Transcript Meditech and MedRec - Markham Stouffville Hospital

Medication
Reconciliation
MUSE 2006
Markham Stouffville Hospital
Alice Watt, B.Sc.Pharm
2006
AIM
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Med Rec - What is it?
The Journey
Toolbox
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Admissions
Transfers
Discharge
Reports
Lessons Learned
What is it?
Medication Reconciliation
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Process of :
1. Getting the Best Possible Med History
2. Using the BPMH to write admission
orders
3. Identifying and reconciling discrepancies
with the physician
Important for our patients
because…
 Saves
lives medication errors
and adverse drug events.
The Journey
Implementation
in ER, 3E, ICU
Pilot
project
2002
Getting
Started
Data collection
2003
Paper
Record
Electronic
record
2004 2005
Hospital-wide
implementation
2006
Toolbox
Admissions
Medication Profile– Paper Record
Diagnosis/Surgical
Procedure
Unit/Rm
Medical Conditions
Physician
Date of
Admission
Allergies
Barriers
Meds
Meds Prior To
Ordered on
Admission
Admission
 Please See Computer
if Dosage
ordered
Med Hx
no
by MD
Pharmacist to Do
 Warfarin
 Amino
 Phenytoin
 CADD
 Other:
 Computer Med
Hx completed
Ht
ABW
Social History
 From home
 From
LTC/NH
 Other:
NAME. (Place
identification
sticker here. )
IBW DBW Age  M
F
Smoking
 Never
 Former
Current
Interventions
Alcohol Sub No use stance
 Social
 Abuse
New Meds Started or
Changes in Regimen
or
Discontinued by MD
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Source of med info
Patient Family
Pharmacy GP
Vials
Community Pharmacy/
Phone Number
Consent
Discharge Date/Plan
Obtained?
 Yes
Process Interventions
Medication History
Patient Name
Synthroid 0.1 mg PO daily
Metformin 500mg PO TID
Synthroid 0.1mg po daily
Metformin 500mg po tidcc
ECASA 81 mg po daily
Medication Reconciliation Screen
Patient Name
Pre-set
options
Patient interview
DPV
Pill’s Pharmacy – (416) 333 - 9999
Synthroid 0.1mg PO DAILY
N
Metformin 500mg PO TIDCC
Y
Called MD
EC ASA 81mgPO daily
Y
Not Necessary
U
D
Order Changed
Patient Assessment
Patient Name
Counsel patient at discharge
concerning new BP meds
Speaks no english – Family to be
present to help translate
Visual FlowSheet - Reconciliation
Pre-op Medication Report
Medication Reconciliation Record and Doctor’s order
Transfers
Transfers
 Medication
orders are compared by
physician at transfer points.
 ICU
Medicine
 Surgery/Short Stay
Rehab
Transfer Order Sheet
Warfarin Monitoring
Warfarin Monitoring - VFS
Discharge
Discharge
 Admission
Medication reconciliation
helps at discharge
 Work in progress
 PDRx
Discharge Medication List
DOCTOR:
LOCATION:
PATIENT:
Reports
Reports
Monthly report for Safer Healthcare now
 Run by date
 Categories include :
 Type of variances
 # of medications reconciled
 # of patients reconciled by ID number
 Time to reconcile vs. time of admission
 Time to reconcile each patient
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Lessons Learned…
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Trial and Error
Task Force
It’s a Team effort
Questions