Improving Medication Safety on Transitions of Care Ged Hawthorn-Snr - - PowerPoint PPT Presentation

Improving Medication Safety on Transitions of Care

Ged Hawthorn-Snr Clinical Pharmacist Education and Training Shannon Townsend- Emergency Medicine Registrar Orange Health Service 2015

Orange Health Service

Med Rec- How do we compare?

• Using adapted QLD health MAP since 2008
• Adopted NSW Health MMP 2011
• 2012- Project Med Rec on admission
• Since then around 75% pts have MMP
• Discharge process

CEC Continuity of Medication Management Audit

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Omission Discrepancy Either Omission or Discrepancy

Percentage of patients with at least one medication omission or discrepancy at discharge – OBH 2013

A Series of Audits

96% 58% 46% 13% 61% 79% 0% 88% 69% 48% 13% 67% 82% 13% 100% 72% 50% 20.00% 73% 85% 18% 22% 0% Patients taking medications with a discharge summary Patients with more than 5 mediciens on discharge Patients on medicines, that had one or more medications omitted Patients with a discharge summary that had additional unexplained medicines Patients with at least one omission or discrepancy on their discharge summary Patients on medicnes which were ceased, new or changed during admission Patients with discharge summary that had a rationale for all changes to medicines Patients who received a patient friendly medication list percentage of identical med lists and discharge summaries 1/01/2013 OHS 1/06/2013 OHS 1/06/2014 CCU

Time for Action

• Engaging Staff:

Feedback, Highlighting risk, engaging, empowering, pts story, solution focused

• The Team:

Pharmacists, JMOs, Regs, NUM, CNC, CNE, IT, Pt Safety

• Combined Aim:

Improve the accuracy of medication documentation and increase patient education by 20% within 6 months

Planning & implementing solutions

Incorrect documentation and lack of patient education regarding medicines on discharge

D/C summary written in Latin

Communication

Pt verbally counselled but not documented Need pharmacist on round for direct and effective communication No Multi-d communication tool No template for meds in EMR

IT

No eMMP and discharge checklist Transcription errors JMO hands documents to ward clerk rather than to engage in conversation with pt. Bed pressure, high turnover, not enough time to prepare d/c. Weekend Discharges no reconciliation process Busy staff conflicting tasks to do

Processes

JMO writing d/c unfamiliar with pt Underfunded pharmacist FTE/ no redundancy Pt not seen by pharmacist on d/c

Staffing

Systems don’t integrate Pharmacist not available

• n ward at time of

discharge No clear plan from team re meds No formal multi-d discharge process. Nursing not taking

• wnership of medication

counselling.

Possible solutions High Impact Low Effort

• Increase communication 
• Remove latin abbreviations
• Develop medicine list template



• Nursing flagging high risk patients 
• Create a Multi-D eMMP 
• Medication safety discharge checklist
• Rostering pharmacist time
• Discharge flow sheet for staff to follow 

Possible solutions High Impact High Effort

• Customise eMR for useful discharge templates Costs $
• Education for nurses to do medication reconciliation Time
• Employ more pharmacists

Attempting to

• Having one integrated eHealth system

I’ll keep dreaming!

• Pharmacist increase med rec on discharge 
• Streamline medical rounding
• Clinical streams for pharmacists to provide redundancy

Enablers | Barriers

Smaller Hospital Motivated staff Consultant buy in SIBR Model Pharmacist med rec on ward Patient Focus Research demonstrating importance CEC toolkit MMP Pharmacy not built into discharge process Staffing Multi-D engagement Med Rec Union’s and position descriptions Med Rec not seen as everyone’s business Individuals

SIBR In Action

Outcomes and evaluation

2015 Western NSW LHD Living Well Together Health Awards

Outcomes and evaluation

Sustaining change

2015 Western NSW LHD Living Well Together Health Awards

• Policies on medication reconciliation developed
• MMP, BPMH and HETI med rec training during orientation
• Cardiologists briefed to educate JMOs on discharge expectations
• eMMP is now in use in ICU and is available for ICIP across district
• Medication reconciliation is a large focus of all pharmacists work
• Engagement and results shown to new team on ward

How to gain support from the Exec

• Financial Savings

Number of discrepancies per patient (1.55- from baseline audit data) x Number of patients per year through cardiovascular ward (1654- from health round table report) x Percent of patients with discrepancies that would result in an adverse drug event (9.4% of errors on a cardiology ward that could result in harm[1]) x Percent effectiveness of process (85% of discrepancies avoided through med rec process, global and local result) x Cost of an average adverse drug event ($2500 conservative)

= Annual gross cost savings ($512 100)

• Accreditation
• helps to meet 15 standard 4 requirements.
• Strategic Fit

Financial model developed by Steven B. Meisel, Pharm D Minneapolis. [1] Magalha˜es GF, Santos GBNdC, Rosa MB, Noblat LdACB (2014) Medication Reconciliation in Patients Hospitalized in aCardiology Unit. PLoS ONE 9(12): e11549doi:10.1371/journal.pone.0115491

Questions