Transcript Ada Koch, PharmD and Carrie Miller, RN Department of Pharmacy

Discharge Medication
Reconciliation At The First
Pediatric Cardiothoracic PostOperative Clinic Visit
Ada Koch, PharmD and Carrie Miller, RN
Department of Pharmacy
Department of Thoracic & Cardiovascular Surgery
Confidential: For Quality Improvement Purposes Only
Project Aim Statement
We aim to familiarize the parents of
pediatric post-operative
cardiovascular patients with their
children’s medication regimen,
specifically the medication name,
dose and frequency.
Confidential: For Quality Improvement Purposes Only
Project Aim Statement
At discharge from the hospital, the post-operative
medication regimen will be reviewed with each
parent by the Pediatric Clinical Pharmacist. A list
of the medications will be provided to the parent
at this time. At the first post-operative cardiac
clinic visit, the parents will be asked to state the
medication name, dose, and frequency to ensure
parent understanding of the medication regimen.
Goal: Parent will correctly recollect the medication
name, dose, and frequency.
Target: 100% compliance
Confidential: For Quality Improvement Purposes Only
Solutions Implemented
Implemented March 2007:
PRIOR TO DISCHARGE (AT THE HOSPITAL):
1. Discharge Medication Sheet – provided to all pediatric
cardiothoracic surgery patients. A copy will be e-mailed to nurse
practitioner at discharge.
2. All prescriptions are filled/called in to patient’s pharmacy prior to
discharge. Insurance issues are identified and solved.
3. Discharge medication teaching provided to all parents/patients.
Parents asked to verbally state regimen/show how to draw-up a
correct dose. Provide parents with oral administration devices.
THE FIRST POST-OP CLINIC VISIT:
1. The pediatric nurse practitioner reviews all scheduled medications
with parent at the first post-op clinic appointment.
2. Parents to verbally state regimen – medication, dose and
frequency.
The pediatric nurse practitioner fills out data collection sheet.
Confidential: For Quality Improvement Purposes Only
Discharge Medication Sheet
Example
Loyola University Medical Center
Ronald McDonald Children’s Hospital
2160 South First Avenue
Maywood, IL 60153
September 5, 2000
Osco Pharmacy (Elmhurst, IL): 630-111-1111 (phone) 630-111-1111 (fax)
PATIENT’S NAME
Weight: 4.8 kg
Medication
Furosemide (Lasix) 10 mg/mL Solution
Administration Times
8 am
8 pm
8 am
8 pm
Give 5 mg (0.5 mL) by mouth twice a day
To help heart beat easier/remove fluid
Ranitidine (Zantac) 15 mg/mL Syrup
Give 15 mg (1 mL) by mouth twice a day
For stomach acid/reflux
Keep all medications out of reach of children!
Confidential: For Quality Improvement Purposes Only
Parent Recollection
Medication Name, Dose, & Frequency
TARGET: 100%
100%
90%
80%
Accurate Recollection
70%
60%
50%
40%
30%
20%
10%
0%
RL (6 meds)
CB (3 meds) DM (3 meds) CB2 (5meds)
ZS (3 meds)
FZ (3 meds)
KL (2 meds)
JO (3 meds)
LM (2 meds)
Patient
Confidential: For Quality Improvement Purposes Only
Analysis
As of February 2008, nine pediatric
cardiothoracic surgery patients were
followed from hospital discharge to their
first clinic visit.
– Parents of eight patients were able to correctly
recollect the prescribed regimen at their first
post-operative visit.
– One parent could correctly state dose and
frequency, but could not pronounce medication
names.
– All nine parents stated that they found
discharge medication sheet very helpful.
Confidential: For Quality Improvement Purposes Only
Next Steps
Continue discharge medication education for the
parents of pediatric cardiovascular patients
Develop a plan to expand discharge medication
teaching to other pediatric populations.
Confidential: For Quality Improvement Purposes Only