medication safety lan event – january 10,...
TRANSCRIPT
Medication Safety LAN Event –Psychologically-integrated approaches to pain management
Wednesday, January 10, 20183:00-4:30 PM ET
Welcome and Reminders
Rachel DigmannEvent Lead
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Amanda RyanChat Manager
• Please be prepared for sharing and open discussion
• Slides and a recording from today’s session can be found on the QIO Program website: http://qioprogram.org/medication-safety-lan-event-january-2018
Agenda
• Continuing Education (CE) details• Amy Wachholtz, University of Colorado Denver• Mitzi Daffron, Qsource• Panel discussion• Wrap-up
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Learning Outcome
• The purpose of this session is to prepare healthcare quality improvement professionals to identify and implement effective healthcare strategies by exploring promising practices to implement psychologically-integrated approaches to pain management.
• We expect that this experience will help participants demonstrate and promote successful delivery of care practices and identify opportunities for improvement, all of which may promote advances in care that impact the Medicare beneficiaries served by the work of the QIO Program.
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Continuing Education Credit
Continuing education credit is available for:• Physicians and Physician Assistants• Registered Nurses and Nurse Practitioners• Dietitians• Pharmacists and Pharmacy Technicians• Certificate of Attendance
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CE Information
Physicians:This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providershipof AKH Inc., Advancing Knowledge in Healthcare, CRW & Associates and Telligen. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.
AKH Inc., Advancing Knowledge in Healthcare designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physician Assistants:NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME.
Pharmacists:AKH Inc., Advancing Knowledge in Healthcare is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.AKH Inc., Advancing Knowledge in Healthcare approves this knowledge-based activity for 1.5 contact hours (0.15 CEUs). UAN 0077-9999-18-001-L04-P; UAN 0077-9999-18-001-L04-T. Initial Release Date: 1/10/18
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CE Information, Continued
Registered Nurses:AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.This activity is awarded 1.5 contact hours.
Nurse Practitioners:This activity has been planned and implemented in accordance with the accreditation Standards of the American Association of Nurse
Practitioners (AANP) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare, CRW & Associates and Telligen. AKH Inc., Advancing Knowledge in Healthcare is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 030803This activity is accredited for 1.5 contact hour(s) which includes 0 hour(s) of pharmacology. Activity ID #21868-1
Dietitians:AKH Inc., Advancing Knowledge in Healthcare is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 1.5 continuing professional education units (CPEUs) for completion of this program/material. CDR Accredited Provider #AN008. The focus of this activity is rated Level 2. Learners may submit evaluations of program/materials quality to the CDR at www.cdrnet.org.
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Disclosure of Financial Relationships & Commercial Support
• The planners and faculty do not have any relevant financial relationships to disclose.
• AKH Inc., CRW & Associates, and Telligen do not have any relevant financial relationships to disclose.
• No commercial support was received for this activity.
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Disclosure of Financial Relationships & Commercial Support
Disclosures:It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whoseproducts or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral toNational Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.
Disclosure of Unlabeled Use and Investigational Product:This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Pleaserefer to the official prescribing information for each product for discussion of approved indications, contraindications, andwarnings.
Disclaimer:This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as ageneral guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or otherprofessional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant's misunderstanding of the content.
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Instructions for Obtaining CE
• Attend the entire event• Complete the post-event assessment that will appear at the
conclusion of the event• Complete a separate CE evaluation that is linked near the
end of the assessment• Once you submit your CE evaluation, you will be provided
with a certificate to retain for your records• For technical assistance, please email Nikki Racelis
([email protected])• If you have questions about this CME/CE activity,
please contact AKH Inc. at [email protected].
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Who’s in the room?
What entity or type of organization do you represent?
• Academic Faculty• Government agency (CMS,
CMMI, CDC, etc.)• Home Health Agency• Hospital• Nursing Home/LTC/SNF• Patient, Family, or Caregiver• Patient or Family Representative• Pharmacist: Clinic
• Pharmacist: Community • Pharmacist: Hospital • Pharmacist: LTC • Prescriber/Practitioner• QIN-QIO staff• Other (please chat in)
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Session Goals
By the end of today’s call, you will be able to:• Describe the interactions between biology and
psychology, and their effects on the patient pain experience
• Identify the difference between pain sensitivity and pain tolerance
• Identify 3 home-based strategies to reduce pain • Describe why a functional pain assessment may be
useful to reduce unnecessary opioid prescribing and how to implement this in a standard 15-minute appointment
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Campaign for Meds Management
• Identifies and promotes resources and interventions that support the following:
• Improve medication use and management, especially in high-risk medication populations
• High-risk medications include opioids, anticoagulants, and diabetic drugs
• Advance patient-centered shared decision-making• Emphasize the patient voice in healthcare• Disseminate favorable resources and tools utilized,
promoted, and/or created by QIN-QIOs
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Why Should I Join
• Participate in Learning and Action Network (LAN) events and receive free continuing education credit
• Access numerous resources to improve medication safety and communication between providers, patients, and caregivers
• Identify various medication safety quality improvement activity opportunities
• Spread medication safety interventions regionally and nationally
• Be a leader in medication improvement activities and interventions
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CMM Website
• http://qioprogram.org/campaign-meds-management
Who should join the CMM…
EVERYONE
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Patient Perspective
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Katharin (Kay) LaughtonPatient
Meet Your Speakers
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Amy Wachholtz, PhD, MDiv, MS, ABPP, FACHPAssistant Professor of PsychologyUniversity of Colorado Denver
Pain Management: Change the Focus - Change the Outcome
Amy Wachholtz, PhD, MDiv, MS Assistant Professor Of Psychology Director of the COAP Lab
Psychological Pain vs “Real Pain”?
Physiological Musclo-skeletal Neuropathic
Psychological Stress Depression Social
Gate Control Theory of Pain
Melzack & Wall, 1965
Bi-directional Pain Pathway
ALL PAIN HAS A PSYCHOLOGICAL COMPONENT
Emotions and Pain
Thoughts and Pain
Thoughts and Pain
Catastrophizing
Fear of pain
Low self-efficacy
Behaviors and Pain
Pain Sensitivity vs. Tolerance:What are you are measuring?
Sensitivity: What is the level of your pain?
Tolerance: What can you do despite that pain level?
Treatment Goal
The patient resumes normal daily activities
NOT JUST PAIN REDUCTION!
Treatment Efficacy
Need Functional Pain Assessment Not just 0-10 scale
Is treatment helping them engage in more activities?
Should be a sliding scale, not either/or
“When my pain is gone then I will…”
Measuring Pain
Psycho-behavioral Treatment Interventions
Cautions…
Benefits…
Needs…
Emotions
Laughing with friends
Hobbies
Pets
Thoughts
•Increase patient self-efficacy
•Decrease patient thoughts that medication is the only answer
•Education regarding realistic expectations of pain management
•Positive self-statements
Behaviors
Basics of Pain Coping Therapy Progressive Relaxation Brief Practices Pain Suppression
Imagery Wound Healing
Imagery Pleasant Activity
Scheduling Communication Skills Challenge
Catastrophizing
Activity-Rest Cycling Distraction Techniques Problem Solving Cognitive
Restructuring Altering Self-Efficacy
Beliefs Increasing Internal LOC Relapse Prevention Chemical Coping
Assessment
Challenges
Hyper-focus on pain
Catastrophizing
Hyperalgesia Long term effects
Aberrant Drug Use Behaviors Addiction Diversion
Individual Care Plan
Remind of goals – quality of life not pain gone Pain functioning assessment 3 goals to accomplish in the next month SMART goals
Example: attending child’s baseball game, volunteering, completing household chores; exercise
Selfies; phone records; GPS/steps as evidence
Things to Monitor
Monitor
Activity Levels
Sleep
Social Support
Addiction Potential
Schedule of Meds
Weight Gain
Mood
Basic needs met
CAM txused
Finding a health psychologist American Psychological Association APA.org
American Board of Professional Psychology AABP.org
If there are no local resources contact your closest medical center or academic medical
center and ask about tele-psychology services with a health psychologist
Meet Your Speakers
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Mitzi Daffron, RN, MS, CPHQIndiana State DirectorQsource
Fighting Back Against Opioid MisuseA Community Approach
Mitzi Daffron, RN, MSIndiana State DirectorJanuary 10, 2018
Overview• Indiana – in 2014, 15 percent of all medications prescribed to
Medicare Beneficiaries were opioids• Ground swell of effort across the State to address the opioid
problem, but no real focus on the senior population• Developed proposal for pilot in one county – selected due to
higher prescribing rate and recommendation of the Indiana State Department of Health
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Key Interventions and Target Population
Hospital Intervention• Intervention listed in RFP – process implemented at Indiana
University Paoli Hospital• Identification of frequent visitors to the ED, particularly
related to opioid requests• Letter sent from the hospital to those frequent visitors noting:
• frequency of visits• prescriptions for opioids (identified also through INSPECT
database)• offering other resources to the patient
• Measuring ED visits after receipt of letter; through INSPECT database also tracking whether they go elsewhere for prescription
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Practitioner Intervention• Recruitment of all Part D prescribers in the county • Using “First Do No Harm” toolkit developed by Indiana Drug
Prevention Task Force – offers resources for prevention and treatment of opioid misuse, as well as non-opioid intervention resources -http://www.in.gov/bitterpill/files/First_Do_No_Harm_V_1_0.pdf
• Mainly educational focus with practitioners• Measured through prescriptions for opioids from participating
practitioners – INSPECT database, as well as claims when available
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Community/Beneficiary Intervention• Working with Healthy Communities of Clinton County
• anywhere from 8 to 11 health fairs and educational events per month within the county
• Showing patient-centered videos from the American Chronic Pain Association (ACPA) at events, as well as on loops in the hospital waiting areas, ED, and in practitioner offices -https://theacpa.org/opioids/default.aspx
• Providing patient-directed materials in both English and Spanish
• Opportunities to do educational presentations at these events
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Goals of the Project• Goal of decreasing ED visits by 40
percent, which translates to 863 fewer ED visits over the course of the contract
• Goal of 25 percent decrease in inappropriate prescribing would result in a reduction of 1,160 opioid claims for the two-year contract
• Goal of 25 percent decrease in opioid related admissions/readmissions translates to 315 fewer hospitalizations over the course of the contract
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Where We Are• Hospital ED intervention implemented December 2017• Practitioners recruited and toolkit distributed December 2017• Community outreach to begin February 2018• Preliminary data should be available for ED late January 2017
49This material was prepared by atom Alliance, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO), coordinated by Qsource for Tennessee, Kentucky, Indiana, Mississippi and Alabama, under a contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Content presented does not necessarily reflect CMS policy. 17.INS1.10.008
Additional Resources• CDC Rx Awareness Resources –
https://www.cdc.gov/rxawareness/resources/index.html• Intermountain Healthcare Tools -
https://intermountainhealthcare.org/services/pain-management/patient-education/
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Questions?
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• Contact information• Cheryl Riddell – Project Lead
• [email protected]• Mitzi Daffron – Indiana State Director
Facilitated Panel Discussion
Chat in your questions and comments.
Press *1 on your telephone key pad to enter the teleconference queue.
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Call to Action
• Visit the CMM at http://qioprogram.org/campaign-meds-management
–Join the CMM–Share your resources/interventions and stories
• Complete the post-event assessment upon exiting WebEx: https://www.surveymonkey.com/r/9R5T2W3
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Save the Date!
• Join us for the next Medication Safety LAN Event!– Wednesday, April 11, 2018– 3:00 - 4:30 PM ET– Registration is required!
• Register at https://qualitynet.webex.com/qualitynet/onstage/g.php?MTID=e84bca76f95932f7c1d9aa61899fdaa18
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Follow the QIO Program on Social Media!
https://twitter.com/QIOProgram
https://www.youtube.com/channel/UCP-3KliHRoKeozEs-7ohQnw
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Thank you!
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This material was prepared by Telligen, the Quality Innovation Network National Coordinating Center, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-QINNCC-01787-12/18/17