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Resolving Patient Safety Issues Related to Methadone Maintenance Clinics

Resolving Patient Safety Issues Related to Methadone Maintenance Clinics

Shirley Lesieur and Nancy R. SmestadPharmacist Consultants

OHI IT Patient SafetyApril 27, 2010

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ObjectivesObjectives

Identify the importance of methadone treatment medication orders as a component of CPRS

Define the methodologies utilized to notify health care staff of methadone treatment enrolled patients

Discuss the importance of a VistA interface between methadone COTS software and CPRS

Share topics for discussion and a few lessons learned

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Initial ReportInitial Report

Methadone Treatment Clinic and Reported Scenario

Overview of the event

How did this occur?

Why did this occur?

Role of Technology in the solution

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Areas of ConcernAreas of Concern

Methadone COTS software – Interface with CPRS

Medication Reconciliation

Accurate Medication Management for methadone treatment patients

 

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Preliminary ScreeningPreliminary Screening Type of methadone software

Utilization of the methadone software

Documentation of methadone clinic patient in CPRS

Methadone clinic medication documentation in CPRS

• Copays ?

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Methadone Maintenance ClinicsMethadone Maintenance Clinics

Number of Clinics

VA Clinic versus Contracted Clinic

Clinic Design

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QuestionnaireQuestionnaire

Development of Questionnaire

Types of information gathering questions

Request for screen captures and/or station guidelines

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Methadone Clinic Setup

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Case StudyCase Study

Opioid Treatment Program and TJC

Recommendation for Improvement (RFI)

Addiction Management System(AMS)

Local Policy

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PRO’s and CON’sPRO’s and CON’s

Outpatient Prescription

CPRS Order with Priority = DONE

Non-VA Meds

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Facility VisitFacility Visit

Team Members

IT Patient Safety Role

Visit Objective

Visit Synopsis

Vulnerabilities Identified

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Facility Visit RecommendationsFacility Visit Recommendations

NCPS Alert

Mental Health Software and Hardware

CPRS documentation

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Post Methadone Clinic Visit Action ItemsPost Methadone Clinic Visit Action Items

Best practice recommendation to inform practitioner’s of Veteran’s active enrollment in the methadone clinic in a readily noticeable way

Best practice recommendation for entry of methadone clinic orders into CPRS

Best practice recommendation for sequence of order placement and appropriate personnel roles

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NCPS Notification: Patient IdentificationNCPS Notification: Patient Identification

Use of Clinical Reminder

Category II Patient Record Flags

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NCPS Notification: Medication EntryNCPS Notification: Medication Entry

Inpatient Meds for Outpatient (Clinic Orders)

Outpatient Prescription

Non-VA Meds

Documentation Responsibility & Timeliness

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Methadone Clinic Order Documentation OptionsMethadone Clinic Order Documentation Options

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Methadone Medication ManagementMethadone Medication Management

Opioid Medication Accountability

Medication Reconciliation

Patient Safety Caveats

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Patient Safety Alert Documentation ResultsPatient Safety Alert Documentation Results

Clinical Warning PRF Cat II Problem List Reminder Dialog CPRS Coversheet

Med List

2 8 1 1 3

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Patient Safety Alert Medication Compliance ResultsPatient Safety Alert Medication Compliance Results

Outpatient Prescription

Inpatient Meds for Outpatient

Non-VA Meds

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2

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QuestionsQuestions