IHI Expedition Expedition: Improving Medication Safety from the - - PowerPoint PPT Presentation
April 9, 2015 These presenters have nothing to disclose IHI Expedition Expedition: Improving Medication Safety from the Patients Perspective Session 4: Medication Reconciliation Anne Myrka, RPh, MAT Joelle Baehrend Todays Host 2
Expedition: Improving Medication Safety from the Patient’s Perspective Session 4: Medication Reconciliation April 9, 2015
These presenters have nothing to disclose
Anne Myrka, RPh, MAT Joelle Baehrend
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Akiera Gilbert
Project Assistant Institute for Healthcare Improvement
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1) Click on the “Participants” and “Chat” icons in the top right hand side of your screen. 2) Click the button
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Joelle Baehrend
Director Institute for Healthcare Improvement
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Session 1 – Improving Polypharmacy
Faculty : Robert Feroli, PharmD and Amanda Brummel, PharmD, BCACP
Session 2 – Health Literacy and Medication Safety
Faculty : Gail Nielsen, BSHCA, FAHRA
Session 3 – Improving Medication Adherence
Faculty : William Strull, MD
Session 4 – Medication Reconciliation
Faculty : Anne Myrka, RPh, MAT
Session 5 – Safe Management of Newly Released Anticoagulants and High-Alert Medications
Faculty : L. Hayley Burgess, PharmD
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Assignment: Have a conversation with a patient at discharge and ask: (1) Do you know what the medication is for? (2) Can you obtain the recommended medication? (3) Do you know about the possible side-effects? Report out: What did you learn? Please chat in any reflections on the exercise.
Medication Reconciliation: My hospital has a process to reconcile medications at admission and all transitions of care:
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Anne Myrka, RPh, MAT
Pharmacist IPRO
Anne Myrka, RPh, MAT IPRO April 9, 2015
medication management
reconciliation
medication reconciliation
medication reconciliation
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Poorly executed med rec.
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medications, herbal supplements and vitamins
medications or diagnosis
medication list remains a challenge for every care setting
changed medications leaving next provider to “guess” whether changes where intended or unintended
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interchanges
document
problems
medication lists
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admission and there are always discrepancies
until discharge so this is when most problems are found and require resolution
rec can take 60 minutes or longer
systems are error prone (e.g., EHR in ED is not the same system as the inpatient side, the pharmacy system does not interface with EHR, etc…)
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throughout the continuum of patient hospital stay from admission to discharge with multiple layers of verification
problems
caused by IT
transcribing from one system to another
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rationale for medical decisions and ensuring such documentation appears on the discharge summary
presented by the patient/family/caregiver into the EHR
for reconciliation
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25 Am J Pharm Benefits. 2014;6(5):217-224
Background: Transitions between healthcare settings are vulnerable times for patients. Medication discrepancies associated with transitions are particularly problematic. Combining medication history information from various sources may improve the completeness and accuracy of medication information, leading to improved safety outcomes. Objectives: To evaluate the accuracy and completeness of patients’ medication history information at the time of hospital admission from 3 different electronic sources, and to assess the additive value provided by each source. Study Design: Case study of admissions to 2 community hospitals in upstate New York between September 2010 and April 2011. Methods: Medication history information was obtained from the hospital’s electronic health record (EHR), a commercial medication database, and a community wide health information exchange web
part of the routine intake medication reconciliation process. Results: We studied 858 patients, who collectively were on 7731 medications. The hospital EHR captured 80% (n = 6152) of medications accurately, the commercial medication database captured 45% (n = 3464) accurately, and the community portal captured 37% (n = 2838) accurately. When all 3 sources of medication information were pooled, medication accuracy increased to 91% (n = 6997).
interviewing tools are available:
Society of Hospital Medicine MARQUIS toolkit: Self Study guide: http://tools.hospitalmedicine.org/resource_rooms/imp_guides/ MARQUIS/MARQUIS_Certification_Simulation_Case_1_Final.p df
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care team
medications, location or condition
iceberg…pharmacotherapeutic interventions improve patient
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Chisholm-Burns MA,, et al.. Med Care. 2010;48:923-33. Chisholm-Burns MA., et al..Am J Health-Syst Pharm. 2010; 67:1624-34
anticoagulants
hypoglycemics, opioids
floor)
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Boockvar KS, et. al. Prescribing discrepancies likely to cause adverse drug events after patient transfer. Qual Saf Health Care. 2009 February ; 18(1): 32–36.
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increasing patient’s and caregiver’s ability to manage their care
knowledge and skills to recognize and address health care problems as they arise
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medication reconciliation at times of transition
condition – and knowledge of action needed
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medication history interview on admission?
patient/family/caregiver? Is the discussion documented?
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medication list? Do you know what to include?
acting vs. short acting drugs
used?
should they care? What are the patient’s goals?
these symptoms?
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monitor medication therapy?
should they do if a dose is missed?
pharmacist can be contacted for questions about any drug?
understands the education provided? Can the patient/caregiver demonstrate internalization of new knowledge?
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downloadable medication reconciliation brochure with medication list
rec
hospital
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medication reconciliation is possible with leadership and optimization of resources – both technological and human
reconciliation and medication management should be explicit and communication bi-directional
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Society of Hospital Medicine MARQUIS Toolkit: http://www.hospitalmedicine.org/marquis/ Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation: http://www.ahrq.gov/professionals/quality-patient- safety/patient-safety- resources/resources/match/index.html
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Anne Myrka, RPh, MAT Pharmacist (518) 320-3591 Anne.Myrka@area-i.hcqis.org
IPRO CORPORATE HEADQUARTERS
1979 Marcus Avenue Lake Success, NY 11042-1002
IPRO REGIONAL OFFICE
20 Corporate Woods Boulevard Albany, NY 12211-2370 www.atlanticquality.org
Template 9/23/14
This material was prepared by the Atlantic Quality Innovation Network (AQIN), the Medicare Quality Improvement Organization for New York State, South Carolina, and the District of Columbia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 11SOW-AQINNY-TskC.3-15-16
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Raise your hand Use the chat
Reflect on the audit and what you have heard from Anne today and identify two challenges and two affordances (things that help) in your medication reconciliation process.
– Please be prepared to share what you come up with on our next
call.
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Director of Clinical Pharmacy and Medication Safety Hospital Corporation of America, Clinical Services Group
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Thursday, April 23rd, 1:00 – 2:00 PM ET
Safe Management of Newly Released Anticoagulants and High-Alert Medications
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Joelle Baehrend jbaehrend@ihi.org Dorian Burks dburks@IHI.org