Transcript Impacted by Medication Reconciliation

Medication Reconciliation in
Rural Hospital Settings
“Presented to”
Georgia Critical Access Hospitals
October 9, 2013
Kristine Gleason, MPH, RPh - Clinical Quality Leader, Northwestern Memorial Hospital
Vicky Agramonte, RN, MSN - Project Manager, Healthcare Quality Improvement Program , IPRO
Objectives
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Describe the benefits of a medication reconciliation process and
linking with other current initiatives.
•
Provide an overview of the MATCH Toolkit for implementing a
sustainable medication reconciliation process.
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Understand the importance of medication reconciliation at highrisk transition periods.
Why Medication Reconciliation?
Medication Reconciliation Process
Goal to decrease medication errors and patient harm by:
1. Obtaining, verifying, and documenting patient’s current prescription and
over-the-counter medications; including vitamins, supplements, eye
drops, creams, ointments, and herbals
2. Comparing patient’s pre-admission/home medication list to ordered
medicines and treatment plans to identify unintended discrepancies
3. Discussing unintended discrepancies (e.g., those not explained by the
patient’s clinical condition or formulary status) with the physician for
resolution
4. Providing and communicating an updated medication list to patients
and to the next provider of service at discharge
Adapted from The Joint Commission National Patient Safety Goal 03.06.01
Institute of Medicine
“Preventing Medication Errors”
•
At least 1.5 million preventable adverse drug events (ADEs) occur
in the U.S. annually in all settings, not including errors of omission.
•
Errors and ADEs are a “very serious cause for concern” in
hospitals. Phases with the highest errors: prescribing &
administration.
•
Estimated 400,000 in-hospital preventable ADEs / year. Cost per
ADE: $8,750 (2006 dollars)
–
Cost increases when extrapolated to 2013 dollars
Preventing Medication Errors: Quality Chasm Series (2007). Committee on Identifying and Preventing
Medication Errors, Philip Aspden, Julie Wolcott, J. Lyle Bootman, Linda R. Cronenwett, Editors.
Current Evidence to Reduce Readmissions:
Implementing Bundled Interventions
Pre-Discharge
Intervention
Bridging
Interventions
• Patient education
• Transition coaches
• Medication Reconciliation • Physician continuity
• Discharge planning
across settings
•Scheduling follow-up
• Patient-centered
appointment
discharge instruction
Post-Discharge
Intervention
• Follow-up telephone calls
• Patient-activated hotlines
• Timely communication with
next provider of service
• Timely follow-up with
ambulatory provider
Note: Individual components of these change packages have not been tested
by themselves and might not reduce the risk for 30-day rehospitalization.
Source: Hansen et al. Interventions to Reduce 30-Day Rehospitalization: A Systematic Review. Ann Intern Med. 18 October 2011;155(8):520-528
Avoiding Readmissions:
Preventing Adverse Events (AE) After Hospital Discharge
•
Study of 400 consecutive hospitalized general medicine patients
discharged home
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19% had an AE within 3 weeks of discharge
66% of AEs were adverse drug events (ADE)
Most ADEs were preventable or ameliorable
System modifications recommended by study authors:
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Evaluate patients prior to discharge to identify unresolved problems
Educate patients about drug therapies, side effects, and what to do if new or
worsening signs/symptoms
Improve monitoring of therapies
Improve monitoring of patients’ overall condition
Source: Forster et al. The Incidence and Severity of Adverse Events Affecting Patients after Discharge from the Hospital.
Ann Intern Med. 2003;138:161-167.
Achieving Synergies:
Linking Medication Reconciliation
with Other Current Initiatives
Does Medication Reconciliation
Impact the Patient Experience?
Hospital Consumer Assessment of Healthcare Providers and
Systems (HCAHPS) Domains:
•
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Communication with Nurses
Communication with Doctors
Responsiveness of Hospital Staff
•
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Pain management*
Communication about medicines*
Discharge information*
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Cleanliness of hospital environment
Quietness of hospital environment
Overall rating of hospital
Willingness to recommend hospital
Source: HCAHPS Home Page. Available at: http://www.hcahpsonline.org/home.aspx
*Impacted by
Medication
Reconciliation
New HCAHPS Care Transition Questions
Effective January 1, 2013
•
During this hospital stay, staff took my preferences and those
of my family or caregiver into account in deciding what my
healthcare needs would be when I left.
•
When I left the hospital, I had a good understanding of the
things I was responsible for in managing my health.
•
When I left the hospital, I clearly understood the purpose for
taking each of my medications.
Scale: Strongly disagree, Disagree, Agree, Strongly agree
“Bundling” Medication Reconciliation
with Current Initiatives
Care Transitions
ED
Admission
Intrahospital
Transfer
Discharge
PostDischarge
Phases of Medication Management
Med History,
Reconcile
Order,
Transcribe,
Clarify
Procure,
Dispense
Deliver
Administer
Monitor
Educate,
Discharge
Identifying Opportunities to “Bundle” Medication-related Initiatives
• Reducing medication-related readmissions
• Process of Care (Core) Measures
• Meaningful Use of EHRs involving medications
• Medicare Beneficiary Quality Improvement
Project (MBQIP)
• Effective communication/handoff practices with
next provider of service
• Avoiding preventable ADEs
• TJC Med Mgmt Standards and NPSGs
(e.g., high alert meds, anticoagulants)
• Patient Experience (HCAHPS)
• Follow-up Phone Calls Post-Discharge
Medications At Transitions and
Clinical Handoffs:
Introduction to the MATCH Toolkit
MATCH Toolkit: Step-by-Step Guide to
Improving Medication Reconciliation
MATCH Toolkit, with
customizable, actionable
information, is available at:
http://www.ahrq.gov/qual/match/
match.pdf
Guiding Principles
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Clearly define roles and responsibilities.
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Standardize, simplify, and eliminate unnecessary redundancies.
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Make the right thing to do the easiest thing to do.
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Develop effective forcing functions, prompts, and reminders during
the appropriate time within workflow.
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Educate workforce, and patients, families, and caregivers.
• Ensure process design meets all pertinent local laws or regulatory
requirements.
Medication Reconciliation Challenges
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Lack of standardized process, clear ownership
Communication failures
Coordination gaps
Non-formulary medications and therapeutic
interchanges
Lack of standardized medication list “one source of
truth” document
Limited Pharmacy Resources
• Consultant pharmacist with minimal
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involvement (3-10 hours/wk)
Onsite pharmacist (40 hours/wk)
Remote pharmacist coverage (24/7)
Combination of onsite and remote
Designing the Process:
“One Source of Truth”
• Single list documents home medications
• Standardized across the facility
• Maintained in a consistent location in the medical record
• All providers are empowered to update the list as new and more
•
accurate information is available
Used at admission, transfer, and discharge for medication
reconciliation
Engaging the Community
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Community education on the importance of maintaining a
home medication list
– Community health fairs
– Hospital newsletter
– On-hold message on hospital phone system
– Flu clinics
– Hospital Web site
Engaging the Community
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CAH’s are in a unique position to make an impact in
medication safety at the community level
Patient accountability for the maintenance of a home
medication list
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Completion of list while waiting in ED
For planned surgery - incorporate into pre-surgery registration
Community education on keeping a medication list in a consistent spot for EMS
Outpatient pharmacy validates discharge lists
Community physicians request and validate medication list at every patient
appointment
Medication Reconciliation - Recommendations
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Examine current medication reconciliation process
– Identify and close failure gaps
– Incorporate information technology solutions
Clinical pharmacist intervention upon admission and discharge
for those patients identified as high risk
OTC, vitamins and other supplements taken at home should
be:
– Included on patients admission medication list
– Assessed for continuation upon discharge, and
– Listed on discharge medication instructions if clinically
appropriate
Questions and Discussion
Vicky Agramonte, RN, MSN
Project Manager
Healthcare Quality Improvement Program
Island Peer Review Organization, Inc. (IPRO)
Albany, NY 12211-2370
(518) 426-3300 X115
[email protected]
Kristine Gleason, MPH, RPh
Clinical Quality Leader
Northwestern Memorial Hospital
Chicago IL 60611
312.926.9172
[email protected]
THANK YOU!
If you want to learn more about IPRO, please visit our website at: http://www.ipro.org.
If you want to learn more about Northwestern Memorial Hospital, please visit our website at http://www.nmh.org.