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6/13/2019 Pharmacy-Initiated Naloxone Pharmacy-Initiated Naloxone Pharmacy-Initiated Naloxone Pharmacy-Initiated Naloxone Co-Prescribing Service Co-Prescribing Service Co-Prescribing Service Co-Prescribing Service Tyle Tyle ler Chia, ler

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Pharmacy-Initiated Naloxone Pharmacy-Initiated Naloxone Co-Prescribing Service Co-Prescribing Service Pharmacy-Initiated Naloxone Pharmacy-Initiated Naloxone Co-Prescribing Service Co-Prescribing Service

LT Miaka Huynh, PharmD PGY-1 Pharmacy Resident Lawton Indian Hospital LT Miaka Huynh, PharmD PGY-1 Pharmacy Resident Lawton Indian Hospital

Tyle ler Chia, r Chia, P Pharm.D arm.D., MP MPH Pharmacist, Lawton Indian Hospital James F Foster er, P Phar arm.D., m.D., BCPS Acting Resident Program Director Je Jessica ca S Stei einert, rt, Pharm. Pharm.D. D., MHA MHA, BCGP BCGP Acting Chief Pharmacist, Lawton Indian Hospital Tyle ler Chia, r Chia, P Pharm.D arm.D., MP MPH Pharmacist, Lawton Indian Hospital James F Foster er, P Phar arm.D., m.D., BCPS Acting Resident Program Director Je Jessica ca S Stei einert, rt, Pharm. Pharm.D. D., MHA MHA, BCGP BCGP Acting Chief Pharmacist, Lawton Indian Hospital

Mentors:

Disclosure Disclosure Disclosure Disclosure

Under guidelines established by the Accreditation Council for Pharmacy Education, disclosure must be made regarding financial relationships with commercial interests within the last 12 months. Miaka Huynh, Tyler Chia, James Foster, and Jessica Steinert have no relevant financial relationships or affiliations with commercial interests to disclose. Under guidelines established by the Accreditation Council for Pharmacy Education, disclosure must be made regarding financial relationships with commercial interests within the last 12 months. Miaka Huynh, Tyler Chia, James Foster, and Jessica Steinert have no relevant financial relationships or affiliations with commercial interests to disclose.

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Learning Objectives Learning Objectives Learning Objectives Learning Objectives

At the completion of this activity, pharmacists will be able to: Describe the number of drug overdoses in the state of Oklahoma Indicate the need for a pharmacy-initiated naloxone co- prescribing service Outline the naloxone consultation process at a federal IHS site At the completion of this activity, pharmacists will be able to: Describe the number of drug overdoses in the state of Oklahoma Indicate the need for a pharmacy-initiated naloxone co- prescribing service Outline the naloxone consultation process at a federal IHS site

3

At the completion of this activity, pharmacy technicians will be able to: Indicate the need for a pharmacy-initiated naloxone co-prescribing service

Pre-Assessment Question #1 Pre-Assessment Question #1 Pre-Assessment Question #1 Pre-Assessment Question #1

In 2017, how many overdose deaths involving opioids occurred in Oklahoma?

  • A. Less than 200
  • B. 200 – 300
  • C. 301 – 400
  • D. More than 400

In 2017, how many overdose deaths involving opioids occurred in Oklahoma?

  • A. Less than 200
  • B. 200 – 300
  • C. 301 – 400
  • D. More than 400

4

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Pre-Assessment Question #2 Pre-Assessment Question #2 Pre-Assessment Question #2 Pre-Assessment Question #2

Why should pharmacy initiate a naloxone co-prescribing service?

  • A. House Bill 2039 (2017) allows pharmacists the authority to prescribe and

dispense naloxone

  • B. Title 535 - Oklahoma State Board of Pharmacy, chapter 10, subchapter 9, allows

pharmacist to “prescribe and dispense Naloxone without a protocol or prescription to any person at risk of experiencing an opioid-related drug overdose”

  • C. As of 2018, the Department of Mental Health and Substance Abuse Services has

promoted an initiative called Prescription for Change to combat the opioid epidemic in Oklahoma

  • D. All of the above

Why should pharmacy initiate a naloxone co-prescribing service?

  • A. House Bill 2039 (2017) allows pharmacists the authority to prescribe and

dispense naloxone

  • B. Title 535 - Oklahoma State Board of Pharmacy, chapter 10, subchapter 9, allows

pharmacist to “prescribe and dispense Naloxone without a protocol or prescription to any person at risk of experiencing an opioid-related drug overdose”

  • C. As of 2018, the Department of Mental Health and Substance Abuse Services has

promoted an initiative called Prescription for Change to combat the opioid epidemic in Oklahoma

  • D. All of the above

5

Pre-Assessment Question #3 Pre-Assessment Question #3 Pre-Assessment Question #3 Pre-Assessment Question #3

What is the correct naloxone consultation process at the Lawton Indian Hospital?

  • A. Provider enters consult, pharmacist educates patient, pharmacist dispenses

naloxone

  • B. Provider enters consult, patient signs consent form, pharmacist dispenses

naloxone

  • C. Provider/pharmacist enters consult, pharmacist educates patient, patient

signs consent form, pharmacist dispenses naloxone

  • D. Provider/pharmacist enters consult, pharmacist educates patient, pharmacist

dispenses naloxone What is the correct naloxone consultation process at the Lawton Indian Hospital?

  • A. Provider enters consult, pharmacist educates patient, pharmacist dispenses

naloxone

  • B. Provider enters consult, patient signs consent form, pharmacist dispenses

naloxone

  • C. Provider/pharmacist enters consult, pharmacist educates patient, patient

signs consent form, pharmacist dispenses naloxone

  • D. Provider/pharmacist enters consult, pharmacist educates patient, pharmacist

dispenses naloxone

6

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Oklahoma Data Oklahoma Data Oklahoma Data Oklahoma Data

Oklahoma Data Oklahoma Data Oklahoma Data Oklahoma Data

8

Ok.gov. Oklahoma Special Emphasis Report: Drug Overdose Deaths,1999-2013.

2013

  • Total drug overdose deaths = 777
  • 477 from opioids pain relievers (61%)

2013

  • Total drug overdose deaths = 777
  • 477 from opioids pain relievers (61%)
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Oklahoma Data Oklahoma Data Oklahoma Data Oklahoma Data

9

2017

  • Total drug overdose deaths = 388
  • 251 from prescription opioids (65%)

2017

  • Total drug overdose deaths = 388
  • 251 from prescription opioids (65%)

Drugabuse.org. Oklahoma Opioid Summary.

Why Pharmacy-Initiated? Why Pharmacy-Initiated? Why Pharmacy-Initiated? Why Pharmacy-Initiated?

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House Bill House Bill 2039 2039 House Bill House Bill 2039 2039

11

Oklegislature.gov. Bill Information for HB 2039.

House Bill House Bill 2039 2039 House Bill House Bill 2039 2039

12

Oklegislature.gov. Bill Information for HB 2039.

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Title 535, Chapter 10, Subchapter 9 tle 535, Chapter 10, Subchapter 9 Title 535, Chapter 10, Subchapter 9 tle 535, Chapter 10, Subchapter 9

13

Elaws.us. Oklahoma Administrative Code.

14

Okimready.org

Okimready.org. Opioid Overdose.

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15

Naloxone Co-Prescribing Service Naloxone Co-Prescribing Service Naloxone Co-Prescribing Service Naloxone Co-Prescribing Service

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Objectives Objectives Objectives Objectives

Primary objective:

Expand a pharmacy-initiated program to identify patients at high risk for opioid overdose and provide them with naloxone for

  • verdose reversal

Secondary objective:

Follow up with patients who received naloxone to assess their knowledge of naloxone’s indication, administration technique, and usage history

Primary objective:

Expand a pharmacy-initiated program to identify patients at high risk for opioid overdose and provide them with naloxone for

  • verdose reversal

Secondary objective:

Follow up with patients who received naloxone to assess their knowledge of naloxone’s indication, administration technique, and usage history

17

Inclusion Criteria Inclusion Criteria Inclusion Criteria Inclusion Criteria

Inclusion criteria:

Patients ≥ 18 years old and at high risk for opioid overdose:

Opioid dose ≥ 50 Morphine Milligram Equivalents (MME) per day Concurrent use of a benzodiazepine Current poly-opioid use

Patients ≥ 65 years old with prescribed long term duration of opioid treatment ( ≥ 3 months)

Inclusion criteria:

Patients ≥ 18 years old and at high risk for opioid overdose:

Opioid dose ≥ 50 Morphine Milligram Equivalents (MME) per day Concurrent use of a benzodiazepine Current poly-opioid use

Patients ≥ 65 years old with prescribed long term duration of opioid treatment ( ≥ 3 months)

18

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Exclusion Criteria Exclusion Criteria Exclusion Criteria Exclusion Criteria

Exclusion criteria:

Patients who are not prescribed opioid medications Patients taking opioids for acute pain ( < 30 days)

Exclusion criteria:

Patients who are not prescribed opioid medications Patients taking opioids for acute pain ( < 30 days)

19 20

Naloxone Co-Prescribing Process Naloxone Co-Prescribing Process Naloxone Co-Prescribing Process Naloxone Co-Prescribing Process

Identify high risk patient Consult entered by provider and/or pharmacist Educate patient and obtain informed consent Dispense naloxone kit Follow-up via telephone

Acs.org. Molecule of the Week Archive – Naloxone.

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Results Results Results Results

389 charts reviewed from July - September 2018

  • 119 patients identified as high risk
  • 7 patients unable to be contacted
  • 112 patients educated on the availability of naloxone at LIH (94%)

76 patients counseled and received naloxone (64%) 36 opted out on receiving naloxone (30%)

389 charts reviewed from July - September 2018

  • 119 patients identified as high risk
  • 7 patients unable to be contacted
  • 112 patients educated on the availability of naloxone at LIH (94%)

76 patients counseled and received naloxone (64%) 36 opted out on receiving naloxone (30%)

21

Results Continued Results Continued Results Continued Results Continued 83%

2% 3% 5% 6% 1%

Patient Characteristics

≥65 years old ≥65 years old + Benzodiazepine ≥65 years old + Poly-opiates Poly-opiates Opiates + Benzodiazepine ≥50 MME 22

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Post-Assessment Question #1 Post-Assessment Question #1 Post-Assessment Question #1 Post-Assessment Question #1

In 2017, how many overdose deaths involving opioids occurred in Oklahoma?

  • A. Less than 200
  • B. 200 – 300
  • C. 301 – 400
  • D. More than 400

In 2017, how many overdose deaths involving opioids occurred in Oklahoma?

  • A. Less than 200
  • B. 200 – 300
  • C. 301 – 400
  • D. More than 400

23

Post-Assessment Question #1 Post-Assessment Question #1 Post-Assessment Question #1 Post-Assessment Question #1

In 2017, how many overdose deaths involving opioids occurred in Oklahoma?

  • A. Less than 200
  • B. 200 – 300
  • C. 301 – 400
  • D. More than 400

In 2017, how many overdose deaths involving opioids occurred in Oklahoma?

  • A. Less than 200
  • B. 200 – 300
  • C. 301 – 400
  • D. More than 400

24

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Post-Assessment Question #2 Post-Assessment Question #2 Post-Assessment Question #2 Post-Assessment Question #2

Why should pharmacy initiate a naloxone co-prescribing service?

  • A. House Bill 2039 (2017) allows pharmacists the authority to prescribe and

dispense naloxone

  • B. Title 535 - Oklahoma State Board of Pharmacy, chapter 10, subchapter 9, allows

pharmacist to “prescribe and dispense Naloxone without a protocol or prescription to any person at risk of experiencing an opioid-related drug overdose”

  • C. As of 2018, the Department of Mental Health and Substance Abuse Services has

promoted an initiative called Prescription for Change to combat the opioid epidemic in Oklahoma

  • D. All of the above

Why should pharmacy initiate a naloxone co-prescribing service?

  • A. House Bill 2039 (2017) allows pharmacists the authority to prescribe and

dispense naloxone

  • B. Title 535 - Oklahoma State Board of Pharmacy, chapter 10, subchapter 9, allows

pharmacist to “prescribe and dispense Naloxone without a protocol or prescription to any person at risk of experiencing an opioid-related drug overdose”

  • C. As of 2018, the Department of Mental Health and Substance Abuse Services has

promoted an initiative called Prescription for Change to combat the opioid epidemic in Oklahoma

  • D. All of the above

25

Post-Assessment Question #2 Post-Assessment Question #2 Post-Assessment Question #2 Post-Assessment Question #2

Why should pharmacy initiate a naloxone co-prescribing service?

  • A. House Bill 2039 (2017) allows pharmacists the authority to prescribe and

dispense naloxone

  • B. Title 535 - Oklahoma State Board of Pharmacy, chapter 10, subchapter 9, allows

pharmacist to “prescribe and dispense Naloxone without a protocol or prescription to any person at risk of experiencing an opioid-related drug overdose”

  • C. As of 2018, the Department of Mental Health and Substance Abuse Services has

promoted an initiative called Prescription for Change to combat the opioid epidemic in Oklahoma

  • D. All of the above

Why should pharmacy initiate a naloxone co-prescribing service?

  • A. House Bill 2039 (2017) allows pharmacists the authority to prescribe and

dispense naloxone

  • B. Title 535 - Oklahoma State Board of Pharmacy, chapter 10, subchapter 9, allows

pharmacist to “prescribe and dispense Naloxone without a protocol or prescription to any person at risk of experiencing an opioid-related drug overdose”

  • C. As of 2018, the Department of Mental Health and Substance Abuse Services has

promoted an initiative called Prescription for Change to combat the opioid epidemic in Oklahoma

  • D. All of the above

26

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Post-Assessment Question #3 Post-Assessment Question #3 Post-Assessment Question #3 Post-Assessment Question #3

What is the correct naloxone consultation process at Lawton Indian Hospital?

  • A. Provider enters consult, pharmacist educates patient, pharmacist dispenses

naloxone

  • B. Provider enters consult, patient signs consent form, pharmacist dispenses

naloxone

  • C. Provider/pharmacist enters consult, pharmacist educates patient, patient

signs consent form, pharmacist dispenses naloxone

  • D. Provider/pharmacist enters consult, pharmacist educates patient,

pharmacist dispenses naloxone What is the correct naloxone consultation process at Lawton Indian Hospital?

  • A. Provider enters consult, pharmacist educates patient, pharmacist dispenses

naloxone

  • B. Provider enters consult, patient signs consent form, pharmacist dispenses

naloxone

  • C. Provider/pharmacist enters consult, pharmacist educates patient, patient

signs consent form, pharmacist dispenses naloxone

  • D. Provider/pharmacist enters consult, pharmacist educates patient,

pharmacist dispenses naloxone

27

Post-Assessment Question #3 Post-Assessment Question #3 Post-Assessment Question #3 Post-Assessment Question #3

What is the correct naloxone consultation process at Lawton Indian Hospital?

  • A. Provider enters consult, pharmacist educates patient, pharmacist dispenses

naloxone

  • B. Provider enters consult, patient signs consent form, pharmacist dispenses

naloxone

  • C. Provider/pharmacist enters consult, pharmacist educates patient, patient

signs consent form, pharmacist dispenses naloxone

  • D. Provider/pharmacist enters consult, pharmacist educates patient,

pharmacist dispenses naloxone What is the correct naloxone consultation process at Lawton Indian Hospital?

  • A. Provider enters consult, pharmacist educates patient, pharmacist dispenses

naloxone

  • B. Provider enters consult, patient signs consent form, pharmacist dispenses

naloxone

  • C. Provider/pharmacist enters consult, pharmacist educates patient, patient

signs consent form, pharmacist dispenses naloxone

  • D. Provider/pharmacist enters consult, pharmacist educates patient,

pharmacist dispenses naloxone

28

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Conclusion Conclusion Conclusion Conclusion

Lawton Indian Hospital (LIH) created a collaborative practice agreement for pharmacists to dispense naloxone to high risk patients to combat the growing trend of

  • pioid misuse
  • Increased naloxone access for high risk patients
  • Educated patients on naloxone service offered at LIH
  • Dispensed 76 naloxone rescue kits

Lawton Indian Hospital (LIH) created a collaborative practice agreement for pharmacists to dispense naloxone to high risk patients to combat the growing trend of

  • pioid misuse
  • Increased naloxone access for high risk patients
  • Educated patients on naloxone service offered at LIH
  • Dispensed 76 naloxone rescue kits

29

References References References References

1. Ok.gov. Oklahoma Special Emphasis Report: Drug Overdose Deaths,1999-2013. https://www.ok.gov/health2/documents/UP_Drug_Overdose_Special_Report_OK_1999-2013.pdf (accessed 2019 May 10) 2. Drugabuse.org. Oklahoma Opioid Summary. https://www.drugabuse.gov/opioid-summaries-by- state/oklahoma-opioid-summary (accessed 2019 May 10) 3. Oklegislature.gov. Bill Information for HB 2039. http://www.oklegislature.gov/BillInfo.aspx?Bill=hb2039&Session=1700 (accessed 2019 May 10) 4. Elaws.us. Oklahoma Administrative Code. http://okrules.elaws.us/oac/535:10-9-15 (accessed 2019 May 10) 5. Okimready.org. Opioid Overdose. https://okimready.org/overdose/ (accessed 2019 May 12) 6. Acs.org. Molecule of the Week Archive – Naloxone. https://www.acs.org/content/acs/en/molecule-

  • f-the-week/archive/n/naloxone.html (accessed 2019 May 15)

1. Ok.gov. Oklahoma Special Emphasis Report: Drug Overdose Deaths,1999-2013. https://www.ok.gov/health2/documents/UP_Drug_Overdose_Special_Report_OK_1999-2013.pdf (accessed 2019 May 10) 2. Drugabuse.org. Oklahoma Opioid Summary. https://www.drugabuse.gov/opioid-summaries-by- state/oklahoma-opioid-summary (accessed 2019 May 10) 3. Oklegislature.gov. Bill Information for HB 2039. http://www.oklegislature.gov/BillInfo.aspx?Bill=hb2039&Session=1700 (accessed 2019 May 10) 4. Elaws.us. Oklahoma Administrative Code. http://okrules.elaws.us/oac/535:10-9-15 (accessed 2019 May 10) 5. Okimready.org. Opioid Overdose. https://okimready.org/overdose/ (accessed 2019 May 12) 6. Acs.org. Molecule of the Week Archive – Naloxone. https://www.acs.org/content/acs/en/molecule-

  • f-the-week/archive/n/naloxone.html (accessed 2019 May 15)

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Pharmacy-Initiated Naloxone Pharmacy-Initiated Naloxone Co-Prescribing Service Co-Prescribing Service Pharmacy-Initiated Naloxone Pharmacy-Initiated Naloxone Co-Prescribing Service Co-Prescribing Service

LT Miaka Huynh, PharmD PGY-1 Pharmacy Resident Lawton Indian Hospital LT Miaka Huynh, PharmD PGY-1 Pharmacy Resident Lawton Indian Hospital

Tyle ler Chia, r Chia, P Pharm.D arm.D., MP MPH Pharmacist, Lawton Indian Hospital James F Foster er, P Phar arm.D., m.D., BCPS Acting Resident Program Director Je Jessica ca S Stei einert, rt, Pharm. Pharm.D. D., MHA MHA, BCGP BCGP Acting Chief Pharmacist, Lawton Indian Hospital Tyle ler Chia, r Chia, P Pharm.D arm.D., MP MPH Pharmacist, Lawton Indian Hospital James F Foster er, P Phar arm.D., m.D., BCPS Acting Resident Program Director Je Jessica ca S Stei einert, rt, Pharm. Pharm.D. D., MHA MHA, BCGP BCGP Acting Chief Pharmacist, Lawton Indian Hospital

Mentors:

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Effects of a Pharmacy‐led Educational Intervention on Penicillin Allergy Documentation in an Ambulatory Care Setting

Stephen Riley, Pharm.D. PGY‐1 Pharmacy Resident, Lawton Indian Hospital

1

Tyler Chia, Pharm.D., MPH Pharmacist, Lawton Indian Hospital James Foster, Pharm.D., BCPS Acting Resident Program Director Jessica Steinert, Pharm.D., MHA, BCGP Acting Chief Pharmacist, Lawton Indian Hospital Mentors:

Disclosure

Under guidelines established by the Accreditation Council for Pharmacy Education, disclosure must be made regarding financial relationships with commercial interests within the last 12 months.

  • Stephen Riley, Tyler Chia, James Foster, and Jessica

Steinert have no relevant financial relationships or affiliations with commercial interests to disclose.

2

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Learning Objectives

At the completion of this activity, pharmacists and pharmacy technicians will be able to:

  • Discuss the importance of proper penicillin allergy documentation

and its impact on patient care

  • Identify the potential consequences of inaccurately documented

penicillin allergies

  • Identify proper medication allergy practices and services

3

Pre‐assessment question #1

What percentage of the American population has a “true” penicillin allergy?

  • A. 10%
  • B. 20%
  • C. 1%
  • D. 5%

4

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Pre‐assessment question #2

What is an example of a potential consequence of inaccurately documented penicillin allergies?

  • A. Increase healthcare costs
  • B. Increase broad‐spectrum antibiotic use
  • C. Increase antibiotic resistance potential
  • D. All the above

5

Pre‐assessment question #3

What question should always be asked when performing an allergy history?

  • A. What was the reaction?
  • B. How long ago did the reaction occur?
  • C. How was the reaction managed?
  • D. All the above

6

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Drug allergy or adverse reaction

  • Many patients state that they have an allergy to a medication,

however, many can be labeled as an adverse reaction.

  • Common signs of drug allergy:

Hives Wheezing/dyspnea Itching Swelling

  • Adverse reactions differ from allergies because they are common and

expected with certain medications, such as experiencing diarrhea with metformin.

CDC.gov. Is it Really a Penicillin Allergy? https://www.cdc.gov/antibiotic‐use/community/pdfs/penicillin‐factsheet.pdf (accessed February 9, 2019). 7

Statistics

  • Approximately 10% of all patients in the United States (U.S.)

report having an allergy to penicillin antibiotics.

  • Only about 1% of the U.S. population have a “true” penicillin

allergy.

  • Patients can lose their sensitivity to penicillin antibiotics over

time.

CDC.gov. Is it Really a Penicillin Allergy? https://www.cdc.gov/antibiotic‐use/community/pdfs/penicillin‐factsheet.pdf (accessed February 9, 2019). 8

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Potential implications

  • Second‐line, broad‐spectrum, and potentially toxic antibiotics may be

used for patients who report a penicillin allergy.

  • Using alternative antibiotics may result in:
  • Increased healthcare costs
  • Increased antibiotic resistance
  • Worse outcomes
  • Accurate and complete allergy documentation reduces the use of

alternative antibiotics and their associated risks.

CDC.gov. Is it Really a Penicillin Allergy? https://www.cdc.gov/antibiotic‐use/community/pdfs/penicillin‐factsheet.pdf (accessed February 9, 2019). 9

Previous data

  • In a retrospective study, patients were evaluated to assess how beta‐

lactam allergy documentation affected subsequent antibiotic choice.

  • The data included 232,616 patients from 198 primary care providers,
  • f which 36,193 were labeled as having a beta‐lactam allergy.
  • Of the patients that were labeled to have a beta‐lactam allergy only

22.7% had allergy reaction documentation.

Shah N, Ridgway J, Pettit N, et al. Documenting Penicillin Allergy:The Impact of Inconsistency. PLoS ONE 11(3): e0150514. https://doi.org/10.1371/journal.pone.0150514 (accessed February 10, 2019). 10

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Previous data (continued)

Shah N, Ridgway J, Pettit N, et al. Documenting Penicillin Allergy:The Impact of Inconsistency. PLoS ONE 11(3): e0150514. https://doi.org/10.1371/journal.pone.0150514 (accessed February 10, 2019). 11

Residency project

  • Primary objective
  • Assess the intervention rate on incompletely documented

penicillin allergies in adult care clinics before and after a pharmacy‐led educational seminar.

  • Secondary objective
  • Assess the overall prevalence of inaccurately documented

penicillin allergies in the outpatient pharmacy before and after a pharmacy‐led educational seminar.

12

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Residency project (continued)

  • Inclusion criteria
  • Patients having an allergy to any agent in the

penicillin class of antibiotics

  • Patients over the age of 18
  • Exclusion criteria
  • Patients who do not have an allergy to any agent in

the penicillin class of antibiotics

  • Patients under the age of 18

13

Data collection

  • Data was collected for 3 months prior to the

educational intervention.

  • After the educational intervention was given, data was

collected for an additional 3 months in order to assess the effectiveness of the session.

14

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Adult care data collection

Online scheduling system reviewed at start of day Qualifying patient identified through chart analysis Scheduling system reviewed for patient attendance Chart analysis conducted for allergy intervention Data recorded Data analyzed

15

Adult care data

Number of visits Number of interventions made Intervention percentage

No allergy reaction specified (before midpoint)

112 4 3.6%

No allergy reaction specified (after midpoint through 5/14/2019)

97 14 14.4%

16

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Pharmacy data collection

Qualifying patient identified through chart analysis Patient asked about allergy history when presenting to the pharmacy History compared to patient’s chart Data recorded Data analyzed

17

Pharmacy data

Penicillin allergies documented accurately Penicillin allergies documented inaccurately Inaccuracy rate

3 months prior to midpoint intervention

28 34 54.8%

3 months following midpoint up to 5/14/2019

9 10 52.6%

18

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Study conclusion

  • According to the data that as been collected, the overall

intervention rate on incompletely documented penicillin antibiotics did increase in the adult care clinic after the educational intervention.

  • However, the overall prevalence of inaccurately documented

penicillin allergies in the outpatient pharmacy did not share the same degree of improvement.

19

What to ask

Do you have any medication allergies? What reaction occurred? How long ago did the reaction occur? What was the outcome of the reaction? When was the last time you received the reacting medication?

CDC.gov. Is it Really a Penicillin Allergy? https://www.cdc.gov/antibiotic‐use/community/pdfs/penicillin‐factsheet.pdf (accessed February 9, 2019). 20

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Future considerations

  • If a medication allergy history is not effective at obtaining accurate

information more objective tests can be utilized.

  • Penicillin skin tests have a negative predictive value of more than 95%

and can be extremely useful in patients who are unable to remember their allergy reaction.

  • A penicillin oral challenge can also be utilized to help further validate

allergy presence.

CDC.gov. Is it Really a Penicillin Allergy? https://www.cdc.gov/antibiotic‐use/community/pdfs/penicillin‐factsheet.pdf (accessed February 9, 2019). 21

Post assessment question #1

What percentage of the American population have a “true” penicillin allergy?

  • A. 10%
  • B. 20%
  • C. 1%
  • D. 5%

22

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Post assessment question #2

What is an example of a potential consequence of inaccurately documented penicillin allergies?

  • A. Increase healthcare costs
  • B. Increase broad spectrum antibiotic use
  • C. Increase antibiotic resistance potential
  • D. All the above

23

Post assessment question #3

What question should always be asked when performing an allergy history?

  • A. What reaction occurred?
  • B. How long ago was the reaction?
  • C. What was the outcome of the reaction?
  • D. All the above

24

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Summary

  • Inappropriately documented penicillin allergies can lead to increased

healthcare costs and increased antibiotic resistance potential.

  • Performing an allergy history is an important first step in obtaining

the most up‐to‐date patient allergy information.

  • Penicillin skin allergy tests and oral penicillin challenge are other

methods that can be potentially utilized to confirm penicillin allergies.

25

References

  • 1. CDC.gov. Is it Really a Penicillin Allergy?

https://www.cdc.gov/antibiotic‐use/community/pdfs/penicillin‐ factsheet.pdf (accessed February 9, 2019).

  • 2. aaaai.org. American Academy of Allergy Asthma and Immunology
  • website. Anaphylaxis TTR. https://www.aaaai.org/conditions‐and‐

treatments/library/allergy‐library/anaphylaxis. (accessed February 11, 2019).

  • 3. Shah N, Ridgway J, Pettit N, et al. Documenting Penicillin Allergy:The

Impact of Inconsistency. PLoS ONE 11(3): e0150514. https://doi.org/10.1371/journal.pone.0150514 (accessed February 10, 2019).

26

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Effects of a Pharmacy‐led Educational Intervention on Penicillin Allergy Documentation in an Ambulatory Care Setting

Stephen Riley, Pharm.D. PGY‐1 Pharmacy Resident, Lawton Indian Hospital

27

Tyler Chia, Pharm.D., MPH Pharmacist, Lawton Indian Hospital James Foster, Pharm.D., BCPS Acting Resident Program Director Jessica Steinert, Pharm.D., MHA, BCGP Acting Chief Pharmacist, Lawton Indian Hospital Mentors:

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6/5/2019 1

De c e ntr alization of the Phar mac ist to an E ndoc r inology Se r vic e in a Diabe te s We llne ss Ce nte r

L IE UT E NANT ASHL E Y D. DE VAUGHAN, PHAR M.D., M.B.A. PGY-1 PHAR MACY R E SIDE NT , CHOCT AW NAT ION HE AL T H CAR E CE NT E R

1

MENTOR: CHRISTOPHER PACK, PHARM.D., AE-C CLINICAL PHARMACIST & RESIDENCY DIRECTOR, CHOCTAW NATION OF OKLAHOMA

PRESENTER DISCLOSURES

Under guidelines established by the Accreditation Council for Pharmacy Education, disclosure must be made regarding financial relationships with commercial interests within the last 12 months.

 Ashley DeVaughan and Christopher Pack have no

relevant financial relationships or affiliations with commercial interests to disclose.

 This presentation is educational in nature and abides by

non-commercial guidelines.

2

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6/5/2019 2

LEARNING OBJECTIVES

At the completion of this activity, pharmacists will be able to:

 Measure improvements in diabetes and co-morbid disease state

management after pharmacist involvement in endocrinology visit by assessing certain objective measures such as hemoglobin A1c, lipid panel, blood pressure, etc.

 Calculate adherence rates through proportion of days covered and

medication possession ratio calculations.

 Assess patient/provider satisfaction with the involvement of a decentralized

pharmacist service. At the completion of this activity, pharmacy technicians will be able to:

 Assess patient/provider satisfaction with the involvement of a decentralized

pharmacist service.

3

PRE-ASSESSMENT QUESTIONS

 Which adherence measure

can produce a value of greater than 100% adherence?

A.

Proportion of Days Covered

B.

Medication Possession Ratio  Which adherence measure

may overestimate adherence, especially for patients who consistently refill medications early?

A.

Proportion of Days Covered

B.

Medication Possession Ratio

4

slide-33
SLIDE 33

6/5/2019 3

OUTLINE

 Background and Significance  Project Design

 Objectives  Phases of Implementation  Program Goals

 Preliminary Data  Study Limitations  Conclusion  References

5

BACKGROUND AND SIGNIFICANCE

Several studies have evaluated the outcomes of including a pharmacist

  • n the primary care team.

Shown that patients are likely to have a greater improvement in:

 medication adherence  health-related quality of life  BMI  better disease-specific measures such as A1c, blood pressure,

cholesterol, and ASCVD risk.1

6

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6/5/2019 4

BACKGROUND AND SIGNIFICANCE

One study in ambulatory care clinics showed significantly more improvement in:

 A1c  LDL  disease-related screenings

Also found comprehensive medication reviews by pharmacists led to significantly more patients appropriately taking:

 an antiplatelet agent  an ARB  and a statin2

7

BACKGROUND AND SIGNIFICANCE

8

 A cost-effectiveness study found that pharmacist-

endocrinologist collaborative practices showed an average cost avoidance of $5,000 per patient in the health system.3

 This project was based on a previous successful project at the

Choctaw Nation Health Care Center.4

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6/5/2019 5

PROJECT OBJECTIVES

 The objective of this study will be to assess the outcomes and

interventions that occur from the decentralization of a pharmacist to the endocrinology service.

 This project has been approved by the Choctaw Nation

Institutional Review Board

9

PROJECT OBJECTIVES

 OBJECTIVE MEASURES

 Adherence Rates: MPR and

PDC

 Disease state measures Hemoglobin A1c, Blood

Pressure, Lipids Profile, Etc.

 Other miscellaneous

interventions

 SUBJECTIVE MEASURES

 Patient Satisfaction  Provider Satisfaction

10

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6/5/2019 6

PROJECT DESIGN

11

Inc lusion Cr ite r ia E xc lusion Cr ite r ia

Patient has a diagnosis of Type I or Type II Diabetes Mellitus Patient is seen by another provider in DWC Patient is seen in endocrinologist’s service Patient does not receive chronic care from the Choctaw Nation of Oklahoma Between the ages of 18-95

PHASES OF IMPLEMENTATION

12

Patients seen in endocrinology clinic and meet criteria for enrollment (Patient consent required) Patient’s data gathered and compared to equal number of patient’s seen without decentralized pharmacist services in endocrinology service Data analyzed and assessed for improvements in disease state conditions using objective data such as: hemoglobin A1c, blood pressure, lipid panel, vaccines etc. Data analyzed and assessed for improvements in medication adherence using MPR and PDC Satisfaction surveys given to both patient and provider at approximately 3, 6, and 9 months

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SLIDE 37

6/5/2019 7

PROGRAM GOALS

13

Improvements in disease state management Increase patient medication adherence Develop patient and provider satisfaction with decentralized pharmacy services Implementation of decentralized pharmacy service at CNHSA

METHODS TO MEASURE ADHERENCE

MPR = Medication Possession Ratio Sum of days’ supply for all fills in period

[Last Rx date – First Rx date + Last Rx days of supply]

  • May overestimate adherence
  • Patients who fill their medications early will have an inflated

MPR

  • Some MPR may be calculated as >100%

14

100%

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6/5/2019 8

PDC = Proportion of Days Covered Number of days in period “covered” Number of days in period

  • Think of each Rx as an “array” of days supplied
  • Moving these arrays forward to the first day the patient would

not have medication from the previous dispensing (array)

  • Impossible to calculate PDC of >100%

15

100%

METHODS TO MEASURE ADHERENCE ADHERENCE RATES

In the United States, 3.8 billion prescriptions are

written annually.5

Approximately one in five new prescriptions are never

filled.

Among those filled, appr

  • ximate ly 50% are taken

incorrectly, particularly with regard to timing, dosage, frequency, and duration . 16

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SLIDE 39

6/5/2019 9

ADHERENCE RATE DATA

17

 Adherence rates above 70% for all medication classes for 6 months  3 months before and 3 months after being seen by pharmacist

 14 patients consented

Me dic ation Class 3 Months Be for e PDC 3 Months Afte r PDC 3 Months Be for e MPR 3 Months Afte r MPR

Antidiabetic 70.9 81.8 90.7 95.4 Antihypertensive 89.7 78.9 96.0 99.1 Antihyperlipidemic 73.4 82.5 96.9 87.1 All Classes 78.0 81.1 94.5 93.9

18

ADHERENCE RATE DATA

70.9 89.7 73.4 78.0 81.8 78.9 82.5 81.1

10 20 30 40 50 60 70 80 90 100 Antidiabe tic Antihype r te nsive Antihype r lipide mic All Me dic ations

PDC Adhe r e nc e Data

3 Months Be for e 3 Months Afte r

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6/5/2019 10 19

ADHERENCE RATE DATA

90.7 96 96.9 94.5 95.4 99.1 87.1 93.9

80.0 82.0 84.0 86.0 88.0 90.0 92.0 94.0 96.0 98.0 100.0

Antidiabe tic Antihype r te nsive Antihype r lipide mic All Me dic ations

MPR Adhe r e nc e Data

3 Months Be for e 3 Months Afte r

A1C MEASUREMENTS

20

A1C Statistic s (without outlie r ) Initial Visit 2 Diffe r e nc e Mean 9.4153 9.0923

  • 0.32

Variance 5.5697 2.4924 Observations 13 13 Pearson Correlation 0.844129 Hypothesized Mean Difference t Stat 0.875095 P(T<=t) two-tail 0.398699 t Critical two-tail 2.178813 A1C Statistic s (All Patie nts) Initial Visit 2 Diffe r e nc e Mean 9.3428 9.4214 +0.08 Variance 5.2149 3.8171 Observations 14 14 Pearson Correlation 0.575796 Hypothesized Mean Difference t Stat

  • 0.14898

P(T<=t) two-tail 0.883857 t Critical two-tail 2.160369

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6/5/2019 11

BLOOD PRESSURE MEASUREMENTS

Systolic BP Initial 2nd Mean 132.35 127.64 Variance 257.32 359.48 Observations 14 14 Pearson Correlation 0.263487 Hypothesized Mean Difference t Stat 0.825556 P(T<=t) two-tail 0.423948 t Critical two-tail 2.160369

21

Diastolic BP Initial 2nd Mean 77.29 75.14 Variance 66.22 72.29 Observations 14 14 Pearson Correlation 0.537488 Hypothesized Mean Difference t Stat 1.001199 P(T<=t) two-tail 0.335003 t Critical two-tail 2.160369

PHARMACIST INTERVENTIONS

 DM medications adjusted: 4  Statins ordered: 3

 1 patient met LDL goal after 3 months

 Labs ordered: 5 (2 A1C, 3 L

ipid)

 Vaccinations: 5 vac c ine s to 4 patie nts  Drug interactions found: 2

 Multiple PPIs, Multiple sedating drugs

 All patients received disease state and adherence counseling

22

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SLIDE 42

6/5/2019 12

PATIENT SATISFACTION

23

 Patient 1:

  • 1. Do you feel more comfortable taking your medications after the pharmacists

service?

  • a. Yes, “I like talking to a pharmacist because it makes me feel better about taking

my medications.”

  • 2. Do you feel more knowledgeable about your medications after the pharmacists

services?

  • a. Yes
  • 3. On scale of 1-10 how helpful was the pharmacist service?
  • a. 10
  • 4. Would you recommend the decentralized pharmacy service to others?
  • a. Yes

PATIENT SATISFACTION

24

 Patient 2:

  • 1. Do you feel more comfortable taking your medications after the pharmacists

service?

  • a. Yes
  • 2. Do you feel more knowledgeable about your medications after the pharmacists

services?

  • a. Yes
  • 3. On scale of 1-10 how helpful was the pharmacist service?
  • a. 10
  • 4. Would you recommend the decentralized pharmacy service to others?
  • a. Yes
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6/5/2019 13

PROVIDER SATISFACTION SURVEY

25

1.

How comfortable are you with the incorporation of decentralized pharmacy services?

  • Very Comfortable

2.

Do you feel that the pharmacist provided recommendations that were beneficial for overall patient care?

  • Yes

3.

On scale of 1-10 how beneficial was the service in improving patient care?

  • 8

4.

Would you like a decentralized pharmacy service in your department?

  • Yes

5.

Would you recommend the decentralized pharmacy service to other providers?

  • Yes

STUDY LIMITATIONS

 Low number of “follow-up” visits = low number of

consented patients

 Chronic disease states have longer follow up times

 3 months- 1 year

 Working with only one provider

26

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6/5/2019 14

POST-ASSESSMENT QUESTIONS

 Which adherence measure

can produce a value of greater than 100% adherence?

A.

Proportion of Days Covered

B.

Medication Possession Ratio  Which adherence measure

may overestimate adherence, especially for patients who consistently refill medications early?

A.

Proportion of Days Covered

B.

Medication Possession Ratio

27

CONCLUSION

► Decentralized pharmacy services have the potential to

bring positive impact to overall patient care while improving workflow and patient/provider satisfaction.

► Disease state counseling ► Medication counseling ► Vaccinations ► Blood pressure/ cholesterol

28

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6/5/2019 15

REFERENCES

29

  • 1. Pousinho S, Morgado M, Falcão A, Alves G. Pharmacist Interventions in the Management of Type

2 Diabetes Mellitus: A Systematic Review of Randomized Controlled Trials. J Manag Care Spec

  • Pharm. 2016;22(5):493-515.
  • 2. Jacobs M, Sherry PS, Taylor LM, Amato M, Tataronis GR, Cushing G. Pharmacist Assisted

Medication Program Enhancing the Regulation of Diabetes (PAMPERED) study. J Am Pharm

  • Assoc. 2012; 52:613–621.
  • 3. Hirsch JD, Bounthavong M, Arimand A, et al. Estimated Cost-Effectiveness, Cost Benefit, and Risk

Reduction Associated with an Endocrinologist-Pharmacist Diabetes Intense Medical Management “Tune-Up” Clinic. J Manag Care Spec Pharm. 2017; 23(3):318-26.

  • 4. Rose CL, Pack, CC. Decentralization of the Pharmacist to Family Practice Clinic in a Small Rural
  • Hospital. Choctaw Nation Health Care Center.
  • 5. CDC Grand Rounds: Improving Medication Adherence for Chronic Disease Management —

Innovations and Opportunities. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/mmwr/volumes/66/wr/mm6645a2.htm. Publish ed December 17, 2017. Accessed December 2018.

De c e ntr alization of the Phar mac ist to an E ndoc r inology Se r vic e in a Diabe te s We llne ss Ce nte r

L IE UT E NANT ASHL E Y D. DE VAUGHAN, PHAR M.D., M.B.A. PGY-1 PHAR MACY R E SIDE NT , CHOCT AW NAT ION HE AL T H CAR E CE NT E R

30

MENTOR: CHRISTOPHER PACK, PHARM.D., AE-C CLINICAL PHARMACIST & RESIDENCY DIRECTOR, CHOCTAW NATION OF OKLAHOMA

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6/5/2019 1

RECOGNIZE THE IMPACT OF PHARMACIST-LED DIABETES MANAGEMENT ON TREATMENT GOALS

Presented by: LT Kristen Young PGY-1 Pharmacy Resident

1

Mentor: CDR John Bousum, Pharm.D. Clinical Pharmacist, Claremore Indian Hospital Mentor: CAPT Tim Murray, Pharm.D., BCPS-AQ Cardiology, NCPS Inpatient Pharmacy Clinical Coordinator, Claremore Indian Hospital

Disclosure

■ Under guidelines established by the Accreditation Council for Pharmacy Education, disclosure must be made regarding financial relationships with commercial interests within the last 12 months. ■ Kristen Young, John Bousum and Tim Murray have no relevant financial relationships or affiliations with commercial interests to disclose. ■ The opinions expressed in this presentation are those of the author and do not necessarily reflect the views of the Indian Health Service.

2

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6/5/2019 2

Learning Objective

■ At the completion of this activity, pharmacists will be able to: Recognize the impact of pharmacist-led diabetes management on medication adherence and treatment goals

3

Pre-Test Assessment Questions

1. Initiating a pharmacist-led Cardiovascular Risk Reduction Clinic in your facility would: a) Increase access to care b) Allow for closer follow-up times between Primary Care appointments c) Both A & B 2. How often should you have pertinent labs drawn such as A1C and Lipid Panels to assess current therapy optimization? a) Every month b) Every 2 weeks c) Every 3 months 3. Pharmacists play a valuable role in optimizing therapy and achieving treatment goals within diabetes management? a) True b) False

4

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SLIDE 48

6/5/2019 3

Background

■ Diabetes is one of the most common chronic conditions within primary care ■ Complications related to the disease state ■ Evaluate the impact of pharmacist-led cardiovascular risk reduction management in our facility

5

Methods

■ Select Adult Medicine Clinic patients referred to the Cardiovascular Risk Reduction Clinic between August 2018 - October 2018 ■ Initial, up-to-date, baseline labs – Follow-up labs every 3 months or as needed ■ Adjust medication regimen as warranted ■ Provide dietary and lifestyle modification counseling ■ Monitor clinical outcomes ■ Follow-up with patients in-person or via telephone at least monthly

6

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6/5/2019 4

Methods

■ Inclusion Criteria

– Diagnosis of Type 2 Diabetes – Seen by their primary care provider within the 3 months prior to referral

■ Exclusion Criteria

– > 70 years old – A1C < 8.0%

7

Clinical Outcome Changes Observed

■ Primary Outcome

– A1C

■ Secondary Outcomes

– Total Cholesterol – LDL – HDL – Triglycerides – Blood Pressure

8

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SLIDE 50

6/5/2019 5

Results

113 113 C Charts Rev Reviewed

29 p patients r ents receiv ived a ed a cons consult fr from PCP f

  • m PCP for

r CR CRRC w withi thin tim timeframe Phar Pharmacist Intervention ention (n=19) 19) Ac Activ tively ly participat icipated i ed in CRR CRRC (n= (n=14) 4) Lost to to follo llow-up up (n= (n=5) No i interven ention tion (n= (n=10) 0)

84 84 p patients exc exclud uded

9

Results

Hemoglobin A1C

17.6% decrease

Systolic Blood Pressure

3.5% decrease

Diastolic Blood Pressure

10.7% decrease

Baseline ne Follo llow-Up 10.2% 8.4% Base Baseline ne Follow-Up 144 mmHg 139 mmHg Baseline ne Follo llow-U

  • Up

75 mmHg 67 mmHg

10

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SLIDE 51

6/5/2019 6

Results

Total Cholesterol

12.0% decrease

Triglycerides

48.0% decrease

LDL

8.2% decrease

HDL

No change

Basel seline Follo llow-Up 175 mg/dl g/dl 154 mg/dl 54 mg/dl Basel seline Follo llow-Up 306 mg/dl 306 mg/dl 159 mg/dl 59 mg/dl Basel seline Follo llow-Up 85 mg/dl 85 mg/dl 78 mg/dl 78 mg/dl Basel seline Follo llow-Up 44 mg/dl mg/dl 44 mg/dl 4 mg/dl

11

Conclusion

■ Pharmacist led Cardiovascular Risk Reduction Clinic positively impacted clinical outcomes ■ Providing closer follow-up and offering telephone follow-up options for patients was well received and increased access to care ■ An increase in consults to the clinic from our Primary Care team as been seen at our facility

12

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6/5/2019 7

Post-Test Assessment Questions

1. Initiating a pharmacist-led Cardiovascular Risk Reduction Clinic in your facility would: a) Increase access to care b) Allow for closer follow-up times between Primary Care appointments c) Both A & B 2. How often should you have pertinent labs drawn such as A1C and Lipid Panels to assess current therapy optimization? a) Every month b) Every 2 weeks c) Every 3 months 3. Pharmacists play a valuable role in optimizing therapy and achieving treatment goals within diabetes management? a) True b) False

13

Questions

14

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SLIDE 53

6/5/2019 8

References

  • 1. American Diabetes Association. Standards of Medical Care in Diabetes – 2018. Diabetes
  • Care. 2018. 41(Supplement 1):S86‐S104. https://doi.org/10.2337/dc18‐S009.
  • 2. Greer N., Bolduc J., Geurkink E. et al. Pharmacist‐led chronic disease management: a

systematic review of effectiveness and harms compared to usual care. VA ESP project #09‐009: Department of Veterans Affairs; 2015:40‐2. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0088187/pdf/PubMedHealth_PMH 0088187.pdf/ Accessed August 23, 2018.

15

RECOGNIZE THE IMPACT OF PHARMACIST-LED DIABETES MANAGEMENT ON TREATMENT GOALS

Presented by: LT Kristen Young PGY-1 Pharmacy Resident

16

Mentor: CDR John Bousum, Pharm.D. Clinical Pharmacist, Claremore Indian Hospital Mentor: CAPT Tim Murray, Pharm.D., BCPS-AQ Cardiology, NCPS Inpatient Pharmacy Clinical Coordinator, Claremore Indian Hospital

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6/4/2019 1

Medication Utilization Management

INGA D. MERRY, PHARM.D. PHARMACY RESIDENT AT CHEROKEE NATION W. W. HASTINGS HOSPITAL MENTOR: KARI BARRETT, PHARM.D., MBA, BCPS OUTPATIENT PHARMACY DIRECTOR, CHEROKEE NATION W.W. HASTINGS HOSPITAL

Disclosure

 Under guidelines established by the Accreditation

Council for Pharmacy Education, disclosure must be made regarding financial relationships with commercial interests within the last 12 months.

 Inga Merry and Kari Barrett have no relevant

financial relationships or affiliations with commercial interests to disclose

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6/4/2019 2

L e a rning Ob je c tive

 At the c o mple tio n o f this a c tivity, pha rma c ists will b e

a b le to :

 De sc rib e the b e ne fits o f a uto ma te d dispe nsing

c a b ine t re po rt a na lysis o n me dic a tio n utiliza tio n a nd sa fe ty

Pre -Asse ssme nt Que stio n 1

 Why sho uld c o ntro lle d sub sta nc e s b e wa ste d a t time o f

re mo va l?

 A) T

  • ma inta in a so me wha t a ppro pria te inve nto ry

 B) T

  • e nsure the c o rre c t me dic a tio n is b e ing a dministe re d to

the pa tie nt

 C) T

  • e limina te o ppo rtunity fo r dive rsio n

 D) T

  • a llo w fo r te a mwo rk a mo ng the nursing sta ff
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6/4/2019 3

Pre -Asse ssme nt Que stio n 2

 Auto ma te d Dispe nsing Ca b ine ts a re prima rily use fo r:

 A) Ma na g e distrib utio n o f c o ntro lle d sub stanc e s  B) Me dic a tio n inve nto ry a nd a c c e ss re po rts  C) T

  • limit a c c e ss o f me dic a tio ns to a utho rize d sta ff fo r

a dministra tio n to spe c ific pa tie nts

 D) All o f the a b o ve

Pre -Asse ssme nt Que stio n 3

 Me dic a tio n o ve rride s a re a ppro pria te whe n:

(ma rk a ll tha t a pply)

 A) T

he nurse pulle d wro ng me dic a tio n fro m a n o pe n ma trix dra we r a nd wa nts to o b ta in the c o rre c t me dic a tio n

 B) T

he a uto mate d dispe nsing c a b ine t is no t func tio ning pro pe rly

 C) Whe n the pro vide r de c la re s a n e me rg e nt ne e d fo r a

me dic a tio n

 D) I

f the nurse is tire d o f wa iting fo r a me dic a tio n to b e ve rifie d

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6/4/2019 4

Auto ma te d Dispe nsing Ca b ine t (ADC)

Distrib utio n o f pa tie nt spe c ific me dic a tio n Re c o rds e a c h e nc o unte r Mo nito rs wa sting o f c o ntro lle d sub sta nc e s I

nve nto ry o f me dic a tio n

Me dic a tio n Ove rride

 Po ssib le e rro rs Alle rg y Drug -drug Drug -dise a se Wro ng me dic a tio n I

nve nto ry disc re pa nc ie s

 Me dic a tio n dive rsio n

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6/4/2019 5

Me dic a tio n Ove rride

Appro pria te o ve rride

E

me rg e nt a c c e ss to me dic a tio n

E

rro r in pro c e ssing

De la y in ve rific a tio n

ADC Ove rride s

100 200 300 400 500 600 700 800 900 Number of Overrides Months Jul‐18 Aug‐18 Sep‐18 Oct‐18 Mar‐19 Apr‐19

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6/4/2019 6

Co ntro lle d Sub sta nc e Wa sting

 Co ntro lle d sub sta nc e s a dministe re d in pa rtia l

do se s re q uire wa sting

 Wa sting sho uld b e do ne a t time o f re mo va l

fro m ADC

 L

a te wa sting – a ny wa sting do ne a fte r initia l re mo va l fro m the ADC

Co ntro lle d Sub sta nc e Wa sting

 Wa ste a t time o f re mo va l

 Re q uire s a witne ss

 T

ime to wa ste mo nito re d

 Appro pria te vs I

na ppro pria te la te wa ste

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6/4/2019 7

Co ntro lle d Sub sta nc e Wa sting

 Po ssib le issue s with la te wa sting

 Dive rsio n  E

rro r in a dministra tio n

Co ntro lle d Sub sta nc e Wa sting

 Appro pria te la te wa sting

 E

pidura ls

 Pa tc he s  Drips  Pa tie nt Co ntro lle d Ana lg e sia (PCA)

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6/4/2019 8

Re vie w o f L a te Wa ste

0% 2% 4% 6% 8% 10% 12% 14% 16% Percentage of Late Waste Months Jul‐18 Aug‐18 Sep‐18 Oct‐18 Mar‐19 Apr‐19

Po st-Asse ssme nt Que stio n 1

 Why sho uld c o ntro lle d sub sta nc e s b e wa ste d a t time o f

re mo va l?

 A) T

  • ma inta in a so me wha t a ppro pria te inve nto ry

 B) T

  • e nsure the c o rre c t me dic a tio n is b e ing a dministe re d to

the pa tie nt

 C) T

  • e limina te o ppo rtunity fo r dive rsio n

 D) T

  • a llo w fo r te a mwo rk a mo ng the nursing sta ff
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6/4/2019 9

Po st-Asse ssme nt Que stio n 2

 Auto ma te d Dispe nsing Ca b ine ts a re prima rily use fo r:

 A) Ma na g e distrib utio n o f c o ntro lle d sub stanc e s  B) Me dic a tio n inve nto ry a nd a c c e ss re po rts  C) T

  • limit a c c e ss o f me dic a tio ns to a utho rize d sta ff fo r

a dministra tio n to spe c ific pa tie nts

 D) All o f the a b o ve

Po st-Asse ssme nt Que stio n 3

 Me dic a tio n o ve rride s a re a ppro pria te whe n:

(ma rk a ll tha t a pply)

 A) T

he nurse pulle d wro ng me dic a tio n fro m a n o pe n ma trix dra we r a nd wa nts to o b ta in the c o rre c t me dic a tio n

 B) T

he a uto mate d dispe nsing c a b ine t is no t func tio ning pro pe rly

 C) Whe n the pro vide r de c la re s a n e me rg e nt ne e d fo r a

me dic a tio n

 D) I

f the nurse is tire d o f wa iting fo r a me dic a tio n to b e ve rifie d

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6/4/2019 10

Co nc lusio n

 T

he Auto mate d Dispe nsing Ca b ine t is use d to e nsure the c o rre c t me dic a tio n is dispe nse d fo r the a ppro pria te pa tie nt, pro duc e re po rts whic h e va luate e nc o unte rs with the ADC, mo nito r to c o ntro lle d sub stanc e wa sting a nd me dic a tio n

  • ve rride s.

 I

ssue s whic h c o uld re sult fro m la te wa sting - po ssib le dive rsio n o f c o ntro lle d sub stanc e s a nd a c c ide nta l a dministra tio n o f inc o rre c t me dic a tio n to pa tie nt

 Cha lle ng e s a sso c ia te d with me dic a tio n o ve rride s inc lude - la c k

  • f re vie w b y a pha rma c ist, inc o rre c t me dic a tio n withdra wn

fro m ADC a nd e rro rs in inve nto ry.

Me dic a tio n Utiliza tio n Ma na g e me nt

I NGA D. ME RRY, PHARM.D. PHARMACY RE SI DE NT AT CHE ROK E E NAT I ON W. W. HAST I NGS HOSPI T AL MENTOR: KARI BARRETT, PHARM.D., MBA, BCPS OUTPATIENT PHARMACY DIRECTOR, CHEROKEE NATION W.W. HASTINGS HOSPITAL