February 18, 2016

Center for Individualized Medicine Team Enhances Patient Safety Through Teamwork

By Jeff Briggs

“The keynote of progress in the 20th century is system and organization — in other words, ‘teamwork.'”

Dr. Charles Mayo, 1916

Excellence Team-lg

The Pharmacogenomics Clinical Decision Support Rules Implementation Team: Front row, from left: Padma Rao, Cloann Schultz, Pedro Caraballo, M.D., Caer Rohrer Vitek, Jamie Bruflat. Back row, from left: Robert Bleimeyer, Joe Sutton, Wayne (Nick) Nicholson, M.D., Pharm.D. Missing: Kelly Wix, Pharm.D., R.Ph.; Lois Hines, R.Ph.

When Dr. Charles Mayo, one of the founding Mayo brothers, uttered that line over a century ago, he could have been referring to the Pharmacogenomics Clinical Decision Support Rules Implementation Team of today. In an organization that values and promotes teamwork, this Center for Individualized Medicine-supported team excels. And patients are safer because of it.

The Pharmacogenomics (PGx) Clinical Decision Support (CDS) Rules Implementation Team recently won the prestigious Mayo Clinic Excellence Through Teamwork Award for its efforts to enhance patient safety by decreasing potential adverse drug events and increasing drug efficacy. The Excellence through Teamwork Award provides Mayo the opportunity to recognize individuals for their exemplary teamwork skills.

The PGxCDS Rules Implementation Team created, implemented and maintained pharmacogenomics (drug-gene) clinical decision support rules in the electronic medical records (EMR) and point-of-care education for prescribers that has been replicated throughout the enterprise.

This multidisciplinary, enterprise-wide team of physicians, pharmacists, informaticists, IT experts, laboratorians, and education staff met weekly to:

  • Collaborate with clinical champions and informatics to define rules and garner support across the enterprise
  • Develop new IT processes for implementing drug-gene rules
  • Build consensus among the laboratory, clinical and pharmacy practices
  • Create and update supporting point-of-care education in AskMayoExpert

The PGxCDS Rules Implementation Team took its direction from the Pharmacogenomics Task Force.  The scope of the task force was to identify, monitor and manage genetic variants with implications for clinical care.

“Having a direct impact on patient care is a powerful motivator,” said team member Cloann Schultz, M.S., P.M.P.

“The first drug/gene pair our team worked on made clear the importance of implementing alerts," Schultz added.  "Abacavir/HLA-B*5701 has a black box warning that all patients should be tested for the genetic variant before being put on the medication. It requires the physician to remember to order the testing. If the patient has the variant and receives the medication they are at risk for a serious, potentially fatal hypersensitivity reaction.  Now on all orders for abacavir for new patients, the physician receives an alert reminding them to test for the variant.”

The team built trust and showed extraordinary commitment as they experienced new challenges with each rule implemented. Despite multiple moratoriums, resistance and other issues and barriers, the team worked together to find solutions resulting in the:

  • Successful implementation of 22 drug-gene rules
  • 3,692 drug-gene alerts fired
  • 3,247 positive test results added in the EMR
  • 600+ potentially harmful/ineffective prescriptions cancelled

 “Every member of the team took on their portion of the responsibility in addition to their day jobs,” says Scott Beck, administrator, Center for Individualized Medicine, who nominated the team for the award. “The team came together because of the new opportunity to help patients, and to be among the first groups in the country to implement drug-gene rules in the EMR. Every member felt strongly that this would enhance patient safety, and they came together as a cohesive unit under Dr. [Pedro] Caraballo’s guidance to form an extremely close-knit group of like-minded and committed individuals.”

 Team members included Robert Bleimeyer; Jamie Bruflat, M.S.; Pedro Caraballo, M.D.; Lois Hines, R.Ph.; Wayne Nicholson, M.D., Pharm.D.; Padma Rao, M.S.; Cloann Schultz, M.S., P.M.P; Joe Sutton; Carolyn Rohrer Vitek, M.S.; Kelly Wix, Pharm.D., R.Ph.

This project was supported by the Center for Individualized Medicine as part of a strategic effort to implement genomic medicine into the practice.

About the Award
The Excellence Through Teamwork Award provides Mayo Clinic the opportunity to recognize individuals for their exemplary teamwork skills. They are the dedicated people who exemplify the values and excellence for which Mayo Clinic is known. Their efforts go beyond that of normal job responsibilities and obtain outcomes that have a positive impact for the organization.



Tags: center for individualized medicine, Cloann Schultz, drug-gene alerts, pharmacogenomics, Pharmacogenomics Clinical Decision Support Rules Implementation Team, Scott Beck, Uncategorized

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