Transcript Medication Reconciliation 30 Minute Presentation SPREAD Nov0

Medication Reconciliation
A Saskatoon Health Region
Initiative
…a shared
responsibility
for health care
Medication Reconciliation – what is it?
• A formal process of:
– Obtaining a complete and accurate list of each
patient’s current home medications (name, dosage,
frequency, route)
– Comparing the physician’s admission, transfer, and/or
discharge orders to that list
– Bringing discrepancies to the attention of the
prescriber and ensuring changes are made to the
orders, when appropriate
Reference: IHI, Getting Started Kit: Prevent Adverse Drug Events (Medication Reconciliation)
Medication Reconciliation can:
• Prevent omission of an at-home medication
• Match in-house dose, frequency and route
with at-home dose
• Assure medications follow the patient from
one care site to another
Why?
• Recent media attention and legal cases
• Concern over patient safety is growing, both among the
Canadian public and among health care providers
• 2.9-16.6% of patients in acute care hospitals
experienced one or more adverse events
• Greater than 50% of all hospital medication errors occur
at the interfaces of care
– Admission to hospital, Transfer from one nursing unit to another,
Transfer to step-down care, Discharge from hospital
Why Now?
• It’s the right thing to do……..
– Culture of safety: reduce medication errors & potential
for patient harm
– Key component of seamless care strategies
– Saves time for physicians, nurses, and pharmacists in
the long-term
• Medication Reconciliation is a new Canadian
Council on Health Services Accreditation Standard
• Senior Leadership has endorsed Medication
Reconciliation as a Regional Project of high priority
Potential Impact
• Implementation of medication reconciliation along with
other interventions decreased the rate of medication
errors by 70% and adverse drug events by 15%, over
a seven month period.[i]
• Implementation in a surgical population reduced
potential adverse drug events by 80% within three
months of implementation.[ii]
[i] Whittington J, Cohen H. OSF healthcare’s journey in patient safety. Qual Manag
Health Care 2004;13(1):53-59
[ii] Michels RD, Meisel S. Program using pharmacy technicians to obtain medication
histories. Am J Health Syst Pharm 2003;60:1982-1986
Potential Impact
• There was a five fold reduction (1.75% to 0.35%) in the
number of medication errors upon admission with
implementation of medication reconciliation upon
admission.[i]
• For those with no missing medications, drug related
problems after discharge were reduced from 85% with
original prescription process, to 35%.[ii]
[i] Rodehaver C, Fearing D. Medication reconciliation in acute care: ensuring an
accurate drug regimen on admission and discharge. J Qual Patient Saf
2005;31(7):406-413
[ii] Poole DL, Chainakul MP, Graham L. Medication reconciliation: A hospital necessity
in promoting a safe hospital discharge. J Healthc Qual (NAHQ) 2006 May/June
Potential Impact: The Time Crunch!!
• Nursing Time at admission was reduced by
20 minutes per client, and pharmacist time
at discharge was reduced by over 40
minutes per client.[i]
[i] Rozich JD, Resar RK, et al. Standardization as a mechanism to improve safety
in healthcare: impact of sliding scale insulin protocol and reconciliation of
medications initiatives. Jt Comm J Qual Patient Saf 2004;30(1):5-14
Origins of Medication Reconciliation
• The Institute for Healthcare Improvement (IHI)
introduced the 100K Lives campaign in December
2004 to challenge health care providers to join a
national effort to make health care safer & more
effective & ensure hospitals achieve the best
possible outcomes for all patients
• On April 12, 2005, the Canadian campaign, Safer
Healthcare Now! was created. SHR is a registered
member.
SHR Medication Reconciliation Initiative
Ultimate goal:
– Prevent adverse drug events by implementing medication
reconciliation
How?
• Use the Model for Improvement
– Use Plan, Do, Study, Act (PDSA) cycles to test form and
process
– Make small changes, test, obtain feedback, revise and retest.
• Start with the Admission process
Pilot Sites & Champions
•
•
•
•
•
RUH Pediatrics
RUH Surgery 5000
SPH 6th Medicine
SCH Gynecology 4300 (PAC)
St. Elizabeth’s Hospital (Humboldt)
Stories
SHR Baseline Data
• Undocumented Intentional Discrepancies:
– 1.32 / patient
• Unintentional Discrepancies:
– 1.28 / patient
• Medication Reconciliation Success Index:
– 67.9%
SHR Form and Process
• A formal process of:
– Obtaining a complete and accurate list of each
patient’s current home medications (name, dosage,
frequency, route)
– Using the information obtained to write the
admission orders
– Referring back to the information obtained to write
transfer and discharge orders
Medication Reconciliation
Form and Process
2. Allergies
ISMP
standard.
Required
information
for
pharmacist
to process
order.
1. Addressograph
3. Height &
Weight
ISMP standard
4. List all
medications
patient was taking
PTA, including
name, dose,
frequency, route.
[MD, RN/LPN/RPN,
BSP]
Do not re-write
meds on admitting
databases [use
stamp].
5. Time / date of
last dose.
7. MD to indicate if
med is to continue,
stop, or change.
Comments can also
be added.
6. Name of
person
who
obtained
history.
8. MD signs /
dates order.
Once this occurs
no further
changes can be
made to order
section. RN
crosses out
blank lines.
10. A form is
completed for all
patients even if on
no medications
prior to
admission.
9.
RN/LPN/RPN
initials when
orders are
processed,
faxed, and
MAR’d.
11. Document any
comments,
concerns, or followup required.
Other:
• If PAC patient:
double check
info on day of
surgery.
Check if
information
continues
on second
page.
• Source of
information.
• Disposition of
patient’s
medications.
Page number
Page 2 available,
when necessary
Patient / caregiver, etc.
provide new information
at later date.
Take new form
& check
‘addendum’ if
additional
information
becomes
available after
the original form
has been signed
by the physician.
Document the
changes only.
Stamp
Complete & Accurate Medication List
• Essential component of safe and effective patient
care.
• Essential component of medication reconciliation.
• List should include information on all medications
the patient was taking prior to admission, including
prescription, non-prescription, herbal products, and
supplements.
Questions to Obtain Admission Medication List
• Do you have any allergies to medication? Describe the
reaction.
• What medication were you taking prior to admission?
• Did a doctor change the dose or stop any of your
medication recently?
• Have you changed the dose or stopped any of your
medication recently?
• Have you recently started any medications?
Questions to Obtain Admission Medication List
• Have any of your medications been causing side effects?
• When you feel better, do you sometimes stop taking your
medication?
• Sometimes if you feel worse when you take your medication,
do you stop taking it?
• Are the pills in the bottle the same as what is on the label?
• Have you changed your daily routine to accommodate your
medication schedule?
Vision for the Future
• Admission Form linked to Drug Plan Information
• IT solutions - Transfer and Discharge piece
• Working on various strategies to make the process
safer and simpler
DRAFT
The Train Has Left The Station...Are YOU On It?
• Medication reconciliation fits perfectly with SHR’s culture of
safety and optimal patient care
• Medication reconciliation has already shown reduced
medication discrepancies on pilot sites within SHR
Results: Run Charts of Key Measures
1.0 Mean Number of Undocumented Intentional Discrepancies
1.40
1.20
Baseline
PDSA #2
0.80
0.60
PDSA #3
0.40
0.20
Month
Actual
Goal
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
0.00
Nov
2005
Mean
1.00
Results: Run Charts of Key Measures
2.0 Mean Number of Unintentional Discrepancies
2.00
PDSA #2
1.80
1.60
1.40
PDSA #3
Baseline
Mean
1.20
1.00
0.80
0.60
0.40
0.20
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
Nov
2005
0.00
Month
Actual
Goal
Improving! Provide enhancements to facilitate medication history.
Results: Run Charts of Key Measures
3.0 Medication Reconciliation Success Index
120%
Baseline
PDSA #3
PDSA #2
100%
60%
40%
20%
Actual
Month Goal
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
0%
Nov
2005
Percentage
80%
The Train Has Left The Station...Are YOU On It?
• Medication reconciliation will save time for nurses,
physicians, and pharmacists
• HCPs already take a medication history: now we are
doing it on one form and it will be easier to find
• Future computerization will simplify the process
even more (e.g. drug plan histories will appear on
the admission form)
The Train Has Left The Station...Are YOU On It?
• HCPs will know that a medication change is
intentional (rather than wonder if there was a
transcription error or a missed order), and be able
to advise the patient and family members
accordingly
• It will be easy to find the at-home medication list in
order to reconcile on discharge as all preadmission
medications will be on the new admission form
The Train Has Left The Station...Are YOU On It?
• Transcription errors will be eliminated on transfer
and discharge using current computer capabilities
• A clear discharge medication list will be available for
patients, pharmacists and physicians
• Outcomes from the changes are being monitored
(PDSA cycles), and improvements are already
evident
Questions?