Transcript SHN Medication Reconciliation WebEx Slides Oct 2010

Medication Reconciliation:
Partnering with the
Community
What worked, what didn’t !
October 2010
Ann Nickerson BSc (Pharm)
Susan Crawford RN
Extra Mural Driscoll Unit
Moncton New Brunswick
[email protected]
[email protected]
Acknowledgement
Thanks to the other Extramural
Driscoll Medication Reconciliation
Team members:
Cheryl Leger, RN
Joan Peddle, RN,BN;
Maura Dalton, RN, BScN;
Linda Price, RN,BScN;
Margaret Meier RN,BScN
SELF ASSESMENT QUESTIONS
What are the critical steps and questions in
the process of medication reconciliation
and taking of the best possible medication
history (BPMH)?
What key transition areas in my practice
setting are problem-prone points in our
medication management system?
THE RIGHT TIME
Transition Points
Admission
Transfer to another setting, service
provider or level of care within or
outside the hospital setting
Discharge to the community
Over half of all hospital medication errors occur
at interfaces of care
Rozich, Resar (2001) J Clin Outcomes Manage.
THE RIGHT STAKEHOLDERS
“ Medication reconciliation is a shared
responsibility. Communication between the
various levels of care/service is vital to
accurate medication reconciliation.” CCHA
Suggest: include a hospital pharmacist, a
physician and home care RNS &/or those who
take the medication histories
Community pharmacist, physicians and nurses
from various levels of service in the community
and hospital and risk manager
THE RIGHT STAKEHOLDERS
FORM THE TEAMBecome champions for the patient!
Result : The safety benefit of an
accurate medication history
It’s so much more than a list
Medication History
“Medication-history taking is a
skill” NOT a technical
responsibility
Aug.1.2005 AJHP News
Remind yourself
“It’s NOT just a list”
Med Reconciliation at the
time of admission is ideal.
The longer you wait, may
delay someone from
preventing a medication error.
“I take a small white pill and a large blue pill”
Converse with patient’s community
pharmacist, family member, hospital
discharge nurse and most importantly
THE PATIENT
Important Questions
PROMPT the patient to remember patches,
creams, eye drops, inhalers, physician
samples, shots, herbal, vitamins, minerals
Regularly used OTC products
Allergy VS side effects: Describe the reaction.
Have patients describe how and when they
take their medications
Information from the patient
This is the key to a good medication history!
Dangerous practice to record a history JUST from
the directions on the medication bottle or print out
from the community pharmacy.
The medication history should be “as stated by the
patient.” It is from here we can make modifications
and actually uncover reasons for admission
E.g.. Patient taking 10mg of paroxetine(Paxil)
because 20mg caused diarrhea, shakiness,
unsteady on her feet. Label reads 20mg.
Improvement Model
What are we trying to
accomplish?
How
will we know that
change is an
improvement?
What changes can we
make that
will result in improvement?
Act
Plan
Study
Do
The Form - Documentation
Customization! Standardization!
Have only ONE area where a
patient’s medication history can
be recorded
Adopt the medication
Reconciliation form as the
admitting order for the patient’s
home meds
Am.J.Nurs.Vol 105(3) supplement March
2005.31-36
On Action:
“There are costs and risks to a program
of action, but they are far less than
the long-range risks and costs of
comfortable inaction”
John F. Kennedy (1917-1963)
35th U.S. President