Strategies for Success

Strategies for Success NYSOMH Quality Improvement Initiative

Overview • Welcome and Introductions • Agency Presentations • Cardiometabolic Risk: Long Island Consultation Center • Polypharmacy: Federation of Organizations • Questions and Answers

Long Island Consultation Center QI Point: Elaine Lederer Executive Director Project: Cardiometabolic Risk

Clinic Structure • Clinic prescribers: 5 part-time psychiatrists (shared with OASAS program) • Medical Director oversees psychiatrists, but they do not meet as a team. • Clients see psychiatrist monthly; individual therapy is weekly. • Clinic census: 642 (OMH program)

Engagement and Communication • With prescribers • Medical Director or QI point met with psychiatrists. • Psychiatrists were receptive to information about improving prescribing practices. • Reviewed both polypharmacy and cardiometabolic; chose cardiometabolic. • With leadership • QI point reports to the Board of Directors.

Project Structure • Identification of positive cases • PSYCKES reports were printed by the QI point. • A memo and form were placed in the client’s chart to be completed by psychiatrist every time a case was identified. • Clinical review and medication change • Psychiatrist would discuss options with client. • If switching, psychiatrist would begin a cross-taper. • Clients would be seen bi-weekly (when indicated) during the cross-taper.

Project Structure (cont.) • Tracking and follow-up • QI point would pull chart after a visit to see completed form. • QI point reviewed all positive cases with Medical Director at the end of each month.

Tools- Memo to Prescribers

Tools- Review form for Prescribers

Integration into Workflow • Therapists were aware of project; knew to look for signs of relapse. • CQI project was reviewed in supervision meetings. • Therapists read psychiatrist notes; psychiatrists read therapist notes as well. • Therapists alert psychiatrist to significant clinical changes via an "alert" form.

Summary • All positive cases were reviewed • Cross-taper is an effective method for switching medications • Well-received by clients • Ongoing monitoring of high-risk patients • Involved team approach with therapists • Active follow-up for “no-shows”

Next Steps • Screen for positive cases on intake • Expand to OASAS program • Expand to non-Medicaid recipients

Federation of Organizations QI point: Lisa Weiss, LMSW Corporate Compliance Officer and Director of Quality Management Project: Polypharmacy

Clinic Structure • Clinic is located within an adult home. • Clinic Prescriber: 1 psychiatrist, averages 7 hours per week. • Clients see psychiatrist once every 4-8 weeks (every 6 weeks on average). • Social Workers and RN’s facilitate group therapy • Clinic census: varies between 96-100

Engagement and Communication • With prescribers • Polypharmacy project was chosen during a collaborative meeting with the QI point, Chief Medical Officer (CMO), and psychiatrist. • Prescriber has attended CQI Committee meetings • With leadership • QI point had support of CMO, CEO, COO. • QI point reports at senior management meetings and executive meetings; submits monthly reports to the Board. • Agenda item at monthly Consumer Advisory Board meetings.

Engagement and Communication (cont.) • With staff • Program Manager discusses CQI Project quarterly at Provider Meetings (adult home staff and federation staff). • Regular agenda item at weekly clinic staff meetings. • Clinical case conferences occur on a weekly basis between prescriber, clinic supervisor, and RN. • Case management staff also receive notice of medication changes. • With consumers • Bulletin Board posted at clinic with pertinent CQI Project information.

Identification of positive cases QI point printed reports from PSYCKES for psychiatrist. QI Team/clerical staff verified data from PSYCKES by creating excel spreadsheet of all clients with their medication by class; updated monthly and distributed to team QI Team/clerical staff conducted chart reviews and reviewed medication and progress note documentation. Clinical review Psychiatrist and therapist discuss options with the client. Weekly case conferences between psychiatrist, clinical supervisor, social worker, and RN. Psychiatrist documented rationale in the client’s chart if determined that polypharmacy is necessary. Project Structure

Project Structure (cont.) • Tracking and follow-up • QI point reviews positive cases with CMO and psychiatrist on an ongoing basis. • CQI Committee meets monthly in person or via conference call and discusses progress and changes in all positive cases. • CMO and QM Department reviews documentation of psychiatrist re: medication changes/rationale for such. • Team members assist prescriber with accessing PSYCKES.

Integration with Workflow • Initially identified positive cases only through PSYCKES; now, identify additional positive cases at intake and at time of service planning. • Created a form for case conferences with prompts. • See slide. • Amended sheets for physician’s progress notes with prompts. • See slide.

Tools- Clinical Case Conference Note

Tools- Prescriber Progress Note

Summary • Used a top-down approach for engagement • Identified a cohort of positive cases via PSYCKES • Intake and service planning time • Team effort to review positive cases • Educated CMO who assisted in engaging prescriber • Team effort to choose indicator • Team meets monthly; prescriber periodically attends; all members to review PSYCKES data. • Clinical case conferences and chart reviews • Documentation a priority • Developed new forms and tailored existing forms in order to integrate best practices into routine clinic operations • Results

Next Steps • Continue screening for positive cases at intake and service planning • Continue to enhance communication among staff (prescriber, case managers, QI team, therapists, adult home staff) • Consider expanding to other OMH licensed programs

Questions and Answers

Strategies for Success