To Kaiser Permanente National Patient Safety Program
Kaiser Permanente Colorado's Patient Safety Program is managed by our Regional Patient Safety Manager and overseen by our Director of Clinical and Business Risk Management. The Colorado Permanente Medical Group's Medical Director designates a physician to partner in the development and implementation of patient safety initiatives.
The purpose and objectives of our Patient Safety Program include developing, implementing and maintaining a comprehensive, proactive process that promotes patient safety and enhances the quality of care and service provided to members. Critical goals of the program include assessing potential risks to the health plan and well-being of our members and reducing those risks.
Our Patient Safety Program encompasses all patient care delivery areas including the medical offices, allied health services, Kaiser Ambulatory Surgical Center and the affiliated care programs for Denver/Boulder and Colorado Springs service areas. Additionally, the Patient Safety Program covers administrative programs and departments, such as Information Technology, which contributes to the provision of safe care for our members.
Denver/Boulder Service Area
We have various systems in place at the point of dispensing to minimize prescription drug errors including: allergy screening, drug-drug interaction screening, drug-pregnancy screening (identification of drugs that may not be appropriate for pregnant women), and drug-renal screening (identification of drugs or drug doses that may not be appropriate for patients with impaired renal function).
Retrospective drug reviews are often identified on an as-needed basis or performed as part of an ongoing program.
One such ongoing drug review program involves appropriate laboratory monitoring for patients prescribed a medication identified as requiring baseline or ongoing laboratory monitoring. Our Clinical Pharmacy Call Center (CPCC) receives a daily report of patients prescribed one of the identified medications who have not had the appropriate laboratory monitoring completed within a specified time period. A CPCC pharmacist reviews the patient's medical record, calls the patient to discuss the needed lab work, orders the appropriate labs, and follows up with the patient's provider.
We have also developed centralized services to manage high-risk populations or drugs, such as our Clinical Pharmacy Anticoagulation Service, which monitors and manages anticoagulation therapy for over 5,700 patients, and our Clinical Pharmacy Cardiac Risk Service, which monitors and optimizes drug therapy for patients with a history of cardiovascular disease to reduce their risk of having another cardiovascular event. Our CPCC plays a role in transitioning the pharmaceutical care of new members to the Kaiser Permanente system, which may include: continuing current medications, switching patients' medications to appropriate therapeutic alternatives when they have been prescribed a non-formulary medication, ordering lab tests necessary for monitoring specific medications or disease states, and ensuring patients are on evidence-based drug regimens. As part of these processes, a pharmacist reviews the drug name, strength, directions for use, dispense dates, refill history, and prescriber's name.
Colorado Springs Service Area
The Kaiser Colorado Springs network contracts with a pharmacy benefits management company (MedImpact) to process claims submitted on behalf of our members by our contracted pharmacies. As part of the concurrent review, all claims are screened for problems such as incorrect/improper dosage and drug interactions. The screening module uses information in three nationally recognized databases to screen for interactions. The dispensing pharmacist is notified as to the drugs involved in the interaction and the level of importance of that interaction.
There are 7 different drug utilization review (DUR) edits (Drug Interaction, Drug Dosage, Ingredient Duplication, Age Precaution, Pregnancy Precaution, Gender Conflict and Therapeutic Duplication) that send advisory information to the pharmacist. Based upon his/her professional judgment and the clinical situation, the dispensing pharmacist will take the action he/she feels is appropriate.
Since approximately one-fourth of all avoidable drug errors are related to confusing drugs with similar names, a final kind of soft edit, the "SOUND ALIKE DRUG EDIT", alerts the pharmacist that the name of the drug being dispensed is similar to another drug. This prompts the pharmacist to again double-check the name of the drug being dispensed with the one on the prescription. The classic examples of this type of "sound alike error" are the drugs hydroxyzine and hydralazine.
Generally, retrospective reviews only occur on an ad hoc basis, as clinically relevant information on drug interactions becomes known. We have the ability to query the dispensing records of all our Colorado Springs members. These records are updated nightly and include all of the previous day's transactions. With such current data, we can perform retrospective reviews for interacting medications and identify those members who have filled such medications and alert their physicians. A recent example of such a query involved a drug to treat arthritis, leflunomide, and the blood thinning agent warfarin.
In order to spread patient safety information throughout the Colorado Region, Patient Safety Program staff uses various methods, including providing patient safety information in mailed communications to physicians. Our Patient Safety Program's scope, objectives, and key contact information are provided to all new physicians and staff during their orientation. In addition, an internal Patient Safety Newsletter is published quarterly that contains information about patient safety improvements, best practices and tips to enhance practitioner and staff ability to provide safe care. Patient Safety Program staff in Colorado also contribute information about our region's patient safety programs to the National Kaiser Permanente Patient Safety Website, which is accessible to all physicians and staff.
Kaiser Permanente members receive a quarterly magazine, Rocky Mountain Health, which periodically features articles on specific patient safety practices of interest to members. During National Patient Safety Week in March, we provide brochures to members on tips they can use to help us provide them with the safest care possible. We encourage members to be active participants in the decisions around their care.