The Medical Department Activity Bavaria was recently awarded two Defense Health Agency Advancement toward High Reliability in Healthcare awards for initiatives in quality and patient safety.

MEDDAC-B won in the Healthcare Quality category for the submission, 'Enhancing Antibiotic Stewardship among Pediatric Patients;' and in the Patient Safety category for their submission, 'Improving Opioids Safety.'

According to the Military Health System website "The Advancement toward High Reliability in Healthcare Awards aims to recognize those who have shown initiative and commitment to the development of systems and processes that will help advance the MHS toward its goal of becoming a safer, higher quality system that promotes a culture that encourages learning, sharing and continuous improvement."

Brandye Mize, MEDDAC-B Deputy to the Commander for Quality and Safety, submitted the organization's Healthcare Quality project, 'Enhancing Antibiotic Stewardship among Pediatric Patients.'

This submission looked at antibiotic stewardship practices directly related to improving the diagnoses and management of Group A Streptococcal Pharyngitis in children ages 3-18.

Mize said, the prevalence and incidence of infections caused by multidrug-resistant organisms continue to increase, and therefore, organizations such as The Joint Commission have deployed quality healthcare standards to improve outcomes and reduce adverse events associated with overzealous antibiotic use.

"Foundational principles of a high-reliability organization include engaged leadership, robust process improvement, and a culture of safety," Mize said. "This organization applied all three of those principles. First, by recognizing that overzealous use of antibiotics could lead to poor patient outcomes and adverse events which was a significant patient-safety concern."

For process improvement, MEDDAC-B utilized the Institute for Healthcare Improvement's Plan-Do-Check-Act methodology to plan, implement, monitor and sustain improvement efforts focused on the diagnosis and management of GAS pharyngitis.

"Finally, our performance would not have improved were it not for the engagement of our leadership at all levels including the point of care, the medical treatment facility, the parent-level, regional-level and beyond," Mize said. "Leaders played the largest part by encouraging change in clinical practice, addressing provider clinical practicing patterns, and providing positive encouragement throughout the process. Collectively, awareness and application of all three HRO principles have helped us lead the way in appropriate utilization of antibiotics among a very specific and a significantly at-risk cohort of patients."

Maj. Victoria O'Shea, MEDDAC-B Pharmacy Consultant, oversaw the patient safety submission, 'Improving Opioids Safety.' She said the submission "was for the process change that we implemented across Bavaria pharmacies to improve opioid safety. We actively look for ways to improve patient safety with a systematic approach."

In 2017 the U.S. Army Medical Command published the Naloxone Prescribing and Dispensing policy in response to the opioid epidemic in the U.S. According to the policy, "over 14,000 people died from opioid overdose deaths in 2014."

The new policy required pharmacists to offer and dispense naloxone upon determining the patient's risk for fatal opioid overdose.

According to O'Shea, MEDDAC-B "quickly implemented the Risk Index for Overdose or Serious Opioid-Induced Respiratory Depression screening in the pharmacies. The ultimate goal was to improve opioid safety.

In Army military treatment facilities with oversight from MEDDAC-B, pharmacy staff now screen the patients who receive an opioid prescription for risk of overdose that could lead to respiratory depression (patient could stop breathing). This screening is based on 15 different risk factors to identify high-risk patients who would benefit from having the antidote -Naloxone, which the pharmacist could prescribe for them.

"We led the effort in improving opioids safety and the prevention of fatal overdose at the point of dispensing where it is most effective as the last line of defense," O'Shea said.

Col. Mark Swofford, MEDDAC-B commander, said the organization is always looking at systems and processes and how they can be improved to ensure patients are getting the highest quality healthcare.

"Quality and Safety is one of our top priorities here at MEDDAC-B," Swofford said. "These two initiatives have helped our organization advance to a higher quality of patient care and fostered a culture of safety."

For more information on MEDDAC-B, visit http://rhce.amedd.army.mil/Bavaria/index.cfm