SOS Rx

Senior Outpatient Medication Safety

Full Coalition Meeting, October 1, 2003

Meeting Report

________________________________________________________________________

 

The second meeting of Senior Outpatient Safety (SOS) Rx, held October 1, 2003, included 40 participants and observers from 30 organizations. A full list of meeting attendees is attached.

 

The meeting began with introductory remarks from SOS Rx convening organization National Consumers League and founding sponsor, Express Scripts, introduction of new participants, and a brief overview of the new participants’ previous and current patient safety activities.

 

The first presentation by Dr. Tejal Gandhi, Director of Patient Safety at Brigham and Women’s Hospital, discussed ambulatory and outpatient medication safety.  Dr. Gandhi’s presentation is presentation is available at www.nclnet.org/sosrx under the October 1 meeting documents.

 

Highlights from her presentation include:

 

 

The second presentation, by Barb Rudolph, Director of Leaps and Measures at the Leapfrog Group, discussed physician office clinical decision support systems.  Ms. Rudolph’s presentation is available at www.nclnet.org/sosrx under the October 1 meeting documents.

 

Highlights from the presentation include:

 

·        Leapfrog has taken three “leaps” so far in the hospital setting regarding CPOE, ICU physician staffing and evidence-based hospital referral.

·        Next on the agenda: hospitals and physician offices, specifically priorities approved by NQF, physician office clinical decision support (PODS) and pursuit of comparative excellence.

·        PODS leap seeks better, safer care for patients through e-prescribing, e-lab results tracking and e-care reminders.

·        Finishing touches on report expected late October or November 2003.

 

Following the two presentations, the consensus retreat workgroup and education campaign workgroup meeting reports were delivered to the entire group.

 

Discussion Points:

 

After the presentations and workgroup reports, questions and suggestions led to discussion of the following points/issues:

 

·        Patient and physician communication is critical for reducing errors, especially for elderly patients and those with chronic conditions and taking multiple medications

·        Physicians and pharmacists are increasingly pressed for time and alerts need to be “prioritized” to be effective and reduce “overriding” alerts

·        A system might be developed similar to a patient’s list of drug allergies with the information about their reactions to specific medications

·        Since many alerts are ignored, perhaps developing a list of the “Top Ten” ADEs would aid physicians and pharmacists (ASCP has this list)

·        There may need to be a re-assignment of tasks in the physician’s office—i.e. the nurse or PA might ask questions so the physician can spend more time with patients

·        Patients need to assume more personal responsibility for health and averting ADEs—they have the time and doctors don’t (and won’t)

·        Consider getting foundations involved for future project funding

·        Consider using 2004 presidential candidate to leverage SOS Rx agenda

·        Most important goal for consensus group meeting is to choose a highly concentrated focus for coalition efforts

 

Administrative Issues/Upcoming Events:

 

·        The action agenda consensus retreat is scheduled for November 9-11 at the Aspen Institute, Wye Mills, MD.  During the retreat a small group of about 35 experts will identify the consumer actions and system changes with the greatest potential for enhancing the safe outpatient use of medications.  Facilitator for the consensus retreat will be Hugh Tilson, steering committee chair of the Centers for Education and Research on Therapeutics (CERTS). 

 

·        The prioritized consumer actions and system changes emerging from the consensus retreat will then serve as targets for the campaign-style education and communication initiatives undertaken by SOS Rx.  In preparation for that campaign, media and resource audits have been performed and were presented during the report of the education work group.

 

Moving Forward:

·        In addition to the November 9-11 consensus retreat, the action agenda work group will meet on December 2 to review the results of the retreat and the education campaign work group will meet on December 12 to work on plans for the 2004 education campaign.  The next full meeting of the coalition will occur on January 7.  All meetings will be held in Washington, DC, and accessible via telephone conference call.

 

 

Addendum 1: Brief Overview of New Participants’ Activities/Efforts Surrounding Patient Safety

 

Medical Records Institute

·        Working on mobile health and continuity of care efforts

 

American Society of Consultant Pharmacists

·        Focus on increasing pharmacists’ role in administering meds to seniors

 

American Hospital Association

·        Safety focus on ADE-related hospital admissions

 

Joint Commission on Accreditation of Healthcare Organizations

·        Focusing on patient safety internationally; looking to standardize patient safety data

 

Johnson & Johnson

·        Together Rx program focusing on senior prescription drug savings and compliance

 

 

Addendum 2: Additional Organizations To Be Contacted for SOS Rx Involvement

 

·        National Association of Community Health Centers

·        Disease Management Assn. of America Alternative medicine

·        CDC

·        USP

·        American Lung Association

·        American College of Law and Medicine

·        American College of Emergency Physicians

·        American National Standards Institute

·        Doctors, nurses and pharmacists student associations

·        Long term care group 

·        Disability group

·        National Hispanic Nurses Association

 

 
Addendum 3: List of Meeting Participants

 

Mike Anderson

UnitedHealth Group

 

Andrew Barbash
Medical Records Institute

 

Mike Borgia

Johnson & Johnson

 

Angela Brennan

Laborer Health & Safety Fund of North America

 

Richard J. Bringewatt

National Chronic Care Consortium

 

Ray Bullman

National Council on Patient Information and Education

 

Rebecca Burkholder

National Consumers League

 

Andrew Chang

Joint Commission on Accreditation of Healthcare Organizations

 

Tom Clark

American Society of Consultant Pharmacists

 

Daniel J. Cobaugh

American Society of Health-System Pharmacists.

 

Paul Dennett

American Benefits Council

 

Tejal Gandhi

Brigham and Womens Hospital

 

Linda Golodner

National Consumers League

 

Paula Griswold

Massachusetts Coalition for the Prevention of Medical Errors

(via phone)

 

Jessica Harper

Families USA

 

Jennifer Haslip

National Health Council

 

Gordon Johnston

Generic Pharmaceutical Association

 

Will Lang

American Association of Consultant Pharmacists

 

Alan Lazar

Agency for Healthcare Research and Quality (AHRQ)

 

Theodore LeBlang

American College of Legal Medicine

 

Steve Littlejohn

Express Scripts

 

Eliana Loveluck

National Alliance for Hispanic Health

 

Lee Lynch

Hill & Knowlton

 

Bob McNellis

American Academy of Physician Assistants

 

Suzanne Mintz

National Family Caregivers Association.

 

Don Nielsen

American Hospital Association

 

Jill Birdwhistell Pierce

American Medical Women's Association Foundation

 

Susan Randall

Visiting Nurses Association of America

 

Lee Rucker

National Council on Patient Information and Education

 

Barb Rudolph

The Leapfrog Group

 

Marissa Schlaifer

Academy of Managed Care Pharmacy

 

Mary Jean Schumann

American Nurses Association

 

Joshua Seidman
Center for Information Therapy

 

Ingrid Sheriff

Hill & Knowlton

 

Sharon Sweede

American Academy of Family Physicians

 

Claudia Tessier

Medical Records Institute.

 

Andrew Weber

Johnson & Johnson

 

Ed Weisbart

Express Scripts

 

Pat Wise
Healthcare Information and Management Systems Society

 

Bill Wolfe

Rite Aid Corporation

 

Chunliu Zhan

Agency for Healthcare Research and Quality