Transcript 2010 NQF Safe Practices for Better Healthcare

NQF-Endorsed®
Safe Practices for Better Healthcare
Safe Practice 17
Medication Reconciliation
Chapter 6:
Improving Patient Safety Through
Medication Management
© 2010 TMIT
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Slide Deck Overview
Slide Set Includes:
 Section 1:
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Section 2:
Section 3:
Section 4:
Section 5:
Section 6:
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NQF-Endorsed® Safe Practices for
Better Healthcare Overview
Harmonization Partners
The Problem
Practice Specifications
Example Implementation Approaches
Front-line Resources
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NQF-Endorsed®
Safe Practices for Better Healthcare
Overview
Safe Practice 17
Medication Reconciliation
Chapter 6:
Improving Patient Safety Through
Medication Management
© 2010 TMIT
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2010 NQF Safe Practices for Better
Healthcare: A Consensus Report
34 Safe Practices
• Criteria for Inclusion
• Specificity
• Benefit
• Evidence of Effectiveness
• Generalization
• Readiness
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Culture SP 1
2010 NQF Report
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Culture
Structures
and Systems
Culture Meas.,
FB., and Interv.
Team Training
and Skill Bldg.
Risk and Hazards
CHAPTER 2: Creating and Sustaining a Culture of
Safety (Separated into Practices]
 Culture of Safety Leadership Structures and Systems
 Culture Measurement, Feedback, and Intervention
 Teamwork Training and Skill Building
 Risks and Hazards
Consent
& Disclosure
Consent
and
Informed
Consent
Life-Sustaining
Treatment
Care of
Caregiver
Disclosure
Workforce
Nursing
Workforce
Direct
Caregivers
CHAPTER 4: Workforce
• Nursing Workforce
• Direct Caregivers
• ICU Care
ICU Care
Information Management and Continuity of Care
Patient
Care Info.
Read-Back
& Abbrev.
Labeling
Diag. Studies
Discharge
Systems
CHAPTER 3: Consent and Disclosure
• Informed Consent
• Life-Sustaining Treatment
• Disclosure
• Care of the Caregiver
CPOE
Medication Management
CHAPTER 5: Information Management and Continuity
of Care
 Patient Care Information
 Order Read-Back and Abbreviations
 Labeling Diagnostic Studies
 Discharge Systems
 Safe Adoption of Computerized Prescriber Order
Entry
CHAPTER 6: Medication Management
 Medication Reconciliation
 Pharmacist Leadership Structures and Systems
Med. Recon.
Pharmacist Leadership
Structures and Systems
Healthcare-Associated Infections
Influenza
Prevention
Hand Hygiene
Sx-Site Inf.
Prevention
VAP
Prevention
Central Line-Assoc.
BSI Prevention
MDRO
Prevention
UTI
Prevention
Condition- and Site-Specific Practices
Wrong-site
Sx Prevention
Contrast
Media Use
Organ
Donation
Press. Ulcer
Prevention
Glycemic
Control
VTE
Prevention
Falls
Prevention
Anticoag.
Therapy
Pediatric
Imaging
CHAPTER 7: Healthcare-Associated Infections
• Hand Hygiene
• Influenza Prevention
• Central Line-Associated Blood Stream Infection
Prevention
• Surgical-Site Infection Prevention
• Daily Care of the Ventilated Patient
• MDRO Prevention
• Catheter-Associated UTI Prevention
CHAPTER 8: Condition- and Site-Specific Practices
• Wrong-Site, Wrong-Procedure, Wrong-Person
Surgery Prevention
• Pressure Ulcer Prevention
• VTE Prevention
• Anticoagulation Therapy
• Contrast Media-Induced Renal Failure Prevention
• Organ Donation
• Glycemic Control
• Falls Prevention
• Pediatric Imaging
Harmonization Partners
Safe Practice 17
Medication Reconciliation
Chapter 6:
Improving Patient Safety Through
Medication Management
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Harmonization – The Quality Choir
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The Patient – Our Conductor
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The Objective
Medication Reconciliation
 The healthcare organization must develop,
reconcile, and communicate an accurate
medication list throughout the continuum of
care
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The Problem
Safe Practice 17
Medication Reconciliation
Chapter 6:
Improving Patient Safety Through
Medication Management
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The Problem
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[http://www.medscape.com/viewarticle/586617]
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[http://content.nejm.org/cgi/content/full/362/5/380]
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[http://www.myfoxny.com/dpp/health/091226_near_miss_registry]
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[http://www.ashp.org/import/news/HealthSystemPharmacyNews/newsarticle.aspx?id=3023]
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The Problem
Frequency
 Medication reconciliation errors are estimated
to be 20% of adverse drug events (ADEs)
 A study found that ADEs occur in approximately
12% of patients
[Rozich, J Clin Outcomes Manage 2001 Oct;8(10):27-34; Forster, Ann Intern Med 2003 Feb 4;138(4):161-7]
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The Problem
Severity
 ADE statistics:
 41% of medication reconciliation errors
were clinically important
 22% would have resulted in serious harm
had the pharmacist not intervened
 75% of potential ADEs occurred at
discharge and 60% were due to omissions
of medications
[Gleason, Am J Health Syst Pharm 2004 Aug 15;61(16):1689-95; Akwagyriam, J Accid Emerg Med 1996 May;13(3):166-8;
Pippins, J Gen Intern Med 2008 Sep;23(9):1414-22]
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The Problem
Preventability
 A multicenter study of 50 hospitals found that
reduction of errors and ADEs is most strongly
correlated with active physician and nurse
involvement:
 having an effective improvement team
 using small tests of change
 having an actively engaged senior
administrator
 sending teams to multiple collaborative
sessions
[Rogers, Jt Comm J Qual Patient Saf 2006 Jan;32(1):37-50]
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The Problem
Cost Impact
 Costs associated with all ADEs are estimated
to be about $3.8 million annually per hospital,
of which $1 million is preventable
 One study found that ADEs increased patients’
length of stay by 2.2 days, increasing costs by
$3.2K
 Preventable ADEs caused an increased length
of stay of 4.6 days, increasing costs by $5.8K
per patient
[Classen, JAMA 1997 Jan 22-29;277(4):301-6; Bates, JAMA 1997 Jan 22-29;277(4):307-11]
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Practice Specifications
Safe Practice 17
Medication Reconciliation
Chapter 6:
Improving Patient Safety Through
Medication Management
© 2010 TMIT
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Additional Specifications
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Safe Practice Statement
Medication Reconciliation
 The healthcare organization must develop,
reconcile, and communicate an accurate
patient medication list throughout the
continuum of care
[Institute for Healthcare Improvement, Luther Midelfort – Mayo Health System. Medication Reconciliation Review, 2004; Society
of Hospital Medicine, BOOSTing Care Transitions Resource Room. BOOSTing Care Transitions Resource Room Project Team,
2008; American Society of Health-System Pharmacists, ASHP Medication Reconciliation (Med Rec) Toolkit, 2009; Institute for
Healthcare Improvement, Medical Reconciliation at all Transitions. IHI Improvement Map, 2009; Joint Commission Resources,
2010 Comprehensive Accreditation Manual: CAMH for Hospitals: The Official Handbook. National Patient Safety Goals, 2010]
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Additional Specifications
 Educate clinicians upon hire about the
importance of medication reconciliation
 Providers receiving a patient in transition of
care should check the medication
reconciliation list to ensure accuracy
 Include the full range of medications in the list
as defined by accrediting organizations
 At the time the patient is admitted, create and
document a complete list of medications the
patient is taking at home
[Joint Commission Resources, 2010 Comprehensive Accreditation Manual: CAMH for Hospitals: The Official
Handbook. National Patient Safety Goals, 2010]
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Additional Specifications
 Medications ordered for the patient while under
the care of the organization are compared to
those on the list created at the time of admission
 Any discrepancies are reconciled and
documented while the patient is under the care of
the organization
 When the patient’s care is transferred within the
organization, the current provider(s) inform(s) the
receiving provider(s) about the up-to-date
reconciled medication list and documents the
communication
[Joint Commission Resources, 2010 Comprehensive Accreditation Manual: CAMH for Hospitals: The Official
Handbook. National Patient Safety Goals. 2010]
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Additional Specifications
 The patient’s most current reconciled
medication list is communicated and
documented to the next provider
 At time of transfer, the new provider is
informed about how to obtain clarification list
of reconciled medications
 When the patient leaves the organization’s
care, the current list of reconciled medications
is provided to the patient, explained, and the
interaction is documented
 In settings where medications are used
minimally, modified medication reconciliation
processes are performed
[Jack, Ann Intern Med 2009 Feb 3;150(3):178-87]
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Example Implementation
Approaches
Safe Practice 17
Medication Reconciliation
Chapter 6:
Improving Patient Safety Through
Medication Management
© 2010 TMIT
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Example Implementation Approaches
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Example Implementation Approaches
 Develop and use a template medication
reconciliation form to gather information about
current medications and medication allergies,
to standardize care, and to prevent errors
 The Medical Executive Committee should aid
in the creation and reinforcement of
medication reconciliation
 Identify internal champions to lead
implementation of the practice
 Educate providers about reviewing the
necessity of medications upon admission and
discharge
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Example Implementation Approaches
 Changes to the “home” medication list
should be clearly noted and explained to the
patient
 Consider patient needs and barriers when
creating medication regimens
 Review and utilize sources of fully
developed implementation solutions
 Provider education should include
complementary and alternative medication
and providers should then educate patients
about the state of scientific knowledge
[Jack, Ann Intern Med 2009 Feb 3;150(3):178-87; Institute for Healthcare Improvement, Prevent Adverse Drug Events
(Medication Reconciliation), 2008]
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Example Implementation Approaches
 Encourage patients to carry an accurate
medication list and share with their healthcare
providers and pharmacist
 Organizations should coordinate with the
patient’s home pharmacy in the creation of an
accurate home medication list
 Use consumer-based kiosk technology to
improve medication reconciliation and decrease
facility costs
 Safe medication ordering practices may be
implemented by pharmacy leaders across the
organization
[Institute for Safe Medication Practices, A Call to Action: Protecting U.S. Citizens from Inappropriate Medicine Use. A White
Paper on Medication Safety in the U.S. and the Role of Community Pharmacists, 2007; American Society of Health-System
Pharmacists, Safe Medication: My Medication List, 2008; Lesselroth, Jt Comm J Qual Patient Saf 2009 May;35(5):264-70]
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Example Implementation Approaches
Strategies of Progressive Organizations
 Implementation strategies most strongly
correlated with success include:
 an active interdisciplinary focus
 having an effective improvement team
 using small tests of change
 having an actively engaged senior
administrator
 having teams participate in collaborative
initiatives
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Example Implementation Approaches
Strategies of Progressive Organizations
Cont’d
 Require second check systems by a separate
care provider to validate patient medication
home lists
 Include budgetary resources to support the
medication reconciliation process
 Conduct pharmacist review of medication lists
 Collect accurate medication histories on
patients identified as high risk for medication
errors
[Kaboli, Arch Intern Med 2006;166:955-64; Schnipper, Arch Intern Med 2006 Mar 13;166(5):565-71]
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Front-line Resources
Safe Practice 17
Medication Reconciliation
Chapter 6:
Improving Patient Safety Through
Medication Management
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[http://www.ncbi.nlm.nih.gov/pubmed/18792654; http://archinte.ama-assn.org/cgi/content/abstract/169/8/771;
http://www.ncbi.nlm.nih.gov/pubmed/14691892]
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[http://www.ihi.org/imap/tool/#Process=7ce51016-b4f0-423c-9f8b-5e1ea8d7b810]
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[http://www.ashp.org/Import/PRACTICEANDPOLICY/PracticeResourceCenters/PatientSafety/ASHPMedicationReconciliationToolkit_1.aspx]
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[http://www.jointcommission.org/PatientSafety/SpeakUp/]
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Poster available in Spanish
[http://www.jointcommission.org/PatientSafety/SpeakUp/]
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Poster available in Spanish
TMIT National Webinar Series
Barcoding End-to-End Solutions:
From Pharmacy to Bedside (SP 16 & 18)
 Charles R. Denham, MD – Topic: Safe Practice Overview
 David W. Bates, MD, MSc – Topic: Bar-Coding and Medication
Safety
 Eric Poon, MD, MPH – Topic: Barcode Medication Verification
Technology: How Strong Is the Evidence?
 Tejal K. Gandhi, MD, MPH –Topic: Clinical and Operational Pearls
 Ulrike Kreysa –Topic: Harmonization of Supply ChainTechnology
Standards
 Dan Ford, MBA – Topic: The Role of the Patient Advocate
 Go to: http://safetyleaders.org/webinars/indexWebinar_June2010.jsp
(June 17, 2010)
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NQF & TMIT National Webinar Series
Leadership Lessons for Pharmacy, Nursing,
and Hospital Leaders
 William W. George, MBA – Topic: 7 Lessons for Leading in
Crisis
 Charles R. Denham, MD – Topic: Review of Safe Practice 1,
Leadership Structures and Systems
 Hayley Burgess, PharmD – Topic: Review Safe Practice 18,
Pharmacist Leadership Structures and Systems
 Peter B. Angood, MD – Topic: National Perspective on
Leadership Issues
 Go to: http://www.safetyleaders.org/pages/idPage.jsp?ID=4945
(August 25, 2009)
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NQF & TMIT National Webinar Series
Medication Safety – Complex Issues for All
(Safe Practices 17-18)
 Peter B. Angood, MD – Topic: Challenges of Policy Development for
Medication Management
 Michael R. Cohen, RPh, MS, ScD – Topic: Medication Safety
Overview, Evolution, and Current Issues
 Mary A. Andrawis, PharmD, MPH – Topic: Perspectives on the
Importance of the Pharmacist Leadership Safe Practice in the
Hospital Environment
 Jeffrey Schnipper, MD, MPH – Topic: Where the Rubber meets the
Road: Implementation of Medication Reconciliation at the Practitioner
Level
 Patti O'Regan, ARNP, ANP, NP-C, PMHNP-BC, LMHC – Discussion:
Patient Perspective on Medication Management Safe Practices
 Go to: http://safetyleaders.org/pages/idPage.jsp?ID=4935
(June 18, 2009)
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TMIT National Webinar Series
Medication Management (Safe Practices 14-18)
 David W. Bates, MD, MSc - Chief of the Division of General
Medicine, Brigham and Women's Hospital
 Hayley Burgess, PharmD - Director, Performance
Improvement, Measures, Standards, and Practices, TMIT
 Mary E. Foley, MS, RN - Associate Director, Center for
Research and Nursing Innovation, University of California,
San Francisco (UCSF)
 Go to: http://www.safetyleaders.org/pages/idPage.jsp?ID=4803
(November 8, 2007)
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