DUHS Adverse Drug Event Surveillance (ADE-S)
Safety Goal
Quality improvement
officers within DUHS require consistent, longitudinal information on adverse
drug events (ADEs) occurring in high risk medications in order to improve
overall medication safety. We administer a daily, computerized rules
engine called ADE-Surveillance, that scans the clinical information systems of
inpatients at each of our three DUHS hospitals to look for patient
demographics, lab results, and medication orders that may be indicative of
potential harm. ADEs related to opiate and benzodiazepine medications
identified via Surveillance have been added to the DUHS balanced scorecard.
Plan & Scope
- Provided technical and administrative maintenance of ADE-S, including the development of new trigger rules and system enhancements
- Tailor trigger rules to the needs of pediatric patients
- Provide comprehensive aggregate ADE rate reporting to quality improvement stakeholders using Cognos business intelligence technology
- Present ADE-S event data to DUHS operational medication safety committees
- Create real-time trigger alerts that are integrated into the DUHS electronic health record
DUHS Safety Reporting System (SRS)
Safety Goal
Non-punitive, voluntary reporting of safety-related events is a key component of DUHS culture. We administer and lead enhancement development for an elaborate web portal for the reporting of all safety events. SRS is live in inpatient and outpatient areas at Duke University Hospital, Durham Regional Hospital, and Duke Raleigh Hospital, as well as Duke HomeCare & Hospice. Employee events are also captured. The system is highly utilized by staff for reporting of safety events and it contains many features that facilitate efficient event review by DUHS quality improvement leadership. Leadership can the investigate and apply lessons learned to improve safety across Duke Medicine.
Plan & Scope
SRS development is guided by the DUHS Patient Safety Systems Oversight Committee, which informs and guides Duke Medicine patient safety and quality initiatives. We offer both clinical and technical expertise to achieve committee goals, which include:
- Provide administrative oversight for SRS. This includes offering continual functional and technical support for the application. In addition to the standard maintenance requests, we partner with our customers to organize and implement various new approaches to improve usability and performance.
- Assist in the prioritization of patient safety system enhancements and project requests while ensuring alignment with DUHS patient safety goals. We continually work to advance SRS functionality in ways that are mindful of internationally recognized data classifications and taxonomies, human factors design, and user types. We recently augmented SRS by applying the International Classification for Patient Safety structure to our data for patient falls, blood transfusions, and clinical labs categories
- Foster the use of patient safety data in clinical quality initiatives using Cognos business intelligence technology. Manual and automated reports have been created using the Cognos BI tool. This tool allows novice users to select from simple web prompt widgets and generate complex SQL queries. Data returned is presented in both graphical and list formats. Users can then click on specific pieces of a chart or graph to obtain more detailed data about the area selected. The goal of these reports is twofold. First to help operational leaders ensure proper review is performed on SRS events and secondly to help safety personnel identify areas for quality improvement actions. An automated rolling quarterly fiscal year report is sent to each service unit detailing general report trends and actionable data. Specific reports can then be manually run to focus in on specific attributable causes of events codified in the WHO safety taxonomy. Specific reports are available for medication/iv, falls, and clinical labs categories.
DEDUCE Research Portal
Safety Goal
Clinical data systems collect an enormous volume of information, but all too often this treasure trove of data is seen as a disposable byproduct of patient care. National patient safety mandates to improve outcomes demand we have the ability to explore this data creatively and return the acquired knowledge back to all patient care stakeholders. We wish to empower clinical researchers with data by creating a sophisticated research portal that provides access to the DUHS data warehouse using business intelligence technology.
Plan & Scope
- Develop a web-based research portal to give clinicians dynamic access to clinical data in support of research questions.
- Develop a research-appropriate, patient-centric data model with five axes of patient care information
- Provide data to researchers in two forms: Simple, prompted query forms using Cognos business intelligence software and a sophisticated Query Builder to develop one’s own extracts.
- Use the research portal to implement recommended patient safety measures by healthcare quality stakeholders and develop a methodology to share this information with clinicians.
- Use the portal to drive analytical techniques that discover risk areas for DUHS patients.
Medication Safety at Duke University Hospital
Safety Goal
Collaborate with health system leadership and DUH providers to leverage data to guide quality and safety improvements and reduce the incidence of patient harm attributable to high risk medications: anticoagulants, opiates, and hypoglycemic agents.
Plan & Scope
- Maintain an active presence in DUH committees related to patient safety and quality improvement
- Maintain and enhance computerized surveillance monitoring and reporting of adverse event rates attributable to high risk medications (e.g. warfarin, heparin, insulin, morphine, hydromorphone.)
- Create summary reports for aggregate event analysis and and provide feedback to clinical services and individual providers regarding event rates
- Employ best practices, compliance, and regulatory standards to proactively identify quality and safety metrics for assessing and monitoring care quality related to the use of high risk medications.
- Iteratively improve and implement clinical decision support within computerized physician order entry (CPOE) systems to enhance medication ordering practices
- Utilize electronically available data for measuring the impact of IT interventions on patient care processes, outcomes, and care quality with the use of high risk medications
- Streamline measures into quality metric models which can be operationalized within the organization and used as continuous quality measures of best practices and/or compliance
CPOE Metrics at Duke University Hospital
Safety Goal
Provide leadership for CPOE and patient safety metric initiatives, proactively identifying and prioritizing projects in alignment with institutional leadership directives. Leverage the data repository for assessing and monitoring patient care processes, outcomes, and care quality.
Plan & Scope
CPOE metrics are a collaboration between CPOE and Health Analytics and IT Patient Safety team members within Duke Health Technology Solutions
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