track a: safe drug return get rid of unused pharmaceuticals (group) campaign speakers: elizabeth a....

Track A: Safe Drug ReturnTrack A: Safe Drug Return

Get Rid of Unused Pharmaceuticals Get Rid of Unused Pharmaceuticals (GROUP) Campaign(GROUP) Campaign

Speakers:Speakers:Elizabeth A. Smith, Ph.D.Elizabeth A. Smith, Ph.D.

Matthew C. Mireles, Ph.D., M.P.H.Matthew C. Mireles, Ph.D., M.P.H.Community Medical Foundation for Patient SafetyCommunity Medical Foundation for Patient Safety

November 1, 2007November 1, 200710:30 am – 11:15 am10:30 am – 11:15 am

Improving Patient Safety through Informed Improving Patient Safety through Informed Medication Prescribing and Disposal PracticesMedication Prescribing and Disposal Practices

Fifth Annual Maine Benzodiazepine Study Group Fifth Annual Maine Benzodiazepine Study Group Conference & Fourth Annual Unused Drug Return Conference & Fourth Annual Unused Drug Return

ConferenceConference

Copyright 2007 Community Medical FoundCopyright 2007 Community Medical Foundation for Patient Safetyation for Patient Safety

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Get Rid of Unused PharmaceuticalsGet Rid of Unused Pharmaceuticals(GROUP) Campaign(GROUP) Campaign

1. Dangers of unused and expired medicines 1. Dangers of unused and expired medicines (UEM)(UEM)

2. Community of Competence™: a method 2. Community of Competence™: a method and framework to study UEMand framework to study UEM

3. History and evolution of GROUP3. History and evolution of GROUP4. Standardized data collection and 4. Standardized data collection and

methodologymethodology5. Current status and results of GROUP5. Current status and results of GROUP

Learning ObjectivesLearning Objectives


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Get Rid of Unused PharmaceuticalsGet Rid of Unused Pharmaceuticals(GROUP) Campaign—LO1(GROUP) Campaign—LO1

135 million use prescription meds monthly135 million use prescription meds monthly11

4 billion prescriptions each year4 billion prescriptions each year22

90% seniors use at least one med90% seniors use at least one med33

40% used 5 or more meds weekly40% used 5 or more meds weekly33

Average person over 65 take 2 to 7 meds Average person over 65 take 2 to 7 meds daily (30% of meds prescribed)daily (30% of meds prescribed)44

15 million misuse meds15 million misuse meds55

4 out 5 patients leave doc’s office with 1 or 4 out 5 patients leave doc’s office with 1 or more prescriptionsmore prescriptions66

Too Many Medications!Too Many Medications!


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Non-adherence to prescription and therapyNon-adherence to prescription and therapy Med error causes 700,000 ER visits yearlyMed error causes 700,000 ER visits yearly77

36% of poisoning among kids happens at 36% of poisoning among kids happens at grandparents’ homesgrandparents’ homes44; pets get poisoned; pets get poisoned

19% (4.5 million) teenagers abuse 19% (4.5 million) teenagers abuse prescription medsprescription meds88— “pharming”— “pharming”

Meds stolen and sold on the streetsMeds stolen and sold on the streets Improper disposal contaminates waterImproper disposal contaminates water Possible “dumping” of UEM overseasPossible “dumping” of UEM overseas

Dangers of UEMDangers of UEM


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Not just any group, committee, or Not just any group, committee, or coalition...but a true community of coalition...but a true community of individuals based on knowledge, individuals based on knowledge,

skills, expertise, experience, skills, expertise, experience, motivation, and competencymotivation, and competency

Communities of Competence™ (CC)Communities of Competence™ (CC)



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PATIENT

Nurses

Educators

Engineers

Volunteers

Partners

Ethicists Info Sc.

Env. Sc.

Interns

Oslerians

Others

Culture

Environment

Community of Competence™ Community of Competence™

for Patient Safetyfor Patient Safety


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Globalization—cultural diversity, politics, Globalization—cultural diversity, politics, distance, continuous production, distance, continuous production, communication, etc.communication, etc.

Complexity of work itself—numerous disciplines, Complexity of work itself—numerous disciplines, experience levels, e-work, growing number of experience levels, e-work, growing number of products and servicesproducts and services

Organizations are becoming flatter, virtual and Organizations are becoming flatter, virtual and boundarylessboundaryless

Turbulent external environment--limited Turbulent external environment--limited resourcesresources

Challenges in behaving, learning, adapting, and Challenges in behaving, learning, adapting, and survivingsurviving

Theories and Driving ForcesTheories and Driving Forces


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A new framework to first visualize what type of A new framework to first visualize what type of group exists and what type of group should be group exists and what type of group should be created to do a specific task or jobcreated to do a specific task or job

A methodology to describe, assess, and A methodology to describe, assess, and combine separate strengths and core combine separate strengths and core competencies of individuals, groups, and competencies of individuals, groups, and organizations into a meaningful, goal-oriented organizations into a meaningful, goal-oriented whole--synergywhole--synergy

A team of highly skilled, specialized people with A team of highly skilled, specialized people with proven competenciesproven competencies

A flexible, learning organization; network of A flexible, learning organization; network of organizations or systemsorganizations or systems

Operational Definition of CCOperational Definition of CC


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Do specific tasks or jobs for which they are most Do specific tasks or jobs for which they are most qualified or competentqualified or competent

Engage in continual learning and improving skillsEngage in continual learning and improving skills Work together cooperatively and recognize Work together cooperatively and recognize

expertise of their members and of other individualsexpertise of their members and of other individuals Rotate leadership based on unique competencies Rotate leadership based on unique competencies

and expertiseand expertise Make maximum use of tacit knowledge based on Make maximum use of tacit knowledge based on

common sense and information sharingcommon sense and information sharing Communicate openly and share skills, abilities, Communicate openly and share skills, abilities,

knowledge, unique expertise, and lessons learnedknowledge, unique expertise, and lessons learned

General Tasks of CC MembersGeneral Tasks of CC Members


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Identify and address a complex problem—high Identify and address a complex problem—high national…international concern and impactnational…international concern and impact

Recognize oneself as part of a problem-solving Recognize oneself as part of a problem-solving communitycommunity

Understand the forces driving the problem and Understand the forces driving the problem and solutionssolutions

Know one’s own skills, abilities, knowledge, and Know one’s own skills, abilities, knowledge, and unique professional responsibilities and resourcesunique professional responsibilities and resources

Acknowledge and value the individual and Acknowledge and value the individual and collective competencies of others needed to solve collective competencies of others needed to solve the problemthe problem

Organization-Driven Tasks of MembersOrganization-Driven Tasks of Members


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Develop ways to meet in formal, informal, and/or Develop ways to meet in formal, informal, and/or virtual groups or networks to solve the problemvirtual groups or networks to solve the problem

Divide tasks, assignments, and responsibilities Divide tasks, assignments, and responsibilities based on expertise and competenciesbased on expertise and competencies

Create a way to share information across disciplines Create a way to share information across disciplines and organizations (boundary expanding)and organizations (boundary expanding)

Share data, information, and knowledge from one’s Share data, information, and knowledge from one’s own discipline and experience with membersown discipline and experience with members

Evaluate efforts and outcomes to stay on target Evaluate efforts and outcomes to stay on target toward a solutiontoward a solution

Action-Driven Tasks of MembersAction-Driven Tasks of Members


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UEM

MedicalPractice

Drug/LawEnforcement

Public Safety and Policy

ConsumerProtection

Patient Safety

EnvironmentalProtection


Community of Competence™ for UEMCommunity of Competence™ for UEM

Academia andResearch

Others


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UEM problem is large and too complexUEM problem is large and too complex UEM problem is relatively unknown and has UEM problem is relatively unknown and has

enormous impactenormous impact Problem requires diverse expertise, authority, Problem requires diverse expertise, authority,

and intra-organizational involvementand intra-organizational involvement Experts often work together at great distancesExperts often work together at great distances Experts must address current legal and political Experts must address current legal and political

barriers and technologybarriers and technology Problem requires complex solutions that are Problem requires complex solutions that are

both short-term and long-termboth short-term and long-term

Benefits of CC in Studying UEMBenefits of CC in Studying UEM


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Developed as part of patient safety education Developed as part of patient safety education and outreach in safe medication practicesand outreach in safe medication practices

Focus on building awareness and the CC to Focus on building awareness and the CC to address issues of UEMaddress issues of UEM

Created the UEM Registry in 2004 to Created the UEM Registry in 2004 to systematically collect and analyze datasystematically collect and analyze data

Collaborated with partners to standardized data Collaborated with partners to standardized data collection (anonymous with only 5 basic collection (anonymous with only 5 basic variables: drug name, strength, quantity variables: drug name, strength, quantity returned, reason for return, and zip code)returned, reason for return, and zip code)

Published the GROUP Manual of ProceduresPublished the GROUP Manual of Procedures

History and Evolution of GROUPHistory and Evolution of GROUP


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Continue to collect data from various sources Continue to collect data from various sources and locationsand locations

Standardized classification based Drug Abuse Standardized classification based Drug Abuse Warning Network (DAWN) of DHHS Substance Warning Network (DAWN) of DHHS Substance Abuse & Mental Health Services Administration Abuse & Mental Health Services Administration (SAMHSA)(SAMHSA)

Data from UEM Registry requested and used for Data from UEM Registry requested and used for research and policy (State of ME, ONDCP)research and policy (State of ME, ONDCP)

History and Evolution of GROUP (Cont.)History and Evolution of GROUP (Cont.)


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Research Rationale (Questions)Research Rationale (Questions)

WhatWhat kinds of medicines prescribed and not used?kinds of medicines prescribed and not used? WhyWhy medicines not taken as prescribed? medicines not taken as prescribed? WhyWhy people keep UEM in homes? people keep UEM in homes? WhyWhy people stop taking medicines? people stop taking medicines? WhichWhich UEM are controlled substances? UEM are controlled substances? WhatWhat is the cost of UEM? is the cost of UEM? WhatWhat is the environmental impact of UEM? is the environmental impact of UEM?

Methods to Standardize Data CollectionMethods to Standardize Data Collection


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Establish consensus on the variables and why Establish consensus on the variables and why we are collecting themwe are collecting them

Develop standardized data collection Develop standardized data collection instrumentinstrument

Implement use of standardized instrumentImplement use of standardized instrument Evaluate and modify instrument if neededEvaluate and modify instrument if needed Encourage wide use of instrument to collect Encourage wide use of instrument to collect

data the same waydata the same way Use CC as a model and framework for Use CC as a model and framework for

promoting standardized data collectionpromoting standardized data collection Report usage of instrumentReport usage of instrument

Methods to Standardize Data CollectionMethods to Standardize Data Collection


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GROUP Manual of Procedures completed and GROUP Manual of Procedures completed and now availablenow available

US EPA has included GROUP Manual into its US EPA has included GROUP Manual into its Resource Kit for Drug DisposalResource Kit for Drug Disposal

Proposed service: designated data repository Proposed service: designated data repository and analysis of UEM nationally…internationallyand analysis of UEM nationally…internationally

GROUP Campaign to support other projects and GROUP Campaign to support other projects and programs (e.g. Green Pharmacy and Maine Safe programs (e.g. Green Pharmacy and Maine Safe Drug Disposal Project)Drug Disposal Project)

Ongoing study to evaluate GROUP Campaign Ongoing study to evaluate GROUP Campaign and data collection for the UEM Registryand data collection for the UEM Registry

Current Status and ResultsCurrent Status and Results


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Pilot study of GROUP Campaign in Houston, TXPilot study of GROUP Campaign in Houston, TX AimsAims: estimate response rate for participation; : estimate response rate for participation;

evaluate education materials; study the utility of evaluate education materials; study the utility of self-administered returned drug formself-administered returned drug form

PopulationPopulation: senior adults at a local church: senior adults at a local church MethodsMethods: 3-part educational workshop with a drug : 3-part educational workshop with a drug

(UEM) inventory and collection at the end(UEM) inventory and collection at the end ResultsResults::

• Response rate = 18% based on enrollment in Response rate = 18% based on enrollment in workshop (8 participants of 45 enrolled)workshop (8 participants of 45 enrolled)

• Educational materials (slide presentation) Educational materials (slide presentation) increase awareness of danger of UEMincrease awareness of danger of UEM



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Pilot study of GROUP Campaign in Houston, TXPilot study of GROUP Campaign in Houston, TX Results (cont.)Results (cont.)::

• Participants rated the presentation very useful Participants rated the presentation very useful and important, and they learned something newand important, and they learned something new

• Participants filled out drug return form without Participants filled out drug return form without any problemany problem

Discussion and ConclusionsDiscussion and Conclusions::• Pilot study is small; population is uniquePilot study is small; population is unique• Response (participation) rate can be increased Response (participation) rate can be increased

with addition promotion and publicitywith addition promotion and publicity• Participants have no problem filling out formsParticipants have no problem filling out forms



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Get Rid of Unused PharmaceuticalsGet Rid of Unused Pharmaceuticals(GROUP) Campaign(GROUP) Campaign

Need leaders and champions to promote public Need leaders and champions to promote public awareness of the problem and widely adopt the awareness of the problem and widely adopt the UEM RegistryUEM Registry

Need funding to support and expand the Registry Need funding to support and expand the Registry and personneland personnel

Integrate the Registry with collection and disposal Integrate the Registry with collection and disposal systemssystems

Develop standard process for reportsDevelop standard process for reports Identify other uses of the RegistryIdentify other uses of the Registry Reinforce the values and principles of CC to Reinforce the values and principles of CC to

strengthen collaboration and actionsstrengthen collaboration and actions

Challenges and OpportunitiesChallenges and Opportunities


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AcknowledgementsAcknowledgements

Anita Hampton, MS, FellowAnita Hampton, MS, Fellow Jerry Miller, Ph.D.Jerry Miller, Ph.D. Racheal Johnson, BS, Graduate InternRacheal Johnson, BS, Graduate Intern John SullivanJohn Sullivan Cheenu SrinivasanCheenu Srinivasan Hari Ayyer Hari Ayyer Sonali PatelSonali Patel Ye SunYe Sun Faye WangFaye Wang


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For more informationFor more information

Community Medical FoundationFor Patient Safety

6800 West South Loop, Suite 190Bellaire, Texas 77401

832-778-7777www.comofcom.com


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ReferencesReferences1. Center for Disease Control. (2006). Therapeutic Drug Use.

National Center for Health Statistics, http://www..cdc.gov/nchs/fastats/drugs.htm, p.1.

2. Garey, K.W. et al. (2004). “Economic consequences of unused medications in Houston, Texas.” The Annals of Pharmacotherapy, July/August; 38: 165-1168.

3. Smith, S.R. and Clancy, C.M. (2006). “Medication therapy management: A new opportunity to optimize therapeutic outcomes in medicare,” Patient Safety & Quality Healthcare, September-October, p. 12.

4. Minnesota Poison Control System, Hennepin County Medical Center, “Seniors and Medication Safety”. www.mnpoison.org/index.asp?pageID=198

5. Maine Benzodiazepine Study Group, University of Maine, Center on Aging (2006). Conference Proposal for a National Unused Drug, Nov. 22, 2006.


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References (cont.)References (cont.)

6. Testimony before the House Government Reform Committee Subcommittee on Criminal Justice, Drug Policy, and Human Resources. Joseph T. Rannazzisi, Deputy Assistant Administrator, Office of Diversion Control, July 26, 2006.

7. Houston Chronicle. (2006). “Everyday medicines, big risks”. October 19, 2006, B2.

8. The Partnership for a Drug-Free America. (2005). “Latest teen drug trends”. www.drugfree/org/Portal/DrugIssue/Research/Teens_2005/Generation_Rx_Study-…

track a: safe drug return get rid of unused pharmaceuticals (group) campaign speakers: elizabeth a....

Documents

patient safety slide

community medical foundation

pharming meds

streets meds

misuse meds

evolution of group

dangers of unused

true community of individuals