CHOOSING WISELY CAMPAIGN WELCOME Anthony Pudlo, PharmD, MBA Vice President, Professional Affairs Iowa Pharmacy Association PRESENTER Deborah Pasko, Pharm.D, MHA Senior Director of Medication Safety and Quality ASHP Choosing Wisely: ASHP & the States Deborah A Pasko, Pharm.D, MHA Sr. Director of Medication Quality and Safety ASHP What is Choosing Wisely • Started in 2012 • Mission: – Supported by evidence – Not duplicative of other tests or procedures already received – Free from harm – Truly necessary • In 2012 developed questions about “Things Providers and Patients Should Question.” • They are not firm guidelines and should not be used as such but as a means to start asking questions http://www.choosingwisely.org/wp-content/uploads/2017/10/Choosing- Wisely-at-Five.pdf Since 2012 what has happened? CHOOSING WISELY BY THE NUMBERS • Over 80 specialty society partners • 525 specialty society recommendations • Over 70 consumer and employer groups • 29 current and former grantees • 45 Choosing Wisely Champions • 1,330 journal articles referencing Choosing Wisely in 2016* • 1.9 million visits to www.choosingwisely.org in 2016 • 19 countries that have created their own Choosing Wisely campaigns http://www.choosingwisely.org/our-mission/facts-and- figures/ U.S. Choosing Wisely Spreads to the Globe Choosing Wisely: Just not us…. International Efforts • Since that time, Choosing Wisely Canada and similar campaigns in over 20 countries have emerged, including: • Choosing Wisely Australia • Choosing Wisely Brasil • Choosing Wisely Israel • Choosing Wisely Italy • Choosing Wisely Japan • Choosing Wisely New Zealand • Choosing Wisely UK • Choosing Wisely Wales • International collaboration is coordinated by Choosing Wisely Canada through the Choosing Wisely International Learning Network. • If your country is interested in becoming part of this growing international movement to combat unnecessary care, please contact us at: [email protected] • To help countries get their Choosing Wisely campaigns underway, the Network has developed a Starter Kit. • Download Starter Kit https://choosingwiselycanada.org/campaign/international/ The U.S. List • Over 100 medication related topics before ASHP was asked to join • ABIM asked ASHP for 5 medication focused initiatives and one of them should be consumer sided • ASHP started with internal taskforce – Intern did the initial “scrub” of the list – Then staff developed 10 topics not already on the list • Started using the list from Rita Shane at UCSD • Used article and guidance from Northwestern, Bruce Lampbert, PhD – This list then sent out to specific counsels for review – Developed top 5 from those lists ASHP Recommendation One One: Do not initiate medications to treat symptoms, adverse events, or side effects without determining if an existing therapy or lack of adherence is the cause, and whether a dosage reduction, discontinuation of a medication, or another medication is warranted. New medications should not be initiated without taking into consideration patient compliance with their pre-existing medication and whether their current dose is effective at controlling/treating symptoms. Medications are often prescribed to treat symptoms that are really side effects of other medications without determining if the pre-existing medication is truly needed or could be discontinued ASHP Recommendation Two Two: Do not prescribe medications for patients on five or more medications, or continue medications indefinitely, without a comprehensive review of their existing medications, including over-the-counter medications and dietary supplements, to determine whether any of the medications or supplements should or can be discontinued Studies have shown that patients taking five or more medications often find it difficult to understand and adhere to complex medication regimens. A comprehensive review, including medical conditions, should be done at periodic intervals, at least annually, to determine if the medications are still needed and if any medications can be discontinued ASHP Recommendation Three Three: Do not continue medications based solely on the medication history unless the history has been verified with the patient by a medication-use expert (e.g., a pharmacist) and the need for continued therapy has been established The patient or caregiver should be the sole source of truth when taking the medication history. The patient or caregiver should be interviewed by someone with medication-use knowledge, ideally a pharmacist, and medications should only be continued if there is an associated patient indication. If a pharmacist is not available then at a minimum, the healthcare worker taking the history should have access to robust drug information resources. The history should include the drug name, dose, units, frequency, and the last dose taken; and indication if available ASHP Recommendation Four Four: Do not prescribe patients medications at discharge that they were on prior to admission without verifying that these medications are still needed and that the discharge medications will not result in duplication, drug interactions, or adverse events. Treatments and procedures during a hospitalization may impact a patient’s ongoing need for a medication they were receiving prior to admission. Care should be taken at discharge to consider each medication taken prior to hospitalization in light of the patient’s current state. Unnecessary medications should be discontinued, duplicate or overlapping therapies should be changed, and the specific changes should be clearly communicated to the patient. The Joint Commission recommends a thorough medication review at admission and discharge to prevent any unnecessary medications being continued ASHP Recommendation Five Five: Do not prescribe or administer oral liquid medications using teaspoon or tablespoon for measurement; use only milliliters (mL) when measuring with an approved dosing device (e.g., medication cup or oral syringe Serious medication errors, including patient deaths, have occurred because oral liquids are prescribed and/or administered using English measurement units such as the teaspoon or tablespoon. For medical professionals, best practice is using units and volume when prescribing a single agent liquid medication, to be sure the dose is clear; but for administering only use mL for measuring the amount. Safety organizations and agencies such as the Centers for Disease Control and Prevention and the Institute for Safe Medication Practices have recommended using only the metric system units (e.g., mL) for measurement and using a measuring device that only contains metric markings. Prescribing using the metric system and dispensing with a metric measuring device will help avoid these preventable errors. #5 Consumer Focus Pfizer Recalls Children's Advil Product After Its Measuring Cup Confused Milliliters With Teaspoons http://fortune.com/2018/08/27/pfizer-childrens-advil-recall-how- to-tell/ Non-pharmacological U.S. Efforts Continuous Process Improvement • Each organization asked for yearly review • Goes through many association boards • Each organization is asked to endorse/review – ASHP does participate with this with ABIM Choosing Wisely and Putting the Pieces of the Puzzle Together Choosing Wisely and Deprescribing • Polypharmacy? – What’s true definition – No systematic approach – Appropriate vs. inappropriate • Deprescribing – Haven’t we been doing this for years? – When did we start using this term? Deprescribing www.desprescribing.org Questions? OutlineQUESTIONS of Today’s 2/2/2 HUMAN TRAFFICKING: HOW TO HELP Questions? Contact David Schaaf at [email protected] or 515-270-0713.