Transcript GLACE BAY HOSPITAL - Canadian Patient Safety Institute

HEADS UP TO A SAFER
HEALTH CARE AT
THE GLACE BAY HOSPITAL
Medication Reconciliation
Prepared and Presented by :
The Medication Reconciliation
Champions
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1. Billy MacPherson
2. Carol Tobin
3. Sharon Moore
4. Amanda Dean
5. Linda Carabin
6. Ruth O’Connell
3rd South/West.
I.C.U. Dept.
3rd West Medical
O.B.S. Dept.
3rd West Medical
3rd East Telemetry
What is Medication Reconciliation ?
• M.R. is a process designed to prevent medication errors at
patient transition points.
• It includes :
A) Creating the most complete and accurate list or Best Possible
Medication History of all home medications for each patient.
B) Using that list when writing medication orders.
C) Comparing the list against the physician’s admission, transfer,
and /or discharge orders; identifying and bringing any
discrepancies to the attention of the physician; and , if
appropriate, making changes to the orders ensuring the changes
are documented.
Why is Medication Reconciliation
important ?
• 1. To prevent adverse drug events.
• 2. To prevent medication errors at
patient transition points.
a) Admission
b) Transfer
c) Discharge
3. It is a (ROP) Required
Organizational Practice
( It is a required practice for all
personnel to perform when
admitting, transferring, and
discharging patients in the
health care system)
Accreditation (Qmentum)
What is a “Best Possible Medication
History (BPMH)”
• 1. Please refer to the form called “Best Possible
Medication History on Admission”.
• 2.This is a list of medication that is obtained
after interviewing the patient.
• 3.This list is made up of all the medication the patient
is presently taking and how they take each of them,
“as stated by the patient”.
• 4. This list includes a review of the patients
medication with their Community’s Pharmacy.
Patient interviews are a critical
process for medication reconciliation
• Without the patient interview, a vital source of
information in the forming of a medication list will
cause you not to be able to complete the medication
reconciliation process.
• The patient, in most instances, is the one person who
knows exactly how, when, and if he or she is taking
prescribed medications.
• The information the patient offers goes far beyond
confirming an established medication list.
Best Possible
Medication
History Form
At The
Glace Bay
and
New Waterford
Site
• The medication
reconciliation process
is considered
complete when all
discrepancies have
been resolved
(reconciled) and all
components of the
form have been
completed.
Patient and family having the
medication reconciled
Medication Reconciliation on Transfer
• Med. Rec. is done on every transfer of a patient from
unit to unit and site to site.
• At the Glace Bay/NW site if a patient is less then 24
hrs in the Emergency department a nurse to nurse
review of the BPMH on admission is done and signed
by both parties (the ER nurse with the receiving unit
nurse).
• If the patient is greater then 24 hrs in the emergency
department a “new” sheet (transfer) is to be completed
by the receiving unit nursing personnel .
• When a transfer occurs between 3rd West and 3rd South
Med. Rec. is to be completed by both nurses
(transferring nurse & receiving nurse) performing a
medication review, to reconcile any discrepancies.
Transfer
Form
(Completed by
Receiving Unit
Nursing
Personnel)
Medication Reconciliation on Discharge
• At the Glace Bay/NW site when a patient is discharged,
they will receive a copy of the discharge form that has
been signed and reviewed by the discharging physician.
• That same form will be faxed to the patients Community
pharmacy and it will serve as the patients medication
profile on discharge .
• Nursing home patients and those going to LTC, a
discharge form will be faxed.
• Please remember to clarify the patient’s Community
pharmacy .
• Obtain a consent from the patient to have this
information sent off to their Community Pharmacy.
• The patient on discharge will have the same information
as the Community Pharmacy, Physician, and it will
become a part of the patients record.
Patient
Medication
Profile/
Discharge
Form At the
Glace Bay
Site
We see this many times with our
patients on admission.
“I take that blue and red one”,
“I think its for my heart”????
Summary
Steps to Medication Reconciliation:
• 1. Review the chart ( Doctors
orders)
• 2. Interview the patient/ family
• 3. Review the “list/medication
bottles”
• 4. Contact Community Pharmacy
• 5. If a discrepancy– return to
interview the patient.
Any Questions ?
Case Scenario
• Patient M 73 year old female, arrived at the
E.R. c/o anterior chest pain.
• Anxious
• Family not present.
• No medication bottles on arrival
• Chest pain has since resolved and pt is now
stable. Medication Reconciliation interview
can now take place….
Best Possible Medication History
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Tamoxifen 10mg twice daily
Vitamin B12 1000mcg daily
Synthroid .025 mg once daily
Apo-hydro 25 mg ½ tab daily
Alendonate FC 70 mg once weekly
Betnovate cream to groins twice daily
Crestor 10 mg once daily
ASA 81 mg once daily
BPMH Con’t
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Vit D 1000 IU once daily
Calcium 650 mg once daily
Ibuprofen 200 mg two tablets PRN
Garlic Tablet two three times daily
Garamycin eye gtts one drop both eyes four
times a day
• Amytriptyline 10 mg one tab at bedtime-no
longer taking.
• Zantac 150 mg- states taking prn
Best Possible Medication History
• Tamoxifen 10 mg twice
daily
• Vit B12 1000 mcg once
daily
• Synthroid .025 mg once
daily
• Apo-hydro 25 mg ½ tab
daily
• Alendonate FC 70 mg
once weekly
• Betnovate cream to left
elbow twice daily
• Zantac 150 mg-prn
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Crestor 10 mg once daily
ASA 81 mg once daily
Vit D 1000 IU once daily
Calcium 650 mg once
daily
Ibuprofen 200 mg two
tablets PRN
Garlic Tablet two three
times daily
Garamycin eye gtts one
drop both eyes four times
a day
Elavil 10 mg hs-not taking
Meds & more Meds
Research has shown that poor communication of
medication information
at transition points
is
responsible
for
medication errors
and
adverse events.
Thank you