TABLE 1.

Cross Walk Between Key Principles of an HRO and the VIONE Program

High Reliability Organizations Principles	VIONE Implementation Principles
Sensitivity to operations	Incorporates into the workflow with ease, whereby providers can document VIONE related interventions as they are making decisions regarding appropriate medication continuation/planned cessation of medications; Considers EVERY medication within methodology; no medication is excluded from a review as any could lead to AEs; and Focuses on deprescribing as a solution rather than blaming the original prescriber, accepting that overprescribing and polypharmacy is a known health system issue rarely related to a single HCP.
Reluctance to simplify	Does not make sweeping assumptions about a single medication or medication class as inappropriate; it deals with each patient’s clinical picture individually; Incorporates shared decision making and captures, transmits, communicates relevant data in simple formats; Training focuses on patient safety and quality of life, in addition to medication management.
Preoccupation with failure	Staged to become a standard mind-set for polypharmacy, PIM deprescribing practice; every patient could (and should) be evaluated with the VIONE methodology as a standard to prevent any patient from having an AE; and Going forward, the VIONE Risk Score is a malleable evolving stratification method to identify high-risk patients based on new risk factors identified by experts.
Deference to expertise	Empowers HCPs at all levels in all specialties to focus on deprescribing in polypharmacy situations; and Patient identification and review can be a team approach, deferring to either the intake nurse, clinical pharmacy specialist, or specialty prescriber depending on the expertise required for the medication.
Commitment to resilience	Designed to address risk factors for poly pharmacy/PIM related AEs; patients who have historical polypharmacy related AEs (falls, emergency department visits, vulnerable patients, aged > 65 years, on > 15 medications, etc), have higher VIONE Risk Scores and thus warrant expedited review to prevent a similar AE in the future.

Abbreviations: AE, adverse event; HCP, health care provider; HRO, high reliability organization; PIM, potentially inappropriate medication.