Michael E. DeBakey VA Medical Center, Veterans Health Administration (VHA) – Gold Award Winner of the Quality and Patient Safety Award 2022

Date:  20 June 2023

VIONE: an innovative, simple, portable, modern medication optimization and deprescribing global methodology to improve patient safety and quality of care

Prescription medicines are notoriously misused by many patients. About 45% of prescribed medications are not taken by patients, leading to environmental pollution, unsafe practices, clinical waste, and compromised quality of care. The overuse, misuse, and underuse of medications are longstanding and widely acknowledged global concerns; yet there are neither any generally accepted methodologies nor mandates to address these challenges.

To address this gap, a small group of healthcare professionals from the Veterans Health Administration (VHA), working across the USA, developed VIONE: an innovative and scientific methodology that optimizes and simplifies medication deprescribing. VIONE uses medical informatics and population health management to optimize the prescription of various medicines, which in turn increases the quality of care and improves patient safety.

“Our group is multidisciplinary, multicultural, multigeneration and our focus remains improvement of patient safety and quality of care through decreased use of potentially inappropriate medications (PIMs) and medication optimization.”

Dr Saraswathy Battar, [who was the] Medical Director at the Michael E. DeBakey VA Medical Center

“The VIONE methodology is an award-winning, USA-based patient safety project that uses clinical, academic, research, leadership, innovative informatics to achieve sustainable reductions and optimization of PIMs to prevent adverse outcomes such as hospitalizations, falls, clinical waste, even death while reducing costs and empowering patients and medical providers.”

A multi-pronged approach

VIONE medication deprescribing methodology uses five filters to promote patient safety – Vital, Important, Optional, Not indicated, and Every medication has an indication (VIONE). Examples: Vital = lifesaving medicines such as diabetes medicine, Important = drugs important for a patient’s quality of life, such as pain and constipation medicines. Optional = elective medications, such as vitamin supplements which do not make an absolute difference whether taken or not taken. Not indicated = prescriptions which may not be ideal for all situations, might cause more harm than help, such as the use of blood pressure-reducing medications when the patient is suffering from low blood pressure with falls and dizziness. Lastly, Every medication has an indication serves as a warning that if the prescribing providers and consuming patients do not know the reason for a prescriptions, deprescribing could be carefully considered.

Through VIONE, the VHA was able to decrease polypharmacy-related preventable harm across the continuum of clinical care across various clinical settings and locations in the USA. With the understanding that medication deprescribing is a complex process that requires balancing multiple considerations, VIONE offers globally viable, simple, portable, practical strategies and enduse friendly resources to unpack the complexity, and to standardize patient safety initiatives.

VIONE was initially launched on a 15- bed inpatient unit and has since spread to 118 veterans affairs (VA) programmes. Clinical outcomes include empowerment of patients and providers, redesigning healthcare delivery models, and successful deprescribing of over 1.2 million unnecessary medications with a cost avoidance of around USD 110 million. VIONE has impacted the lives of over 525,000 veterans belonging to various age groups, both in rural and urban settings, and spread out across the continuum of care, ranging from inpatient, outpatient, home care, end of life, virtual care, academic, clinical, research, and leadership settings.

Recent studies show statistically significant outcomes with the use of VIONE. A report by the MIDAS Quality Enhancement Research Initiative showed that VIONE adoption led to an average decrease of 2.5 medications per patient, while patients 65 and older were prescribed 0.3 fewer potentially inappropriate Beer’s medications. Patients were also less likely to have an emergency department visit or hospitalization over a six-month period compared to patients seen prior to VIONE adoption and sustained implementation.

A key strength of VIONE is that it is a less resource-intensive system that is couched in colloquial language that is easily understandable for both patients and caregivers. It promotes holistic approaches, realizing that sometimes less medications offer more comfort and safety. It can be easily adapted across different global healthcare settings with ease and effectiveness.

Since it was launched, VIONE has garnered prestigious awards and has been adopted across the national healthcare delivery model. VIONE has also formed a global alliance with Sustainable Medicines Partnerships to share lessons learned, best practices, and promote environmental safety through safe medication optimization practices. “VIONE exemplifies successful project initiation, refinement, incremental expansion to regional, national and international therapeutic and global alliances,” Dr Battar said.

“Our goal is to eventually make VIONE a colloquial global tool that transforms safe medication practices and allows patients and healthcare teams to easily, effectively, continually use the five V-I-O-N-E filters to determine whether a medication should be prescribed or not, or if it could be deprescribed.”

Submit entries now!

The IHF Awards 2023 is accepting entries across 7 categories until 30 June 2023

Written by:

IHF Secretariat

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