Transcript Document

eReconciliation
A Tasmanian Perspective
Rory Gilmour
Nov 2014
Department of Health
and Human Services
Medication reconciliation is the formal process of
obtaining and verifying a complete and accurate
list of a patient’s current medicines.
Department of Health and
Human Services
Background
DHHS Tasmania:
 4 public hospitals
Medication Reconciliation:
originally ad hoc and not well structured
paper based
electronic (web based)
HCS developed the “Clinical Suite” enabling
 state-wide access to information
 the sharing of information between disciplines
 linking medication management activities
Department of Health and
Human Services
HCS Clinical Suite
Is a useful tool allowing:
Pharmacists to complete
 medication admission interviews
 medication reconciliations
 add, withdraw or update allergies, alerts and comorbidities
 medication profiles / counselling sheets
 episode notes
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Human Services
HCS Clinical Suite
Within the same environment doctors complete
 discharge prescriptions
 discharge summaries
 outpatient prescriptions
 outpatient summaries
 add, withdraw or update allergies, alerts and comorbidities
Provides decision support and access to
 state formulary (MIMS, PBS, DHHS meds list and guides)
 patient medication and other alerts
 real time decision support
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Human Services
Medication
Admission
Interview
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Human Services
Medication Admission Interview
 conducted upon admission to hospital
 obtained using a systematic process (ie. using a defined checklist)
 utilise several sources
 check for commonly missed medications or items recently ceased or
changed.
 check for allergies and alerts
 check whether a supply of each medication is required on discharge.
 example
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Human Services
Medication
Admission
Interview
Chart
Review
(Paper)
Department of Health and
Human Services
Chart Review
Department of Health and
Human Services
Medication
Admission
Interview
Chart
Review
(Paper)
Medication
Reconciliation
Department of Health and
Human Services
Medication Reconciliation
A “Med Rec” should
 compare a patients medication history to the
medications that have been charted
 highlight potential issues or discrepancies in therapy
to all treating clinicians
 example
Paper copy placed in the patient’s progress
notes
Department of Health and
Human Services
Department of Health and
Human Services
Medication
Admission
Interview
Chart
Review
(Paper)
Medication
Reconciliation
Discharge
Prescription
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Human Services
Discharge Prescription
Information obtained from the
 Medication Admission interview
 NIMC (inpatient drug chart)
is then used to prepare an electronic prescription
Still require a paper based Rx to enable PBS
claiming
Some information withheld
Department of Health and
Human Services
Some information withheld
Department of Health and
Human Services
Department of Health and
Human Services
Medication
Admission
Interview
Chart
Review
(Paper)
Discharge
Reconciliation
Medication
Reconciliation
Discharge
Prescription
Department of Health and
Human Services
Discharge Reconciliation
conducted by a clinical pharmacist
review and compare the electronic Rx with
medication reconciliation
once reconciled – Rx dispensed
Department of Health and
Human Services
Medication
Admission
Interview
Chart
Review
(Paper)
Discharge
Dispensing
Discharge
Reconciliation
Medication
Reconciliation
Discharge
Prescription
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Human Services
Discharge Dispensing
prescription dispensed
details of medications dispensed sent to the Clinical Suite
patient’s Clinical Suite medication profile updated for future
admissions as well as to aid in the completion of:
 discharge medication summary (Dr)
 medication profile / counselling sheet (Ph)
 DAA label (Ph)
Department of Health and
Human Services
Medication
Admission
Interview
Chart
Review
(Paper)
Discharge
Dispensing
Discharge
Summary
Discharge
Reconciliation
Medication
Reconciliation
Discharge
Prescription
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Human Services
Discharge Summary
Populated by numerous systems
Completed & signed off by treating doctor
Allows for other allied health involvement
Emailed to the patient’s:
 GP
 digital medical record
 PCEHR (depending on consent status)
 example
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Human Services
eMedication Managment
DHHS Tasmania has achieved eMM across the state
true closed loop needs to involve ALL care settings!
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Human Services
Advantages
single medication record across all hospitals
allows for information sharing
is informed by other systems (+/- … PAS, iPcy, etc)
standards compliant (AMT v3, SNOMED, Nehta stds)
promoting best practice in –
 Accurate and PBS compliant prescribing
 Past medication actions within reconciliations
easier reporting and statistic gathering
helps provide better communication and
handover (eg tasks and worklists)
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Human Services
Disadvantages
initially slower than hand written
human error still possible (minimise not eliminate)
currently does not check dose ranges
relies on availability / accuracy of other systems
manual updating in some areas
IT support 9 to 5, hospitals 24/7.
user needs to be computer “savy”
Department of Health and
Human Services
eReconciliation
eReconciliation works if a hospital provides
 reliable software (eg HCS)
 reliable wi-fi
 iPad / Android or Windows tablets
 and adequate training
Question: Would I return to paper based
reconciliations?
Answer: Not if I don’t have to!
Department of Health and
Human Services
Thanks for listening
Questions
Department of Health and
Human Services
Rory Gilmour
Nov 2014