Reducing Adverse Drug Events Among Older Adults

Organization Profile

The organization under analysis is Eisenhower Health Center.

Eisenhower Health Center is an acute care facility in southern California. It is a progressive 463-bed hospital. Its mission is to serve the changing healthcare needs of the region by providing excellence in patient care with supportive education and research (Eisenhower Health, n.d.).

The organization was rated with five stars by the Medicare website, which is a sign of the quality of care provided by the healthcare facility. Eisenhower Health Center has a culture of constant improvement, which makes it an excellent target for implementing a change program.

Problem Statement

In the hospital setting, one of the major concerns for healthcare managers is pharmaceutical products management and distribution. According to recent studies, one of the leading causes of severe complications is adverse drug events (ADEs) due to unaccounted drug-to-drug interactions (Toivo et al., 2016). ADEs are most frequent among older adults due to polypharmacy (Earl et al, 2020). Thus, the central purpose of my capstone project will be to create an initiative that will decrease the number of ADEs among older adults.

Proposed Solution

There are different approaches to reducing ADEs among older adults. They include the introduction of protocols and algorithms that support the decision-making process, direct education to patients, and medication reviews by pharmacists or clinicians. I propose a dual approach to the problem by introducing a clinical decision support system and provision of direct education to patients about ADEs. The solution of the problem was inspired by the national action plan for adverse drug event prevention published by the US Department of Health and Human Services (HHS, 2014). The policy recommends that education programs should concern anticoagulants, diabetic agents, and opioids, strict guidelines should be adopted to promote safe medication use, and organizations should monitor adherence to the guidelines. Thus, the action plan will be based on these recommendations.

Draft of Evidence

ECLIPSE Question

Asking the right question is crucial for acquiring support for clinical practice. Thus, the principles of evidence-based practice require that the clinical question is formulated precisely to ensure that evidence can be translated into practice. There are three mnemonics that are usually used for formulating clinical questions, including PICO (population, intervention, comparison, outcome), ECLIPSE (expectations, client groups, location, impact, profession, service), and PECOT (population, exposure, comparator, outcome, time period) (International Center for Allied Health Evidence, 2016). The proposed project will use the ECLIPSE mnemonic to ensure that the question includes all the vital elements of a well-built question.

The problem I am trying to address in my capstone project is adverse drug events (ADE) among older adults. Thus, the primary expectation (E) of the program is a decreased number of ADEs. The client group (C) is older adults, and the location (L) is the Eisenhower Health Center, as I used the healthcare facility for my previous projects. The impact (I) of the program will be similar to the expectation, as the success will be measured in the number of ADEs. The profession (P) is the front-line personnel, including nurses and physicians. The service (SE) under analysis is the provision of patient education about the prevention of ADEs. Thus, the ECLIPSE question is:

Will patient education about the prevention of ADEs provided by nurses and physicians decrease the number of ADEs among older adults in the Eisenhower Health Center?

Evidence

Medline and Cochrane databases were used to acquire evidence. The utilized keywords included adverse drug events, prevention, patient education, reporting. Even though the search generated more than 2000 results, the majority of studies were excluded as they did not relate to the topic of interest.

The results of the literature revealed that ADEs is a topic of increased interest among scholars and care providers. However, currently, patient education is not a popular method for reducing morbidity from ADEs. Medication review was the most common intervention to address the problem of ADEs (Tecklenborg et al., 2020). At the same time, the literature review revealed that education intervention is associated with decreased morbidity from ADEs (Ducoffe et al., 2016; Joshi et al., 2015; Khalil & Huang, 2020; Pagotto et al., 2013; Tecklenborg et al., 2020). In particular, patient education increases timely ADE reporting, which decreases morbidity and mortality (Ducoffe et al., 2016; Joshi et al., 2015 Pagotto et al., 2013). Additionally, it was found that patient education of older adults can decrease the occurrence of adverse drug events and the chances of opioid overdose (Tecklenborg et al., 2020; Khalil & Huang, 2020). Patient education was found to work well with other interventions, including drug reviews.

Implementation Plan

Goals and Timeline

There are at least three goals that can be identified for the project. First, the project aims at increasing the awareness among care providers about adverse drug events. Second, the project will improve the ability of frontline medical personnel to provide patient education concerning ADEs. Finally, the central goal of the program is to decrease the number of ADEs among older adults. Achievement of these three goals is expected to decrease morbidity and mortality from adverse drug events among older adults.

The project is expected to take almost six months. The implementation of the project will be based on the Diffusion of Innovation (DOI) theory. In 1962, E. M. Rogers identified five types of people, depending on their readiness to adopt change (Lien & Jiang, 2017). According to the theory, there are innovators (2.5%), early adaptors (13.5%), early majority (34%), late majority (34%), and laggards (Lien & Jiang, 2017). The theory includes three major steps, which are awareness, initial use, and prolonged use (Lien & Jiang, 2017). Base on DOI, the proposed timeline is the following:

1. January 4, 2021: Program start
2. January 4, 2021 – January 31, 2021: The dissemination stage
3. February 1, 2021- February 28, 2021: Needs assessment and intervention planning
4. March 1, 2021 – May 31, 2021: Provision of ADE education
5. June 1, 2021 – June 14, 2021: Assessment of results. Consideration for further use
6. June 15, 2021: Project End

Financials

The initiative is expected to have a significant financial impact. In particular, it will require some resources for providing education to care providers and increasing awareness about the necessity of change. The initiative will not require significant financial investments, as it is an educational project. However, there is some expenditure the Eisenhower Health Center will need to cover. First, every front-line employee will be required to finish a two-hour training course about how to provide patient education about adverse drug events. This will be associated with around $8,000 in cost associated with hiring a certified trainer and losing some productive hours of the personnel. Second, the facility will need to cover the expenses associated with the dissemination stage. During this stage, Eisenhower Health will conduct meetings, make posters, and email information concerning the problems with adverse drug events. This implies the meeting rooms and equipment for presentations will be needed. The overall cost is expected to be around $2,000. Finally, the facility will need to pay for the extra working hours of the change leader. They are estimated at $5,000 in total.

While the initiative is associated with several costs, it can bring some financial benefits. Currently, the cost of every adverse drug event is at least $2,000, including prolonged hospital stay and decreased reimbursements (Bhat & Udupa, 2016). Reduction in ADEs will lead to several changes, that can be converted into cash. First, decreased number of ADEs will decrease the average hospital stay. This will allow the hospital to serve more patients with the same resources. This will lead to increased revenues. Second, ADEs are often considered as the fault of the organization, which leads to reimbursement problems. Thus, the initiative will decrease the amount of bad debt by reducing the number of non-reimbursed services.

Finally, decreased number of ADEs will lead to improved quality of provided care, which will improve the facility’s reputation. This can also be converted to financial benefits.

Legal and Ethical Considerations

The initiative is not expected to experience any significant ethical or legal issues. However, there are two points that should be noted during the implementation. First, the program should be congruent with the National action plan for adverse drug event prevention developed by the US Department of Health and Human Services (2014). Additionally, patient education should be provided only if the patient agrees,

Measuring the Success

Goals and Milestones

The goal of the project is to decrease the number of ADEs among older adult patients. The goals are expected to be achieved by achieving the following objectives:

• Disseminate information about the impact of ADEs;
• Develop a patient education program about ADEs for older adults;
• Provide training for frontline personnel;
• Implement the new patient education program;
• Evaluate the program.

The project is expected to have the following milestones:

• January 4, 2020: Project Start; Dissemination phase starts.
• February 1, 2020: Needs assessment and intervention planning phase starts.
• March 1, 2020: The implementation phase starts.
• June 1, 2020: The evaluation phase starts.
• June 15, 2020: Project close.

Measures of Progress

The success will be measured using two variables.

The first variable will be the prevalence of ADE cases among older adults in percent. The variable will be measured using a pre-test post-test methodology. After receiving the results, statistical analysis will be used to understand if the change was significant.

The second variable will be the approval of first-line personnel. There is a high probability that statistical analysis will not detect the change, as the timeframe is rather small. Thus, an additional variable may be needed to assess the effectiveness of the intervention. This variable will be measured by asking the front-line personnel if they believe that the program was beneficial. If 80% or more agree that the intervention is beneficial for older adults, it will be considered a success.

Information

Four types of information will be gathered to measure the success of the program. First, the prevalence of ADE among older adults will be measured using electronic health records (EHRs). The data will be collected automatically using the hospital database. Second, adherence to the initiative will be measured by asking patients if they received education about ADEs. Third, employee approval will be measured by asking the front-line personnel if they believe that the intervention is beneficial for the target population. The assessment will be conducted using Google Forms. This survey will be one of the measures of success. Finally, patient satisfaction will also be measured by conducting surveys to see if provided education affected it.

Communication Plan

Audience

Before articulating the communication plan, it is crucial to understand the audience. The audience of the present communication plan includes different groups of stakeholders.

First, the project will be steered by the project management team. The primary interest of the management team is to implement the change with maximum efficiency, which implies that there is a low chance of resistance from these stakeholders.

Second, the project will need to be approved by the board of directors. This stakeholder provides the money for implementation with the primary aim to receive returns on investments. The interest of the stakeholder is to improve the efficiency and quality of provided services. Thus, medium resistance is expected due to the possibility of distrust with methods.

Third, care providers are the central stakeholders as they will need to implement the change. Their primary interest is personal growth and receiving money for their services. Since they will not be paid for providing patient education, they are likely to be the source of resistance.

Finally, trainers are another crucial group of stakeholders who will deliver training to the care providers. Since they will be paid for their service, there is a small chance that they will be a source of resistance.

Progress Communication

Even though the project requires the participation of multiple stakeholders, the communication plan is expected to be rather simple due to the straightforwardness of the action plan. There are expected to be three aspects of communication. First, there will be only two live meetings, at the beginning, and at the end of the project. All the major stakeholders will be invited to these meetings, including the board of directors of Eisenhower Health, the project management team, and front-line personnel. Formal progress report meetings will be held every first Wednesday of the month, where the project manager will provide a comprehensive assessment of the project. The meeting will be held in Zoom, where everyone will be provided with a formal document designed to outline the current state of the initiative. Apart from meetings, all the stakeholders will be able to communicate at any time via messages in a WhatsApp chatroom that will be created with all the stakeholders.

Change Management Plan

The desired change can be successful only if closely managed throughout the implementation. The change management plan for the initiative will include four stages. During Phase 1, the desire for change will be aroused in all the stakeholders. This will be achieved by conducting an assessment of the current situation about ADEs in Eisenhower Health and explaining the findings to the stakeholders. The need for change is usually aroused using effective communication, including meetings, posters, and motivating emails. All of these will be used in the first stage of the change management plan.

During Phase 2, the change plan will be created using the ideas of all the stakeholders. The plan will include detailed information about training schedules and ongoing assessments.

Phase 3 is the implementation of change, which implies that it is a very active change. During this stage, the change will be tailored using ongoing assessments and on-demand coaching.

The final stage will include assessments of the results to evaluate if the change was successful. During this stage, a decision will be made if the change was beneficial, and if the practice should be continued.

Post-implementation Communication

Post-implementation communication will consist of two aspects. First, all the stakeholders will be provided with a final report. This is a formal summative document that will include the analysis of results, including changes in the occurrence of ADEs, adherence to the new practice, and expected financial benefits. The report will also provide recommendations about if the new practice of providing patient education about ADEs to older adults should be continued.

The second aspect of post-implementation communication is the final meeting of stakeholders. During this meeting, the stakeholders will ask questions about the final reports and decide if the project was successful and the new practice should be continued.

References

Ducoffe, A. R., York, A., Hu, D. J., Perfetto, D., & Kerns, R. D. (2016). National action plan for adverse drug event prevention: recommendations for safer outpatient opioid use. Pain medicine, 17(12), 2291-2304.

Earl, T. R., Katapodis, N. D., & Schneiderman, S. R. (2020). Reducing adverse drug events in older adults. In Making healthcare safer III: A critical analysis of existing and emerging patient safety practices [Internet]. Agency for Healthcare Research and Quality (US).

Eisenhower Health. (n.d.). About us. Web.

International Center for Allied Health Evidence. (2016). Elements of a well-built question. Web.

Joshi, A., Shah, N., Mistry, M., & Gor, A. (2015). Evaluation of knowledge and perception toward adverse drug reactions among patients visiting tertiary-care teaching hospital. National Journal of Physiology, Pharmacy and Pharmacology, 5(4), 280.

Khalil, H., & Huang, C. (2020). Adverse drug reactions in primary care: a scoping review. BMC Health Services Research, 20(1), 5.

Pagotto, C., Varallo, F., & Mastroianni, P. (2013). Impact of educational interventions on adverse drug events reporting. International journal of technology assessment in health care, 29(4), 410.

Tecklenborg, S., Byrne, C., Cahir, C., Brown, L., & Bennett, K. (2020). Interventions to reduce adverse drug event-related outcomes in older adults: A systematic review and meta-analysis. Drugs & Aging, 37, 91–98

Toivo, T., Mikkola, J., Laine, K., & Airaksinen, M. (2016). Identifying high risk medications causing potential drug–drug interactions in outpatients: A prescription database study based on an online surveillance system. Research in Social and Administrative Pharmacy,12(4), 559-568.

US Department of Health and Human Services. (2014). National action plan for adverse drug event prevention. Health.gov. Web.