2.11 Conduct Medication Management

1. 2.11 Conduct Medication Management University Medical Center Health System Lubbock, TX Jason Mills, PharmD, RPh Assistant Director of Pharmacy

2. Project Options • 2.11.2 Evidence-base interventions that put in place the teams, technology and processes to avoid medication errors. This project option could include one or more of the following components: • a) Implement a medication management program that serves the patient across the continuum of care targeting one or more chronic disease patient populations • b) Implement Computerized Physician Order Entry (CPOE) • c) Implement pharmacist-led chronic disease medication management services in collaboration with primary care and other health care providers • d) Conduct quality improvement for project using methods such as rapid cycle improvement.

3. Rationale • Approximately 1.5 million preventable ADEs occur annually as a result of medication errors • Cost more than 3 billion per year • 1 in 5 patients discharged from hospitals suffers an adverse event • 72% are related to medications • 76% of Medicare readmissions in 2007 were potentially preventable • 13-15 billion in readmission costs may be preventable • Pharmacist-provided medication therapy review and consultation in various settings resulted in reductions in physician visits, ER visits, hospital days, and overall health care costs • Uniquely positioned to help increase medication safety and compliance in patients across the continuum of care

4. Rationale • Diabetes is a complex, increasingly common chronic condition that remains one of the most serious health problems in Lubbock County and Texas • 6th leading cause of death in Texas • 21.9% of adult diabetics do not have health insurance in Texas • Lubbock BRFSS data indicate that 10.7% have diagnosed diabetes • Death rate from diabetes in Lubbock is 38.6/100,000 compared to 26.5/100,000 in Texas • Approximately 1.8 million adult Texans have type 2 diabetes and 460,000 are undiagnosed • 4th leading cause of death for African Americans and Hispanics • One study found that a decrease in diabetes medication adherence resulted in a 58% increase in hospitalizations and 81% increase in all-cause mortality

5. Project Description • Provide medication management for adult diabetes mellitus patients across the continuum of care • Age 18 and older • Approximately 5000 total patient visits per year with about 1000 visits being Medicaid or uninsured • Establish a patient-centric medication management program that includes the following components: • Written medication management plan focused on medication safety • Clearly defined roles for interdisciplinary participants • Process and criteria to screen for adult diabetic patients • Standardized medication reconciliation process and counseling by a pharmacist • Utilization of patient friendly education and medication management tools • Patient access to outpatient prescriptions on site at UMC Outpatient Pharmacy • Targeted post-discharge follow-up

6. Project Process • Population-based screening • Identify targeted adult diabetic population • Admission assessment • Best Possible Medication History (BPMH) • Compliance • Lack of efficacy • Adverse drug effects • Discharge counseling • Comprehensive review of discharge medication list and counseling by a pharmacist • Individualized patient education • Comprehension of medication instructions and therapy plan • Coordinate the filling and delivery of discharge prescriptions to the patient’s room • Post-discharge Follow-up • Phone call by a pharmacist • Assess compliance, identify ADEs, and answering any patient questions

7. Project Goals • Project Goals • Reduce medication errors and adverse drug events • Increase adherence to an appropriate medication regimen • Cost saving to the health system • Provide access to outpatient medications • Decrease unplanned visits to the ER • Decrease hospital’s diabetes 30 day readmission rate (IT-3.3) • Improve patient satisfaction regarding issues and questions about their medications • Regional Goals • Improve access to care and medications • Address the high incidence of diabetes mellitus • Provide a specialist to assist in the treatment of diabetes mellitus

8. Expected Outcomes • DY2 (10/1/12 – 9/30/13) • Develop criteria and identify targeted patient populations • Develop written medication management plan • Implement an evidence based program based on best practices for medication reconciliation to improve medication management and continuity between acute care and ambulatory setting • DY3 (10/1/13 – 9/30/14) • 20% or about 1000 patients receive medication management therapy • DY4 (10/1/14 – 9/30/15) • 40% or about 2000 patients receive medication management therapy • DY5 (10/1/15 – 9/30/16) • 60% or about 3000 patients receive medication management therapy

9. Challenges • Complex disease state and co-morbidites • Engagement and education of patients • History of poor medication compliance • Lack of understanding of the severity of their disease state • Collaboration with other services and departments • Case Management • Social Services • Nursing • Physicians • Pharmacist education and training • Pharmacist staffing • Hospital census

10. CQI • Pharmacy medication management team meets internally at least every two weeks • Lessons learned • Project impacts • Challenges • Pharmacy medication management team meets with IT monthly to discuss issues and improvements • Pharmacy medication management team meets routinely with case management, social services, and nursing • Medication errors, ADEs, and compliance are continuously monitored for trends and areas of improvement

11. June 1, 2013- March 22, 2014

12. October 1, 2013-March 22, 2014

13. Readmissions