Transcript 4 Medication Reconciliation Conf Dr Paula Creighton Sept 08

Medication Reconciliation
in Continuing Care
Getting It Right Together
Creating a Culture of Safety
September 8, 2008
Dr. Paula Creighton MD, FRCP(C)
Geriatric Medicine Specialist
Cape Breton District Health Authority
Outline
Understand why Medication Reconciliation
is getting so much attention through:
• Understanding how adverse drug events (ADEs)
commonly occur
• Identify practical steps that can reduce the risk
of ADEs in practice
• Identify key features of a safer system
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Definition Adverse Event
• UNINTENDED act or event during care
• May result in potential harm
• Harm = increase length of stay
= temporary/permanent disability
= death
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How ADEs occur?
• Increase range of medicines to treat or
prevent disease
• Multiple co-morbid conditions
• Age-related changes physiology
Tsilimingras, Rosen, &. Berlowitz 2003.
Canadian Patient Safety (CPSI) Institute 2006
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How ADEs occur?
• Multiple health care practitioners
• Frequent visit to hospital setting
(hospitalization, procedures, tests)
• Adherence problems
Tsilimingras, Rosen, &. Berlowitz 2003.
Canadian Patient Safety (CPSI) Institute 2006
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How ADEs occur?
• OTC medication use
• Impaired vision, dexterity, literacy
Tsilimingras, Rosen, &. Berlowitz 2003.
Canadian Patient Safety (CPSI) Institute 2006
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When ADEs occur?
• Entry and exit points of clinical encounters
Cornish P. et al Arch Intern Med 2005:165; 424-429
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Traditional Medication History
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Labels
Lists
Verbal (open ended inquiry)
Someone else has/will complete
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Limitations to Traditional
Medication History
Discrepancies:
• Unintentional
• Undocumented Intentional
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Unintentional Discrepancies
• Over-the-counter medications
• Shared prescriptions
• Labels “as directed”
• Prescription change without script
• Samples
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Undocumented Intentional
Discrepancies
• What changed and why?
• Convey a clear understanding of desired
outcomes to therapy.
• Written communication with patient/family
and pharmacist
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Get Involved
safer healthcare
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Key Features toward a
Safer System
Change
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Key for a Safer System
• Doing our jobs differently…
…If you always do what you have
always done;
You always will get what you
always got
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Practical steps to reduce
risk of ADEs
• “To prescribe according to best evidence
from scientific research and to be mindful
of the precepts of patient autonomy”
Holland R, Wright D. Medication Review for Older Adults. Geriatrics and Aging March
2006, Vol 9. No.3.
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Practical steps to reduce
risk of ADEs
• When might it be best to withhold or
discontinue medications that are otherwise
appropriate on the basis of guidelines?
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Practical steps to reduce
risk of ADEs
• Consider life expectancy
• Goals of care and quality of life defined by
patient/family
• Potential benefit & risk of medications
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Practical steps to reduce
risk of ADEs
Start low,
Go slow,
Or don’t start at all!
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Practical steps to reduce
risk of ADEs
Partnering with Patients
“Nothing about me, without me”
(author unknown)
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Medication Reconciliation
Partnering with Patients
• patient/family interview
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Practical steps to reduce
risk of ADEs
• Humans require formal cues/processes to
stay on track reliably
• Reliable work processes account for the
known imperfections of humans
Adapted from PSO Training Course (IHI) 2004
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Medication Reconciliation
MEDICATION RECONCILIATION:
Drug Name
include on list below
Drug
Strength
Over the counter products, Samples, Shared pills
When Taken
Morning
Noon
Evening
Bedtime
Indicate if:
-New
-Change from label
-Effects from new and change
1
2
3
4
5
6
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Threats for Change toward a
Safer System
• Power Gradient
• Fear
• (Mis)-Perception “touchy, feely” initiatives
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Key for Change toward a
Safer System
Self audit:
• More mirrors and fewer windows
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Self Audit
• "One of the major impediments to
convincing people of the prevalence and
seriousness of cognitive error is the faith
they have in their own thinking abilities"
Croskerry, P. The Science of Human Factors in Healthcare, QHN, October 2003
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Key for Change toward a
Safer System
“ Many little people
Doing many little things
In many little places
Can change the world.”
(Chinese Proverb; author unknown)
Susan Sheridan, Chair, Patients for Patient Safety Strand, WHO World Alliance for
Patient Safety; Co-Founder, Consumers Advancing Patient Safety, Eagle, Idaho
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Get Involved
safer healthcare
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