation”. Webinar link: https://stateoftennessee.adobeconnect.com/antimicrobialstewardship/ Bridge Line: | Passcode: July ADE webinar – Date/time TBD TPA’s 127th Annual Convention—July 21-24th, Hilton Head Marriott, Hilton Head, S.C. Upcoming Events

67 TCPS Monthly Webinar on Readmissions—June 27; Time TBD TCPS Regional Meetings Knoxville—Tuesday, August 19 th Nashville—Thursday, August 21 st Memphis—Tuesday, August 26 th THA Leadership Summit—November 5, Opryland Hotel and Convention Center, Nashville, TN Upcoming Events

68 Webinar Evaluation: Earn contact hours for webinar participation after completing TCPS Newsletter: Sent every Tuesday afternoon IHI Open School: THA is providing free access to the IHI Open School curriculum for 2014 to employees and trustees of our safety partner hospitals. AHRQ Hospital Survey on Patient Safety (HSOPS): The Tennessee Center for Patient Safety offers the survey to all safety partners at NO COST. Go to  Tools and Resources  AHRQ Culture Survey for more information. Other Reminders


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