Ascension honored for enhancing medication safety

It was all Cheers and no Jeers when Ascension, the largest non-profit health system in the United States, stepped up to the plate during the 2016 ASHP Midyear Clinical Meeting, held in December in Las Vegas.

The occasion: The Institute for Safe Medication Practices’ (ISMP) Cheers Awards, which honored Ascension for its comprehensive implementation of  ISMP’s six 2014-2015 Targeted Medication Safety Best Practices for Hospitals. Ascension achieved compliance levels that exceeded the national average, according to ISMP. 

Ascension, which is based in St. Louis and has 141 facilities in six states, provided outcomes data to ISMP that supported its implementation of the best practices, said Allen Vaida,  PharmD, FASHP, Executive Vice President of ISMP. To ensure that its efforts were on target, Ascension hired an outside consulting firm to monitor the progress of the initiative. Facilities across the health care system were 93% compliant with ISMP’s Best Practices, said Roy Guharoy, PharmD, MBA, and Chief Pharmacy Officer at Ascension.

“We felt that implementation was critical to improvement in patient safety, Guharoy told Drug Topics. “Medication errors can be catastrophic, so within Ascension, we issued a ‘call for action’ among multidisciplinary teams to incorporate these Targeted Best Practices into patient care.

The “call to action” began with representatives from the pharmacy department, as well as from the quality and safety areas. The initiative then moved to the hospital level where doctors, nurses, risk managers, IT experts, and other disciplines were included.

Critical to success, explained Guharoy, was communicating with each facility within the health system about why these changes were so important. With facilities ranging from 25 beds to 500 beds, the challenge was to reach each one and ensure that each facility was on board. “We had a conversation with each hospital,” Guharoy said.

According to an ISMP Medication Safety Alert, the six Targeted Medication Safety Best Practices for Hospitals were:

 â–º Dispense vincristine (and other vinka alkaloids) in a minibag, not a syringe.

 â–º Use a weekly dosage regimen default for oral methotrexate; if overridden to daily, a hard stop verification of use for a cancer indication is required. Also provide education to patients being discharged on weekly dosing.

 â–º Measure and express patient weights in metric units only.

 â–º Dispense oral liquids not commercially available as unit dose products in oral syringes.

 â–º Use oral liquid dosing devices that display only the metric scale.

 â–º Eliminate glacial acetic acid from all areas of the hospital and replace with vinegar (5% solution) or commercially available diluted acetic acid 0.25% (for irrigation) or 2% (for otic use).

Using the second Best Practice as an example, Vaida stressed that the support of executive leadership within Ascension helped steer the health system in the right direction. Since daily doses of methotrexate when indicated for arthritis or another autoimmune disease can be fatal, an electronic alert can reduce the potential for this error. But an IT department may not view this as a priority. “Senior management, however, can step in and ask them to make it a priority,” Vaida said 

Vaida also noted that while each facility within Ascension did not achieve compliance with every standard, a facility may have exhibited the intent to do so in the future. For example, while some facilities still used scales that measured in pounds, they planned to request metric scales with their next order.

Guharoy stressed that the implementation of the Best Practices is an ongoing effort. In fact, ISMP has revised two of its existing practices and added additional ones, said Vaida. Ascension leadership is committed to engage in the same process for the new standards, according to ISMP.