A Multidisciplinary Strategy to Address A Public Health Issue

Guila Lion, Pharmacy, Maaynei Hayeshua, Bne Brak, Israel (guila@mhmc.co.il)
Rina Irene Fermont, Isop Israel, Tel Aviv, Israel
Igor Zaikin, Hebrew University of Jerusalem, Jerusalem, Israel

Background: Unacceptable rates of morbidity and mortality with anticoagulants rank them as the therapeutic class with of the highest priorities in drug safety issues.

ISMP (the Institute for Safe Medication Practices, USA) built the Self-Assessment® for Antithrombotic Therapy with a system-approach. ISOP ISRAEL, in partnership with ISMP, has designed a multidisciplinary strategy combining several approaches which was implemented in Maayanei Hayeshua Medical Center.

Methods: The ISMP self-assessment tool covers all key areas in the treatment process and all stakeholders, with 115 questions divided in 8 sections. It is led by a multidisciplinary team including pharmacists, physicians, nurses, risk managers, and quality officer. The finalization of the assessment leads to a score and identifies the organization weaknesses. The ISMP Failure Mode and Effects analysis (FMEA) allows both the root cause analysis and the prioritization of the actions in a corrective and preventive action plan (CAPA). The CAPA efficiency is reflected in obtaining a new ISMP assessment.

Results: The project started in June 2018 with a large communication within the medical center to setup the multidisciplinary team. The ISMP self-assessment was translated into Hebrew and a Pharm D student was dedicated to the project. Six meetings were necessary to run the 115 questions, the answers where completed with the involved departments. Eventually a score was obtained in January 2019, distributed in 8 Key Elements:

• Patient Information (62%)
• Drug Information (18%)
• Communication of Drug Orders and Drug Information (50%)
• Drug Storage, Stock, Standardization, Distribution (68%),
• Medication Device Acquisition, Use, And Monitoring (20%), Competency And
• Staff Education (36%),
• Patient Education (29%)
• Quality Processes & Risk Management (25%).
  

Following the FMEA, the CAPA main actions are focused on:

• Protocols writing
• Training healthcare professionals
• Correct POC use
• Patient education
• CHAMELEON (IT System) modifications
• Medications reconciliation

It is expected that the corrective actions will be finalized and the ISMP Score will be run again by the end of July 2019.
Conclusions: One of the main challenges was the set-up of a multidisciplinary team and all stakeholders’ collaboration. With the 1st results, however, the project was taken to heart at the hospital level. The lessons learnt and the CAPA actions have improved the sensitivity and the practices. The ultimate success in building a sustainable safety culture will be measured by the decision to apply the same approach to other high alert medication and by the impact on other hospitals.