Transcript Slide 1
Improving Patient Safety through Informed Medication Prescribing and Disposal Practices
Fifth Annual Maine Benzodiazepine Study Group Conference & Fourth Annual Unused Drug Return Conference
Track A: Safe Drug Return
Get Rid of Unused Pharmaceuticals (GROUP) Campaign
Speakers:
Elizabeth A. Smith, Ph.D.
Matthew C. Mireles, Ph.D., M.P.H.
Community Medical Foundation for Patient Safety November 1, 2007 10:30 am – 11:15 am
Get Rid of Unused Pharmaceuticals (GROUP) Campaign
Learning Objectives
1. Dangers of unused and expired medicines (UEM) 2. Community of Competence™: a method and framework to study UEM 3. History and evolution of GROUP 4. Standardized data collection and methodology 5. Current status and results of GROUP 2 Copyright 2007 Community Medical Foundation for Patient Safety
Get Rid of Unused Pharmaceuticals (GROUP) Campaign—LO1
Too Many Medications!
135 million use prescription meds monthly 1 4 billion prescriptions each year 2 90% seniors use at least one med 3 40% used 5 or more meds weekly 3 Average person over 65 take 2 to 7 meds daily (30% of meds prescribed) 4 15 million misuse meds 5 4 out 5 patients leave doc’s office with 1 or more prescriptions 6 3 Copyright 2007 Community Medical Foundation for Patient Safety
Get Rid of Unused Pharmaceuticals (GROUP) Campaign—LO1
Dangers of UEM
Non-adherence to prescription and therapy Med error causes 700,000 ER visits yearly 7 36% of poisoning among kids happens at grandparents’ homes 4 ; pets get poisoned 19% (4.5 million) teenagers abuse prescription meds 8 — “pharming” Meds stolen and sold on the streets Improper disposal contaminates water Possible “dumping” of UEM overseas Copyright 2007 Community Medical Foundation for Patient Safety 4
Get Rid of Unused Pharmaceuticals (GROUP) Campaign—LO2
Communities of Competence™ (CC) Not just any group, committee, or coalition...but a true community of individuals based on knowledge, skills, expertise, experience, motivation, and competency
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Community of Competence™ for Patient Safety Culture Oslerians Others Interns Nurses Educators Engineers PATIENT Volunteers Env. Sc.
Info Sc.
Ethicists Partners
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Environment
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Theories and Driving Forces
Globalization—cultural diversity, politics, distance, continuous production, communication, etc.
Complexity of work itself—numerous disciplines, experience levels, e-work, growing number of products and services Organizations are becoming flatter, virtual and boundaryless Turbulent external environment--limited resources Challenges in behaving, learning, adapting, and surviving Copyright 2007 Community Medical Foundation for Patient Safety 7
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Operational Definition of CC
A new framework to first visualize what type of group exists and what type of group should be created to do a specific task or job A methodology to describe, assess, and combine separate strengths and core competencies of individuals, groups, and organizations into a meaningful, goal-oriented whole--synergy A team of highly skilled, specialized people with proven competencies A flexible, learning organization; network of organizations or systems Copyright 2007 Community Medical Foundation for Patient Safety 8
Get Rid of Unused Pharmaceuticals (GROUP) Campaign—LO2
General Tasks of CC Members
Do specific tasks or jobs for which they are most qualified or competent Engage in continual learning and improving skills Work together cooperatively and recognize expertise of their members and of other individuals Rotate leadership based on unique competencies and expertise Make maximum use of tacit knowledge based on common sense and information sharing Communicate openly and share skills, abilities, knowledge, unique expertise, and lessons learned Copyright 2007 Community Medical Foundation for Patient Safety 9
Get Rid of Unused Pharmaceuticals (GROUP) Campaign—LO2
Organization-Driven Tasks of Members
Identify and address a complex problem—high national…international concern and impact Recognize oneself as part of a problem-solving community Understand the forces driving the problem and solutions Know one’s own skills, abilities, knowledge, and unique professional responsibilities and resources Acknowledge and value the individual and collective competencies of others needed to solve the problem Copyright 2007 Community Medical Foundation for Patient Safety 10
Get Rid of Unused Pharmaceuticals (GROUP) Campaign—LO2
Action-Driven Tasks of Members
Develop ways to meet in formal, informal, and/or virtual groups or networks to solve the problem Divide tasks, assignments, and responsibilities based on expertise and competencies Create a way to share information across disciplines and organizations (boundary expanding) Share data, information, and knowledge from one’s own discipline and experience with members Evaluate efforts and outcomes to stay on target toward a solution 11 Copyright 2007 Community Medical Foundation for Patient Safety
Get Rid of Unused Pharmaceuticals (GROUP) Campaign—LO2
Community of Competence™ for UEM
Drug/Law Enforcement Environmental Protection Medical Practice Patient Safety
UEM
Public Safety and Policy Academia and Research Consumer Protection Others Copyright 2007 Community Medical Foundation for Patient Safety 12
Get Rid of Unused Pharmaceuticals (GROUP) Campaign—LO2
Benefits of CC in Studying UEM
UEM problem is large and too complex UEM problem is relatively unknown and has enormous impact Problem requires diverse expertise, authority, and intra-organizational involvement Experts often work together at great distances Experts must address current legal and political barriers and technology Problem requires complex solutions that are both short-term and long-term 13 Copyright 2007 Community Medical Foundation for Patient Safety
Get Rid of Unused Pharmaceuticals (GROUP) Campaign—LO3
History and Evolution of GROUP
Developed as part of patient safety education and outreach in safe medication practices Focus on building awareness and the CC to address issues of UEM Created the UEM Registry in 2004 to systematically collect and analyze data Collaborated with partners to standardized data collection (anonymous with only 5 basic variables: drug name, strength, quantity returned, reason for return, and zip code) Published the GROUP Manual of Procedures 14 Copyright 2007 Community Medical Foundation for Patient Safety
Get Rid of Unused Pharmaceuticals (GROUP) Campaign—LO3
History and Evolution of GROUP (Cont.)
Continue to collect data from various sources and locations Standardized classification based Drug Abuse Warning Network (DAWN) of DHHS Substance Abuse & Mental Health Services Administration (SAMHSA) Data from UEM Registry requested and used for research and policy (State of ME, ONDCP) 15 Copyright 2007 Community Medical Foundation for Patient Safety
Get Rid of Unused Pharmaceuticals (GROUP) Campaign—LO4
Methods to Standardize Data Collection
Research Rationale (Questions) What Why kinds of medicines prescribed and not used?
medicines not taken as prescribed?
Why Why people keep UEM in homes?
people stop taking medicines?
Which What UEM are controlled substances?
is the cost of UEM?
What is the environmental impact of UEM?
16 Copyright 2007 Community Medical Foundation for Patient Safety
Get Rid of Unused Pharmaceuticals (GROUP) Campaign—LO4
Methods to Standardize Data Collection
Establish consensus on the variables and why we are collecting them Develop standardized data collection instrument Implement use of standardized instrument Evaluate and modify instrument if needed Encourage wide use of instrument to collect data the same way Use CC as a model and framework for promoting standardized data collection Report usage of instrument 17 Copyright 2007 Community Medical Foundation for Patient Safety
Get Rid of Unused Pharmaceuticals (GROUP) Campaign—LO4
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Get Rid of Unused Pharmaceuticals (GROUP) Campaign—LO5
Current Status and Results
GROUP Manual of Procedures completed and now available US EPA has included GROUP Manual into its Resource Kit for Drug Disposal Proposed service: designated data repository and analysis of UEM nationally…internationally GROUP Campaign to support other projects and programs (e.g. Green Pharmacy and Maine Safe Drug Disposal Project) Ongoing study to evaluate GROUP Campaign and data collection for the UEM Registry 19 Copyright 2007 Community Medical Foundation for Patient Safety
Get Rid of Unused Pharmaceuticals (GROUP) Campaign—LO5
Current Status and Results
Pilot study of GROUP Campaign in Houston, TX Aims : estimate response rate for participation; evaluate education materials; study the utility of self-administered returned drug form Population : senior adults at a local church Methods : 3-part educational workshop with a drug (UEM) inventory and collection at the end Results : • • Response rate = 18% based on enrollment in workshop (8 participants of 45 enrolled) Educational materials (slide presentation) increase awareness of danger of UEM 20 Copyright 2007 Community Medical Foundation for Patient Safety
Get Rid of Unused Pharmaceuticals (GROUP) Campaign—LO5
Current Status and Results
Pilot study of GROUP Campaign in Houston, TX Results (cont.) : • • Participants rated the presentation very useful and important, and they learned something new Participants filled out drug return form without any problem Discussion and Conclusions : • Pilot study is small; population is unique • • Response (participation) rate can be increased with addition promotion and publicity Participants have no problem filling out forms 21 Copyright 2007 Community Medical Foundation for Patient Safety
Get Rid of Unused Pharmaceuticals (GROUP) Campaign
Challenges and Opportunities
Need leaders and champions to promote public awareness of the problem and widely adopt the UEM Registry Need funding to support and expand the Registry and personnel Integrate the Registry with collection and disposal systems Develop standard process for reports Identify other uses of the Registry Reinforce the values and principles of CC to strengthen collaboration and actions 22 Copyright 2007 Community Medical Foundation for Patient Safety
Acknowledgements
Anita Hampton, MS, Fellow Jerry Miller, Ph.D.
Racheal Johnson, BS, Graduate Intern John Sullivan Cheenu Srinivasan Hari Ayyer Sonali Patel Ye Sun Faye Wang Copyright 2007 Community Medical Foundation for Patient Safety 23
For more information
Community Medical Foundation For Patient Safety 6800 West South Loop, Suite 190 Bellaire, Texas 77401 832-778-7777 www.comofcom.com
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References
1. Center for Disease Control. (2006). Therapeutic Drug Use. National Center for Health Statistics, http://www..cdc.gov/nchs/fastats/drugs.htm
September-October, p. 12.
Center, “Seniors and Medication Safety”. www.mnpoison.org/index.asp?pageID=198 Drug, Nov. 22, 2006.
, p.1.
2. Garey, K.W. et al. (2004). “Economic consequences of unused medications in Houston, Texas.” The Annals of Pharmacotherapy, July/August; 38: 165-1168. 3. Smith, S.R. and Clancy, C.M. (2006). “Medication therapy management: A new opportunity to optimize therapeutic outcomes in medicare,” Patient Safety & Quality Healthcare, 4. Minnesota Poison Control System, Hennepin County Medical 5. Maine Benzodiazepine Study Group, University of Maine, Center on Aging (2006). Conference Proposal for a National Unused 25 Copyright 2007 Community Medical Foundation for Patient Safety
References (cont.)
6. Testimony before the House Government Reform Committee
Subcommittee on Criminal Justice, Drug Policy, and Human
Resources. Joseph T. Rannazzisi, Deputy Assistant Administrator, Office of Diversion Control, July 26, 2006.
7. Houston Chronicle. (2006). “Everyday medicines, big risks”. October 19, 2006, B2.
8. The Partnership for a Drug-Free America. (2005). “Latest teen drug trends”. www.drugfree/org/Portal/DrugIssue/Research/Teens_2005/Gen eration_Rx_Study-… Copyright 2007 Community Medical Foundation for Patient Safety 26