Holmes Regional Medical Center Pharmacists Use VigiLanz to Improve Care

Innovative projects improve glycemic control and decrease thrombosis risk

This success story was written in 2021.

Pharmacists across the country face numerous competing demands and priorities—from preventing adverse events to supporting cost-saving objectives to partnering with physicians to ensure high quality care. With so many critical tasks, it can be difficult to implement and pursue new initiatives.

That’s why the achievements of the pharmacy team at Holmes Regional Medical Center (HRMC), part of the four-hospital Health First network in Central Florida, are so impressive. The team continually pursues new and innovative projects, using technology to support their efforts.

“Our department thrives when novel patient care initiatives enable pharmacists to practice at the top of their license,” said Michael Sanchez, PharmD, BCCCP, Pharmacy Residency Coordinator. “We’re always looking for ways to optimize medication therapies, prevent adverse events, and contribute to antimicrobial stewardship.”

Three recent initiatives spearheaded by HRMC’s pharmacy team and supported by VigiLanz have significantly improved patient care while reducing costs.

Initiative #1: Medication optimization protocol reduces hyperglycemia in patients with acute COPD

In September 2019, HRMC pharmacists began collaborating with pulmonologists across the Health First network to identify opportunities to improve care for patients with acute exacerbation of COPD (AECOPD).

“We had seen some small studies describing the benefits of having pharmacists transition IV corticosteroids to PO, and we wanted to see how that could impact our hospital,” said Sanchez. “Oral and IV corticosteroid therapy have comparable outcomes, but oral therapy is associated with fewer adverse events and is less expensive.”

To test and evaluate the impact, HRMC implemented a protocol enabling pharmacists to independently change IV corticosteroids to oral prednisone, when appropriate. VigiLanz supports the initiative by sending an alert to pharmacists whenever a patient with AECOPD meets HRMC’s eligibility criteria.

“The VigiLanz alert is highly accurate in detecting patients who would benefit from streamlining to oral corticosteroids,” said Sanchez. “We wouldn’t have been able to implement this new protocol without it, due to the complexities of the eligibility criteria.” The criteria include current use of IV corticosteroids, respiratory rate, blood gas results, allergies, and history of asthma.

The workflow:

  • VigiLanz alerts pharmacists of eligible patients, based on eligibility criteria
  • Pharmacists review patients’ medical records to confirm eligibility
  • Pharmacists switch eligible patients from IV corticosteroids to 40 mg of oral prednisone per day for five days

To assess the impact of the new protocol, HRMC pharmacists compared outcomes for 128 AECOPD patients admitted pre-protocol (November 1, 2018 to February 9, 2019), with outcomes for 134 AECOPD patients admitted post-protocol (November 1, 2019 to February 9, 2020).

“To our knowledge, this is the largest study examining the impact of a pharmacist-led IV to PO corticosteroid conversion protocol for AECOPD, and it’s the only study to examine safety endpoints, such as hyperglycemia,” said Sanchez.

While the study found no significant differences in average length of stay, 30-day readmissions, average blood glucose, or mean cost of corticosteroids per patient, it did find that the post-protocol group had a significantly lower rate of hyperglycemia (62% vs 37%).

“The odds were really stacked against that outcome because the intervention group had

more diabetic patients,” said Sanchez. “In the next few years, I hope we can gather more data to evaluate if there’s also a reduction in glucose related complications.”

The Health First network is considering incorporating the protocol into an AECOPD order set to guide physicians toward oral corticosteroid treatment. Based on feedback from providers, the new protocol would recommend moving from a single 40 mg daily dose of prednisone to two 20 mg doses to further reduce hyperglycemia.

Initiative #2: Kcentra initiative reduces thrombosis risks and cuts

In early 2020, Ted Heierman, PharmD, Clinical Pharmacy Specialist at HRMC, and Brianna Glenn, Pharmacy Resident at HRMC, noticed an increase in prescriptions for Kcentra, the only FDA-approved alternative to plasma for urgent warfarin reversal.

“We suspected that some of the increase in Kcentra utilization was inappropriate, and we confirmed that suspicion with a medication use evaluation,” said Heierman. “We began exploring how VigiLanz could help us address this problem.”

Heierman and Glenn worked with VigiLanz to create a Kcentra alert that is sent to the pharmacy team whenever the medication is prescribed.

The workflow:

  • VigiLanz alerts pharmacists of Kcentra orders in real-time
  • Pharmacists screen patients to ensure they meet Kcentra use criteria
  • If patients don’t meet use criteria, pharmacists discuss medication alternatives with prescribers

“With this new approach, we found that Kcentra was being inappropriately prescribed about 15 percent of the time,” said Heierman, noting that the alert has been in place since September 2020. “This new approach has reduced inappropriate use to nearly zero.”

HRMC’s Kcentra use criteria:

  • Life-threatening bleed
  • Documented warfarin or direct-acting oral anticoagulant (DOAC) use
  • For DOAC use, anti-factor Xa (AntiXa) above 0.5.
  • For intracerebral hemorrhage-Glasgow coma scale(ICH-GCS) above 8 and neurosurgical evaluation and planned surgical intervention

“The initiative has significantly improved patient care and reduced costs,” said Heierman, noting that Kcentra comes with thrombotic risks, so ensuring appropriate use decreases the risk of thrombosis. “With a 15 percent reduction in use and 100 percent appropriate use, our HRMC can potentially save around $105,000 each year.”

Initiative #3: Pharmacist interventions reduce hypoglycemia and cut costs

In 2019, Health First identified that one of the top risk factors for severe hospital-acquired hypoglycemia in its health system was providers not adjusting insulin regimens after patients had episodes of hypoglycemia. HRMC pharmacists immediately began exploring how they could help prevent this problem.

The result was a new protocol, implemented in March 2019, that enables pharmacists to independently decrease rapid and long-acting insulin regimens if a hospitalized patient has had a severe hypoglycemic event after receiving insulin.

When the protocol was first implemented, nurses were tasked with notifying pharmacists of severe hypoglycemic events. However, the pharmacy team quickly recognized that real-time clinical surveillance could improve efficiency and reduce the risk of an error. “VigiLanz ensures we receive timely notifications and can adjust the patients’ insulin therapy sooner,” said Sanchez.

The workflow:

  • VigiLanz alerts pharmacist when patients with hypoglycemic events have received insulin in the past 24 hours
  • Pharmacists review patients’ information, and decrease insulin based on glucose value, as follows:
    • 61 – 69 mg/dL = Reduce all meal insulin by 1 unit
    • 51 – 69 mg/dL = Reduce basal insulin by 20 percent daily
    • Less than or equal to 60 mg/dL = Reduce all meal insulin by 2 units
    • Less than or equal to 50 mg/dL = Reduce basal insulin by 40 percent daily

    HRMC had completed VigiLanz activations for 235 patients as of November 2020, and the protocol had decreased severe hypoglycemic events in patients with insulin from 7.14 percent to 5.45 percent.

    The new protocol has also reduced costs, because the Centers for Medicare and Medicaid characterizes certain complications due to hypoglycemia as never events, said Sanchez. As a result, it does not reimburse hospitals for the extra costs associated with these events.

    “On a personal level, my passion for supporting this initiative arose from helping the code response team identify severe hypoglycemia in a coding patient,” said Sanchez. “I’m confident this protocol has, and will continue to, prevent devastating outcomes for many patients.”

    To learn more about how VigiLanz helps hospitals improve their patient safety and clinical surveillance, visit https://vigilanzcorp.com/ today.

Why Choose VigiLanz for Your Hospital’s Event Reporting Needs?

Detecting, reporting, and managing safety events in a healthcare setting should not be overly burdensome, and neither should finding an efficient software platform that streamlines the event reporting process for your hospital or healthcare facility. You need powerful tools that are customizable enough to help your medical teams concentrate on their main responsibility and specialty – providing high quality, safe care to patients. Without a modern healthcare incident reporting software solution, they could face a time consuming and ineffective process for capturing and analyzing important safety events that could improve the level of patient care at your institution.

Benefits of Our Healthcare Incident Management Software

A few of the benefits of using VigiLanz for incident reporting in healthcare settings include:

  • Manage all events from start to completion in a single centralized platform
  • Automatic detection and escalation of safety events
  • Quickly gather the correct information at the time of reporting through customizable data entry forms with auto-populating fields
  • Increase workflow efficiencies through automatic event routing as well as auto-populated email and letter templates
  • The ability for event reporters to track the status of their submitted events throughout the investigation process
  • User-friendly and customizable report generation
  • Real-time insights to monitor trends and launch improvement initiatives
  • Streamlined communication of safety event analysis and action plans

When it comes to incident reporting in hospitals, our safety surveillance software can help reduce the burden on your staff by making safety event reporting quick and easy. Less time spent manually tracking safety events means more time to focus on strategies that can drive real safety improvements and elevate the quality of patient care at your hospital. We’d love to show you more.

For more information about the capabilities of our safety surveillance software, call us at 855.525.9078, complete our contact form, or request a demo today.

How to Optimize Patient Safety Event Reporting

Patient safety event reporting enables hospitals to efficiently track and analyze safety events and take steps to reduce them in the future. By having safety event reporting systems in place, hospitals can also create a culture of continuous safety improvement by helping staff and clinicians identify safety gaps.

However, some hospitals face barriers in safety event detection and management; read on to see what strategies your hospital should implement to avoid these barriers and for a strong patient safety event reporting system:

Integration, Implementation, and Training

A hospital’s safety event reporting system should never become a burden for employees or IT staff. Seamless integration, easy implementation, comprehensive training, and timely support are key.

Automated Event Detection

Automated event detection reduces the likelihood of a missed safety event, ensures a faster response, and decreases time spent entering data.

Event Reporting

Customizable reporting forms, pre-populated data, and intelligent fields minimize time spent capturing events and enhance reporting accuracy.

Event Communication

Strong safety event communication ensures gaps are identified and addressed as quickly as possible—and that no information slips through the cracks.

Event Analysis and Investigation

In order to foster continuous safety improvements, the system should make it easy to analyze and investigate safety event data.

Scalability and Collaboration

The most effective safety event systems work with hospitals as an extension of their clinical teams—adapting to meet expanding needs, delivering on new initiatives, and helping instill a culture of continuous improvement.

Hospitals that utilize patient safety event reporting solutions with all six of these features can enable better identification, reporting, management, and communication of patient safety events, resulting in a stronger culture of safety. To learn more about how your hospital can implement these features, check out our safety event reporting Buyer’s Guide.

How to Set Up an Optimal Patient Safety Reporting System

A strong patient safety event reporting system can enable a hospital to identify and fill safety gaps to create a culture of safety. To help hospitals with this initiative, VigiLanz is proud to provide its Safety Surveillance software solution, an innovative, configurable platform for identifying, reporting, managing, and communicating safety events.

With VigiLanz’s patient safety reporting system, hospitals can rapidly identify and analyze enterprise-wide safety events, minimize time capturing and managing safety events, and promote a culture of safety. Additionally, features like auto-detection, enterprise-wide dashboards, reporter feedback, and auto-populated email and letter templates can further reduce adverse events.

Many of our hospital partners have capitalized on this solution, including Community Health Network (CHN). A large health system serving over 618,000 patients across 200 sites of care, CHN was looking for a tool that could support monitoring safety events and identifying improvement opportunities across its entire enterprise.

After implementing VigiLanz’s safety surveillance solution, CHN experienced a 16% increase in monthly average number of reported events compared to before, in addition to more intuitive and efficient workflows for staff.

VigiLanz features that the CHN team loved included:

  • Customizable forms, single sign-ons, mobile access, and mandatory fields that allowed for quick documentation
  • Analytics and investigative tools that helped staff obtain meaningful safety event insights
  • Customizable and automated email notifications and escalations that ensured events are properly reviewed and addressed
  • On-demand and live sessions that helped train new users

It is important for hospitals like CHN to access the tools they need to support safety initiatives, and we continue to add solutions to our platform to help hospitals achieve these goals. Not sure how to find the best patient safety reporting system for your organization? Check out our Buyer’s Guide to see the top qualities these systems should have.

Your Top Questions About Patient Safety Software, Answered

Patient safety software and solutions can be a critical tool for hospitals to improve patient outcomes, reduce costs, and enhance patient and staff satisfaction. As more hospitals consider implementing patient safety software, we’re receiving more questions about the technology and the benefits it provides. Here are our answers to some of the most commonly asked questions:

What is patient safety software?

Patient safety software continuously reviews and analyzes safety-related data across a healthcare organization. The most effective solutions provide real-time alerts when safety problems occur, so that hospitals can intervene quickly and prevent them from happening in the future. Effective patient safety software provides insights across multiple patient safety categories and hospital departments, including pharmacy surveillance, infection prevention, antimicrobial stewardship, safety surveillance, and risk and claims.

How can these solutions benefit my hospital?

Once implemented, this technology can help hospital leaders and staff make smarter business decisions and optimize care. Key use cases include:

  • Identifying potential infections and outbreaks sooner
  • Managing safety risks
  • Monitoring and correcting medication errors
  • Enhancing antimicrobial stewardship initiatives

What should I look for in a patient safety software?

The most effective patient safety software solutions include the following capabilities:

  • Ability to integrate with your current systems, including your EMR
  • A robust rules library that can be adjusted based on your unique needs and challenges
  • Easy-to-access and timely analytics tailored to your needs
  • Support from a clinical team to ensure make the most of your data

Patient safety software and solutions are vital for any hospital to maintain high standards of safety. Want to learn more about how these solutions can help your hospital? Check out these additional resources:

Hospital Patient Safety Report 2022

The Hospital Patient Safety Report, released each year since 2019, serves as a barometer of safety performance within U.S. hospitals. Based on an annual survey of hospital executives and clinical leaders, the report reveals how safety challenges, initiatives, and priorities are evolving.

This year’s report also explores both how and how much the hospital safety landscape has changed two years into the COVID-19 pandemic.

A New Vision For Hospital Safety

What safety challenges are on hospitals’ watch lists, and what are they doing to overcome them? This infographic—featuring insights gathered from VigiLanz’s Hospital Patient Safety Report 2022, Becker’s Hospital Review, JAMA, and more—has answers.