…a shared responsibility for health care How Medication Reconciliation Supports Patient Safety 15...

transcript

…a shared responsibility for health care

How Medication Reconciliation Supports

Patient Safety15 September 2007

Jane Richardson, BSP, PhD, FCSHPCoordinator, Clinical Pharmacy ServicesTeam Lead, SCH Med Rec Pilot Site

Objectives

• To define Medication Reconciliation & describe why it’s important.

• To outline our initial experience with admission Medication Reconciliation within the Saskatoon Health Region (SHR).

• To describe early use of the Pharmaceutical Information Program (PIP) auto-populated Medication Reconciliation form in SHR Emergency Departments.

Medication Reconciliation – what is it?• A formal process of:

– Obtaining a complete and accurate list of each patient’s current home medications (name, dosage, frequency, route)

– Comparing the physician’s admission, transfer, and/or discharge orders to that list

– Bringing discrepancies to the attention of the prescriber and ensuring changes are made to the orders, when appropriate

Reference: IHI, Getting Started Kit: Prevent Adverse Drug Events (Medication

Reconciliation)

Institute for Healthcare Improvement• The Institute for Healthcare Improvement introduced the 100K

Lives campaign, December 2004, to challenge health care providers to join a national effort to make health care safer & more effective & ensure hospitals achieve the best possible outcomes for all patients

– How? Implement six targeted strategies proven to prevent

adverse events

• The initiative captured the attention of Canadian care providers, hospital administrators & others committed to improving patient safety.

• On April 12, 2005, the Canadian campaign, Safer Healthcare Now! was created.

IHI / Safer Healthcare Now! Initiatives• Improved care for AMI• Prevent surgical site infections• Prevent central line infections• Prevent ventilator associated

pneumonia• Deploy rapid response teams• Prevent adverse drug events:

Medication reconciliation

Why Medication Reconciliation?

• 2.9-16.6% of patients, in acute care hospitals, have experienced one or more adverse events

• Adverse drug events are a leading cause of injury to hospitalized patients

• Greater than 50% of all hospital medication errors occur at the interfaces of care – Admission to hospital– Transfer from one nursing unit to another– Transfer to step-down care– Discharge from hospital

Why Medication Reconciliation?

• Frequency of medication discrepancies on a general medicine clinical teaching unit

– 53.6% of patients had at least one unintended discrepancy

– 38.6% of the discrepancies were judged to have the potential to cause moderate – severe discomfort or clinical deterioration

– Most common error was an omission of a regularly used medication (46.4%)

Arch Intern Med, 2005

SCH Patient: MP• 76 y.o. woman attending GDH admitted to CCU with

bradycardia, then returned to GDH after receiving a pacemaker

• CCU admission medication orders based on faxed hand-written list from community pharmacy

• Errors:– Lescol 20mg written as Losec 20mg (Rx error)– Tramacet recorded as Tagamet (MD error)– On warfarin for AF: not ordered on admission or restarted

on discharge– Sertraline & metformin put on hold in hospital but not

reordered on discharge• Community pharmacist had no idea what this woman

should or shouldn’t have in her blister pack

Medication Reconciliation – the solution?

• Medication Reconciliation can:1. Prevent omission of an at-home

medication2. Match in-house dose, frequency, and

route with at-home usage3. Ensure medications follow the patient

from one care site to another

Why Now? • It’s the right thing to do……..

– Culture of safety: reduce medication errors & potential for patient harm

– Key component of seamless care strategies– Saves time for physicians, nurses, and pharmacists in

the long-term

• Medication Reconciliation is a Canadian Council on Health Services Accreditation Standard (ROP)

• In the SHR, Senior Leadership has endorsed Medication Reconciliation as a Regional Project of high priority

SHR Form and Process

• A formal process of:– Obtaining ONE complete and accurate list of each

patient’s current home medications (name, dosage, frequency, route)

– Using the information obtained to write the admission orders

– Referring back to the information obtained to write transfer and discharge orders

SHR ManualMedication Reconciliation

Form and Process

Medication ReconciliationForm, page 2

Measuring Progress: Discrepancies

• Undocumented intentional discrepancy:– physician made an intentional choice to add,

change or discontinue a medication but this choice is not clearly documented

• Unintentional discrepancy:– physician unintentionally changed, added or

omitted a medication the patient was taking prior to admission

• Goal: – reduce number of discrepancies by 75%

SHR Baseline Data (5 Pilot Sites)

• Undocumented Intentional Discrepancies:– 1.32 / patient

– Goal: 0.33 / patient

• Unintentional Discrepancies:– 1.28 / patient

– Goal: 0.32 / patient

1.0 Mean Number of Undocumented Intentional Discrepancies

Nov 200

Actual Goal

Are we making a difference?

Baseline

PDSA 1survey

PDSA 2

PDSA 3

PDSA 4

Reviseform

1 yr datacheck

National: 1.1

National: 0.6

2.0 Mean Number of Unintentional Discrepancies

Oct 20

Actual Goal

Are we making a difference?

Baseline

PDSA 1survey

PDSA 2

Education

PDSA 3

PDSA 4

Reviseform

1 yr datacheck

National: 1.2

National: 0.65

Comments on the Manual Form

• It’s a blank form!– All medication information will have to be written in:

• Will need to get the information from someone or somewhere.

• How accurate is that information?• Potential for transcription errors when recording the

medication history.

• We need to get the medication history right for the rest of the process to work

The Next Step

Using PIP to Generate

an Admission

Medication Reconciliation Form

PIP Auto-populatedMedication

ReconciliationForm

Has it made a difference?

• SCH Emergency Admissions to General Medicine:– Undocumented Intentional Discrepancies

• SHR Goal: 0.33 / patient• April 2007 (Manual Form): 0.1• September 2007 (PIP Form): 0.2

– Unintentional Discrepancies• SHR Goal: 0.32 / patient• April 2007 (Manual Form): 3.1• September 2007 (PIP Form): 1.3

Comments on the PIP Auto-populated Form• Gives medication name, strength, most recent

fill date & prescriber’s name– A better starting point than a blank page, especially

if a patient or caregiver cannot provide information.• Dose & interval still need to be clarified (& may be

different than what was on the original prescription)• Still need to ask about medications not recorded on

– Avoids name & strength transcription errors for auto-populated medications

Conclusions

• Medication Reconciliation does decrease medication errors

• The Pharmaceutical Information Program auto-populated history and admission order form is a valuable tool for this initiative

• Through collaboration we are advancing patient safety in Saskatchewan

…a shared responsibility for health care How Medication Reconciliation Supports Patient Safety 15...

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