Transcript People are stealing my underwear!

Med Rec in Rural
NSW hospitals –
the High 5s study
and accreditation
OUR HIGH 5 EXPERIENCE
• 8 hospitals in southern NSW collected data from July 2010 till
September 2011 – all had on site clinical pharmacists
• 5 days/wk in 5 (7 days/wk for some time in 1) 4 days/wk in 3
• 3 hospitals employed junior medical staff, the remainder were VMO
only
• We added a measure: discrepancies on discharge
• We discontinued involvement due to
• requirement to only measure those reconciled within 24 hours significantly
increased the sample size
• workload associated with independent observer verification
Our data showed
.. consistently high coverage of patients in target group received
clinical pharmacy services including med rec
medication reconciliation rates
percentage
100
90
80
70
60
50
40
30
20
10
0
percentage of patients
reconciled
percentage of patients with
medications reconciled within
24 hours of admission
percentage of patients with at
least one unintentional
discrepancy
month
Our data showed (2)
.. no great change in discrepancies over time
.. as expected, discharge was more of a problem than on admission
medication reconciliation discrepancies
number per patient
1.60
1.40
1.20
1.00
no. of undocumented intentional
medication discrepancies per
patient
0.80
0.60
no. of unexpected discrepancies
per patient on discharge
0.40
0.20
number of unintentional
medication discrepancies per
patient
0.00
month
how medication hx verified
• Front of drug chart (red box) was common
• At the time 2 sites using paper MMP
• Electronic solution (GP prescribing software) in 3 hospitals
• Definition of verification – 2nd source
• traditional pharmacist approach or
• could also be eg admitting doctor using medicines list / webster
pack / nursing home charts provided evidence in clinical record
that it had been checked /annotated
what is different in small hospitals
• Less steps between GP and inpatient stay: often same doctor or same
practice sends patient to hospital -> better information
• Good liaison with community pharmacy in small towns
• Group GP practices have routine processes for transmitting
information to and from hospital out of GP prescribing software (but
these lists are not always up to date, verification still needed)
• GP VMOs may access surgery software from in hospital and transmit
data back on discharge
• RACF charts and DAA packs are highly reliable sources of information
standard 4 – what we did in 2013
• Extended the high 5 approach, incorporating key
questions into routine medication chart audits done
post discharge, LOS > 24hrs; pharmacist + 1 does the
audit
• Included all hospitals, subacute, MPS’s, mental health
• Since high 5, electronic medical record used in more
facilities -> forcing function if electronic discharge
summaries are used
Clinical pharmacy service
med rec indicator
discharge is where it’s at
.. we were previously poor at documenting actions taken on discharge
.. now if it’s not in the clinical record it didn’t happen
.. med rec on discharge is incorporated into generation of pt “medilist”
electronic MMP / discharge plan eg
hard coded look up lists
- Pharmacies
- GP surgeries
- Hospital pharmacists
can be written to emr
copy and paste
medilist, medication charts
can be generated
Conclusion
• Participation in High5 forced us to be more accountable in the way we
documented histories and particularly actions taken at discharge
• Electronic MMP’s are either fully implemented or being implemented
in all hospitals – if emr being used for discharge summaries
pharmacist med rec is not optional – “forcing function”
• We continue to measure key outcome measures (% clinical pharmacy
review, med rec on admission, med rec within 24 hours, discharge
information given)