Because diagnostic and minor surgical procedures on pediatric patients outside the operating room (OR) have increased in recent years, the need for procedural sedation and analgesia in outpatient settings, non-hospital settings and imaging facilities has markedly increased. As a result, more non-anesthesiologist healthcare professionals with varied training and credentialing are providing these services. Documentation of procedural sedation and analgesia also varies tremendously. Within Akron Children's Hospital (ACH), completion of pre-screening, physical exam, sedation plan and discharge paperwork by the Procedural Sedation and Analgesia Services is near 100% while those from other departments or offsite locations are well below 10%. Because completion of the presedation and sedation depth assessments reduces many sedation-related complications, we propose to utilize a modified WHO Surgical checklist in which items not applicable for work flow outside the OR have been removed (e.g., sponge/needle counts) with inclusion of additional items important for patient safety during procedural sedation (e.g., a graded risk stratification tool, obesity identification, medication safety tools, etc.). Implementing an augmented WHO Surgical Checklist specific for procedural sedation would not only create a single checklist to be used institution-wide, but also ensure that the necessary assessments are performed, thereby increasing patient safety.

We propose to develop and implement an easy to use iPad and internet compatible electronic application (Hospital Checklist App) that will facilitate the use and documentation of safety checklists throughout our Children's Hospital.  For proof-of-principle, the initial version will include both WHO surgical safety checklists and checklists specific to the insertion and maintenance of central lines in children or adults.

This initiative aims to implement the WHO Surgical Safety Checklist as a best practice in order to eliminate the number of retained foreign bodies and wrong side/site procedures in the operating rooms and surgical procedure areas across Main Line Health. The E3 Grant would help to facilitate the training and process improvements needed to enhance the culture of safety that we have been building here at Main Line Health, one in which we aim to achieve zero events of preventable harm.

NCCS will hire a public relations and marketing firm to assist in the development and implementation of a cross-channel marketing campaign that targets various media to create buzz and overall interest in its Pocket Cancer Care Guide mobile app for cancer survivors and patients. The campaign will include advertising in major trade publications, online cost-per-click advertising through Google Ads and Facebook Ads, submitting the app for review by top mobile app sites, and creating marketing materials for use at conferences and hand-outs. The goal of the marketing campaign will be to drive more individuals to download and use the mobile app to assist them in their cancer care. By creating a greater awareness of the mobile app, more patients will have the skills necessary to effectively communicate with their health care team, asking the right questions and ensuring they have all the proper information to maintain a healthy and safe journey through treatment and into life after cancer.

This proposal seeks $34,998.55 in funding from your Foundation to support the expansion of a team-training program with the goal of training at least one representative from the checklist implementation team at each hospital. During the next year, we propose to hold eight regional workshops that focus on how to use the checklist as a communication tool and other techniques to improve communication in the operating room. This team-training program is innovative in that it is tailored to operating room personnel. We also propose to visit a subset of hospitals following the regional workshop to better understand how participants apply the curriculum in their institutions.  It is our belief that successful implementation of such a program in South Carolina will improve patient safety and become a model that can be spread to other states and countries seeking to pursue similar work.

SSM Cardinal Glennon is continually looking for ways to improve upon existing processes to maintain exceptional care.  We recognize that breakdowns in communication and teamwork can be a leading cause of surgical errors. Implementing the WHO Surgical Safety Checklist will be an effective way to eliminate these errors. Several years ago, SSM Cardinal Glennon began using Timeout Slider Boards in conjunction with the Joint Commission's Universal Protocols for all invasive procedures to eliminate WSPE's and other errors.  The Timeout Slider Boards have red indicators that are moved to green as each step in the timeout process is completed.  The Boards have a dry-erase surface that can be used to indicate the patient's name, date of birth, procedure and any other pertinent information.  As part of a grant from Cardinal Health, we wish to remanufacture the Slider Boards in all 10 of our operating rooms to include all components of the WHO Surgical Safety Checklist.  We will also construct a template within our electronic medical records system to allow the circulating nurse to enter key concerns into the official record and code a 'hard-stop' so that the patient cannot be handed off until this information is entered into the medical record.

With the improvements in neonatal intensive care and recognition of the hazards in transporting high-risk neonates to the operating rooms, surgical intervention in the neonatal intensive care unit (NICU) has become routine practice. Despite safe practice routines, surgery and neonatal intensive care units are major contributors to medical errors and adverse events. Due to this disproportionate number of events related to surgery, several interventions have been proposed to increase patient safety including improving the quality and teamwork in the operating rooms. The formal implementation of the WHO surgical safety checklist with appropriate training and education is essential in our safe practice of surgical care in the NICU.

This project will utilize the WHO surgical checklist and modify the debriefing process to make implementation easier for staff and physicians. The aim of this project is to increase the quantity and quality of debriefings in the operating room. In addition, errors occuring with the handling of surgical specimens will be addressed as well as a process implemented for resolving issues identified during the debrief.

We believe that by establishing an outpatient clinic, we can:
•Decrease the number of anticoagulant associated adverse events (from 8.4% to less than 1%)
•Decrease the admission rates secondary to an adverse event from the use of anticoagulants (from 52% to less than 1%)
•Decrease our inpatient length of stay, by providing a means for continuum of care (from 6.5 days to 2.5 days)
•Reduce INR's outside therapeutic range and incidence of bleeds from 17.5% to 0 % and 11.1% to 0% respectively
•Enable continuous systematic monitoring of patients to include diet, concomitant drug therapy, and disease states
•Provide education on anticoagulation therapy to patients and healthcare providers
•Reduce in healthcare associated costs through lower hospital readmission rates, reduced need for inpatient monitoring, lower frequency of early complications, malpractice suits, morbidity, and mortality
•Increase patient and physician satisfaction

"There are two components to the proposed project; 1) a foundational component begun in October, 2008 that is a comprehensive Medication Reconciliation Initiative, and 2) the Blue Folder project, an innovative tool for patient safety derived from the broader component. This tool, developed and piloted at Bridgton Hospital (a partner hospital of the Central Maine Healthcare System), directly engages patients with the reconciliation process for their own medications.  It is a vinyl folder containing a patient's medication list and personal health record needed to facilitate successful reconciliation at various sites of care.  Blue Folder has now been adopted by 12 hospitals throughout Maine and it is this component that we wish to expand and disseminate further with support from Cardinal Health Foundation. Our next steps will begin the process of rolling these components out, on a phased basis, to additional inpatient units at our tertiary hospital, Central Maine Medical Center, as well as to additional outpatient practices affiliated with the hospital. In so doing, we expect to 1) save at least 4 lives, 2) realize a 10% decrease in readmission rates at the inpatient units, 3) save 168 patient days, and 4) realize $718,545 in savings.

Delta Health Alliance will expand current activities in the area of Care Transitions and the reduction of readmissions to target hospitals that have some of the highest readmission rates in Mississippi. In 2010, DHA was awarded a grant through the Beacon Community project to promote adoption of electronic health records systems in our region. One significant component of that effort was the implementation of Care Transition services in select locations to reduce avoidable hospital readmissions through better use of health information technologies. DHA, through the BLUES Beacon Community Program is currently coordinating for the delivery of Care Transitions services at three Mississippi Delta hospitals. The focus of the care transitions effort related to the BLUES Beacon Community is restricted to diabetes diagnosis codes only.  There is a great need for the services to be expanded to include other disease states, and DHA is requesting funds to expand the patients eligible for Care Transition services at two of our Care Transition sites.  In a region where hospital readmission rates are among the highest in Mississippi, we propose to reduce hospital readmissions to or below the national averages of AMI = 19.8; HF = 24.8; and Pneu = 18.4.

The objective of our project is to determine the impact the Florida Society of Health System Pharmacists will have on a 'medication safety across transitions of care' endeavor through collaboration with 3,000+ members and 1,000 attendees at our annual meeting.

1)    Presentation of interventions implemented in 20 or more health systems through poster presentation
2)    4 or more different types of transitions of care
3)    700 or more pharmacists attending FSHP annual meeting offering
4)    Survey of attendees indicating a 25% response rate for implementation of discussed strategies within their health systems (citing specific interventions)
5)    National success when presented at ASHP mid-year (4 or more posters including the FSHP poster will be considered a success)

Homeless, mentally ill individuals lack access to and continuity of healthcare services, which leads to the inhumane and costly cycling of this population between public hospitals, county jails and the streets/shelters - the 'revolving door phenomenon.' Healthcare for the Homeless - Houston (HHH) works to combat this phenomenon through policy and research initiatives aimed at enacting systems change and through programs such as the Jail Inreach Project, which works with inmates of the county jail to safely transition them into a health home immediately upon release. This prevents rapid deterioration of health status cause by dangerous revocation of medications and treatment, return to the streets and subsequent arrests. Homeless patients being discharged from public hospitals face similar barriers, lack of access to and continuity of care. HHH proposes to evaluate and use baseline data on public hospital utilization patterns of homeless mentally ill patients to establish the Hospital Inreach Project. It will be modeled after HHH's Jail Inreach Project, which has demonstrated significant success in reducing rearrest rates and number of days in jail and, thus, providing considerable cost-savings to the county.  It is anticipated that hospital inreach will have similar effects on reducing readmissions, especially within 30 days.

The Pharmacist Discharge Counseling program is designed to provide counseling for patients being discharged from the hospital. The pharmacy department will partner with hospitalists, nursing managers and their teams, and the case managers on the target floor.  The group developed the plan to identify and counsel patients at high risk of readmission.
The care managers will see patients and identify those being discharged to a personal residence.  Following rounds, this list of tentative patient discharges is faxed to the Clinical Pharmacy Specialists for review and to determine which patients are appropriate for counseling.
At the time of discharge, the provider completes the discharge paperwork and enters a consult for 'Pharmacist Discharge Counseling' in the computerized physician order entry (CPOE) system.  This consult notifies the Clinical Pharmacist that the patient is nearing discharge and needs medication review and reconciliation.
Upon completion of the counseling, the pharmacist will include a copy of the patient's medication list from www.medactionplan.com in the patient's chart.  The pharmacist will also provide documentation in the patient's medical record pertaining to the counseling session, including the time spent with the patient.

Grant's Post-Anesthesia Care Unit (PACU), like many others in the United States, does not have a standardized assessment and/or algorithm used to assess opioid sedation and respiratory depression. This grant will pilot the Pasero Opiod Sedation Scale (POSS) algorithm at Grant Medical Center's PACU to determine the best implementation process as well as to project any additional resources required in terms of surgeon and anesthetist. Upon completion of this pilot, the scale will be reviewed for implementation across the OhioHealth system.

This project, Clinical Transitional Experts in Residence Program: Training & Sustaining Safe Medication Practices at Transitions of Care, aims to educate discharge advocates, case managers and pharmacists on the Transitional Care Model for adoption in clinical practice.  The Clinical Transitional Experts in Residence Program will include:  a formalized education program for the current multidisciplinary direct care team through a 32-hour professional development series at the University of Pennsylvania; expansion of time and resources, to include point-of-care technology, for the Clinical Transitional Expert in Residence (Pharmacist); attainment of Certification in Geriatric Pharmacy by the Clinical Transitional Expert in Residence (Pharmacist) and; support of the clinical preceptorships of pharmacy and nursing students with special emphasis on safe medication transitions in the elderly.

The vision of this project is to obtain 'Triple Aim': best care experience, affordable services, improve population health by having a pharmacist complete the interdisciplinary care team at Providence Hood River Memorial Hospital's Chemotherapy Outpatient Infusion Clinic.  The objective is for the pharmacist to improve patient care, satisfaction, and affordability through 20-40 minute medication therapy management consults and follow up phone calls.  The potential implications is better control of chemotherapy induced nausea, vomiting, and diarrhea, decreased anxiety, less hospital admissions due to dehydration and other complications reducing overall healthcare costs to the patient and to the system (Reference #1, Study shows that each pharmacist encounter saved an estimated $86), and a reduction of patient out of pocket expense for oral chemotherapy medications.  The benefit to the patient is the potential for a higher quality of life through education about their therapy that can mitigate chemotherapy side effects, reduce cost, and increase satisfaction in care experience.

To improve patient safety we propose an expansion of our outpatient parenteral antimicrobial therapy (OPAT) service. The OPAT team reviews antibiotic care plans at hospital discharge to improve patient safety, clinical efficacy, and health care expenditures. The ID pharmacists ensure that the selection and dosing of antimicrobial therapy are safe, practical, and effective; suggest monitoring plans; and any necessary follow-up information. The goal of the OPAT team is to optimize patient care and remove barriers to hospital discharge.
An ID-trained clinical pharmacist is central to this project, owing to a solid understanding of evidence-based outcome data, treatment guidelines, and antibiotic pharmacology. Through post-discharge monitoring of patients we propose the following outcomes: follow-up >80% of identified patients, achieve a complication rate less than the national published complication rate, zero readmissions due to avoidable drug related toxicity.

This proposal is Phase IV of a quality improvement collaborative involving patient care units at Nationwide Children's Hospital.  The overall goal is to decrease harmful adverse drug events (ADEs) to zero by December 31, 2013.  The specific aim of Phase IV is to decrease ADE rate from 0.09 to 0.045 ADEs per 1000 medication doses-dispensed by December 31, 2012.  To that end, we expanded the collaborative to include all inpatient and outpatient units.   Effective interventions established in Phases I-III of the collaborative will be spread to all units.  Phase IV interventions will target ADEs due to a) vaccine administration errors in the outpatient clinics, b) errors that result from the growing drug shortage problem; and errors related to insulin therapy.  Specifically, we will implement a newly developed health maintenance module for the outpatient electronic medical record; task a pharmacy technician to monitor safety of medication substitutions resulting from drug shortages, and c) support a quality improvement team to optimize insulin therapy.  We project that during Phase IV an additional 150 ADEs and $700,000 related costs will be avoided. Since February 2010, the collaborative has reduced the harmful ADE rate 62.5%, avoided 385 harmful ADEs and $1.8 M in ADE-related costs.

Roper Hospital serves a coastal region of South Carolina that is disproportionately stricken by poverty and has one of the highest unemployment rates in the country, high levels of uninsured, and the third-highest illiteracy rate in the United States.  Major barriers to recovery from heart failure include medication adherence and low health literacy, both of which are worsened by the circumstances under which many of our citizens live. The purpose of the proposed Keep Your Heart at Home Medication Safety Program is to introduce a pharmacy-based intervention to address medication adherence and low health literacy barriers faced by patients with heart failure.  Program objectives are: 1). to improve medication safety across the transitions of care for these complex patients at high-risk of readmission and 2.) to improve application and knowledge of medication use throughout the management of an acute heart failure exacerbation. We believe that this program expansion will decrease days in the hospital, lower emergency department visits, and save dollars as it improves the transitions of care from hospital to home for patients with heart failure.

Financing from the Cardinal E3 Grant Program would be used to partially fund one component of a comprehensive facility-wide medication reconciliation improvement program.  This portion of the project will focus on placing pharmacy staff in the Emergency Department, the entry point for approximately 80% of patients entering the hospital.  Pharmacy staff would interview patients and family members on current medications, document the patient's medication profile in a computerized system, follow-up with primary care providers and retail pharmacies to clarify unclear information and educate patients on their current medications and how those medications may change while hospitalized.  The objectives of this project are to improve the accuracy of the initial medication history and increase the timeliness of medication reconciliation. By providing an initial accurate medication history in a timely manner, we hope to improve patient safety both during the hospital stay by reducing prescribing errors on admission and at discharge by reducing the discharge error rate.

PeaceHealth Southwest, a 450 bed hospital, serves Clark County and outlying communities. PHSW embraces the vision for patient safety set forth by the Institute for Health Care Improvement.
Our interdisciplinary team will focus on reducing 30-day hospital readmissions and providing individualized discharge medication education based on health literacy assessment. Patients meeting certain criteria will be flagged during admission using the LACE (Length of Stay, Acute Admission, Co-morbidities, ER visits) tool.
The pharmacy technician will obtain the patient's prior-to-admit, hospital and discharge medication lists.  Any discrepancies will be identified and clarified by the pharmacist.  Utilizing our outpatient pharmacy, the patient may opt to receive discharge medications. All patients will receive a medication calendar and education from the pharmacist prior to discharge. The pharmacy technician will follow-up by calling the patient or key learner 3 to 5 days after discharge; and notify patient's outpatient physician of delivery of medication reconciliation information.
Quality measurements will use the current medication reconciliation process as a baseline. Comparison of previous hospital readmissions with post-intervention readmission rates will be measured.  Nursing and physician perception of the service will be assessed. These quality measurements will meet the Joint Commission requirements.

Southwest General has made progress in improvements to the vulnerable hand off point from hospital to home thanks to a Cardinal Health Foundation grant, which is funding a Transitional Care Nurse Program pilot focusing on heart failure patients.  An analysis of diagnoses with high 30-day readmission rates revealed that COPD had Southwest General's highest rate at 22%.  Readmission rates for COPD are high throughout the U.S., yet few, if any, of the current transitional care research initiatives have focused on these patients.  Funds are therefore being requested to expand Southwest General's program to include both heart failure and COPD patients.  If awarded, transitional care nurses will ensure that recently-discharged patients receive the support they need by implementing best practices recommended by the NIH and the IHI.  Approximately 200 patients will receive services, resulting in a decrease in the readmission rate for COPD patients to below the national average of 16.67%, while the readmission rate for heart failure patients will continue to drop to below 10% for complications related to heart failure and to below 18% for all other complications.  Other anticipated outcomes include improved medication safety, increased efficiency, lower health care costs, and enhanced patient safety and quality of life.

Expansion of a soon to be implemented transitional coaching program to focus on medication reconciliation from hospital discharge through nursing home admission, stay, and ultimately discharge home.  We believe errors/omissions in medications in the hospital to nursing home transition lead to increased morbidity and often readmission.  By improving discharge reconciliation, and instituting a reconciliation process in the nursing homes, we expect to decrease readmissions, ultimately saving both dollars and lives.

"The Swedish Heart and Vascular Institute recently implemented a Collaborative Health Action Team (CHAT) approach to manage the transition to post-acute outpatient care, either at home or at a nursing care facility, for inpatients who have been treated for acute heart failure (HF) at Swedish. The Program's goal is to reduce readmissions by addressing key patient barriers to self-management. Following discharge, CHAT nurses conduct telephone follow-ups with patients to manage transitions from post-acute care at Swedish to care received from primary care providers and/or outside cardiologists. Phone calls focus on maintaining contact with patients to ensure that proper and appropriate medication is sustained through the transition and that patients understand and adhere to treatment plans. CHAT nurses also provide patient education (re: heart disease) and monitor patients' follow-up appointments with post-acute providers.
This proposal seeks funding for an expansion of this CHAT Program to provide similar post-discharge medical reconciliation support to Acute Myocardial Infarction (AMI) patients. Funds requested will be used to pay salary and benefits for a half-time RN familiar with care management of AMI patients to conduct CHAT follow up calls with this group of patients."

The University of Cincinnati Foundation is submitting a proposal on behalf of UC Health/ University Hospital's Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine, to hire a part-time Obstructive Lung Disease Nurse Coordinator to facilitate safe medication management; symptom and self-care education; and care coordination for asthma and COPD patients.  Our goals in seeking this funding are to:
• Reduce current asthma and COPD Emergency Room visits and 30 day readmission rates from their current levels (26% - 51%) by at least 10% in the first year
• Increase asthma/COPD diagnosis accuracy through use of spirometry testing to avoid inappropriate or over-use of medications, improving patient safety and outcomes
• Improve patient knowledge about and self-management of their chronic conditions in order to mitigate symptoms and improve their quality of life
• Demonstrate significant patient improvement and hospital cost savings through this year trial, that will form the basis for both making this position permanent and sharing our results through publications and conferences

WMHS is taking a two pronged approach in a medication reconciliation program.  We will implement both internal and external processes to optimize this process with outcomes that will align with the Institute for Healthcare Improvement's suggested outcomes of reducing readmissions, decreasing harm to the patient, increasing reliable care 100% of the time and increasing patient satisfaction.  Externally, our process will educate the community on thorough personal medication lists and provide products to help provide that information effectively.  Internally, we recognize the Emergency Department (ED) as our main point of access and wish to staff a pharmacist in the ED to obtain accurate medication lists and use interventions to avoid drug interactions and errors.   We are requesting $35,000 from Cardinal Health Foundation to cover the initial pharmacist salary expenses for this endeavor.   We have secured another grant through the Western Maryland Insurance Company to fund the community education and resources for that part of the program.

The overarching goal of the MedKey Project is to better equip WRMC inpatients to share their current medications list and immunization history with healthcare providers to increase the efficiency and accuracy of their transition of care from: (1) hospital to home (2) hospital to local pharmacy (3) Hospital to physician (4) Physician to physician (5) Physician to pharmacy.  MedKey outcomes include: (1) increasing patient satisfaction scores in relation to information communicated with them regarding medication usage and side effects utilizing the HCAHPS survey, (2) Reduce readmissions of MedKey Project eligible patients to the hospital, (3) Decrease the cost of healthcare by decreasing the number of medications prescribed to patients, (4) Anticipate the impact of future CMS rulings affecting reimbursements to the hospital for accurate and efficient inpatient medication reconciliation by implementing and supporting change early.

Our Pharmacy Anticoagulation Program is aimed at improving patient safety specifically in high risk patients on anticoagulation therapy. There is much literature demonstrating a high risk of errors that can happen at transitions of care.  We have seen similar reports internally, specifically related to anticoagulation.  We propose to expand our current program to the outpatient setting by implementing a pharmacist discharge phone call program for patients on therapeutic anticoagulation therapy. By implementing a pharmacist discharge phone-call program, we plan to address the patient's transition to home and follow up care regarding the use of anticoagulant therapy. We hope to not only improve outpatient compliance with medications and follow up care, but we believe that this will reduce hospital readmissions and ultimately improve patient outcomes. The outcomes proposed include improving education of patients who are to be discharged on therapeutic anticoagulation, obtaining high level of patient satisfaction with the discharge process and information about medications,  reducing hospital re-admissions associated with bleeding event and/or clotting events for patients on anticoagulation, specifically dalteparin and warfarin, and quantifying pharmacist intervention opportunities post-discharge and time requirements per patient.  We hope to reduce our 30 day readmission rate for bleeding and clotting by 10%.