Resolving Patient Safety Issues Related to Methadone Maintenance Clinics

1. Resolving Patient Safety Issues Related to Methadone Maintenance Clinics Shirley Lesieur and Nancy R. Smestad Pharmacist Consultants OHI IT Patient Safety April 27, 2010

2. Objectives • Identify the importance of methadone treatment medication orders as a component of CPRS • Define the methodologies utilized to notify health care staff of methadone treatment enrolled patients • Discuss the importance of a VistA interface between methadone COTS software and CPRS • Share topics for discussion and a few lessons learned

3. Initial Report • Methadone Treatment Clinic and Reported Scenario • Overview of the event • How did this occur? • Why did this occur? • Role of Technology in the solution

4. Areas of Concern • Methadone COTS software – Interface with CPRS • Medication Reconciliation • Accurate Medication Management for methadone treatment patients

5. Preliminary Screening • Type of methadone software • Utilization of the methadone software • Documentation of methadone clinic patient in CPRS • Methadone clinic medication documentation in CPRS • Copays ?

6. Methadone Maintenance Clinics • Number of Clinics • VA Clinic versus Contracted Clinic • Clinic Design

7. Questionnaire • Development of Questionnaire • Types of information gathering questions • Request for screen captures and/or station guidelines

8. Methadone Clinic Setup

9. Case Study • Opioid Treatment Program and TJC • Recommendation for Improvement (RFI) • Addiction Management System(AMS) • Local Policy

10. PRO’s and CON’s • Outpatient Prescription • CPRS Order with Priority = DONE • Non-VA Meds

11. Facility Visit • Team Members • IT Patient Safety Role • Visit Objective • Visit Synopsis • Vulnerabilities Identified

12. Facility Visit Recommendations • NCPS Alert • Mental Health Software and Hardware • CPRS documentation

13. Post Methadone Clinic Visit Action Items • Best practice recommendation to inform practitioner’s of Veteran’s active enrollment in the methadone clinic in a readily noticeable way • Best practice recommendation for entry of methadone clinic orders into CPRS • Best practice recommendation for sequence of order placement and appropriate personnel roles

14. NCPS Notification: Patient Identification • Use of Clinical Reminder • Category II Patient Record Flags

15. NCPS Notification: Medication Entry • Inpatient Meds for Outpatient (Clinic Orders) • Outpatient Prescription • Non-VA Meds • Documentation Responsibility & Timeliness

16. Methadone Clinic Order Documentation Options

17. Methadone Medication Management • Opioid Medication Accountability • Medication Reconciliation • Patient Safety Caveats

18. Patient Safety Alert Documentation Results • Clinical Warning • PRF Cat II • Problem List • Reminder Dialog • CPRS Coversheet Med List • 2 • 8 • 1 • 1 • 3

19. Patient Safety Alert Medication Compliance Results • Outpatient Prescription • Inpatient Meds for Outpatient • Non-VA Meds • 7 • 2 • 4

20. Questions