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Effective Strategies for Hospitals Responding to the Opioid Crisis

This document provides hospital and health system administrators and leaders with specific improvement ideas for five system-level strategies that address the challenges of preventing, identifying, and treating opioid use disorder.

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.

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.

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.

Anticoagulant Toolkit: Reducing Adverse Drug Events

ADEs associated with anticoagulants can be reduced by implementing recognized safe practices in high-risk areas, redesigning care processes, partnering with patients and families, and maximizing communications within and across the care continuum.

How-to Guide: Prevent Harm from High-Alert Medications — Rural Hospitals Supplement

This How-to Guide specifically tailored for rural hospitals describes key evidence-based care components for preventing harm from high-alert medications, describes how to implement these interventions, and recommends measures to gauge improvement.

Annotated Bibliography for Preventing Harm from High-Alert Medications

This annotated bibliography presents selected literature for preventing harm from high-alert medications.

How-to Guide: Prevent Harm from High-Alert Medications — Pediatric Supplement

This How-to Guide specifically tailored for pediatrics describes key evidence-based care components for preventing harm from high-alert medications, describes how to implement these interventions, and recommends measures to gauge improvement.

How-to Guide: Prevent Harm from High-Alert Medications

This How-to Guide describes key evidence-based care components for preventing harm from high-alert medications, describes how to implement these interventions, and recommends measures to gauge improvement.

Guide to Coumadin (Warfarin) Therapy

An educational and reference tool for patients that provides important information about anticoagulation therapy for patients who take warfarin, and answers many common questions about the drug.

Warfarin-Herbal Interactions List

A reference for prescribers, nurses, and pharmacists listing herbal agents known to interact with warfarin and the types of interactions to expect.

High-Alert Medications Require Heightened Vigilance

The classification "high-alert medication" is helping those concerned with patient safety to draw attention to the risks associated with certain drugs, even when used as intended, and the steps that can be taken to prevent injury.

Proactive Approaches to Reduce Harm from High-Alert Medications

In this 2007 IHI National Forum workshop presentation, two medication safety experts report on efforts at their hospitals to prevent medication errors.

OSF St. James–John W. Albrecht Medical Center: Where Patients Receive Focused Outpatient Medication Management

At OSF St. James, the anticoagulation clinic helps patients manage their high-alert medication a contrast to the more typical care model in which patients are managed by their primary care provider.

High-Alert Adverse Drug Events per 1,000 Doses

The total number of ADEs related to a specific high-alert drug or class identified in a sample of patient records, divided by the total number of doses of the high-alert drug or class administered to those patients. Multiply the result by 1,000.

Percent of Patients Receiving a Specific High-Alert Medication with a Related Adverse Drug Event

The total number of patients identified as having experienced any ADE related to a specific high-alert drug or class from a sample of patient records, divided by the total number of records in the sample. Multiply the result by 100 to express as a percentage.

Reduce Adverse Drug Events Involving Chemotherapy

Use extra safety measures with chemotherapy medications to prevent adverse drug events (ADEs), which can be extremely serious due to the toxicity of these drugs.

Reduce Adverse Drug Events Involving Narcotics and Sedatives

Careful monitoring and management of narcotics and sedatives can help prevent harm, especially from overdoses.

Reduce Adverse Drug Events Involving Insulin

Coordinate care processes and use standardized tools when caring for patients on insulin to reduce the risk of adverse drug events (ADEs).

Allow Pharmacists to Manage an Anticoagulant Service

Allow pharmacists to manage an anticoagulation service to improve efficiency and help prevent adverse drug events.

Eliminate the Use of Heparin Solution with Arterial Lines

Eliminate the use of heparin solution in the pressurized bags attached to arterial lines, a practice known to cause accidental administration of heparin doses that can lead to adverse drug events.

Use Low Molecular Weight Heparin (LMWH)

Administration of low molecular weight heparin (LMWH) has a lower adverse drug event (ADE) profile than regular heparin and presents significantly less risk of error because it is simpler to use.

Use Anticoagulation Flowsheets

Recording all of a patient’s anticoagulation information on a flowsheet makes anticoagulation therapy easier for the staff to administer and may reduce the risk of errors.

Adjust Anticoagulants with Thrombolytic and G2b/3A Inhibitors

A system that reminds prescribers to take into account thrombolytic and G2b/3A inhibitors as they set anticoagulant doses can help reduce the risk of bleeding or other adverse drug events.