Transcript VCH-PHC Med Rec Training Module

Medication Reconciliation Using
PharmaNet-based Forms
…It’s about the conversation.
2010
Pharmacy Services
Outline
•
•
•
•
•
•
Why reconcile?
What is Medication Reconciliation?
Change of Practice
PharmaNet-based Med Rec Forms
Obtaining a Best Possible Medication History (BPMH)
Documenting the BPMH on the PharmaNet-based
Med Rec Form
• Processing Medication Reconciliation
Orders
Pharmacy Services
Why Reconcile?
• Over half of medication errors occur at the
interfaces of care
Rozich JD, Reser RK. Medication Safety: One Organization’s Approach to the Challenge.
J Clin Outcomes Manage. 2001;8(10): 27-34
• An up-to-date and accurate medication list
is essential to ensure safe prescribing in
any setting
Safer Healthcare Now! Getting Started Kit: Medication Reconciliation Prevention of Adverse Drug Events
Pharmacy Services
Medication Reconciliation
•Working Definition:
…a formal, systematic process in which health
care professionals partner with patients to
ensure accurate and complete medication
information transfer at transitions of care.
Pharmacy Services
Medication Reconciliation
•Working Definition:
…a formal, systematic process in which health
care professionals partner with patients to
ensure accurate and complete medication
information transfer at transitions of care.
Pharmacy Services
Medication Reconciliation
• Prevent Unintentional Discrepancies
• Document Intentional Discrepancies
Pharmacy Services
Medication Reconciliation
P re-H o sp ital
M ed icatio n s
P rescription
N onP rescription
P rov P rog
S am ples
A lternative
R ecreational
In p atien t
M ed icatio n s
(A d m issio n )
R econciliation
In p atien t
M ed icatio n s
(C ritical)
R econciliation
In p atien t
M ed icatio n s
(A cu te)
R econciliation
R econciliation
Pharmacy Services
D isch arg e
M ed icatio n s
R econciliation
Medication Reconciliation
• Three step process:
– Collection
Best Possible Medication History (BPMH)
– Clarification
– Reconciliation  Medication Orders
Pharmacy Services
Change of Practice (Admission)
Current state
• Multiple individuals take medication histories and document
them in different locations in the clinical record
• Medication orders are written on a separate form
• Discrepancies occur without any effective way of identifying or
resolving them
Future state
• One individual will obtain and document the best possible
medication history (BPMH)
• The prescriber will confirm/write medication orders
on the same form to increase transparency and
eliminate transcription errors
Pharmacy Services
Standard Forms
• Use data in existing databases to:
– Minimize transcription
– Ensure no active orders are overlooked
• Formatted to support three-step process:
– Collection (existing data)
– Clarification (modified/additional data)
– Reconciliation  medication orders
• Transparent process
– Apparent to all subsequent caregivers
• Documentation of BPMH in single location at
admission which can be referred to at discharge
Pharmacy Services
Medication Reconciliation at Admission
• Three step process:
– Collection
– Clarification
– Reconciliation
Pharmacy Services
COLLECTION
CLARIFICATION
RECONCILIATION
CLARIFICATION
COLLECTION
CLARIFICATION
RECONCILIATION
Best Possible Medication History
• An up-to-date and accurate medication list is essential to
ensure safe prescribing in any setting
Safer Healthcare Now! Getting Started Kit: Medication Reconciliation Prevention of Adverse Drug Events
• Goal is to determine how a patients is actually using
their medications (versus how they were prescribed)
• Three steps:
– Preparation
– Conversation
– Documentation
• Tools available at:
http://vchconnect/programs_services/regional_pharmacy/
medication_reconciliation/resources/page_69550.htm
Pharmacy Services
Preparation
• Review chart for clinical conditions and any
medication lists obtained previously
• Print and review the patient’s PharmaNet-based
Medication Reconciliation Form from
CareConnect
Pharmacy Services
Limitations of PharmaNet
• Record of prescriptions dispensed
• Reflect current use of prescription medications
less than 30% of the time
Shalansky, S et al: Accuracy of a Prescription Claims Database for Medication Reconciliation
for Outpatients with Heart Failure. Can J Hosp Pharm 2007;60(3):169-176
• Information in PharmaNet MUST be
clarified/verified with the patient or caregiver
Pharmacy Services
Limitations of PharmaNet
• MAY contain discontinued medications
• Does NOT contain
–
–
–
–
–
–
–
Updated administration instructions
Non-prescription drugs
Samples
Investigational/clinical trial drugs
Complementary and alternative therapies
Antiretrovirals, some chemotherapeutic agents and vaccines
Prescriptions obtained outside of BC or over the internet
• Fraudulent use
• Information in PharmaNet MUST be clarified/
verified with the patient or caregiver
Pharmacy Services
Printing PharmaNet-based Forms
• Forms are accessed via CareConnect
• Detailed instructions are available at:
http://vchconnect/programs_services/regional_pharmacy/medication_
reconciliation/page_67071.htm
Pharmacy Services
Total Pages and Print Date
Patient
Identification
Interpreting PharmaNet Entries
Generic name,
strength and dosage
form of medication
Usage instructions
Fill date
Prescriber
Fill quantity
Prescription status
Pharmacy Services
Preparation continued
 Review chart for clinical conditions and any
medication lists obtained previously
 Print and review the patient’s PharmaNet-based
Medication Reconciliation Form from CareConnect
• Anticipate non-prescription medications based on
clinical history + PharmaNet
• Review any medication containers that the patient
brought to hospital
• Arrange for a translator or family member to
assist if required
Pharmacy Services
Conversation
Pharmacy Services
Conversation
• Introduction
• Ask to see home medications if available
• Ask patient to describe why and how they are taking each
medication regardless of what is on the label or in PharmaNet
• Ask specifically about:
– nonprescription medications, especially
• aspirin
• analgesics (acetaminophen, ibuprofen)
• vitamins, calcium, iron and other supplements
• allergy medications, eye drops, creams, etc
– Samples
– Previous adverse effects (or lack of effect) of medications
• Any further questions?
Pharmacy Services
Conversation
Pharmacy Services
Documentation
Pharmacy Services
Documentation
Pharmacy Services
Documentation – Peri-op
Pharmacy Services
Reconciliation
Pharmacy Services
Summary
•
•
•
•
•
•
Why reconcile?
What is Medication Reconciliation?
Change of Practice
PharmaNet-based Med Rec Forms
Obtaining a Best Possible Medication History (BPMH)
Documenting the BPMH on the PharmaNet-based
Med Rec Form
• Processing Medication Reconciliation
Orders
Pharmacy Services
Acknowledgements
• Crystal Amos, Medication Safety Pharmacist,
Vancouver Acute HSDA
• Jane de Lemos, Coordinator, Professional Practice,
VCH-PHC Pharmacy Services
• Debbie Jeske, Interim Director, Peri-operative
Services, Vancouver Acute HSDA
• Elinor Orsini, Patient Services Coordinator,
Preadmission Clinic, Vancouver Acute HSDA
• Fruzsina Pataky, Medication Safety Coordinator,
VCH-PHC Pharmacy Services
Pharmacy Services