ASSIGNED SEATING CHART

10

98

75

6

3

42

11

Metro HealthMI MedicineMidMI AlpenaMidMI ClareMidMI GratiotMidMi MidlandMidMi W Branch

3MH HackleyMH St Mary’sSJM Ann ArborSJM ChelseaSJM LivingstonSJM OaklandSt Mary Mercy

4Bronson Battle Creek Bronson MethodistHenry Ford HF AllegianceHF MacombHF W BloomfieldHF Wyandotte

6HillsdaleHollandLakeland RegionalMcLaren CentralMcLaren FlintMcLaren Gr LansingMcLaren Norther MI

5BHS DearbornBHS Farmington HillsBHS Grosse PointeBHS Royal OakBHS TaylorBHS TrentonBHS TroyBHS Wayne

7Bronson Battle Creek Bronson MethodistHenry Ford HF AllegianceHF MacombHF W BloomfieldHF Wyandotte

8CovenantHurley MedicalMemorial OwossoOaklawnSparrowSparrow CarsonSpectrum Butterworth

9DickinsonGarden CityLake HuronMunsonMunson CadillacMunson GraylingUP Marquette

2Asc BorgessAsc GenesysAsc Macomb OaklandAsc RochesterAsc Southfield/NoviAsc River DistrictAsc St JohnAsc St Mary’s

10McLaren BayMcLaren LapeerMcLaren Macomb McLaren OaklandMcLaren Port HuronMcLaren Thumb

SCQR Breakout SessionIn the Driver’s Seat

Crash Course: De-Riving Tricky Drug

Calculations

ØUnusual/Infrequent situations

What do we see from your questions?

Crash Course: Rearview Mirror

ØSingle dosing issues

ØSource of truth

ØName of RxAlways need 4 items

Crash Course: Hands on the Wheel & In Control

ØDose (single dose)ØUnit (mg; ml; mcg/ml; mcg/hr)

ØQuantity (total: 25 pills; 473 ml in bottle; 20 patches)

ØDose/UnitCrash Course: Re-calculating…

ØQuantity

ØLiquids/elixirs/solutionsØNeed ‘concentration’ of liquidØSet up ratio to solve: Lortab elixir 7.5mg/15mL

Ø7.5 mg/15 ml = ‘X’ mg/dose mL

ØHow many doses were ordered & calculate total quantity

ØFull volume in bottleØ5mg tablet for 4x day x 4 days = 16 tablets

Ø15mL dose for 4x day x 5 days = 300mL

Crash Course: Getting Up to SpeedScript #1

OXYCODONE CONCENTRATE 100mg/5mL• Volume: 30mL • Directions: Take 0.5 to 1ML every by mouth every 5 hours as needed

for pain for 7 days

o Name of Opioido Doseo Unito Quantity

Crash Course: Getting up to speedInformation and Process• Oxycodone liquid concentration: 100 mg/ 5ml

§ Prescribed by physician: 0.5 to 1 ml per dose§ Need to determine ‘milligrams’ per dose What do we report: mg (tablet) or mL (liquid)?

Based on 100mg in 5ml, then how many mg are in 1ml?• Set up Ratio

Solving for the dose • To solve for X mg, begin by secluding ‘X’ mg on one side of the ‘=‘

§ To do this, we ‘move’ 1 ml by multiplying both sides by ‘1 ml’

100 mg/5 ml = X mg/1 ml

Ø So: (100mg/5ml) x 1ml = (X mg/1ml) x 1ml

Ø Or this: 100 mg x 1 ml = X mg x 1ml 5 ml 1ml

Crash Course: Getting Up to SpeedScript

OXYCODONE CONCENTRATE 100mg/5mL• Volume: 30mL • Directions: Take 0.5 to 1ML every by mouth every 5 hours as needed

for pain for 7 days

o Name of Opioido Doseo Unito Quantity

OxycodoneDose: 20 (read as mg/mL)Unit: mL (liquids are per 1 mL)Quantity: 30 (mL in the bottle)

Crash Course: Getting Up to Speed #2Script #2

Lortab elixir 10mls prescribed at discharge• Volume: 100 mL

o Name of Opioido Doseo Unito Quantity

Crash Course: Getting up to speed #2Information and Process• Lortab elixir 10mls prescribed at discharge

§ NORCO elixir (Lortab) – commercial preparation is 7.5mg/15mLs § Prescribed by physician: 10 ml per dose

Ø Need to determine ‘milligrams’ per doseWhat do we report: mg (tablet) or mL (liquid)?

Based on 7.5 mg in 15mL, then how many mg are in 10mL?• Set up Ratio

Solving for the dose • To solve for X mg, begin by secluding ‘X’ mg on one side of the ‘=‘

§ To do this, we ‘move’ 10 mL by multiplying both sides by ‘10 mL’;

7.5 mg/15 ml = X mg/10 ml

Ø 7.5 mg x 10 mL = X mg x 10 mL 15 mL 10 mL

Ø 5 mg x 1 mL = X mg x 1 mL = 5mg = 0.5 mg10 mL 1 mL 10

§ Solve for 1 mL (since definition states ‘per 1 mL’)

Crash Course: Getting Up to Speed #2Script

Lortab elixir 10mls prescribed at discharge• Volume: 100 mL

o Name of Opioido Doseo Unito Quantity

HydrocodoneDose: 0.5 (read as mg/mL)Unit: mL (liquids are per 1 mL)Quantity: 100 (mL in the bottle)

Re-tooling and Optimizing Follow-up Process

to Drive Up PROS

SCQR Breakout SessionIn the Driver’s Seat

Re-tooling: Follow Up WorkflowRetooling and Optimizing

• Sample and Upload on/near POD 30 days

• Enter physical address & email address • Demographics Tab & Save • Verify patient death with YES or NO

• Generate letters for the cycle

Re-tooling: Follow Up WorkflowRe-tooling and Optimizing

• Emails and Letters sent on or near postop day 31Ø Follow up has begun J

• Abstract the cases (goal 30-60 days)• GOAL: Emails and Letters will be received while

abstraction is being done.

Re-tooling: The Best Time for Follow Up

TIMING is EVERYTHING!!

• Easier to reach patients when they are still home after surgery.

• Optimize “Prime Time”: Most patients will be at home at least 6-8 weeks after surgery

• Follow up through email, letter or phone call.

Re-tooling and Optimizing

2020 P4PCollaborative

Wide Measure

30-Day PRO Response Rate by Age Group

100%Cases Sampled,

Complete, Date Range 1/1/2018 -

12/31/2018

44.8% 71.7% 19.4%Emails captured of those cases

30-day PROs emails sent out of

those emails captured

30-day PROs email responses received out of

those sent

56209 25206 18066 3498

From 2019/09/11 dataset

Tuning Up Your Engine to

Drive Down Opioid Prescriptions

Rapid Cycle NetworkingBarrier Questions to Consider1. How do you get surgeons to prescribe based on M-OPEN guidelines?2. How do you address barriers with following M-OPEN guidelines? 3. Have you observed a trend/issue with non-surgeon prescribers?4. What barriers have you faced with obtaining the PROS responses?5. Do you experience a difference in time management between Follow Up methods

(letter, email, phone)?

1. What elements/processes have worked at your site in reducing over-prescribing? 2. How did you get C-suite engagement with education and compliance? 3. What successes have you had with increasing the PROS responses?

Success Prompts/Processes to Share

Rapid Cycle Networking

Learning from the best…EACH OTHER

Share strategies that have helped you with getting PRO’s responses…qA representative from each table will report the tips and strategies sharedqPlease leave the TABLE Worksheet for us to collect at the end. qWe will compile and disseminate to all later via email/newsletter.

THANK YOU!!Rhonda, Cheryl and Jami