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Ashika Maharaj/Gill Robb

Ashika Maharaj/Gill Robb. Improvement Science Professional Development Program Tackling Opioid-related Harm. Global Trigger Tool (GTT). Systematic methodology for quantifying patient harm using a targeted chart review process Adverse Drug Event Trigger Tool (ADE TT) subset of GTT

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Ashika Maharaj/Gill Robb

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  1. Ashika Maharaj/Gill Robb Improvement Science Professional Development Program Tackling Opioid-related Harm

  2. Global Trigger Tool (GTT) • Systematic methodology for quantifying patient harm using a targeted chart review process • Adverse Drug Event Trigger Tool (ADE TT) subset of GTT • Developed by IHI 2003

  3. Definition of Harm • ‘Unintended physical injury resulting from or contributed to by medical care that requires additional monitoring, treatment or hospitalisation or that results in death’ • Reference: White Paper: IHI Global Trigger Tool for Measuring Adverse Events 2009

  4. Harm Category

  5. Background • Revelations from 2011 ADE data: • 30% of medication-harm related to Opioids • 23% of this was Constipation • Risk highest on surgical wards • Forum to discuss findings (mid 2012) • Retrospective detailed analysis of a surgical ward requested

  6. Pareto Chart of Harm 2011

  7. New Data Collection Tool

  8. Baseline Data N = 131 Opioids = 114 Harms = 49

  9. Results: Focusing on Constipation

  10. Opioids implicated in Harm

  11. Projects identified Project A Tackling high rate of opioid-related constipation Project B Tackling opioid-related oversedation

  12. Aim (Project A) To reduce Opioid related constipation on Ward 10 (combined surgical ward) from 30% to 15% by 1 July 2013

  13. Driver Diagram

  14. Change Concepts & Ideas for PDSAs

  15. Measures

  16. Team established Phase 1: Bowel monitoring (implemented) Phase 2: Charting and administration Phase 3: Patient Experience Retrospective analysis Next steps (Project A)

  17. Examples 89 year old patient was admitted due to R) femur fracture following a fall. His bowels did not open for seven days whilst on the ward secondary to regular oxycodone, fentanyl, and morphine. He required several interventions including laxatives and fleet enema.

  18. Examples 35 year old was admitted to orthopaedics after developing lower back pain in medical ward. Cause was not identified, however, patients bowel had not moved for five days. She was on regular morphine for pain. It was only after she complained that laxatives and enemas were offered and her bowels opened.

  19. Examples Other DHB(worst case scenario): Patient passed away suddenly and unexpectedly shortly after admission to the Surgical Unit. The cause of death was ascertained by the coroner to be due to bowel ischaemia (from constipation) and that morphine could not be excluded as a contributing factor. Patient had also been on clozapine.

  20. By Gill Robb

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