VILSECK, Germany -- For the second year in a row the U.S. Army Medical Activity Bavaria polypharmacy team was recognized for their accomplishment and achievement, winning a patient safety award in the 2019 Advancement toward High Reliability in Healthcare Awards Program.

The Advancement toward High Reliability in Healthcare Awards Program aims to recognize those who identified and successfully implemented systems and processes that will help advance the Military Health System toward its goal of becoming a safer, highly reliable system that promotes a culture that encourages learning, sharing, and continuous improvement, according to Erika Piernas, program operations support specialist for the Defense Health Agency.

Project submissions from various Department of Defense health organizations were made in the following disciplines: Healthcare Quality, Patient Safety, Improved Access, and Patient Engagement. The winning project MEDDAC Bavaria submitted for consideration under the disciple of Patient Safety was titled 'Improving Medication Safety through Trending Near Miss Errors.'

Medication safety continues to be on the forefront of many patient safety initiatives within MEDDAC Bavaria as the organization actively looks for ways to improve patient safety with a systematic approach. That was the focal point of the project submission.

According to the Institute of Medicine's Preventing Medication Errors, there are four errors for every 250 prescriptions dispensed. The pharmacy review process requires repetitive interventions by the pharmacist to prevent patients from receiving prescriptions which may cause harm.

MEDDAC Bavaria developed a method to reduce provider order entry, or POE, near miss errors which would decrease the number of incorrect prescriptions dispensed. The end goal was a reduction of pharmacist interventions by 50 percent for these repetitive near miss errors. To accomplish this, four things had to happen. The polypharmacy team:

• Internalized the documentation of POE near miss errors into the pharmacy review process.
• Developed a list of edit codes using a Failure Mode and Effects Analysis (FMEA) and data analysis.
• Developed a Composite Health Care System (CHCS) Ad Hoc report to obtain audit trail data.
• Increased transparency of the data for identification of trends and communication vertically and horizontally across the organization.

The process the polypharmacy team developed positively impacted the number of near miss errors.

There was a 64 percent decrease in the near miss errors requiring provider contact and the rate of near miss errors per new prescriptions had remained under their SMART (Specific, Measurable, Achievable, Relevant, Time-bound) goal of four percent.

The list of near miss edit codes could be integrated into MHS Genesis and standard reports developed to allow the process to be utilized at all DHA sites.

By implementing POE near miss error edit codes, trending the causes of near miss errors, and increasing the transparency of the data, the polypharmacy team demonstrated the utmost stewardship for medication safety.

The project lead for MEDDAC Bavaria was Dr. Richard Juneau, a polypharmacy clinical pharmacist who has been with the organization since 2016. His primary responsibility is the Army's polypharmacy program -- polypharmacy pertains to concurrent use of multiple medications by a patient.

"Identifying and reporting prescription errors and near misses has always been a continuous effort at MEDDAC Bavaria," said Juneau as he explained how this particular project evolved within the last three year.

In the years 2017 and 2018 the polypharmacy team was able to identify an audit trail which allowed them to see exactly how the prescription was changed.

"What was the original directions, medication or quantity and what was it changed to," Juneau adds. "In 2019, we developed a Tableau Storyboard which gave access to the trending data for all the Army health clinic commanders, the medical directors, pharmacy staff, and patient safety coordinators."

Given the fact that the pharmacy is the last line of defense before medication reaches a patient, the near miss medication error prevention process is being expanded throughout the Regional Health Command. The efforts of the polypharmacy team has dramatically decreased the risk of patient harm and ultimately improved patient outcomes by ensuring patients take their medications as intended by the prescriber.

MEDDAC Bavaria's award recognition comes on the heels of last year's success when the organization won two awards in the 2018 Advancement toward High Reliability in Healthcare Awards Program in the disciplines of Healthcare Quality for 'Enhancing Antibiotic Stewardship among Pediatric Patients' and Patient Safety for 'Improving Opioids Safety,' respectively.

When asked if the polypharmacy team plans to submit work for the 2020 Advancement toward High Reliability Healthcare Awards Program, Juneau said the team has several projects that could potentially be submitted.

"We have developed a novel process to identify high risk benzodiazepine use by prioritizing dose, duration of therapy, and intensity of use," said Juneau. "We are also piloting a modular clinical pharmacy service which will bring clinical pharmacy services to Army Health Clinics where there is no clinical pharmacist assigned, and also to expand current services to improve patient convenience and access."