Transcript Medication Reconciliation at Osborne Park Hospital

Medication Reconciliation
at Osborne Park Hospital
•Karen Chapman, Senior Pharmacist
•Aaron Cook, SQuIRe Project Officer
1
Background
• State-wide SQuIRe program
• Why the need for a Med-Rec project?
• AIMS data and anecdotal evidence
• Medication reconciliation previously
performed but poorly documented
2
Target Areas
• Reconciliation Project on 3 aged care & rehab wards
• Safety initiatives across other wards
• Majority of patients over 65 years of age, multiple co-morbidities,
visual and/or hearing impairments, fluctuating cognitive state,
language barriers, multiple medications (average 15), multiple
medical professionals seen prior to OPH admission = high risk
patients
• Average length of stay on rehab wards is 19 days (reduce)
3
Medication Reconciliation Process
• Admission: take medication history, confirm and
reconcile
• Discharge/transfer: reconcile, liaise/communicate
information to next point of care
• Aiming to achieve a new system which creates
accountability, continuity of care and communication,
saving time (overall) = safer care for patients
4
‘My Own Medicines’ List
Developed for maternity
patients to list their
medications and ADRs
prior to admission
5
‘My Medication’ Bags
To encourage patients to bring in
their own medications, assisting
with reconciliation and safe
medication storage during
admission.
6
Pharmacy Admission Data Sheet
Admission data sheets are
completed to list and cross
check all medications and
indications
7
Medication Reconciliation Form
Ensures admission and
discharge processes have
been completed correctly
and details any
discrepancies identified
8
This is what happens
when Doctors make
medication
errors……!
9
Discharge Dispensing Checklist
Discharge dispensing
checklist to ensure all
stages of discharge process
completed
10
General Practitioner and Community
Pharmacy Facsimile
Created to promote
community liaison
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Promotion & Education
• Launched ‘My Medicine bag’ campaign for OPH
• Created and launched the OPH ‘My Own Medicine’ List through the
antenatal clinic
• Provided ‘My Medicine bags’ to all rehabilitation wards
• Local community centre posters and presentation promoting a
patient’s own medication management
• Regular education sessions with medical and nursing staff
• Liaison with patient’s family, carers, GP and community pharmacist
• Commenced home medicines review initiative with patient’s GP
12
Promotion
• Local newspaper (Stirling Times) article and picture
• Northern Lights (OPH’s monthly newsletter/magazine) article and
picture
• Osborne GP Network Ltd fax article
• Promotion of ‘My Own Medicines’ on inpatient televisions
• OPH Internet article
• OPH telephone ‘messages on hold’ to promote bringing own
medications to hospital
• Liaison with OPH Community Advisory Council
13
Improvements in Admission Process
Pharmacists documenting and processing a complete medication
history on admission, confirming and reconciling it, has risen from 0%
(0/20 patients, March 2007) on 1 ward, to 100% (76/76 patients,
August 2008) across 3 wards.
100
80
60
40
20
0
Mar May
Jul
Sep Nov Jan Mar May
Jul
14
Improvements in Discharge Process
Similarly, documenting the reconciliation of medications and
appropriate liaison/correspondence on discharge has improved from
35% (7/20 patients, March 2007) on 1 ward, to 100% (69/69 patients,
August 2008) on 3 wards.
100
80
60
40
20
0
Mar May Jul
Sep Nov Jan Mar May Jul
15
Discrepancies Found on Admission
• May 2008: 56 patients (2 wards), 146 medication discrepancies/errors
• June 2008: 47 patients (2 wards), 88 medication discrepancies/errors
• July 2008: 92 patients (3 wards), 122 medication discrepancies/errors
• August 2008: 76 patients (3 wards), 110 medication discrepancies/errors
160
140
120
100
Patients
Discrep/Errors
Omissions
80
60
40
20
0
May
Jun
Jul
Aug
16
Challenges
• Time and resources required for complete reconciliation
(which is reliant upon communication with multiple
sources)
• Reliance on Pharmacists …….
‘Don’t worry, the Pharmacist will correct it’
• Transient (rotational) nature of some medical staff
resulting in a continuous need to retrain, up skill etc
17
Future Plans – Medication Safety
Initiatives
• Labelling, documentation size increase
• Continue strong engagement of medical staff
• Trial medication storage in centralised area
• Continue community promotion/awareness
• Investigate electronic medical record
alternatives
• Investigate methods for preventing/reducing
interruptions during Nurse medication rounds
18
Questions
19