online evaluation, self-assessment and ce credit

Sentri7 Best Practices: Increasing Efficiency & AdoptionQuorum Health Pharmacy Education Series

ProCE, Inc.www.ProCE.com 1

2017 Pharmacy Education Series

October 26, 2017Sentri7 Best Practices: Increasing Efficiency & Adoption

Speakers:

Joe DeMattei, Pharm.D. Laura PurdyDirector of Pharmacy Supervisor, Application SpecialistsCrossroads Community Hospital Clinical Software Solutions

Wolters Kluwer

Providing Continuing Education For Healthcare Professionals

Submission of an online post‐test and evaluation is the only way to obtain CE credit for this webinar

Go to www.ProCE.com/QuorumRx

Webinar attendees will also receive an email with a direct link to the web page

Print your CE statement of completion online

– Credit for live or enduring (not both)

Deadline: November 24, 2017

CPE Monitor (applicable to pharmacists)

– CE credit automatically uploaded to NABP/CPE Monitor upon completion of post‐test and evaluation (user must complete the “claim credit” step)

Online Evaluation, Self-Assessmentand CE Credit

Attendance Code

Code will be provided at the end of today’s activity 2



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B. Keith Yarde, R.Ph., M.S

Pharmacy Operations Director

QUORUM Health

Update on Current Pharmacy Initiatives and Strategies

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October 26, 2017Sentri7 Best Practices: Increasing Efficiency & Adoption

Speakers:

Joe DeMattei, Pharm.D. Laura PurdyDirector of Pharmacy Supervisor, Application SpecialistsCrossroads Community Hospital Clinical Software Solutions

Wolters Kluwer

Providing Continuing Education For Healthcare Professionals

It is the policy of ProCE, Inc. to ensure balance, independence, objectivity and scientific rigor in all of its continuing education activities. Faculty must disclose to participants the existence of any significant financial interest or any other relationship with the manufacturer of any commercial product(s) discussed in an educational presentation. Dr. DeMattei does not have any relevant commercial and/or financial relationships to disclose. Ms. Purdy does not have any relevant commercial and/or financial relationships to disclose.

Please note: The opinions expressed in this activity should not be construed as those of the CME/CE provider. The information and views are those of the faculty through clinical practice and knowledge of the professional literature. Portions of this activity may include unlabeled indications. Use of drugs and devices outside of labeling should be considered experimental and participants are advised to consult prescribing information and professional literature.

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CE Activity Information & Accreditation

ProCE, Inc. (Pharmacist)

– 2.0 contact hours

Funding:This activity is self‐funded through Quorum Health.

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Sentri7 Best Practices: Increasing Efficiency & Adoption

October 26, 2017

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Learning Objectives

Describe new tools in rule writing to enhance Sentri7® alerts List new features to streamline Dashboard view Discuss how rule prioritization, real-time

notification, and advanced reviews can drive improved performance metrics Describe dashboard-centric vs. patient-centric

workflows in Sentri7 Describe Sentri7 antibiogram reporting Explain how Sentri7 can be used at Quorum for

workflow, regimen optimization, antimicrobial stewardship, and regulatory compliance

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ADVANCED TOOLS IN RULE WRITING

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Zero Occurrences Operator

Look for the absence of a drug order or lab result

In the past, other negation operators used such as Is Not, Is Not In were used to try to mimic the new operator; however, they would sometimes produce unexpected results

When used at the top of a rule block (for drug orders, chemistry lab results), you can set the operator to 0 or no to find zero occurrences of the specific

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IV/PO THERAPEUTIC INTERCHANGE

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WARFARIN WITHOUT INR

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1. Dashboard Approach2. Patient Approach

Sentri7® Recommended Surveillance Workflows:

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Types of Documentation

Advanced Review

May be used when the rule alert has been reviewed, but no clinical action is taken at that time

May be used when therapy is appropriate and no clinical change is necessary

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Sentri7® Examples of Advanced Review

IV/PO Linezolid - Patient meets rule criteria for therapy interchange but due to nausea cannot be converted to oral administration; document findings and reset time to follow-up

Albumin Assessment - Confirmed that patient received an infusion of albumin that was deemed appropriate based on criteria for use recommendations. No additional albumin is ordered and no follow-up is necessary.

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Advanced Review Workflow

Click Review link to the right of the alert

Document pertinent notes in ‘Notes’ section

Select Reset Time when additional review is clinically necessary (if not, select ‘Never’)

Click Review to close

This will gray the patient out for the

selected times as a visual cue that the patient has been

reviewed. This patient will re-illuminate when review time expires.

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Closed (One-Time) Intervention (‘Submit’ with no further follow-up)

May be used to document if clinical action was taken on an alert and no additional monitoring or follow-up is necessary

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Sentri7® Examples Closed (One-Time) Interventions

IV/PO Linezolid - IV linezolid therapy was adjusted to oral therapy; document intervention and ‘Submit’ outcome with no further follow-up

Insulin Formulary Use - Patient had order for non-formulary insulin product and was switched over to a formulary insulin; document intervention and ‘Submit’ with no further follow-up

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Closed (One-Time) Intervention Workflow

Click INT link to the right of the alert

Document pertinent notes in the ‘Event’ section

Complete following question in Outcomes section:

‘Was the primary INT accepted?’

‘YES’ = clinical action made

‘NO’ = clinical action not taken or physician did not

accept

Select Primary Physician and click ‘Submit’

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Closed (One-Time) Intervention Workflow

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Open (Monitoring) Intervention (‘Submit, Continue F/U’)

May be used to document clinical action or potential action that needs further monitoring or follow-up

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Sentri7® Examples Open (Monitoring) Interventions

Warfarin Patients – Patient has active warfarin therapy and requires dosing and monitoring daily; document an intervention and ‘Submit, Continue F/U’ then update due date when next clinical review is necessary

Vancomycin Monitoring – Patient has active gentamicin therapy and requires dosing, laboratory, and culture monitoring. Document an intervention and ‘Submit, Continue F/U’

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Open (Monitoring) Intervention Workflow

Click INT link to the right of the

alert

Document pertinent

notes in the ‘Event’ section

Enter pertinent notes in

‘Follow Up’ section

Update due date when next clinical

review is necessary

Click ‘Submit, Continue

F/U’

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Open (Monitoring) Intervention Workflow

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Open & Closed Intervention Flow

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Surveillance Workflow: Dashboard Approach

Initiative-centric

Streamline Dashboard surveillance with new design features

No limit to # of rules per tab

Hide rules with 0 patients

Tab count

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Dashboard Approach: More than 10 rules per tab

No longer limited to 10 rules per tab

Allows you to consolidate similar rules under a single tab, thus reducing dashboard clutter and size

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Dashboard Approach: Hide rules with zero patient qualifications

With this feature engaged, rules with 0 patient hits can be hidden from view

Feature respects the service area filter

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Dashboard Approach: Tab Count

Feature enables you to easily see how many unreviewed patients exist on each tab, adding efficiency to Dashboard surveillance

Count appears in parenthesis next to each tab name, and count reflects Service Area Filter

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Dashboard Approach

Sentri7® Recommended Surveillance Workflow Demonstration:

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Surveillance Workflow: Patient Approach

Patient-Centric

Streamline Patient tab surveillance with prioritization features

Service Area Filter

Rule Priority

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Patient Approach: Service Area Filter

Engage Service Area Filter for your assigned units to display patients matching rules in your rounding area(s)

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Patient Approach: Rule Priority

Sort patient list by priority to display highest priority patients at top by clicking twice on Rule Matches column header

Sentri7 will display number and identify rules for each priority (high, medium, or low) in Rule Match column

Hover over rule match column to view rules

Rules that were already reviewed will be grayed out

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Modify rule priority on Rules tab and engage real time email/text notifications for high priority alerts

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Patient Approach

Sentri7® Recommended Surveillance Workflow Demonstration:

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INTRODUCING THE RULE PERFORMANCE REPORT

Aligning Sentri7 Setup and Workflow to Improve Clinical Outcomes

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Rule Performance Report (New October 2017!)

Report is intended to help measure whether Sentri7 patient alerts are being addressed effectively and in a timely manner, answering questions such as: What percentage of patients on our Antimicrobial Stewardship

rules are being reviewed or intervened on?

How long does it take someone to respond to patient alerts in the ICU?

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Rule Performance Metrics

Rule performance is then calculated as the number of patients who were reviewed and/or intervened on divided by the total number of unique patients who qualified for the rule

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Rule Performance Metrics

Every unique patient to quality on a rule for greater than 10 minutes is evaluated and placed in 1 of 3 buckets:

Unreviewed

Reviewed Only

Intervened On

Multiple reviews/interventions on the same patient are only counted once toward overall performance, even if the patient qualifies for the rule multiple times

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Data Display - Trending Components

Display what proportion of patients are reviewed and intervened on over time

Analyze data by Rule, Dashboard Tab, or Point of Care

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Data Display - Rule Performance Breakdown

By rule, shows raw rule performance metrics (patient alerts, # of patients reviewed, etc.) over time

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Data Display – Response Time by Priority

Displays how long, on average, it takes someone to respond to a patient alert

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How can I get this report?

Will be emailed every 5th of the month to all Sentri7 Pharmacy Administrators with email addresses in Sentri7 user profile

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Generating your Sentri7®

Antibiogram through Data Matching

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Sentri7® Antibiogram

Developed under the CLSI guidelines

Customizable to indicate non-formulary medications, restricted antimicrobials, and relative cost of antibiotics

Rolling 12-month, real-time

Filter by specimen and location

View year-over-year trending with the 5-year susceptibility graph

Match local terms to standards for consistency

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What is data matching?

Process of standardizing your local microbiology data (left) to consistent and industry terminology (right)

Local Facility Data can be matched to a standard value from the Matched Data dropdown or set to “DO NOT MATCH” – Sentri7® excludes these values from the antibiogram

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Why is data matching important?

Your microbiology data is unique

Matching to a standard format is critical and required to accurately use antibiogram

Must be completed before use of antibiogram and will periodically require updated matching

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What data matching is required?

Organism Names

Susceptibility Results

Susceptibility Tests

Culture Test Name

Point of Care (Location)

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Organisms

Match your local system organism names to a standard list of pathogens

Any organisms found in “Not Matched” or “Do Not Match” will be excluded from antibiogram

Tip: Match gram negative rods to “Do Not Match,” as these were likely preliminary results without susceptibility testing

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Susceptibility Tests

Match agents used by local microbiology to test the sensitivity of an organism to standard CDC-recognized antibiotics

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Susceptibility Result

Must be matched to one of the standard interpretations (S, S-DD, I, R, NS, N) so the susceptibility percentage can be calculated properly

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Additional guidance on Data Matching for your Sentri7® Antibiogram:

Sentri7® Pharmacy Enhanced Antibiogram Flash Tutorial (15:00) https://asp.pharmacyonesource.com/help/Sentri7/

tutorials/Demo/Antibiogram_2016_Q1/Antibiogram_2016_Q1.htm

Sentri7® Pharmacy Antibiogram FAQ https://asp.pharmacyonesource.com/help/Sentri7/

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Antimicrobial Stewardship

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Antibiogram

Advantages over Facility-generated antibiogram:

Gives the most current version of susceptibility trends at the facility Lab-driven antibiograms often only updated annually

Can manipulate dates to see trends in susceptibility

Sentri7 antibiogram defaults to only show bacteria with > 30 isolates (WHO recommendation)

Sentri7 shows separate susceptibility info for MRSA & MSSA

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Antibiogram: Facility-generated

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Antibiogram- Sentri7

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Antibiogram- Sentri7

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Antimicrobial Stewardship

48 hour assessment of all antibiotics

Assessment of appropriateness for all pts. on anti-pseudomonal antibiotics & antibiotics for MRSA

Bug/Drug mismatch

Narrowing of antibiotic spectrum

Inappropriate antibiotic duplication

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Regulatory Compliance

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Regulatory Compliance CDC, Joint Commission: Antimicrobial

Stewardship

Rule showing all antibiotics active for 48-72 hours (CDC recommendation)

Rule to aid assessing appropriateness of tx. For all patients on anti-pseudomonal tx. and all pts. On anti-MRSA tx.

Antibiogram providing pharmacist w/ most current susceptibilities

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Regulatory Compliance Joint Commission National Patient Safety

Goals

“Take extra care with patients on anticoagulants” Anticoagulant rules showing lab trends on all

anticoag pts.

Duplicate anticoagulant rule

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Regulatory Compliance Joint Commission- Clarify priority of use

Pts. on multiple PRN Anti-emetics

Multiple PRN Antipyretics

Multiple PRN pain meds

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Priority of Use Rule:

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Sentri7 Workflow Rules

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Workflow

Cart fill

Advantages to using Sentri7 for cart fill: No need to edit orders to change floor stock

status

Advanced Review option lets you determine when that pt./drug will show up again (e.g. never, in 5 days, 3 days, etc.)

Can customize to make dose-specific E.g. Levetiracetam IV doses > 500 mg

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Cart Fill: Dose-specific

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Workflow

Cart fill

Advantages to using Sentri7 for cart fill: No need to edit orders to change floor stock

status

Advanced Review option lets you determine when that pt./drug will show up again (e.g. never, in 5 days, 3 days, etc.)

Can customize to make dose-specific E.g. Levetiracetam IV doses > 500 mg

Can also make Pyxis-specific or unit-specific

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Cart Fill: Unit-specific

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Workflow

Patient Own Medications

Displays all patients who have a “Patient Own Medication” profiled

Using the review function allows all users to see when a Pt. Own Med has been verified

Allows Pharmacy to profile a patient’s home med before it has been brought to the hospital to clear up work queue

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Patient Own Medications

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Workflow Allergy Check

What it is: Prompt to check the allergies of all new admits

to ensure no free text medication allergies on the profile

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Allergy Check

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Workflow Allergy Check

What it is: Prompt to check the allergy screen of all new

admits to ensure no free text medication allergies on the profile

Why it’s important: HMS will not screen medications for allergies

that are entered as free text medication allergies

From the pt. profile screen, it’s impossible to determine if HMS recognizes the allergy or not

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Allergy Check

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Allergy Check, cont.

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Workflow Interdisciplinary Rounds Lab Display

Creates a simple, consolidated place to view most common labs & trends for patients in one location

Can be tailored to be unit-specific for hospitals with unit-specific pharmacists

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Workflow Interdisciplinary Rounds Lab Display

Creates a simple, consolidated place to view most common labs & trends for patients in one location

Can be tailored to be unit-specific for hospitals with unit-specific pharmacists

Can also add a Microbiology link to easily access patient’s culture history

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Workflow

Pharmacy to dose orders

Order clarifications

Therapeutic interchange documentation

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Sentri7 Workflow Notifications

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Sentri7 Notifications

You can be notified two ways:

1. Text message

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Text Notifications

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1. Text message

2. E-mail

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E-mail Notifications

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1. Text message

2. E-mail

Benefits:

No PHI displayed in notifications; can use cell phone or personal e-mail for notifications

Notifications sent as soon as MD/RN enters the order (i.e. as soon as it shows up to verify)

Allows you to create safety checks that you don’t have to actively view a report to use

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Possible uses for notifications

Lab/micro results:

Vancomycin & Aminoglycoside levels resulted

INR resulted

Finalized culture & sensitivity reports

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Drug-specific notifications:

Call back drug notification

Respiratory Therapy notification of new nebulizer pts.

Pharmacy to dose notifications

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“Background” safety checks: GI bleed pts. w/ GI irritating drugs or anticoagulants

ordered

Contact precaution pts. prescribed common canister MDI

C. difficile-positive pts. prescribed antidiarrheal

Double check that pts. aren’t prescribed drugs they’re allergic to

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Possible uses for notifications Double check that pts. aren’t prescribed drugs they’re

allergic to

HMS does not prioritize allergies when displaying warnings on a given order Especially in post-op pts. this can result in seeing anywhere

from 2-6 pages of duplicate therapy warnings prior to even seeing the allergy warning

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Allergy Screening Notification

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Regimen Optimization

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Regimen Optimization Reports

Drug-Food Interactions

Levothyroxine given before any food/med

PO Quinolones before/after food d/t calcium

Rivaroxabann doses > 15 mg given w/ meal

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Drug-Drug Interactions

PO Quinolones w/ Calcium/Mg/Fe/Al

Drug-specific Frequency/Timing

Diuretics

Stimulants

DM Meds/short-acting insulins before meals

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Identify meds that should be added to a patient’s regimen

ICU pts. Needing stress ulcer prophylaxis

DM pts. not on Aspirin, ACE-Inhibitor/ARB, or Statin

Sliding Scale Insulin Pts. w/o D50W profile

Eliquis & Prednisone Taper pts.

Can use for drug interactions/duplicate therapy screenings to decrease alerts in HMS & reduce alert fatigue

E.g. multiple potassium-increasing therapies

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online evaluation, self-assessment and ce credit

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