Transcript Go the Distance with MedRec Web-based Application for Transfer

Web-based Application for
Transfer-Discharge
Medication Reconciliation
Nick Honcharik, Pharm. D.
Regional Pharmacy Manager
WRHA
Case – MedRec at discharge
• Mrs DE, 83 presented to ER with nausea,
weakness and a history of “passing out’ at
home
• PMH: HTN, Diabetes, AFib
• In ER significant lab tests:
– Glucose 2.8
• Med Hx: Glyburide 5mg bid, Metformin 500mg
bid, Warfarin 4mg daily, Hydrochlorothiazide
25mg daily, Metoprolol 25mg bid.
• Recent discharge from hospital with similar
symptoms.
Case review
• Glyburide discontinued last admission, but
patient told to resume home medications on
discharge.
• The previous admitting physician had
intended to discontinue Glyburide but had
not stated this explicitly.
Outcome:
The repeat admission could have been
prevented and potential harm avoided.
Transfer / Discharge process
• Many WRHA sites had started and
moved toward sustaining admission
MedRec
• Eagerness to start transfer/discharge
process
• Development of a Pharmacy
Information System (Cerner/Centricity)
generated medication list for discharge
MedRec
Electronic Discharge Form
• Easy to read
• Avoids transcription errors
• Allows prescriber to select the
medications that should continue (or
change, stop) at the next level of care.
• Becomes a valid prescription
• Community pharmacies love it!
• Copy remains in the chart
• Closes the loop of communication
between patient, community pharmacies,
primary care physician
Transfer / Discharge process
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Unable to spread electronic discharge form due
to inaccessibility of form by non-pharmacy
personnel
Trial of manual discharge MedRec - Failed
Some areas/sites do not want to start admission
process without having the discharge process
Discharge MedRec may promote the importance
of admission MedRec and potentially increase
compliance
Briefing note to senior management - pharmacy
resources to print discharge MedRec form
Web based MedRec application
• In cooperation with Manitoba e-Health,
developed web-based application
• Provides an electronic discharge form for
medication reconciliation
• Populates medication information from
pharmacy computer system into Discharge
MedRec form
• Access given to designated staff members
on the unit for generating the form on
demand
FAX COVER
SHEET
Confidential Facsimile
section to be completed
when faxing Rx
General instructions to
Pharmacist
Physician certification as
per legislation
Demographics
print on the form
Scheduled medications
checked off as
“Continue”,“Change”
or “Discontinue”
Quantity DEFAULTS
to 30 days. Space
available to write in
different quantity, along
with number of refills.
QuickTime™ and a
decompressor
are needed to see this picture.
QuickTime™ and a
decompressor
are needed to see this picture.
Pre-admission medications
to be restarted or
discontinued are indicated in
this section
Changes to current
medication
(dose/route/frequency)
written in this section, along
with new medication starts
FOOTER - DISCHARGE Medication Reconciliation/Prescription
Physician prints and signs
EACH page along with
date/time & licence #
Date and time
prescription printed
Total number of
pages provided
Pediatric Discharge MedRec Rx
DATA ENTRY function of application
Physician Survey HSC Pilot Unit
N=5
Question
Form easy to access
Strongly Disagree Neutral
Disagree
2
Accurate med list
Easy to use
Helpful in the
Discharge
process
Saved Time compared
to traditional process
1
3
Agree
Strongly
Agree
1
1
1
1
2
2
1
1
2
2
1
2
2
HSC Pilot Unit Discharge Audit
June 21-27, 2010
• 14 charts audited
– 79% (11/14) had a discharge MedRec form
• 10/11 with a discharge MedRec had an
Admission MedRec
• 10/11 had a “prn” med continue
• 8/11 had the last page available
– 5/8 completed “pre-admission” section
HSC Pilot Unit Discharge Audit
June 21-27, 2010
• Done Well
• Form was reviewed and signed the same day generated
• All decision boxes checked off – i.e. no orders missed
(scheduled or PRN)
• Each page was stamped with “COPY”
• Improvement Needed
• Ensuring ALL pages are in the chart
• Completion of “pre-admission” section
• Filling of the form in the orders section of the chart
QuickTime™ and a
decompressor
are needed to see this picture.
MedRec Example
Admission to Discharge
EXAMPLE OF COMPLETED MEDICATION HISTORY
Completed MedRec Discharge Form
PRN
medications
are
reconciled
Each page is
invalidated