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WIHI: Opioid Crisis: Changing Habits and Improving Pain Management
January 11, 2018 | As efforts continue to curb the opioid addiction epidemic in the US and reduce deaths from overdoses, the underlying problem of overprescribing remains very much in the spotlight.
Reducing Inappropriate Medication Use by Implementing Deprescribing Guidelines
This case study from the IHI/Commonwealth Fund International Program for US Health Care System Innovation describes how a multidisciplinary team of clinical experts in Ottawa, Canada, created a credible, low-cost process for developing and implementing evidence-based deprescribing guidelines and tools for assessing, tapering, and stopping medications that may cause harm or no longer benefit patients.
Health Care Providers Must Act Now to Address the Prescription Opioid Crisis
While a community-wide approach is also needed to effectively address the opioid crisis, the authors describe some key actions that both providers and organizations can take to begin making a difference, including changing provider prescribing practices.
Addressing the Opioid Crisis in the United States
This IHI Innovation Report discusses key reasons why current efforts to reduce prescription opioid use and misuse in the US have thus far been largely ineffective in stemming the crisis; highlights gaps in current efforts that underscore the need for a coordinated and collaborative community-wide approach; identifies four primary drivers to reduce opioid use; and proposes a high-level construct for a system approach at the community level to address the US opioid crisis.
WIHI: Nurturing Trust: Addiction and Maternal and Newborn Health
June 2, 2016 | Addiction is always a complex challenge, but when a woman using substances is pregnant, suddenly two lives are at stake.
WIHI: The Opioid Crisis: How Health Care and the Community Can Act
April 21, 2016 | The US is in the midst of a serious opioid addiction epidemic, driven largely by an explosion of prescribed pain medications. This WIHI discusses IHI's work to scan for best practices that comprise a community-driven, integrated, and multi-sector approach to address the opioid crisis, as well as efforts underway in New Hampshire and California.
ISMP Medication Safety Best Practices
Developed with the help of leading medication safety experts, and patterned after the Joint Commission’s National Patient Safety Goals, the ISMP has issued six 2014-15 Targeted Medication Safety Best Practices for hospitals.
Reduction in Medication Errors in Hospitals Due to Adoption of Computerized Provider Order Entry Systems
The findings of this study suggest that computerized provider order entry (CPOE) systems can substantially reduce the frequency of medication errors in inpatient acute-care settings; however, it is unclear whether this translates into reduced harm for patients.
National Coordinating Council (NCC) for Medication Error Reporting and Prevention (MERP)
The National Coordinating Council (NCC) is an independent body of 27 national organizations whose aim is to maximize the safe use of medications and increase awareness of medication errors through open communication, increased reporting, and promotion of medication error prevention strategies.
Profiles in Improvement: Frank Federico, Executive Director, IHI
IHI's Frank Federico talks about his early work as a pharmacist to improve medication safety, and his current role at IHI working with teams around the world to implement proven best practices in patient safety.
Signal and Noise: Applying a Laboratory Trigger Tool to Identify Adverse Drug Events among Primary Care Patients
This study tests the use of six abnormal laboratory triggers for detecting adverse drug events among adults in outpatient care.
20 Tips to Help Prevent Medical Errors Patient Fact Sheet
These tips tell consumers what they can do to get safer care.
MATCH Medication Reconciliation Toolkit
Use the materials in the toolkit as guidance for developing a medication reconciliation process in your hospital or outpatient practice setting.
Measures: Prevent Harm from High-Alert Medications
Care teams should measure each of the key interventions recommended in the How-to Guide: Prevent Harm from High-Alert Medications.
Measures: Prevent Adverse Drug Events (Medication Reconciliation)
Care teams should measure each of the evidence-based interventions for preventing adverse drug events using medication reconciliation recommended in the How-to Guide: Prevent Adverse Drug Events (Medication Reconciliation).
What's in your toolbox to improve care quality?
This article describes tools and skills that hospitals and pharmacists need to test, change, and improve health care quality and to establish multidisciplinary medication safety programs.
WIHI: Managing Medication Shortage: Best Practices for a Crisis
September 22, 2011 | Three pharmacy-trained improvers who’ve tapped their expertise on medication safety share strategies that can enable hospital staff to stay on top of the fast-moving drug shortage problem on a daily basis.
Drug shortages: A patient safety crisis
This article outlines the key issues surrounding prescription drug shortages and the errors and harm that can result, and provides guidance for leaders in supporting their medical staff members.
Passport Exclusive: Providing Reliable Perinatal Care by Using Clinical Bundles
In this video, Sue Leavitt-Gullo, MS, RN, Director for IHI, reviews providing reliable perinatal care through usings clinically proven bundles.
Passport Exclusive: Medication Reconciliation
In this video, Frank Federico discusses the challenges many hospitals face with nedication reconciliation and ways health care providers can make implementing the process easier.
Author in the Room: Managing Medications in Clinically Complex Elders
November 2010 | A discussion with the author of the JAMA article "Managing Medications in Clinically Complex Elders."
Author in the Room: Trends in Opioid Prescribing in US EDs
February 2008 | A discussion with the author of the JAMA article "Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments."
What happens when things go wrong?
What happens to the family of the injured pediatric patient and to the health care providers after an adverse event involving anesthesia occurs?
Making inpatient medication reconciliation patient centered, clinically relevant and implementable: A consensus statement on key principles and necessary first steps
Given the importance of accurate and complete medication reconciliation for patient safety occurring across the continuum of care, the Society of Hospital Medicine convened a stakeholder conference in 2009 to begin to identify and address barriers to implementation, best practices, the role of partnerships with nonclinical and community organizations, and metrics to determine the impact of reconciliation on preventing harm.
Introduction to Trigger Tools for Identifying Adverse Events
The use of triggers, or clues, to identify adverse events is an effective method for measuring the overall level of harm from medical care in a health care organization.