1. MS-TRIP 2: Disseminating the PPRNet Model for Improving Medication Safety Andrea Wessell, PharmD Lynne Nemeth, PhD, RN AHRQ Grant Number 1 R18HS019593

2. WORKSHOP GOALS Summarize lessons learned during final year of MS-TRIP 2 Share best practice approaches to med safety Gather feedback on the PPRNet Medication Safety Toolkit Disseminate “best practices” across PPRNet August 23-25, 2012©PPRNet 2012 AFTERNOON GOALS

3. THE PROBLEM August 23-25, 2012©PPRNet 2012 Prescribing and monitoring errors cause preventable harm in primary care patients Most safety innovations and investments have focused on inpatient settings Real world “safety laboratories” are needed to test and model improvement JAMA 2011; 306 (22):2504-2505.

4. THE OPPORTUNITY August 23-25, 2012©PPRNet 2012 First MS-TRIP project resulted in: –A set of prescribing and monitoring error indicators –Practice strategies used to improve med safety –Modest improvements in indicator set after a 2-year PPRNet intervention Quality and Safety in Healthcare 2010;19(5):1-5. Journal of Patient Safety 2010;6(4):238-243. American Journal of Medical Quality 2012; doi: 10.1177/1062860612445070.

5. Disseminate PPRNet Medication Safety Improvement Model to 60 PPRNet practices Develop a Med Safety “toolkit” August 23-25, 2012©PPRNet 2012 MS-TRIP 2 PROJECT GOALS

6. MS-TRIP 2 PRACTICE PANELS August 23-25, 2012©PPRNet 2012 MS-TRIP 2 PRACTICES IN ATTENDANCE

7. Safety approaches and practice strategies to: –Develop practice culture of medication safety –Assure the accuracy of each patient’s med list –Integrate EHR decision support features –Implement a practice protocol for med refills –Design and execute case management for patients who meet criteria for preventable med errors August 23-25, 2012©PPRNet 2012 PPRNET MEDICATION SAFETY IMPROVEMENT MODEL

8. Quarterly Reports Avoiding potentially inappropriate therapy Avoiding potentially inappropriate dosages Avoiding potential drug-drug interactions Avoiding potential drug-disease interactions Monitoring of potential adverse events MS-TRIP 2 INTERVENTIONS

9. MS-TRIP REPORTS

12. Network Meetings MS-TRIP 2 INTERVENTIONS

13. Webinars Quarterly to coincide with reports PRN for individual practices MS-TRIP 2 ACTIVITIES MS-TRIP 2 INTERVENTIONS

14. Site Visits Large practices or those new to PPRNet research MS-TRIP 2 ACTIVITIES MS-TRIP 2 INTERVENTIONS

15. “…help local health care organizations meet the challenge of implementing safe practice interventions to improve patient safety” MEDICATION SAFETY TOOLKIT

16. Description of the safety problem Key components of the MS-TRIP 2 intervention Practice tools developed during project (ie, templates, handouts, posters, etc.) Case studies to highlight “best practices” TOOLKIT COMPONENTS

17. http://academicdepartments.musc.edu/P PRNet/research/mstrip2home

18. TOOLKIT COMPONENTS August 23-25, 2012©PPRNet 2012 http://academicdepartments.musc.edu/P PRNet/research/mstrip2home

19. Overall, findings corroborated key strategies in MS improvement model Specific lessons will be highlighted during panel discussion Relevant toolkit components will be displayed for feedback LESSONS LEARNED

20. MS-TRIP 2 Lessons Learned: Best Practice Approaches to Medication Safety PPRNet, 2010

21. Develop a practice culture of medication safety  Deliver medication safety education and reminders to patients consistently across the practice  Use MS-TRIP reports to evaluate performance over time and guide improvement plans LESSONS LEARNED

22. BYRON CENTER FAMILY PRACTICE

23. MEDICATION SAFETY TOOLKIT

24. Assure the accuracy of each patient’s med list  Process adapted to meet practice needs and workflow  Greater attention to having patients bring medications to visits  Best approach to sharing med list at the end of visit seems to be a work in progress LESSONS LEARNED

25. MEDICATION SAFETY TOOLKIT

27. Integrate EHR decision support features into routine practice  Dose advisor and HM medication templates were new to many practices  Note templates were often edited to reinforce MS-TRIP measures LESSONS LEARNED

28. MEDICATION SAFETY TOOLKIT

29. Implement a practice protocol for med refills  Many practices worked on a more consistent approach o Staff education o Schedule refills according to monitoring requirements/prompts in HM o Use HM as a standing order LESSONS LEARNED

30. MEDICATION SAFETY TOOLKIT

31. Design and execute case management for patients who meet criteria for potential errors Use reports to identify patients o Start with measures below median performance o Provider/nursing team prioritize measures and decide what works best – messaging, flags on med lists, direct patient outreach Use reports to develop “tracking system” for patients on warfarin LESSONS LEARNED

32. Safety approaches and practice strategies to: –Develop practice culture of medication safety –Assure the accuracy of each patient’s med list –Integrate EHR decision support features –Implement a practice protocol for med refills –Design and execute case management for patients who meet criteria for preventable med errors August 23-25, 2012©PPRNet 2012 PPRNET MEDICATION SAFETY IMPROVEMENT MODEL