General/Measurement
Hypoglycemia
Anticoagulation
Opioid
Stewardship
100
7% (year 1) 20% (total)
What are the HIIN targeted reductions for ADE? 7% was year one & 20% for the two years 36% Anticoag; 32% Hypo; 23% opioids BUT only 46-50% reporting
100
<50 mg/dl
What is a critical value to be considered severe hypoglycemia? …. The American Diabetes Association (ADA) defines severe hypoglycemia as a plasma glucose <50 mg/dl. While many hospitals use the ADA threshold, each hospital may define its own. Please refer to individual hospital definitions and maintain consistent use of this definition throughout the HIIN project.
100
<5
What is a critical INR value for excessive anticoagulation? ….. No national standard defines a threshold for excessive INRs. While many hospitals use an INR of >5, each hospital may define its own threshold provided it consistently maintains this definition throughout the entirety of the HIIN project.
100
Hydrocodone
What is the most frequently prescribed opioid on the market?
100
These two terms for programs dealing with medications and infections in the hospital are NOT interchangeable. One being a subset of the other.
What is antibiotic stewardship and antimicrobial stewardship? ..... Antibiotic Stewardship - promotes the appropriate use of antibiotics (pharmaceuticals only). This is a subset of antimicrobial stewardship. ..... Antimicrobial Stewardship - promotes appropriate processes for antimicrobials (including antibiotics). This is a global intervention that limits the spread of resistant organisms.
200
$5000.00
What is the national average cost to a hospital per adverse drug event?
200
140 - 180 mg/dl .
What is targeted glucose range for hospitalized patients on insulin?
200
INR targets may be outside of established critical values in these two types of patients.
What are a-fib and mitral valve replacement patients?
200
Naloxone
What is one of the reversal agents used for over-sedation or rescue? This includes planned reversals (post-procedural patients).
200
The CFO likes this program because it saves the hospital money.
What is antibiotic stewardship?
300
HIIN-ADE-1a / HIIN-ADE-1b / HIIN-ADE-1c
What are the measure IDs for anticoagulation due to warfarin, hypoglycemia in inpatients receiving insulin and adverse drug events due to opioids?
300
By eliminating this as the sole method of glycemic management, if a patient is eating - utilize basal + bolus + correction. If not eating, utilize basal + bolus.
What is sliding scale?
300
Restricted foods, over the counter medications and herbal supplements
What are things we should ask/educate our patients and families to avoid to prevent interactions with warfarin? For example: kale, green tea, cranberry and alcohol, chamomile, ginkgo biloba, ginseng, cQ-10....
300
Do this to avoid multiple concurrent prescriptions of opioids and sedatives.
What are standardized order sets?
300
Leadership, Accountability, Drug expertise, Action Tracking, Reporting, & Education
What are the core elements of a comprehensive antimicrobial stewardship program?
400
Pharmacy, Information technology, Lab and procedural areas
Who are strategic partners for data collection?
400
By implementing these two things together, hypo- and hyper-glycemia should be normalized.
What is coordination of meal and insulin times?
400
It is essential to obtain this on all patients on warfarin therapy even if they have been chronic outpatient therapy.
What are daily INRs?
400
POSS and RASS
What are effective tools to reduce over-sedation from opioids? ….. Pasero Opioid-Induced Sedation Scale? Purpose - to assess sedation levels in patients who are receiving opioids to prevent over-sedation and respiratory distress. ….. Richmond Agitation Sedation Scale? Purpose - To assess the level of consciousness and agitation in ICU patients to guide sedation and assist in communication among care providers.
400
A collection of data usually in the form of a table summarizing individual bacterial pathogens and susceptibility to antimicrobial agents.
What is an antibiogram?
500
High-alert Medications
What are insulin, anticoagulants and opioids classified as by the Institute of Safe Medication Practice?
500
Scenario - Diabetic patient "Sweet Pea" has been in the hospital for five days and had a critical value fall below 50 mg/dl three times (twice on day 2 and once on day 4). The numerator for ADE-1b is three.
What is NOT a correct reporting for ADE-1b? ..... HRET HIIN FAQ, Tips and Tricks: A single patient with multiple glucose levels below the threshold during a single admission is only counted once. Duplicative events should be removed.
500
Scenario - Iron Man was seen in the ER and had an elevated INR greater than 5. He was admitted and has been an inpatient in the hospital for four days with a critical value greater than 5 three times (once day 2 and twice on day 4). Day 3 INR normalized, Coumadin restarted. The numerator for ADE-1a is 1 (one).
What is a correct reporting for ADE-1a numerator?
500
WAKE-UP
What is the Up Campaign component focused on over-sedation? ….. Warn yourself: This is high risk. ….. Assess: Use tools (STOP BANG, POSS, RASS, PA-PSA). ….. Know: Your drugs, your patient. ….. Engage: Pts & families to set realistic pain expectations ..... Utilize: Does limits, layering limits, soft and hard stops ….. Protect: The patient...out ultimate job. .... Dec. 2017 HIIN Workshops!
500
The Board and medical staff like this program because it saves lives that would have otherwise been lost to infection.
What is antimicrobial stewardship?
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