Arizona patient safety collaborative focuses on diabetes
Arizona patient safety collaborative focuses on diabetes
Potential and actual AEs are reported
The El Rio Health Center in Tucson, AZ, already had collected some outcomes data before the site was selected as a high-performance site with regard to the new national patient safety and pharmacy collaboration.
The health center was highlighted for its best practices on the web site of the Health Resources and Services Administration (HRSA) of the U.S. Department of Health & Human Services (HHS) of Rockville, MD. It's part of the new Patient Safety and Clinical Pharmacy Services Collaborative (PSPC).
"We've been focusing on reporting potential adverse events and actual adverse events," says Sandra Leal, PharmD, CDE, clinical pharmacy supervisor at El Rio Health Center. Leal also is the immediate past-president of the Association of Clinicians for the Underserved and is a consultant with the HRSA Pharmacy Services Support Center.
"We report that information to improve our facility's system and to target those areas where we find errors," Leal says.
The improvements might include changing prescriptions to what's the most appropriate therapy in the treatment guidelines or changing system flow so it facilitates safer prescribing, she explains.
One of the more recent changes under PSPC involved a diabetes prescription change, Leal notes.
"Recently, the national diabetes guidelines were updated, and two medications were removed from the recommended guidelines," Leal says. "So as an organization, we modified our formulary and educated providers about the changes."
Specifically, the new guidelines recommended that patients not be prescribed rosiglitazone maleate (Avandia®) and glyburide because of adverse events.
Avandia was associated with congestive heart failure and myocardial infarctions, Leal says.
And glyburide caused a more profound hypoglycemia or low blood sugar, so the new guidelines recommended alternative drugs be used in their place, she adds.
"When we changed the formulary we took it back to provider meetings and also sent out an e-mail to providers about the change," Leal says. "When providers still send prescriptions for the old drugs to the pharmacy then we contact them and ask for a different option."
Pharmacists also pulled reports of all patients on the old drugs from the center's database and then contacted doctors to tell them which patients still were on glyburide and rosiglitazone, Leal adds.
"We say, 'There's been a formulary change, and we recommend you select another drug,'" she says. "They usually ask for an alternative agent, and then we'll make recommendations or we'll show them tables we created with equivalent drugs."
Since the center has 40 providers, these changes take a while.
Another PSPC best practice involves documenting health outcomes for all patients in the center's diabetes program.
"When a person is enrolled in the diabetes program, we track outcomes before the patient was seen by us and after the patient was seen by us, and make sure we're following the standard of care," Leal says.
The tracking system looks at the following:
- A1C reduction;
- Blood pressure;
- Cholesterol panel;
- Protein and kidney function;
- Preventive care interventions.
"For preventive care, we look at improvements in pneumonia and influenza vaccination rates," Leal says. "People with diabetes are at a higher risk from these infections."
Also, the tracking systems monitors whether patients are taking an aspirin per day to prevent heart attacks, she adds.
"We make sure we're following the standard of care for diabetes and track the information very carefully," Leal says.
Pharmacists in Arizona have prescribing authority, so they can make adjustments in medication regimens, she notes.
"If someone is referred to our program, we can spend time with patients, especially when they have chronic conditions that require multiple medications," Leal says. "Sometimes, diabetics come in with six to 12 medications."
Clinical pharmacists also can help patients with affordability issues since patients often have difficulty paying for their prescriptions even when they have health insurance, she says.
"That's a benefit to the patient to have a pharmacist who can figure out which medication is affordable to them and which won't cause side effects," Leal adds.
This model of having pharmacists participate in clinical team decisions and care might be the standard for the future, and the Patient Safety and Clinical Pharmacy Services Collaborative will help lead the way, Leal says.
"We've really seen more improvement in the program as people become more comfortable having pharmacists providing clinical services," she adds.
El Rio Health Center will continue with the collaboration and recruit more partners, Leal says.
"As we're involved in the collaborative for a longer period of time, we expect to see some outcomes from the interventions," she says.
"I hope from this collaboration it will become the norm to have a clinical pharmacist on the treatment team," Leal adds. "Especially with the older population of patients and more medication issues, we're hoping insurers and Medicare will pay to have pharmacists on the team."
The El Rio Health Center in Tucson, AZ, already had collected some outcomes data before the site was selected as a high-performance site with regard to the new national patient safety and pharmacy collaboration.Subscribe Now for Access
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