medication safety- initiatives in support of promoting ... safety... · 11/4/2015 1 medication...

11/4/2015

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Medication SafetyInitiatives in Support of Promoting

Patient SafetyCOL Gwendolyn Thompson, PharmD, MPA, BCPS

Medication Safety ManagerHQ, US Army Medical Command

Keith Trettin, RPh, MPAProgram Manager

VA National Center for Patient Safety

CPE Information and Disclosures

The American Pharmacist Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

COL Gwendolyn Thompson and Keith Trettin declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.

CPE Information

• Target Audience: Pharmacists & Technicians

• ACPE#: 0202-0000-15-212-L05-P/T

• Activity Type: Knowledge-based

Learning Objectives

1. Describe the impact the Department of Veterans Affairs’ (VA) Prescription labeling initiative had on patient safety.

2. State collaborative Department of Defense (DoD) initiatives that improved safety and quality of care.

3. Discuss DoD policy changes that have been made in support of patient safety.

Self-Assessment Question 1

Name the first initiated policy from Defense Health Agency to standardize pharmacy practice across the Military Health System.

A. TRICARE FOR LIFE

B. Prescription Transfer

C. Polypharmacy

D. Sole Provider


Name the pilot project which utilized the TriService Workflow (TSWF) Clinical Pharmacy form to show economic and clinical outcome.

A. Polypharmacy Project

B. Medical Management Project

C. Medication Therapy Management Project

D. Essentris Update Project

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DoD Medication Safety Initiatives

• Defense Health Agency (DHA) Policy

• Programs– TriService WorkFlow (TSWF) Form

– Medication Therapy Management (MTM) Pilot Study

– Esssentris Updates

– Medical Management Advisory Board (MMAB)

– Extension for Community Healthcare Outcomes (ECHO)

– Polypharmacy Medication Analysis and Reporting Tool (MART)

– Electronic Prescribing (eRx)

– DoD Electronic Health Record (EHR)

MHS Prescription Transfer Policy

• July 1, 2014

• Move prescriptions between military and civilian pharmacies

• First initiative between Defense Health Agency (DHA) and military surgeon generals

• Standardized pharmacy practice across MHS

• TriCare for Life Pharmacy Pilot Program– 500,000 beneficiaries impacted

– Move maintenance medications to either retail or home delivery

TriService Workflow (TSWF) Forms

• Core– Nursing Services

– Pediatrics

– Procedures

• Clinical Practice Guideline (CPG)-Based– Chronic Opioid Therapy

– Cardiovascular

– Low Back Pain

– Metabolic Disorders

– Pulmonary Disorders

• Behavioral Health– Behavioral Health

– Integrated Behavioral Health Care

• Miscellaneous– Case Management

– Clinical Pharmacy

– In/Out Processing

– Population Health Portal

– Separation History and Physical

Core and CPG forms are all Copy Forward compatible

TriService WorkFlow (TSWF)Clinical Pharmacy AIM Form

• Simplify workflow

• Standardize patient encounters

• Capture clinical and economic outcomes

• Enhance Medication Therapy Management

• Quantify value of PharmD

• Easy access to clinical decision-making resources

• Maximize patient compliance

• Improve patient safety

TSWF Clinical Pharmacy Tab

• Intervention Type

– Continue medication

– Initiate new medication

– Initiate consult

– Modify dose and/or schedule of medication

– Discontinue medication

• Reason

– Lack of effectiveness

– Side effects

– Allergy/adverse drug reaction

• Non-medication Changes

– Preventive health measure

– Diagnostic or monitoring test

• Disease State Management

– At Goal

– Not-at-Goal

– Referred

• CPG links

– Dyslipidemia CPG

– VA/DoD CPGs

– Heart Failure CPG

– Tobacco Use Cessation CPG

Medication Therapy Management (MTM) Pilot Project

Count and percent of clinical pharmacist encounters using TSWF Clin Pharm AIM Template, 1 Apr 2014-31 Mar 2015

TAMC Army Air Force Navy NCR Total

Total Number of encounters

24,106 153,761 55,669 52,901 31,479 293,810

% of Total Encounters

52% 19% 18% 11% 100%

% Encounters using TSWF Clin Pharm Template

96% 68% 20% 46% 52%

Thanks to COL Cheryl Filby, LTC Mark Maneval, Dr. Brian White and the Clinical Pharmacy team at Tripler Army Medical Center (TAMC), HI

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Pharmacist intervention counts and costs avoided at Tripler Army Medical Center,1 April 2014 through 31 March 2015

Pharmacist Medication Therapy Interventions

Cost Avoided # Interventions Total Cost Avoided

Allergy/adverse drug reaction $675 91 $61,390 Therapeutic duplication $170 209 $35,511 Drug-drug interaction/contraindication

$399 343 $136,847 Drug-disease interaction/contraindication

$399 73 $29,125 Drug not indicated (inappropriate therapy)

$92 175 16,079Modify medication dose and/or schedule

$364 3,917 $1,424,730 Initiate new medication $1,861 2,339 $4,353,955

Totals $6,057,637 Costs avoided $6,057,637 Investment $1,385,417 Return on Investment 4.4


** Assumes average HbgA1C goal < 70


Clinical Outcome Improvement in Diabetics Seen by PCMH Clinical Pharmacists Over 1 Year, TAMC 1Apr14- 31 Mar15

All Diabetics who were not a CPG Goal and had opportunity to improve

Subset of All Diabetics who Achieved CPG Goal

# of Diabetic Pts 364 121Baseline Hgb A1C (avg) 8.7 8.1Follow-up Hgb A1C (avg) 8.0 6.9Absolute Hgb A1C reduction (avg)

0.7 1.2

Avg Absolute HgbA1C Reduction Needed to Achieve Goal

1.7 1.1

% Closure of HgbA1C to Goal ** 41% (=0.7/1.7) 100%% of Pts Achieving CPG Goal 33%

ESSENTRIS 3.0Pharmacy Metrics

• Intervention Type– Chart review

– Consultation

– Continue medication

– Discontinue medication

– Initiate new medication

– Medication recommendation

– Non-medication recommendation

– Modify dose/route/ form/

frequency and/or

duration of medication

• Intervention Reason– Adverse drug reaction

– Allergy

– Clarification of orders

– Drug information

– Drug-Disease interaction

– Drug-Drug interaction

– Drug-Food interaction

– Education/counseling

– Lack of effectiveness

– Medication reconciliation

– Parenteral nutrition

ESSENTRIS 3.0Pharmacy Update

• Reason for Note

– Antimicrobial stewardship

– Other (MTM, Hem/Onc,

Pain management)

– Pharmacotherapy

– PDF file upload

• Displays 500 patients/page

• Unit census, patient, clinical information

• Admit date

• # of Orders and # of STAT

• Pharmacy comments

• Tech comments

• RN comments

• Discharge med status

• Admit MedRec reviewed

• Discharge MedRec reviewed

• Status Board• Precaution• Command Interest• Height (in or cm)• Weight (kg)• Serum creatinine

• Pharmacy Workload Report

– Lists patients by discharge diagnosis

– Clinical Services education

• Medication reconciliation

• Discharge education

• Medication compliance

• Discharge interventions

– Outcome data

• Adverse events during or after hospitalization

• Readmission w/i 30 days

Essentris 3.0Pharmacy Updates- Reports

• Real Time Reports

– Anticoagulation

– Master

– Renal

– Utilization- top 100

– Utilization- provider

– Workload

Medical Management Advisory Board (MMAB)

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TSWF Disease Management

• Referral reason

– Asthma

– Diabetes

– Chronic obstructive pulmonary disease (COPD)

– Coronary heart disease (CAD)

– Heart Failure

• Referral reason

– Depression

– Anxiety

– High blood pressure

– Obesity

– Hyperlipidemia

– Pain

– Other

• Referral from

– PCM

– Case management

– Self referral

– Behavioral health

• Level of referral

– Inpatient

– Post inpatient

– Post ER

– Outpatient

– Post rehab

TSWF Disease Management

• Co-Managing Team

– Bariatric surgery

– Behavioral health

– Cardiology

– Chaplain

– Endocrinology

– Exercise physiology

– Family advocacy

– Lifestyle modification class

– Neurology

• Co-Managing Team

– Nurse case management

– Nutrition

– Pain Management

– Pharmacy

– Pulmonology

– Rheumatology

– Vascular surgery

– Sleep study

– Social work

– Wellness center

• Type of encounter– Initial assessment

– Post-hospital assessment

– Continuation of care

– Completion/PCM notification

– Post-completion

• Activities of daily living– Ambulation

– Bathing

– Eating

– Dressing

– Toileting

– Transferring

• Asthma– Severity level

– Actionable data

– Self-management education

– Precipitating factors

– Impact of disease

– Goals

– Interim goals

– Goals for next visit

• Asthma education– Pathophysiology

– Triggers

– Treatment

– Emergency treatment indicators

– Lifestyle impact

– Symptom Prevention and Lifestyle Modification

– Meter-dose inhalers

TSWF Disease ManagementExtension for Community

Healthcare Outcomes (ECHO)

• Knowledge-sharing networks

• Led by expert teams

• Virtual training to a learning community

• Mentoring and feedback from specialists

• Exponentially increases specialty treatment

• Reduces health disparities

Extension for Community Healthcare Outcomes (ECHO)

Clinical Pharmacy Anticoagulation Note

Oral Anticoagulation Management

Chronic Disease States Group and Individual Visits

Incorporating the Clinical Pharmacy Technician into Workflow to Meet Polypharmacy Review Goals

Patient Centered Medical Home (PCMH) Pharmacist

Developing the PCMH/Soldier CMH Pharmacist Practice

TriService Workflow (TSWF) Clin Pharm AIM Form

MHS Population Health and CarePoint Overview

Sole Provider

Standardized Coding

Polypharmacy Medication Analysis & Report Tool (Poly-MART)

• Identify enrolled members for direct care

• Comprehensive prescription data from MTF, Mail Order, and Retail network

• Analysis of data to identify high risk individuals

• Report generated monthly

• Email sent when monthly database available

DHA Pharmacy Operations Division (POD) and Pharmacy Analytics Support Section (PASS)

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Polypharmacy and Clinical Pharmacy Technician Documentation

Thanks to Sal Tranam, CPhT and Dr. Jennifer Evans, Kimbrough Army Community Clinic

• Asutype Short Code

• Telephone consult for medication review

– Polypharmacy (Bucket 5)

• History of Present Illness

– Patient was identified by DHA Pharmacy Operations Division generated report base on M2, PDTS prescription data and meets the polypharmacy criteria for:

Opioid Prescription Use (4 or more medications)

Multiple Psychotropic and/or CNS Depressant

Prescriptions

Utilization of Care (3 or more ED visits involving opioids)


Thanks to Sal Tranam, CPhT and Dr. Jennifer Evans, Kimbrough ACC

• Asutype-Select Choices Spoke with patient

Doing well, no questions or concerns at this time

No side effect related issues

Completed treatment, reviewed appropriate disposal of any excess medication

Provided clinical pharmacy service contact information if needed for follow-up

Left a message for patient with clinical pharmacy contact information

Unable to reach patient, with multiple attempts


Thanks to Sal Tranam, CPhT and Dr. Jennifer Evans, Kimbrough ACC

• Asutype – Variable Value

– Enter date/time of scheduled appointment.

• 16 Nov 2015 @ 1400

• Asutype Note

– Spoke with patient. Doing well, no questions or concerns at this time. No side effect related issues. Completed treatment, reviewed appropriate disposal of excess medication. Provided clinical pharmacy service contact information if needed for follow-up. Appointment scheduled with clinical pharmacist for 16Nov15@ 1400 located in Green Clinic.

Electronic Prescribing (eRx)

• Meaningful Use Objective Stage 1

– Generate and transmit permissible prescriptions electronically (eRx)

• Measure

– Greater than 40% of all permissible Rxstransmitted electronically

• Permissible prescriptions

– Restriction by Dept of Justice on electronic prescribing for controlled substances in Schedule II-V

– Any Rx not in restriction is permissible

• MHS deployment completed

December 2014

Stage 1Data capture and

sharing

Stage 2Advance clinical

processes

Stage 3Improved outcomes

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/4_e-prescribing.pdf

Electronic Prescribing (eRx)

• Allows civilian providers to electronically transmit prescriptions to military pharmacies

• Convenient option for providers and patients

• Supports current industry standards

• Supports eRx today and in the future (EHR solution)

•CHCS Rx•“Automatic Creation”

PDTS•CHCS

Civilian Prescriber

Defense Health Agency, Pharmacy Operations Division (POD)

NormalWorkflow

Trends in eRX as a % of Civilian Scripts by Service: January - July 2015

New eRX script counts from Emdeon. New civilian script counts from CHCS as of 8/17/15. Limited to consolidated sites with >200 civilian scripts per month.

10.0%

15.2%

18.3%

20.9%22.7%

24.4%25.8%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Jan Feb Mar Apr May Jun Jul

Air Force % Army % Navy % DHA‐NCA % Overall %

Defense Health Agency, Pharmacy Operations Division (POD)

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DoD Awards Cerner, Leidos, Accenture Electronic Health Record (EHR) Contract

• $35 million obligated at time of award

• 2 year initial contract

– $4.3 billion

• 10 year contract period

– 2 additional three-year options

– 2 year award term

– Valued at $9 billion

• Completion by Sep 2025

• Deploy to 1,000 DoD sites

– 55 hospitals

– Over 600 clinics

• Replaces over 50 legacy systems

– Transition plans differ

• Implementation to take 6-7 years

• Deployment and testing

– 8 MTFs in Pacific Northwest

– Running by end of 2016

• Accenture– Federal health insurance

• Cerner– MHS laboratory contract

• Leidos– 2014, won $70 million

bridge-contract to support AHLTA and CHCS

– Science Applications International Corporation (SAIC)

• Minimum modification

• Interoperability with private sector systems

• MHS right to software and technical data

DoD Awards Cerner, Leidos, Accenture Electronic Health Record (EHR) Contract

Key Points

• Resources available to aid in keeping patient safe

– Several advances in technology to assist us in our workflow process

– Subject matter experts willing to collaborate and share their practices

– Pharmacy analytic support team to provide data analysis

Answer to Self-Assessment Question 1

Name the first initiated policy from Defense Health Agency to standardize pharmacy practice across the Military Health System.

A. TRICARE FOR LIFE

B. Prescription Transfer

C. Polypharmacy

D. Sole Provider


Name the pilot project which utilized the TriService Workflow (TSWF) Clinical Pharmacy AIM form to show economic and clinical outcome.

A. Polypharmacy Project

B. Medical Management Project

C. Medication Therapy Management Project

D. Essentris Update Project

Closing Remarks

COL Gwendolyn Thompson, PharmD, MPA, BCPS

Medication Safety ManagerHQ, US Army Medical Command

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Medication Safety- VA Prescription label Initiative

Keith W. Trettin R.Ph., MBAProgram Manager

VA National Center for Patient Safety

Learning Objectives

Pharmacist and Pharmacy Technician Learning Objective:

• Describe the impact the Department of Veteran Affairs Prescription labeling initiative had on patient safety.


Why did the VA evaluate the format of their prescription labels?

A) Veteran Service organizations asked the VA to make the font size larger.

B) The to make DOD and VA Prescription labels look the same.

C) VA NCPS received 100’s of incident reports indicating the Veterans could not correctly interpret their prescription labels.

D. Make the label format consistent with local retail pharmacies.


Veterans feel which of the following is the most important information on the prescription label?

A) Refill Information

B) Pictures (relating to take w/food, etc.)

C) Dosage instructions

D) Doctors Name


Veterans and VA Pharmacy Staff prefer the following information at the top of the RX Label.

A. Pharmacy Name

B. Directions for Use

C. Veteran’s Name

D. Drug Name

Test Your Knowledge

• HOW MANY PRESCRIPTIONS DOES THE VA FILL DAILY?3,917

39,170

391,700

3,917,000

Too many to count.

VA 391,700 DOD 365,196 *VHA Statistics FY 13

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VA RX Benefit! FY13

24 Million Vets, 4.87 Million used RX benefit. DOD 7.1 Million

142,986,291 VA OP Rx filled at a cost of $3.3 B

60M in 1995. DOD 133 Million

CMOPs filled 77% of all VA Rxs DOD8%

7,276 Pharmacist and 4,149 Pharmacy Techs are employed by VA.

VA Rx labels are not standardized.

Rx#Patient Name

Patient NameRx#

Health Literacy, and Prescription labels, Why should we be concerned?

• 12% of adults have proficient health literacy and can interpret a Rx label correctly! AHRQ Pharmacy Health Literacy Center

• 30% of patients inadequate health literacy were able to state how many pills of a prescription should be taken. *

• 54% of patients can interpret primary label Wolf, et al. Ann Intern Med

2006

• 75% of patients with inadequate health literacy were able to correctly state how to take a medication four times a day!*

*Williams MV, Parker RM, Baker DW, et al. Inadequate functional health literacy among patients at two public hospitals. JAMA. 1995; 274:1677-1682

Others have Identified a need for a patient centric label

• American College of Physicians Foundation (ACPF) 2007“ Improving Prescription Drug Container labeling in the United States” http://www.acpfoundation.org/files/medlabel/acpfwhitepaper.pdf

• NABP “Report of the Task Force on Uniform Prescription Labeling Requirements.” Dec 2008

http://www.nabp.net/ftpfiles/NABP01/08TF_Uniform_Presc_Labeling_Req.pdf

• USP,”Standardizing Medication Label, Confusing Patients Less” 2008

http://www.nap.edu/catalog.php?record_id=12077

• NABP Model State Act, Aug 2009http://www.nabp.net/index.html?target=/annualmeeting/CTFR.asp&

Adherence With Medications Associated with Improved Outcomes

STATINSs ACEI Beta blockers

P. Michael Ho, et al. Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease American Heart Journal Vol. 155, Issue 4, Pages

772-779

Ho et al; Am Heart J 2008

ACEI BETA BLOCKERS

Nonadherence causes $100 Billion in annual wasteful health care spending*

Aren’t VA Labels Clear Already?

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NCPS Database

• 644 Cases involving Rx + label 2000-2011

DOD 2659 Cases of OP Mislabeling Event Reports. FY09-Sept 11.

– “Glyburide 5mg tablets take two tablets by mouth twice a day ( half an hour before a meal )” . Prescription written for glyburide 10mg BID AC. Patient misunderstood directions and was taking his glyburide before every meal three times a day resulting in hypoglycemia. Label changed to read twice a day half an hour before breakfast and dinner.

– "Take one tablet by mouth every day for heart give x 2 doses only (start 8 hours after the initial 250mcg now dose is given). Asked pt how he was taking his digoxin and pt reported "twice daily just as the label says".

• 1229 Cases involving ½ tablet incidents2005-

2009

– “Take one half tablet daily for blood pressure”. Pt called the pharmacy stating he would run out of lisinopril before the refill date. The prescription was for lisinopril 10mg tablet, In talking to the pt it was found he had been taking a whole tablet instead of splitting the tablet and taking only one half daily. The pt was instructed to take just half of the tablet for each dose.

446 Veterans at 11 Survey Sites & 697 Pharmacist/ Technician Participated

Prescriber

Typical VA Prescription Label

Patient name

Directions for use

Drug name

“Use by” Date

Pharmacy name & phone #

“Fill Date”

Rx #

Drug Qty

# Refills

Product Description

Fed/State Cautions

Refill number

66% of respondents were satisfied with their current label!

Aux Info

Vets Don’t read the Rx label Everytime

VETERANS REFERENCED INFORMATION ON THE PRESCRIPTION LABEL

Never Once Sometimes Every time

Drug name 1% 10% 17% 72%

Instructions 1% 17% 27% 55%

Veteran’s name 4% 25% 15% 56%

Doctor’s name 8% 28% 29% 35%

Tell what this picture means.




Chew before swallowing

Do not refrigerate.

Dissolve in full glass of

water.

Avoid the sun while taking

this medicine.

Test Your Knowledge

Veterans rated pictures as the LEAST Understood & LEAST Important part of the Rx label.

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Test Your KnowledgeHow many do you take in a day?

If you said “1” you and 42% of Veterans Answered Correctly

NUMBER OF PILLS IN 1 DAY

% of respondents

One 42%Two 3%

Three 38%Depends on how many meals I eat 13%

Don’t know 4%

More words do not always increase understanding.

Prescription label Grade level to understand*

Take one capsule by mouth three times a day for pain. 1.5

Take one capsule by mouth three times a day for pain and spasticity. 4.9

Take one capsule by mouth three times a day for pain and spasticity. (Approved by Chief of staff)

6.5

Take one tablet by mouth at bedtime and take one tablet at bedtime as needed. 5.9

Take one tablet by mouth at bedtime and take one tablet at bedtime as needed for depression & mood.

7.8

* Flesh-Kincaid Grade Level as determined by Microsoft Word® Version 2007

WHAT VETERANS IDENTIFIED AS MOST IMPORTANT

Patient name

Directions for use

Drug name

“Use by” Date


Prescriber

“Fill Date”

Rx #

Drug Qty

# Refills

Product Description

Fed/State Cautions

Aux Info

Refill number

N= 446Not

Important2 3 4

Very Important

Dosage instructions 1 1 1 9 88Drug name 1 1 3 10 85

Veteran’s name 2 2 6 7 83Fill number (2 of 3) 3 3 6 16 72

Number of refills left 2 3 6 18 71Rx number 7 4 7 11 71

Quantity of pills 2 3 11 21 63Filled date 4 4 10 20 62

VAMC phone number 6 6 9 18 61Discard date 7 10 12 16 55

Written warnings (take w/food, etc.) 4 5 15 22 54

Doctor’s name 5 6 16 21 52Description of pills (shape, color) 7 8 14 21 50

VAMC facility name 11 12 13 18 46Pictures (relating to take w/food,

etc.)17 12 18 16 37

% VETERAN IMPORTANCE OF LABEL INFORMATION

WHAT PHARMACY STAFF IDENTIFIED AS MOST IMPORTANT

Patient name

Directions for use

Drug name

“Use by” Date


Prescriber

“Fill Date”

Rx #

Drug Qty

# RefillsProduct Description

Fed/State Cautions

Aux Info

Refill number

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N=697Not

Important2 3 4

Very Important

Patient name 2 1 2 3 92Drug name 1 1 2 5 91

Dosage instructions 1 2 2 4 91Quantity of pills 1 1 5 14 79

Rx number 4 4 13 16 63Doctor’s name 5 4 13 20 58

Filled date 4 7 13 25 51Description of pills (shape, color) 4 7 17 22 50

Written warnings (take w/food, etc.) 7 7 17 20 49Fill number (2 of 3) 6 9 19 27 39

Number of refills left 10 10 19 25 36VAMC phone number 21 16 14 13 36

Pictures (relating to take w/food, etc.) 15 14 21 18 32VAMC facility name 16 19 17 16 32

Discard date 14 16 19 20 31

% PHARMACY STAFF IMPORTANCE OF LABEL INFORMATION Test Your Knowledge

• HOW MANY ½ TABLET PRESCRIPTIONS DID THE VA FILL IN FY 2011?

8,068,401

*VHA Statistics EOY FY 2011

8 Million ½ Tab Prescriptions

18,414

2.9 Million Veterans

59.2% of all Veterans

VAMC Variance 25-75%

Many different ½ tablet Sig codes TAKE 1/2 TO 1 TABLET BY MOUTH AS DIRECTED TAKE ONE TABLET IN AM ONLY

IF NEEDED AND ONE AND ONE/HALF TABLETS AT BEDTIME ONLY WHEN NEEDED FOR ANXIETY/SLEEP- DO NOT EXCEED PERSCRIBED DOSE. DECREASE AS TOLERATED;DO NOT STOP SUDDENLY.

TAKE 2 AND A HALF OR 3 TABLETS BY MOUTH AT BEDTIME

TAKE ONE AND ONE-HALF TABLETS BY DISSOLVING UNDER THE TONGUE EVERY DAY APPROVED FOR WINDOW PICK-UP 4-6-11; COVERS 4-6-11 TO 4-11

TAKE ONE AND ONE-HALF TABLETS BY MOUTH AT BEDTIME -MAY CAUSE DROWSINESS -DO NOT DRINK ALCOHOL -TAKE WITH FOOD FOR INSOMNIA--MAY TAKE LESS THAN ONE AND ONE-HALF TABLETS

TEST Your Knowledge: How many ½ tablet Sig Codes were used in FY11?

How we ask a Veteran to take ½ tablet makes a difference!

•TAKE ½ (ONE-HALF) TABLET BY MOUTH… 88% gave the correct response.•TAKE ONE-HALF TABLET BY MOUTH… 86% •TAKE ONE-HALF (12.5 MG) TABLET… 82% •TAKE ½ TABLET BY MOUTH … 80% .

½ Tab Education Differences

People with educations of some college or more weremore likely than those with educations of high schoolor less to respond correctly to these questions:

• Take ½ (one half) tablet by mouth in the morning and the evening (92% vs. 78%) P=.001

• Take one-half tablet by mouth in the morning and in the evening (93% vs. 74%) P=.001

• Take one-half (12.5MG) tablet by mouth in the morning and in the evening (88% vs. 71%) P=.001

• Take ½ tablet by mouth in the morning and in the evening (86% vs. 66%) P=.001

The words we use make a difference to the Veteran!

NUMBER OF PILLS% of

respondents

One 81%

Two 8%

Four 4%

Don’t know 7%

NUMBER OF PILLS % of

respondentsOne 42%Two 3%

Three 38%Depends on how many meals I eat 13%

Don’t know 4%

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What does meals mean?

MEALS WITH WHICH TO TAKE THE MEDICATIONVeteran % Rx %

With 2 mealsBreakfast and supper 68% 88%

Breakfast and bedtime snack 6% 2%Lunch and supper 5% 1%

Breakfast and lunch 4% 1%With 1 meal

Breakfast only 5% 1% (2Rx,2T)Supper only 3%Lunch only 3%

Bedtime snack only 1% 1%With 3 or 4 meals

Breakfast, lunch and supper 3% 3% (5Rx,12T)Breakfast, lunch, supper and bedtime 1% 3% (7Rx, 10T)

Don’t know 1%

Veterans & Rx staff prefer Vet name at top of label

PHARMACY STAFF PREFERRED LABEL% of respondents

A much better 53%A a little better 16%

A and B are equal 3%A a little better 13%B much better 15%

VETERAN PREFERRED LABEL % of respondents

A much better 46%A little better 8%

A and B are equal 16%B a little better 9%B much better 21%

VA PATIENT CENTRIC PRESCRIPTION LABEL, IMPLEMENTED IN ALL VAMC JANUARY 1 2015.

Patient name

Directions for use

Drug name“Use by” Date


Prescriber

“Fill Date”

Rx #

Drug Qty

# Refills

Product Description

Aux Info

Fed/State Cautions

Use ½ (one half) Highlighting & bolding of patient centered info

Avoid jargon

Sans serif, min. 12 pt font

The VA is not the first to adopt a Patient-Centric Prescription label.

Veteran Trial of Patient Centric Prescription label

Veterans were consistently positive in their ratings of the new labels

The vast majority of respondents rated the new label favorably compared to the old label

3

4

1

1

1

1

1

1

3

2

1

4

4

11

45

47

51

46

46

118

115

110

109

100

0 25 50 75 100 125 150

I can easily find and read my name on the new label.

The name of the drug/medicine is clearly displayed on thenew label.

Reading the new label, I understand how to take themedication correctly.

I can easily see how many refills are remaining on the newlabel.

Overall, the new label is better than the old label.

Please indicate your level of agreement with the following information on your NEW prescription label compared to your OLD prescription label:

Don't Know Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

1 Mean = 4.68 n= 166

Mean = 4.68 n= 164

Mean = 4.62 n= 166

Mean = 4.59 n= 166

Mean = 4.51 n= 164

Pharmacist Survey Results

Pharmacists were more variable in their responses to the survey items than were Veterans, though still primarily positive

2

1

3

3

2

4

3

4

5

9

3

8

7

10

4

6

4

4

22

13

19

26

27

26

10

17

37

24

32

25

23

22

0 10 20 30 40 50 60

I think that Veterans can easily find and read their names on thenew label.

The name of the drug/medicine is clearly displayed on the newlabel.

When reading the new label, I think Veterans can understandhow to take the medication correctly.

It is easy to see how many refills are remaining on the new label.

From my perspective, I think the changes to the prescriptionlabel will enhance patient safety.

Overall, the new label is better than the old label.

Please indicate your level of agreement with the following information on your NEW prescription label compared to your OLD prescription label:

Don't know Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree

Mean = 4.21 n= 68

Mean = 3.87 n= 68

Mean = 4.24 n= 68

Mean = 3.90 n= 67

Mean = 3.66 n= 65

Mean = 3.65 n= 66

11/4/2015

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This is how the

from the VA

This is how the Veteran

receives PMI from the VA

Next StepsKey Points

• Veterans interpret drug labels differently based on their, age, education and culture.

• Drug information can be presented to increase comprehension and user acceptance.

• Patient Medication Information (PMI) is the next area of study.


Why did the VA evaluate the format of their prescription labels?

A. Veteran Service organizations asked the VA to make the font size larger.

B. The to make DOD and VA Prescription labels look the same.

C. VA NCPS received 100’s of incident reports indicating the Veterans could not correctly interpret their prescription labels.

D. Make the label format consistent with local retail pharmacies.


Veterans feel which of the following is the most important information on the prescription label?

A. Refill Information

B. Pictures (relating to take w/food, etc.)

C. Dosage instructions

D. Doctors Name


Veterans and VA Pharmacy Staff prefer the following information at the top of the RX Label.

A. Pharmacy Name

B. Directions for Use

C. Veteran’s Name

D. Drug Name

Closing RemarksKeith W. Trettin R.Ph.VA National Center for Patient Safety24 Frank Lloyd Wright Drive, M2100Post Office Box 486Ann Arbor, Michigan 48106-0486

Phone: (734) 930-5848E-mail: [email protected]

medication safety- initiatives in support of promoting ... safety... · 11/4/2015 1 medication...

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