2014 Finalist: Minnesota Hospital Association

St. Paul, Minnesota
Minnesota Road Map to Reducing ADEs

The pharmacist-led Minnesota Hospital Association (MHA) “Road Map to a Medication Safety Program” provides evidence‐based recommendations/standards for Minnesota hospitals in the development of a comprehensive medication safety program.

Since 2007, MHA has used the Call to Action framework for best practice development, implementation, training, technical assistance and progress tracking. The Road Map is a tool to focus a hospital’s attention and resources on ADEs. It brings together interprofessional teams in ways that improve communication, cohesion and cooperation. The Road Map provides the technical details of “what to do” in a Call to Action framework that makes the approach flexible, responsive to local culture and useful in a variety of settings.  

An MHA advisory group, comprised of an interprofessional team led by pharmacists, created a Road Map to reduce ADEs in a specific set of drugs:  anticoagulants, diabetes medications and opioids. These drugs were chosen because of their high-risk status and frequent intersection with other hospital‐acquired conditions.

In the absence of standard national outcome measures, the MHA ADE Advisory Group established three measures to quantify improvement. Measures were selected that would (a) provide insight into potential adverse drug events and (b) not pose a significant data collection barrier at hospitals. The metrics were:
•    Anticoagulants: International normalized ratio (INR) > 5/1,000 patient days.
•    Opioids: Number of naloxone administrations/1,000 patient days.
•    Hypoglycemic agents: Number of reports of blood glucose <40 mg/dl/1,000 patient days.

In the first two years, the Road Map helped Minnesota hospitals make significant progress in reducing ADEs. Since its inception, an estimated 1,443 fewer events have occurred. This is equivalent to 60 fewer events per month or 2 fewer events per day.

Most notably, for the anticoagulant measure, INR>5, hospitals experienced a 44.8-percent reduction in events resulting in an INR>5 between the fourth quarter 2010 and fourth quarter 2013 (p<0.0001, Mantel-Hanzael test). A 17.2-percent reduction in blood glucose values was less dramatic but still statistically significant (p = 0.0461). There was no measurable reduction in the utilization of naloxone.

The Road Map’s Call to Action framework is an innovative approach that allows hospitals to achieve, sustain and intensify results. It provides both adaptive and technical elements, basic and stretch goals and specific steps to create the necessary ongoing infrastructure.
Beyond the innovative Call to Action framework, the Road Map pushes the envelope of what has been explored in the past. For example, the Road Map’s Opioid Adverse Drug Event Prevention Gap Analysis provides a detailed method for establishing an effective narcotic stewardship program. To sustain improvement, it advises that every hospital assign someone to screen drugs and orders and recommend modifications as necessary.

As evidenced by the Michigan Keystone Center’s use of the Opioid Gap Analysis, the Road Map can be easily adapted by other hospitals and hospital systems. It does not require a particular electronic medical system. The program is presented in clear, replicable form. It is appropriate for facilities of different sizes and can be introduced in stages.

Interprofessional Team
Steven Meisel, B.S., Pharm.D., CPPS, Team Chair
Director of Patient Safety
Fairview Health Services

Nora Vernon, M.S., R.N., Team Co-Chair
Patient Safety and Quality
Minnesota Hospital Association

Ron Kitzmann, R.Ph., M.B.A.
Park Nicollet Methodist Hospital Pharmacy

Jean Kohs, R.Ph.
Medication Safety Manager
Hennepin County Medical Center

Kristi Gullickson, Pharm.D.
Director of Pharmacy
Abbott Northwestern Hospital

Jill Strykowski, M.S., R.Ph.
Director of Pharmacy & Pain Team
Mercy Hospital & Unity Hospital