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Pharmacy Services Medication Reconciliation Using PharmaNet-based Forms …It’s about the conversation. 2010
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Medication Reconciliation Using PharmaNet-based Forms
…It’s about the conversation. 2010
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Outline
• Why reconcile?• What is Medication Reconciliation?• Change of Practice• PharmaNet-based Med Rec Forms• Obtaining a Best Possible Medication History
(BPMH)• Documenting the BPMH on the PharmaNet-based
Med Rec Form• Processing Medication Reconciliation
Orders
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Why Reconcile?
• Over half of medication errors occur at the interfaces of care
Rozich JD, Reser RK. Medication Safety: One Organization’s Approach to the Challenge. J Clin Outcomes Manage. 2001;8(10): 27-34
• An up-to-date and accurate medication list is essential to ensure safe prescribing in any setting
Safer Healthcare Now! Getting Started Kit: Medication Reconciliation Prevention of Adverse Drug Events
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Medication Reconciliation
•Working Definition:…a formal, systematic process in which health care professionals partner with patients to ensure accurate and complete medication information transfer at transitions of care.
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Medication Reconciliation
•Working Definition:…a formal, systematic process in which health care professionals partner with patients to ensure accurate and complete medication information transfer at transitions of care.
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Medication Reconciliation
• Prevent Unintentional Discrepancies
• Document Intentional Discrepancies
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Medication Reconciliation
Pre-HospitalMedicationsPrescription
Non-PrescriptionProv ProgSamples
AlternativeRecreational
InpatientMedications(Admission)
InpatientMedications(Critical)
InpatientMedications(Acute)
DischargeMedications
ReconciliationReconciliation Reconciliation Reconciliation
Reconciliation
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Medication Reconciliation
• Three step process:– Collection– Clarification– Reconciliation Medication Orders
Best Possible Medication History (BPMH)
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Change of Practice (Admission)Current state• Multiple individuals take medication histories and document
them in different locations in the clinical record• Medication orders are written on a separate form• Discrepancies occur without any effective way of identifying or
resolving them
Future state• One individual will obtain and document the best possible
medication history (BPMH) • The prescriber will confirm/write medication orders
on the same form to increase transparency and eliminate transcription errors
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Standard Forms• Use data in existing databases to:
– Minimize transcription– Ensure no active orders are overlooked
• Formatted to support three-step process:– Collection (existing data)– Clarification (modified/additional data)– Reconciliation medication orders
• Transparent process– Apparent to all subsequent caregivers
• Documentation of BPMH in single location at admission which can be referred to at discharge
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Medication Reconciliation at Admission
• Three step process:– Collection– Clarification– Reconciliation
COLLECTION CLARIFICATION RECONCILIATION
COLLECTION
CLARIFICATION CLARIFICATION
RECONCILIATION
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Best Possible Medication History• An up-to-date and accurate medication list is essential to
ensure safe prescribing in any settingSafer Healthcare Now! Getting Started Kit: Medication Reconciliation Prevention of Adverse Drug Events
• Goal is to determine how a patients is actually using their medications (versus how they were prescribed)
• Three steps:– Preparation– Conversation– Documentation
• Tools available at: http://vchconnect/programs_services/regional_pharmacy/medication_reconciliation/resources/page_69550.htm
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Preparation
• Review chart for clinical conditions and any medication lists obtained previously
• Print and review the patient’s PharmaNet-based Medication Reconciliation Form from CareConnect
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Limitations of PharmaNet
• Record of prescriptions dispensed
• Reflect current use of prescription medications less than 30% of the time
Shalansky, S et al: Accuracy of a Prescription Claims Database for Medication Reconciliation for Outpatients with Heart Failure. Can J Hosp Pharm 2007;60(3):169-176
• Information in PharmaNet MUST be clarified/verified with the patient or caregiver
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Limitations of PharmaNet • MAY contain discontinued medications• Does NOT contain
– Updated administration instructions – Non-prescription drugs– Samples– Investigational/clinical trial drugs– Complementary and alternative therapies– Antiretrovirals, some chemotherapeutic agents and vaccines– Prescriptions obtained outside of BC or over the internet
• Fraudulent use• Information in PharmaNet MUST be clarified/
verified with the patient or caregiver
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Printing PharmaNet-based Forms
• Forms are accessed via CareConnect
• Detailed instructions are available at:http://vchconnect/programs_services/regional_pharmacy/medication_reconciliation/page_67071.htm
Patient Identification
Total Pages and Print Date
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Interpreting PharmaNet EntriesGeneric name,
strength and dosage form of medication
Usage instructions
Fill date
Prescriber
Prescription statusFill quantity
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Preparation continuedReview chart for clinical conditions and any
medication lists obtained previouslyPrint and review the patient’s PharmaNet-based
Medication Reconciliation Form from CareConnect• Anticipate non-prescription medications based on
clinical history + PharmaNet • Review any medication containers that the patient
brought to hospital• Arrange for a translator or family member to
assist if required
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Conversation
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Conversation• Introduction• Ask to see home medications if available• Ask patient to describe why and how they are taking each
medication regardless of what is on the label or in PharmaNet • Ask specifically about:
– nonprescription medications, especially• aspirin• analgesics (acetaminophen, ibuprofen)• vitamins, calcium, iron and other supplements• allergy medications, eye drops, creams, etc
– Samples– Previous adverse effects (or lack of effect) of medications
• Any further questions?
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Conversation
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Documentation
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Documentation
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Documentation – Peri-op
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Reconciliation
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Summary
• Why reconcile?• What is Medication Reconciliation?• Change of Practice• PharmaNet-based Med Rec Forms• Obtaining a Best Possible Medication History
(BPMH)• Documenting the BPMH on the PharmaNet-based
Med Rec Form• Processing Medication Reconciliation
Orders
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Acknowledgements
• Crystal Amos, Medication Safety Pharmacist, Vancouver Acute HSDA
• Jane de Lemos, Coordinator, Professional Practice, VCH-PHC Pharmacy Services
• Debbie Jeske, Interim Director, Peri-operative Services, Vancouver Acute HSDA
• Elinor Orsini, Patient Services Coordinator, Preadmission Clinic, Vancouver Acute HSDA
• Fruzsina Pataky, Medication Safety Coordinator, VCH-PHC Pharmacy Services
