Transcript How Medication Reconciliation Supports Patient Safety

How Medication
Reconciliation Supports
Patient Safety
15 September 2007
…a shared
responsibility
for health care
Jane Richardson, BSP, PhD, FCSHP
Coordinator, Clinical Pharmacy Services
Team 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?
Arch Intern Med, 2005
• 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%)
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 handwritten 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 medication
2. Match in-house dose, frequency, and route with
at-home usage
3. 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 Manual
Medication Reconciliation
Form and Process
Medication
Reconciliation
Form, 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
Are we making a difference?
1.0 Mean Number of Undocumented Intentional Discrepancies
1.40
National: 1.1
Baseline
1.20
1.00
Revise
form
PDSA 2
0.80
Mean
National: 0.6
PDSA 3
Education
0.60
0.40
PDSA 1
survey
0.20
1 yr data
check
PDSA 4
Month
Actual
Goal
20
08
ay
M
ar
20
08
M
20
08
Ja
n
20
07
No
v
00
7
20
07
Se
p
Ju
l2
20
07
M
ay
ar
20
07
M
20
07
Ja
n
20
06
No
v
20
06
Se
p
00
6
Ju
l2
20
06
ay
M
ar
20
06
M
20
06
Ja
n
No
v
20
05
0.00
Mean
National: 1.2
N
ov
D 200
ec 5
2
Ja 00
n 5
Fe 200
b 6
2
M 00
ar 6
2
Ap 00
r2 6
M 00
ay 6
2
Ju 00
n 6
2
Ju 0 0 6
l2
Au 00
g 6
Se 200
p 6
2
O 00
ct 6
2
N 00
ov 6
D 200
ec 6
2
Ja 00
n 6
Fe 200
b 7
2
M 00
ar 7
2
Ap 00
r2 7
M 00
ay 7
2
Ju 00
n 7
2
Ju 0 0 7
l2
Au 00
g 7
Se 200
p 7
2
O 00
ct 7
N 200
ov 7
D 200
ec 7
2
Ja 00
n 7
Fe 200
b 8
2
M 00
ar 8
2
Ap 00
r2 8
M 00
ay 8
2
Ju 00
n 8
20
08
Are we making a difference?
2.0 Mean Number of Unintentional Discrepancies
2.00
PDSA 2
1.80
1.60
1.40
0.00
Revise
form
PDSA 3
Baseline
1.20
PDSA 4
1.00
Education
1 yr data
check
0.80
0.60
0.40
0.20
National: 0.65
PDSA 1
survey
Month
Actual
Goal
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-populated
Medication
Reconciliation
Form
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
PIP
– Avoids name & strength transcription errors for autopopulated 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