Patient Safety
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/30447
Browse
Browsing Patient Safety by Author "Gibson, John"
Now showing 1 - 3 of 3
- Results Per Page
- Sort Options
Item Fall Risk Screening in the Elderly(2021) Scribner, Jacob; Colmenero, Evan; Gibson, John; Hadley, LescaPurpose: The purpose of this project was to increase fall screening for patients over the age of 65. Elderly individuals are at increased risk for falling, and at an increased risk of injury from falls. We set out to investigate if implementing more screening for this vulnerable population would identify those at risk. Methods: We used a simple "yes or no" questionnaire during Medicare annual wellness visits that identifies at-risk individuals based on different attributes that put an individual at higher risk for falling. Based on the answers, we evaluated if a patient is at risk, and, if so, what interventions can be implemented in order to decrease the risk of falling. Results: We were able to identify patients who required intervention to prevent future falls. Because there was no prior method of screening patients over the age of 65 for falls at this clinic, our post-intervention data was able to screen 75% of eligible patients. Conclusions: We found that a simple questionnaire can be a useful tool to determine which patients are at an increased risk. There were some limitations; due to COVID-19, many staff members were out for extended periods of time, thus limiting the amount of data collected. Additionally, as the questionnaire required additional time during a patient encounter, there was not time to survey every eligible patient. Moving forward, a systematic implementation for all Medicare visits would streamline the process and allow for further identification of those at risk for falls.Item QI project to reduce prescription of high risk medications for type 2 diabetes in patients over 65 years old(2021) Philip, Timothy; Cantu, Ramon; Hadley, Lesca; Gibson, JohnPurpose Patients over the age of 65 are at risk of hypoglycemia, which can increase risk of death. The objective of this project is to change high-risk medication (HRM) prescription, in diabetic patients over 65 years old, of long-term sulfonylureas or sliding-scale insulin to medication with less risk of hypoglycemia. Methods Patients over 65 years with non-HRM and HRM diabetes medications prescribed to them were identified. Post-exam, a recommendation was made to change medication from HRM to non-HRM. Results of the encounter will be recorded in data tables. Results After the implementation, only 1 out of 3 possible patients on Glimepiride was changed to an anti-diabetic medication that was not an HRM. This particular patient was prescribed basal-bolus insulin to replace the glimepiride. Conclusions One obstacle in preventing a change from Glimepiride to a non-HRM was cost. Therefore, due to cost of medication, socioeconomic status of the patient, and number of other medications, most patients declined a change. One patient denied the change because he was well-controlled on glimepiride for years. Although the data suggests lower rates of prescribing HRMs, this however is due to natural variability within the patient population and not a significant change caused by the enhancement.Item Quality Improvement: Examining Reduction of High Risk Medication Use in an Elderly Population(2021) Hutton, Sarah; McGaughy, Jennifer; Gibson, John; Hadley, LescaPurpose: The purpose of this project was to decrease the use of high-risk medications in adults age 65 and older. Polypharmacy is a potentially dangerous problem facing older patients in the United States; addressing high risk medication use is important to reduce risk. Methods: A questionnaire and educational handout regarding polypharmacy and high-risk medication were used to address the issue of high-risk medication use. Medication lists were reviewed for every patient meeting the criterion of being over the age of 65. Results: There was no significant reduction in high-rick medication use post-intervention. Those who were prescribed 1 high-risk medication (determined by the Beer's criteria) in the "prior to the enhancement implementation period" was 10.5% compared to the 10.0% of the same category in the "enhancement implementation" period. There was no change in either period for those prescribed 2 or more high-risk medications; these were both 0%. Conclusions: One of the reasons to explain the lack of significant reduction is there is not a large elderly patient population seen at the clinic. Also, a medication review function exists in the EMR that may have already led to a reduction in prescription of high-risk medications. While implementing use of the questionnaire and handout were appropriate, it was difficult to fully address the Beer's criteria extensive list of medications. The next step would be to have the EMR flag high-risk medications and identify those who are at higher risk of drug-drug interactions.