Transcript Medication Reconciliation in the Emergency Department

Medication Reconciliation in the
Emergency Department:
Technician Expansion
subtitle
A Catholic healthcare ministry serving Ohio and Kentucky
1
Objectives
• Describe the implementation of a pharmacy technician
into the medication reconciliation process
• Present data on the technician interventions and
expansion of emergency medicine pharmacy services
• List the preparation process for the med rec technician
ED Pharmacy Services
• October 2013, clinical pharmacists began providing services in
the ED on second shift for 7 day coverage of the department
•
Drug information; therapy recommendations; participate in emergency
responses; medication reconciliation; operations support
• Medication reconciliation technician began as a pilot project in
February 2014
•
•
New job description and responsibilities as part of Technician Career Ladder
Hours of coverage  8am -1:30pm; then 2pm-4:30pm for CC support
• APPE students began rotations in the ED starting April 2014
•
•
1-2 students monthly on rotations
Integrated into activities with pharmacist supervision on second shift
3
ED Technician Process
• Identify patients to be admitted from the ED
• Interview and discuss home medications with patient
• Use family, pharmacies, ECFs, PCPs, etc. as needed
• Identify correct drug, dose, route and frequency as
well as last dose taken if able
• Obtain or confirm outpatient pharmacy
• Clarify allergies*
• Enter Med Rec i-vent into Epic for review by
pharmacist
4
5
Expansion of Pharmacy
Services Project
• This project was designed to review the impact provided by these
additional personnel in newly expanded roles within the ED as
well as to see how their support can impact the services provided
by the ED pharmacists themselves
• Review project from January 2014 through April 2014
• Data compiled and project submitted as abstract for a poster at
ASHP Midyear 2014
•
“Impact of pharmacy extenders on providing emergency medicine pharmacy
services”
6
Methods of project
•
Interventions titled as “medication reconciliation” were reviewed
during a time period that included ED services provided by the
pharmacists alone, the pharmacists and technicians, and the
pharmacists, technicians, and a student
•
The types of interventions made by the pharmacist in addition to
“medication reconciliation” were also reviewed for this time
period to determine if the additional support allowed the
pharmacist to redirect their attention to other clinical
interventions
7
Additional RPh Interventions
Non-Medication Reconciliation Interventions
(Performed by Pharmacist)
•
Code/Trauma
•
Pharmacy consult
•
Antibiotic stewardship
•
Allergy clarification
•
Recommend dose
change
•
PK evaluation
•
Drug therapy evaluation
•
Recommend drug
initiation
•
Drug-drug interaction
evaluation
Recommend drug
discontinuation
•
Drug information
•
Patient counseling
•
Other
•
Recommend drug
therapy change
•
8
Project Results
Month
Pharmacy
Personnel
Medication
Reconciliation
Interventions
Non-Medication
Reconciliation
Interventions
Total Interventions
January
Pharmacist
186
30
216
February
Pharmacist,
technician
279
40
319
March
Pharmacist,
technician
291
43
334
April
Pharmacist,
technician,
student
500
64
564
9
Additional Quality Project
Time spent in ED (h)
Number of patients
Avg number of meds per patient
Omitted medications
Wrong strength
Wrong dosage form
Wrong instructions
Duplicate meds
D/c medications
Correct med history
Unable to complete
Total-July 2014
79
131
11.4
304
93
45
102
19
111
7
3
Avg per day
4.6
7.7
n/a
17.9
5.5
2.6
6.0
1.1
6.5
0.4
0.2
Technician interventions
10
Additional Quality Project
Time spent in ED (h)
Number of patients
Total-July 2014
76.5
91
Avg per day
5.1
6.1
Avg number of meds per patient
Omitted medications
Wrong strength
Wrong dosage form
Wrong instructions
Duplicate meds
D/c medications
Correct med history
Unable to complete
11.6
117
30
0
25
2
95
13
0
n/a
7.8
2
0
1.7
0.1
6.3
0.9
0
Student interventions
11
Technician Preparation
• Provided a technician specific binder
•
•
•
Discusses step-by-step the med rec process: How to…What needs to be
collected…etc.
Includes screen shots of Carepath to assist with direction
Contact information for local pharmacies, home health agencies, ECFs, and
PCPs
• Trained in real-time on a collaborative care unit
•
•
•
Observed pharmacist perform medication history initially
Transition to technician performing med history with pharmacist observation
When comfortable technician to perform med history on own
• Playground version of Carepath available to work through patient
profile—not indicative of live environment for making changes
• Techs training techs
12
Questions?
13