CHRISTUS Health Increases Safety Event Reporting with VigiLanz

Posted on March 13, 2023March 14, 2023 by Sage Growth Partners

Customer Profile

CHRISTUS Health is an international Catholic, not-for-profit health system comprising more than 600 centers, including community hospitals, urgent care centers, health insurance companies, and physician clinics in Texas, Louisiana, New Mexico, and Latin America. With more than 45,000 team members and more than 15,000 physicians providing individualized care, CHRISTUS aims to deliver a complete healing experience that respects every individual.

Challenge

Adverse drug events (ADEs) represent a significant, and often avoidable, problem in United States healthcare. ADEs cause approximately 1.3 million emergency department visits annually, and about 350,000 of those patients need to be hospitalized for further treatment – yet it’s estimated that half of ADEs in the U.S. are preventable.

Often, when these events do occur, they are either unreported or lack critical details and context. This makes it difficult for quality, safety, risk management, and other teams to document, analyze, and prevent similar events from occurring in the future.

While many hospitals have patient safety event reporting processes and procedures in place, many lack automated event detection capabilities to make the event reporting faster, easier, and more accurate.

Common Reasons Many Event Reporting Mechanisms Underperform:

Limited documentation on events that occur
Too much time associated with completing incident forms
Lack of urgency to report events considered minor
Confusion over event reporting responsibilities
Lack of understanding about what should be reported

Solution

With its dedication to improving patient safety, CHRISTUS implemented VigiLanz’s safety surveillance solution, which automates the management, reporting, and detection of safety events, in 2021. This patient safety software integrates clinical data from multiple sources with comprehensive detection and investigation tools. For example, VigiLanz monitors EHR data—including data related to patient demographics, medication orders, medication administrations, lab results, radiology notes, and vital signs—and documents triggered events based on CHRISTUS-defined safety event criteria. This makes it easier for CHRISTUS to quickly identify, manage, address, and prevent adverse drug events.

Key benefits include:

Improved efficiency, accuracy, and completeness of events reported
Safety events recorded in near real-time
Ability for patient safety teams and claims managers to intervene quickly
More comprehensive capture of safety events

CHRISTUS team members can also use the VigiLanz solution to quickly document and self-report safety events through customizable forms, mobile access, mandatory fields, and anonymous reporting. The solution includes:

Patient safety event reporting analytics and investigative tools that can be used within specific departments, sites, and across the enterprise.
Customizable and automated email notifications and automated escalations to ensure timely reviews and management.

Outcomes

Over an 18-month period, CHRISTUS deployed 21 surveillance rules to auto-detect ADEs. This led to a 400% increase in ADRs reported compared to manual reporting.

“Automated event detection saves us a significant amount of time, and gives us more peace of mind that more events are captured,” said Tina Collins, PharmD, Corporate Director of Medication Safety at the Division of Clinical Excellence and CHRISTUS Health. “As a result, we can now spend more time analyzing events and identifying improvement opportunities.”

CHRISTUS facilities with VigiLanz identified 8.7 times more ADRs than facilities that relied on voluntary reporting. In addition, more than 77% of the auto-detected ADEs led to an investigation – a testament to the accuracy of the software’s rules.

Overall, CHRISTUS saw a 66% overall increase in ADRs reported for harm categories (including mild harm, moderate harm, severe harm, and death) with auto-detection compared to manual reporting. Auto-detection also identified 4.8 times more near-miss ADRs, 1.6 times more mild-harm ADRs, and 2.3 times more moderate-harm ADRs compared to manual reporting.

“Our number of reported events is increasing due to automated event detection and reporting,” said Collins. “The technology, which is now used across all of our hospitals, ensures we’re capturing more events and gathering more insights.”

To learn more about how VigiLanz helps hospitals improve patient safety event reporting, visit https://vigilanzcorp.com/safety-surveillance today.

Sharp Grossmont Hospital Uses VigiLanz for Fast, Accurate Patient Recruitment in Clinical Trials

Posted on November 18, 2022January 13, 2023 by Sage Growth Partners

Customer Profile

Sharp HealthCare, a not-for-profit health system based in San Diego, is made up of four acute-care hospitals, three specialty hospitals, three affiliated medical groups, and a full spectrum of other facilities and services. Sharp Grossmont Hospital, the largest healthcare facility in East San Diego County with 536 beds, is known for outstanding programs in emergency and critical care, cardiac care, orthopedics, rehabilitation, neurology, women’s health, children’s health and hospice care.

Challenge

Sharp Grossmont Hospital is dedicated to expanding scientific knowledge and supporting medical advancements by serving as a clinical trial site. However, recruiting and enrolling patients in clinical trials is a challenging, labor-intensive, and time-consuming process. Industry research suggests that 11% of clinical trials never enroll a patient and 68% of sites fail to meet enrollment targets. When Sharp Grossmont Hospital began participating in a complex clinical trial in early 2020, it quickly became apparent that they were going to face similar challenges.

The trial was designed to evaluate the safety and efficacy of a new drug to reduce the risk of major cardiovascular events in patients with acute coronary syndrome and had a complex protocol that made clinical trial enrollment extremely difficult. Sharp Grossmont Hospital’s clinical research team, who at the time relied on a manual review process to identify eligible patients, found that the workflow was extremely inefficient.

“Screening for clinical trials with extensive and specific inclusion and exclusion criteria is very time-consuming,” said DeAnn Cary, PhD, Director of Research at Sharp HealthCare. “Manually screening for a trial like ours means casting a wide net to find potential subjects since they can be in multiple areas of the hospital.”

Solution

Sharp Grossmont Hospital knew there had to be a better way to approach clinical trial enrollment, and in 2020, partnered with VigiLanz to explore an alternative model. VigiLanz Research facilitates a more efficient recruitment process by continuously reviewing EHR data to find patients for clinical trials in real time.

Kyra Rashid, BS, MCR, Clinical Trial Specialist at Sharp, said the solution helps the organization identify eligible patients more quickly, including patients who might have otherwise been missed.

“The technology alerts our team as soon as eligible patients are identified, based on the study-specific inclusion and exclusion criteria,” she said. “It screens the entire hospital patient population, which saves us a significant amount of time that can then be reallocated to other initiatives.”

In addition to screening patients for the clinical trial, the solution provides:

A dynamic worklist that coordinators can use to view or modify patient eligibility status in real time
Automatic alerts that notify coordinators anytime an eligible candidate is located within the hospital network
Enterprise-level reporting that coordinators and leaders can use to evaluate study performance and easily evaluate potential clinical trials.

How VigiLanz Research Works

VigiLanz leverages study-specific inclusion and exclusion criteria to automatically review all patients across a hospital network.
VigiLanz screens the entire patient population to identify eligible patients in real time.
VigiLanz provides automated alerts and notifications to key team members when it identifies eligible patients.
Coordinators can track eligibility status, run timely reports, and manage the recruitment process in a customized worklist.

Outcomes

As a result of the VigiLanz Research partnership, Sharp Grossmont Hospital reduced the time needed to screen and enroll patients in the clinical trial. The time savings and workflow improvements also positively benefited the clinical research team.

“The coordinators’ time is now focused on a more narrowed pool of potential subjects, which allows more time to continue additional screening and accomplish more tasks in our day,” said Cary E. Murphy, BSN, CCRC, Clinical Trial Specialist at Sharp Healthcare. “This makes the team happier and more productive.”

Overall, the partnership:

Increased the number of patients screened. VigiLanz Research increased the number of patients screened to include all ED patients and all patients admitted in all 20 hospital departments.
Cut the time spent screening patients in half. The technology solution reduced the time needed to screen patients, freeing up the clinical research team to work on other high-value tasks.
Identified eligible patients faster. VigiLanz Research helped the team identify eligible patients in real time, which was vital to this time-sensitive study.

Another key benefit, Cary said, is the positive impact the new approach brings patients. “VigiLanz Research has improved our team’s efficiency and helped us ensure more eligible patients can participate in the trial. VigiLanz also helps ensure no potential study participant, regardless of department, is missed. As we work to advance drug and treatment development, we’re excited about how this approach will support those efforts.”

To learn more about how VigiLanz helps hospitals with efficient patient recruitment for clinical trials, visit https://vigilanzcorp.com/ today.

Related Resources: VigiLanz Research

Freeman Health System Pharmacy Uses VigiLanz to Improve Care, Workflows, and Costs

Posted on September 23, 2022January 24, 2023 by Sage Growth Partners

Background

Freeman Health System, a 485-bed, three-hospital system in Joplin, Missouri, serves a population of 450,000 people across Missouri, Arkansas, Kansas, and Oklahoma. Ranked one of the top hospitals in Missouri by U.S. News & World Report, Freeman continually seeks out new and innovative ways to improve patient care.

Within Freeman, the pharmacy department is known for its commitment to exploring new tools that improve efficiency as well as patient safety. Since implementing VigiLanz in 2018, Freeman’s pharmacy team has created over 650 VigiLanz rules that aid in pharmacy department interventions. These rules use dashboards and real-time notifications to alert team members whenever information pulled from the electronic health record (EHR) meets rule criteria.

“This approach has made a significant impact on patient care, pharmacy workflows, and costs,” said Adrienne Carey, PharmD, BCPS, Clinical Pharmacist and Data Mining Program Manager at Freeman Health System. “Because of the improved capabilities within VigiLanz’s rule engine, we’ve been able to identify more opportunities for intervention more quickly than before.”

Here are five examples of how the Freeman team used VigiLanz’s pharmacy workflow solutions to support key initiatives that improved patient care and safety while reducing costs.

Initiative #1: Rule-building to inform discharge counseling

Each year, Freeman Health System residents use VigiLanz to build rules or create data mining searches to identify patient populations and gather data for a 12-month research project. This year, residents used VigiLanz rules to identify cardiology patients who were being discharged with a new medication not listed on their home medication list.

When the rule was triggered, pharmacists received a real-time alert. Pharmacists then educated patients about their new medication(s), documented them in the activation, and followed up with patients to assess the effectiveness of the education and its impact on readmission rates. Since these cardiology patients typically had a short length of stay, the VigiLanz rules were especially helpful in quickly identifying appropriate patients for education.

The patients who received education from pharmacy were 11% more likely to remember their counseling than those who received education through other discharge processes. Patients with the pharmacy education also had a 30-day readmission rate of 5.25% (compared to a rate of 21.25% among those who did not receive the education).

Initiative #2: Validation studies to support antibiotic discontinuation

A negative Methicillin-resistant Staphylococcus aureus (MRSA) nasal screening can help providers determine when to safely discontinue vancomycin, an antibiotic commonly used in patients with MRSA. However, since some providers are reluctant to discontinue the drug based on this test, another Freeman resident used VigiLanz to quantify the probability of disease based on screening results.

The resident created VigiLanz data mining searches to capture MRSA+ screens with positive cultures, MRSA+ screens with negative cultures, MRSA- screens with positive cultures, and MRSA- screens with negative cultures. Results showed a 97.2% correlation that a negative MRSA screen resulted in no MRSA infection. This enhanced providers’ confidence in using the screen to safely discontinue vancomycin, and therefore, reduced the risk of antimicrobial resistance and adverse events.

Initiative #3: Alerts to decolonize patients with positive MRSA screens

Studies indicate that MRSA colonization in the nose could increase the risk of MRSA infection, and that nasal administration of Mupirocin ointment reduces infections in patients with positive MRSA nasal screens. Based on this information, Freeman created a new protocol that authorized pharmacists to order Mupirocin ointment nasally when a patient has a positive MRSA nasal screen.

Freeman then used VigiLanz rules to identify patients with positive MRSA screens and alert pharmacists in real time. Since implementing this rule in January 2022, the facility has ordered Mupirocin decolonization for 162 patients, resulting in $98,000 in estimated cost savings due to less time spent in isolation, lowered risk of infection, and fewer readmissions.

Initiative #4: Tools to monitor drugs and prevent drug shortages

Freeman’s pharmacy team uses VigiLanz to quickly and efficiently search for pharmacy orders (a functionality not included in their health information system). Examples include:

Central staff and buyers use VigiLanz to identify patients on medications in short supply so that pharmacists can alert providers and help prevent drug shortages.
Pharmacists use VigiLanz to search for high alert drugs to monitor proactively. Floor pharmacists run a system-wide kinetics search each morning—including vancomycin, heparin, and aminoglycosides—to identify the patients they are expected to manage.
Night shift pharmacists use pharmacy orders to identify heparin patients that need to be monitored.

Initiative #5: Rules to guide and decrease antibiotic use

A Freeman pharmacy resident used VigiLanz to conduct a research project comparing Freeman providers’ antibiotic orders (including Zithromax, Aztreonam, Cefepime, Ceftriaxone, Ciprofloxacin, Levofloxacin, Meropenem, Zosyn, and vancomycin) for treating pneumonia according to professional guidelines. The study found that, for each type of pneumonia, some antibiotics were prescribed for longer than recommended. As a result, Freeman created order sets to guide providers about the appropriate number of days to prescribe each antibiotic.

Freeman also created a “Pneumonia Pathway Hard Stop” rule in VigiLanz to ensure the hard stop stays with the antibiotic order, regardless of any dosage changes made that could inadvertently remove the initial hard stop.

As a result, floor pharmacists can more easily determine when patients complete their therapies, and Freeman can reduce its usage of antibiotics consistent with professional guidelines.

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

Holmes Regional Medical Center Pharmacists Use VigiLanz to Improve Care

Posted on June 22, 2022June 22, 2022 by Sage Growth Partners

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.

Northern Arizona Healthcare Uses VigiLanz to Fight COVID-19 and Mitigate Drug Shortages

Posted on March 7, 2022March 14, 2022 by Sage Growth Partners

Customer Profile

Northern Arizona Healthcare, the largest healthcare system in a region that encompasses more than 50,000 square miles, provides comprehensive healthcare services through clinics, surgical centers, and two hospitals: Flagstaff Medical Center and Verde Valley Medical Center. The health system serves more than 700,000 people in communities across the region, and is committed to continually improving and enhancing patient safety.

Challenge

Northern Arizona Healthcare’s Flagstaff Medical Center (FMC) is the biggest major medical center in Northern Arizona. The Navajo Nation, the largest Native American Reservation in the country, resides in FMC’s service area. This community was hit hard and early with a significant COVID-19 outbreak. At its peak, the Navajo Nation had a higher per capita COVID-19 rate than all major cities in the U.S. including New York (3.4 percent vs 1.9 percent).

FMC initially bore the brunt of this outbreak, well before the Arizona State COVID-19 Healthcare Surge Hotline was created in mid-May to help balance the load of cases across the state. FMC treated their first COVID-19 patient in mid-March of 2020, and quickly ramped up to more than 30 critically ill COVID-19 patients by the end of the month. They experienced a peak of 51 positive cases (a full third of their census) followed by a second surge in mid-June.

Kristen Bamberg, PharmD, MS, BCPS, BCCCP, Lead Critical Care Pharmacist at FMC, and Andrea Boyce, PharmD, BCIDP, Lead Antimicrobial Stewardship Pharmacist at FMC, were immediately thrust into a fast-paced and highly challenging environment due the influx of COVID-19 patients. They faced constantly evolving therapeutic recommendations, and a continual fight to mitigate critical shortages of medications like sedatives, neuromuscular blockers, and antibiotics.

Solution

Bamberg and Boyce had an excellent team behind them working to overcome the challenges presented by COVID-19, but they also recognized that they needed to fully utilize all of their resources in order to continue to provide optimal care to patients.

“We knew how useful VigiLanz’s alerts and reports already were in helping us care for patients on a day-to-day basis,” said Bamberg. “So we turned to them to help us quickly determine how their alerts and reports could be tailored to help us specifically address the needs and demands of the pandemic.”

Ultimately, Bamberg and Boyce worked with the clinical surveillance provider to implement dozens of new rules and alerts. These rules resulted in three key benefits:

Benefit #1: Real-time alerts that led to a more proactive response to COVID-19 patients and helped conserve PPE

At the beginning of the pandemic, FMC immediately recognized that the earlier healthcare providers could be informed of a patient’s COVID-19 status, the better. If a patient tested positive, that patient could continue to be isolated and contact tracing could begin; if a patient tested negative, staff members no longer needed to use PPE when interacting with that patient (which could help combat the PPE shortage).

As a result, Bamberg and Boyce worked with VigiLanz to implement real-time alerts to inform relevant healthcare providers and staff as soon as a COVID-19 test result was available. They also implemented alerts to inform them if a re-admitted patient had a history of COVID-19.

Examples of alerts:

COVID-19 results: Alerted pharmacists of a new COVID-19 RNA or PCR test result
Patients with a history of COVID-19: Alerted pharmacists if a patient was re-admitted and had a positive result on a previous encounter in the last 90 days

“The support and responsiveness of VigiLanz to our abundance of requests was incredible,” said Bamberg. “It helped us work through countless therapeutic and workflow issues in real time.”

Benefit #2: Real-time alerts for medication optimization and prevention of adverse drug events

Bamberg and Boyce also worked with VigiLanz to implement several new alerts that helped optimize medication safety for COVID-19 patients.

“These alerts were particularly useful since we were dealing with a new disease and treatments that were continually changing,” said Boyce. “Many of the alerts resulted in the discontinuation of certain medications and helped us flag potential problems.”

Examples of alerts:

Hydroxychloroquine (HCQ) ordered: Alerted pharmacists to check for drug interactions and assess and follow the risk of corrected QT(QTc) prolongation
HCQ and weight > 50 kg: Alerted pharmacists to review based on the hospital’s protocol at the time
HCQ patients at high risk for QTc prolongation with higher than normal doses used for treatment of COVID-19: Alerted pharmacists when patients had HCQ + azithromycin + K < 4, HCQ + azithromycin + Mag < 2, HCQ + azithromycin + scheduled ondansetron.
Metoclopramide longer than three days: Alerted pharmacists to assess efficacy and potential discontinuation of metoclopramide (which many COVID-19 patients were prescribed due to ileus or significantly reduced bowel motility) in an effort to minimize adverse drug events.
D-dimer > 1,000: Alerted ICU pharmacists to assess patients (this rule was implemented after a hospital literature review of COVID-19 and thrombosis indicated that patients were experiencing micro thromboemboli and likely required higher than usual doses of chemical deep vein thrombosis prophylaxis). While the hospital eventually abandoned D-dimer as a sole marker of a need for these higher doses, it initially helped the pharmacists make recommendations to intensivists regarding anti-thrombotic therapy.
Enoxaparin 0.5 mg/kg SQ Q12H ordered and no Xa level: Alerted pharmacists to monitor patients’ response to treatment, as COVID-19 patients had a higher propensity to clot, a potentially larger clot burden in the form of microthrombosis, and potentially acquired ATIII deficiencies as a result.
Remdesivir ordered: Alerted pharmacists to monitor patients to adhere to new protocols (the hospital had a specific Remdesivir protocol in place due to emergency use authorization requirements).

Benefit #3: Real-time alerts to mitigate drug shortages

In addition to ensuring optimal medication usage for COVID-19 patients, Bamberg and Boyce also used VigiLanz to help FMC manage medications in short supply.

“We always need to make sure that we have the right medications on hand for each patient, but this process became even more challenging when COVID-19 hit,” said Boyce. “VigiLanz helped us manage many of the unprecedented shortages we faced, especially when it came to necessary medications like sedatives and antibiotics.”

Examples of alerts:

Ketamine ordered: Alerted pharmacists to determine if a more concentrated bag could be used, or if alternative medications were appropriate
IV famotidine ordered: Alerted pharmacists so that, if appropriate, they could recommend an IV alternative or switch the patient to oral
Doxycycline more than five days: Alerted pharmacists to assess patients’ antibiotic therapy and recommend possible discontinuation as appropriate
Albuterol inhaler PRN, not on isolation: Alerted pharmacists to assess whether a non-COVID-19 patient with an active order for an albuterol inhaler could be switched to nebulization

Outcomes

FMC’s ability to quickly respond to the COVID-19 pandemic is a testament to the dedication and innovative ideas of all of its frontline staff—with Bamberg and Boyce playing a critical supporting role. During a significantly challenging time, they were able to think outside the box and use the information they received from VigiLanz to enhance patient care.

Overall, this led to:

Earlier identification of positive and negative COVID-19 tests, which helped conserve PPE and enhance patient treatment
Earlier identification of readmitted patients who previously tested positive for COVID-19, which helped the health system protect non-COVID-19 patients and staff
Optimal medication usage for COVID-19 patients, which enhanced patient treatment
Enhanced monitoring of medications in short supply, which led to more targeted and judicious use of medications

“We were among the first and hardest hit hospitals by COVID-19,” said Bamberg. “We worked with VigiLanz to be proactive in tackling this challenge, and it made a significant difference to our patients and community.”

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

Community Health Network Uses VigiLanz to Improve Safety Event Reporting

Posted on October 21, 2021January 24, 2023 by Leo Bogee

Customer Profile

Community Health Network (CHN), a large health system based in Indianapolis, Indiana, serves more than 618,000 patients across nine hospitals and more than 200 sites of care. With nearly 60,000 inpatient admissions annually and more than 280,000 emergency room visits, CHN is known for its commitment to ensuring optimal safety for patients, staff, and visitors.

Challenge

Most hospitals use basic safety event reporting mechanisms to monitor safety events and identify improvement opportunities. But the effectiveness of these mechanisms is often limited by cumbersome documentation workflows and poor investigative and analytics tools. This reduces the likelihood that safety events will be reported and that safety gaps and trends will be identified and addressed.

CHN knew there had to be a better way, so in 2018, the health system began searching for a new solution that could replace its current vendor and provide more value across the enterprise. “The goal was to provide staff with efficient and intuitive event reporting workflows, while also implementing new investigative and analytics tools,” said Danielle Dillon, MHL, BSN, RN, CCRN-K, who serves as Blood Management Director for the entire CHN health system and who previously served as Risk Manager for Community Hospital East, a CHN hospital in Indianapolis. “We work hard to instill a culture of continual safety improvements, so we’re always looking for new approaches to be even more successful.”

Solution

Community Health Network evaluated several different event reporting solutions before selecting VigiLanz, an award-winning event reporting and clinical surveillance platform that optimizes reporting through real-time alerts, auto-detection of events, management and investigation tools, and analytics and reporting capabilities.

“We felt confident that VigiLanz would meet our current event reporting needs, but also work with us to help address any future objectives,” said Dillon, noting that the solution also stood out due to its form customization abilities, efficient documentation processes, ability to provide enterprise-wide and location-specific reports, and cost-effectiveness. “We knew they would help operationalize best practices in reporting, data collection, and collaboration across multidisciplinary teams.”

To ensure a thorough planning and implementation process, CHN formed a team of risk management, patient experience, claims, peer review, and IT leadership. This group worked closely with VigiLanz to ensure the solution would support enhanced collaboration across the enterprise. “Stronger safety event management and reporting workflows would benefit all of these departments, so their involvement was critical,” explained Dillon.

The new safety event management and reporting system, which went live at CHN in November of 2020 and is known as PACER (Patient and Caregiver Event Reporting), spans the breadth of reporting needs, including:

Employee injuries
Security events
Patient complaints and grievances
Safety events and harm events

CHN is also using other solutions in the VigiLanz event reporting suite, including VigiLanz Risk and Claims and VigiLanz Patient Relations, both of which integrate with the safety event platform. Risk and Claims is used to manage and document medical malpractice claims and legal filings and to maintain relevant financial data. Patient Relations is used to streamline the documentation and management of patient and visitor feedback and to identify opportunities for improving patient satisfaction and service recovery.

“There’s potential for one event to touch all of these areas pretty frequently,” said Dillon. “The new approach makes it easy to share information between departments and improves communication.”

“We’re confident that we aren’t missing things and that we’re addressing more potential safety problems and gaps than before.”– Danielle Dillon, MHL, BSN, RN, CCRN-K, Blood Management Director, CHN

Outcomes

According to Dillon, most hospitals and health systems that implement a new event reporting mechanism experience a temporary decrease in reported events, as it can take time for staff members to adjust. That’s not been the case at CHN. “Throughout the implementation processes, our average number of events reported remained stable and is now increasing,” said Dillon. “In 2021, our monthly average number of reported events is 16% higher than it was before we transitioned to the new system.”

She attributes that increase in reported events to more intuitive and efficient workflows for staff members. “We’re confident that we aren’t missing things and that we’re addressing more potential safety problems and gaps than before.”

Key benefits of the new system include the ability to:

Quickly document events through customizable forms, single sign-ons, mobile access, and mandatory fields
Obtain meaningful safety event insights within specific locations and across the enterprise through analytics and investigative tools
Use customizable and automated email notifications and automated escalations to ensure events are properly reviewed and addressed
Train new users with on-demand sessions and frequent live sessions with Q&As

“My job lives and breathes in PACER,” said Dillon. “I can easily access the system and daily report every morning via my cellphone, and I triage things then and there. We’re responding more quickly and it’s easier to track and trend events across every site.”

The new solution is also increasing collaboration across multiple multidisciplinary teams, said Dillon. For example:

The claims department uses the claims tracking system within the event reporting system to manage and document medical malpractice claims and legal filings.
The quality department uses the peer review tool to identify issues that may require quality review of care provided by physicians and/or advanced practitioners.
The patient experience department uses the system to document patient feedback and maintain regulatory compliance.
The risk management department uses the system to coordinate appropriate involvement of expert individuals to identify, assess, track, and trend issues impacting caregiver and patient safety.

“Creating a safer healthcare system is one of the most critical objectives for our industry right now,” said Dillon. “It’s something we strive to do every day at Community Health Network, and our new event management and reporting system is helping us meet that goal.”

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

Riverside University Health System Uses VigiLanz for NICU Antimicrobial Stewardship

Posted on October 6, 2020January 24, 2023 by Leo Bogee

Customer Profile

Riverside University Health System Medical center

Riverside University Health System Medical Center (RUHS), a 439-bed facility in Moreno Valley, California, is committed to delivering exceptional care—and its quality performance reflects that commitment. Recognized by The Joint Commission as a top performer on key quality measures, RUHS has received awards from the American Heart Association/American Stroke Association. It is also recognized as a Baby Friendly Hospital by the World Health Organization and the United Nations Children’s Fund.

Challenge

As part of its commitment to providing optimal patient care, RUHS participates in the California Perinatal Quality Care Collaborative, a statewide network of California’s neonatal intensive care units (NICUs) and high risk infant follow-up clinics. In 2016, the collaborative launched an antibiotic stewardship (ASP) initiative with 28 NICUs, including RUHS.

At that time, RUHS had an antimicrobial stewardship program (ASP) for all patients, but it did not have a program that was focused solely on pediatric and NICU patients. “As we looked more closely at the younger patient population, we realized there was room for improvement in this area,” said Nikita Patel, Assistant Director of Pharmacy–Clinical Programs & Quality Improvement at RUHS.

She noted that, while there are established clinical practice guidelines for neonatal early onset sepsis management, they can contribute to higher antibiotic use—sometimes unnecessarily.

“If a baby has an active infection the first two to three days of life, the mortality outcomes are staggering and antibiotic use can be life-saving,” said Patel. “But unnecessary antibiotic use can disrupt a baby’s gut microbiome and impact their long-term immune response. This puts them at a higher risk of developing chronic diseases like asthma, and can lead to antibiotic resistance.”

Solution

RUHS turned to VigiLanz to support its efforts to optimize antibiotic use among pediatric and NICU patients. The clinical surveillance solution—which continuously gathers information from the medical center’s EMR and other sources, analyzes that data in real time, and provides meaningful insights to healthcare providers—enables pharmacists to view robust antimicrobial utilization reports. “The reports help us continuously monitor antimicrobial use and assess prescribing trends,” said Patel.

VigiLanz also provides relevant healthcare providers with real-time alerts that promote ASP in the NICU. These alerts include:

48-hour antibiotic timeouts that enable NICU pharmacists to review information and recent lab results on relevant patients.
Positive lab results, so that pharmacists more quickly review critical labs and make appropriate medication change recommendations or antibiotic de-escalation.
Pharmacokinetic monitoring alerts, so that pharmacists can immediately make recommendations regarding dosage changes.

“I can’t emphasize enough how valuable VigiLanz is for us. It helps drive timely and important patient care interventions and improves our efficiency and documentation.” – Nikita Patel, Assistant Director of Pharmacy – Clinical Programs & Quality Improvement, RUHS

Outcomes

The new approach to ASP at RUHS has had a significant positive effect on patient care, said Patel. “I can’t emphasize enough how valuable VigiLanz is for us,” she said. “It helps drive timely and important patient care interventions and improves our efficiency and documentation.”

Two noteworthy outcomes of the new approach include:

A 37% decrease in NICU antibiotic utilization between March 2017 and March 2018. Importantly, that 37% drop has also been sustained since 2018.
More than 90% compliance with 48-hour antibiotic timeouts for all patients admitted to the NICU and initiated on antimicrobials.

VigiLanz also saves pharmacists time, which also benefits patient care, said Patel. “We no longer have to manually review patient lists and data every day,” she explained. “VigiLanz automatically sorts relevant data for us and alerts us when there’s a potential problem or when there’s something new to review. That helps us intervene more quickly and spend more time on other patient care improvement initiatives.”

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

Freeman Health System Uses VigiLanz to Enhance MRSA Screening, Reduce Vancomycin Use

Posted on September 10, 2020January 24, 2023 by Leo Bogee

Customer Profile

Freeman Health System, a 485-bed, three-hospital system in Joplin, Missouri, serves an area of 450,000 people across Missouri, Arkansas, Kansas, and Oklahoma. It is the #1 hospital in Southwest Missouri and the #4 hospital in Missouri, according to U.S. News & World Report.

Challenge

Hospitals across the country are fighting to combat antibiotic overuse, resistance, and unwanted side effects, but many are struggling to implement new and effective workflows that help meet these goals. Much of the challenge boils down to speed and efficiency—hospitals need to identify antibiotic overuse more quickly, and intervene sooner when it does occur.

Freeman Health System is no exception to the challenges associated with antimicrobial stewardship (ASP), and it was looking for a way to improve its ASP processes, particularly related to vancomycin use among patients with pneumonia.

“Data shows that 98 percent of the time, a negative MRSA screen for a patient with pneumonia means that a patient does not have MRSA-pneumonia, and their empiric vancomycin therapy can safely be discontinued,” said Adrienne Carey, PharmD, BCPS, Clinical Pharmacist and Data Mining Program Manager at Freeman Health System. “We wanted to streamline our MRSA screening process so that we could more quickly identify if a MRSA screen is negative, and therefore, discontinue vancomycin use sooner.”

Solution

Freeman Health System’s antibiotic stewardship team had already changed the health system’s pneumonia pathway orders to ensure all patients who came into the ER automatically received a nasal screen for MRSA.

“Our pharmacy department was tasked with educating physicians about the change and with contacting them with the results,” said Carey. “The goal was to de-escalate patients’ antibiotics more quickly.”

The problem was that results were not always communicated quickly to pharmacists, so there was sometimes a delay in identifying patients whose vancomycin therapy could be discontinued.

Freeman Health System turned to VigiLanz to help, working with the VigiLanz clinical support team to create a negative MRSA screen rule within the system. Now, whenever a patient prescribed vancomycin has a negative MRSA screen and no other cultures are positive for MRSA, the pharmacy team and infectious disease physician receive an alert in real time.

“Before implementing the VigiLanz rule, we had to manually run reports through our health information system to view all patients on vancomycin, then check each patient’s microbiology results to see if they had been screened for MRSA,” said Carey. “That took a lot of time.”

Now, pharmacists and physicians can more quickly discontinue vancomycin use and switch to an alternate antibiotic when appropriate, she explained. “We are not leaving our patients on vancomycin any longer than necessary.”

Adrienne Carey, PharmD, BCPS describes real-time alerts helping pharmacists

Outcomes

In the first six months since November 2018, when the new workflow was implemented, Freeman Health System’s pharmacists worked with physicians to discontinue vancomycin therapy in 70 patients.

Other key benefits of the new approach include:

Time savings for pharmacists
Time savings for nurses by reducing doses and drawing fewer labs
Monetary savings by reducing unneeded antibiotics
Reduced risk of infection through an IV route since IV lines are discontinued sooner due to de-escalation
Fewer medication side effects
Less chance for antibiotic resistance
Improved patient satisfaction due to fewer medications being administered
Shorter lengths of stay

“Building this rule and receiving immediate alerts from VigiLanz is helping us better identify all patients who qualify to have their therapy de-escalated and do so in a timely fashion,” said Carey. “We have also seen a trend toward less vancomycin usage overall.”

Related Resource:

Efficiency improvements at Freeman Health System

Capital Region Medical Center Uses VigiLanz to Prevent Bedbug Infestations

Posted on May 8, 2020January 24, 2023 by Leo Bogee

Hospitals across the country are using VigiLanz to complement patient care in many ways. Top uses include pharmacy surveillance, infection prevention, antimicrobial stewardship, and opioid stewardship. But VigiLanz is also completely customizable, so the most innovative and forward-thinking hospitals are using it to create new and unique rules and interventions that lead to optimal patient care. Capital Region Medical Center is one of them.

Customer Profile

Capital Region Medical Center (CRMC), a 100-bed facility in Jefferson City, Missouri, is committed to providing superior patient care, and its safety and quality performance reflects that mission. The hospital, which provides the full spectrum of patient services, is the only one in the area to have received the Missouri Quality Award twice. The Joint Commission has also recognized CRMC as a top performer on quality metrics.

Challenge

An important aspect of providing high quality patient care is fostering a bedbug-free environment. But all hospitals—even those like CRMC that adhere to the highest cleanliness standards—can struggle to keep these pests at bay.

That’s because for most hospitals, bedbugs represent an external challenge, rather than an internal one. Many patients unknowingly bring bedbugs into facilities from the outside, and once the pests gain admittance, they quickly infiltrate the system.

Addressing these infestations can cost hospitals a significant amount of money. A March 2019 study of a 937-bed hospital in Cleveland, Ohio, found that during a one-year period, the hospital had 180 bedbug infestations. Costs were between $125 and $1,050 per infestation, with total costs for the year totaling $22,844 for the ED and $55,915 for the hospital.

While bedbug bites are generally not considered a health hazard, the itchy, red welts can lead to infections if patients scratch them. In hospitals, where there is a higher likelihood of catching MRSA, this is particularly problematic. Bedbug infestations also drive down patient satisfaction, which can lead to lower revenue for hospitals participating in value-based payment models.

Solution

In January 2017, CRMC implemented VigiLanz to support its pharmacy surveillance and infection prevention initiatives. Immediately, the value it provided became clear—and the healthcare providers’ use of the clinical surveillance platform has continually led to higher quality care and reduced costs (see sidebar).

But as CRMC was exploring the VigiLanz platform that January, they recognized there was much more they could be doing with it. “Since the software is completely customizable, we knew we could create new rules and alerts based on our needs and initiatives,” said Valerie Lyon, RN, AA, AS, BSN, CIC, Infection Preventionist at CRMC. “That led me to begin considering how we could use it to curb bedbugs.”

Less than one month after implementing VigiLanz, Lyon’s curiosity and innovative idea resulted in the rollout of a new protocol around bedbug-sightings at CRMC.

“The whole process was built around VigiLanz’s ability to automatically identify that lab result as soon as it is available, and immediately send an alert and email notification,” said Lyon.

CRMC is also using VigiLanz to address environmental bedbug sightings (when a bedbug is spotted but can’t be tied back to a specific patient). In this case, healthcare providers enter the bedbug information into the EMR as a lab for a “dummy patient.” If the lab determines that it is in fact a bedbug, VigiLanz automatically issues alerts and sends emails to the appropriate parties.

Outcomes

CRMC’s bedbug identification process is helping to prevent infestations, control costs, and increase efficiency, said Lyon. Since healthcare providers know much more quickly if there has been a potential bedbug sighting, and they are alerted as soon as a bedbug is confirmed, it’s much easier to limit the movement of these patients through the facility.

This reduces the number of rooms that need pest control treatment, said Lyon, noting that prior to implementing the new process, CRMC regularly performed pest control treatments in multiple rooms and procedural areas.

Since implementing VigiLanz in 2017, the average number of bedbug alerts issued annually has been 14, and CRMC has experienced zero infestations.

“The rules we created enable us to be proactive rather than reactive,” said Lyon. “The real-time alerts help us respond the same day we receive a bed bug alert, which mitigates any risk of a bedbug infestation.”

To learn more about how VigiLanz helps hospitals improve their patient safety and clinical surveillance, request a demo today.

VigiLanz Improves Efficiency, Patient Care at Riverside University Health System

Posted on April 10, 2020April 20, 2020 by Leo Bogee

Andy Williams, PharmD, BCPP, BCGP, Senior Clinical Pharmacist at Riverside University Health System, discusses how VigiLanz improves patient care.

“I’ve seen VigiLanz make some very strong, important interventions, especially in the realm of our pharmacokinetic monitoring,” says Williams, adding that VigiLanz serves as a second set of eyes for pharmacists.

Watch this short video to learn more about how Williams and his team are using VigiLanz to improve patient care.

Transcript:

I think the biggest benefit that VigiLanz provides for patient care is that it helps us work more efficiently, so we’re able to quickly get the information that we need, so that we can spend more time out on treatment team rounds or out directly interacting with patients on the unit conducting our pharmacist-led patient education groups. It helps us to take care of any reports or lab monitoring we need to do quickly and efficiently, so that we’re able to then realign our time on something else that could help strengthen patient care.

Since we are a psychiatric hospital, we may have a little bit unique methods in which we use VigiLanz. We use VigiLanz largely for our reports, so it’s able to help us with conducting our quality assurance measures. We’re able to run reports on which patients have received long-acting injectable anti-psychotics each quarter, and then cross compare that with their readmission rates. We’re able to use it to run our Joint Commission Hospital-Based Inpatient Psychiatric Services measures to see patients that are on two or more anti-psychotics. We’re able to use it to run whether or not they have appropriate labs, so if they have their lipid panels or their A1Cs for the patients that are receiving second generation antipsychotics, as well as for pharmacokinetic monitoring of Lithium or valproic acid sodium.

I’ve seen VigiLanz make some very strong, important interventions, especially in the realm of our pharmacokinetic monitoring. Many of our patients are receiving Lithium, which is a narrow therapeutic index drug, and with that, it has the potential for many drug interactions. It could be very easy for one of our pharmacists to overlook a lab or not see an out-of-range lab. VigiLanz is able to provide that safety net and that second look of eyes to alert us in real time if something is out of range so that we can act quickly, without leaving the patient exposed to a higher level or risk them receiving another dose when that really isn’t appropriate.”