Transcript Presentation Name

Medication Safety
The Role of
Medication Reconciliation &
Medicine Lists
Presenter Name & Organization
Objectives
• Be familiar with Washington Patient Safety Coalition
• Understand where medication reconciliation, My Medicine List,
and safe transitions fit into the medication safety strategic plan.
• Understand the current regulatory drivers around medication
reconciliation, such as The Joint Commission’s National Patient
Safety Goal (NPSG)
• Advocate and implement medication reconciliation into
workflow
• Promote patient awareness and utilization of My Medicine List
Patient Case
• 52 year old man goes to the clinic for a
check-in visit with his Specialist provider.
• Patient’s electronic chart indicated he was
to take 1 tablet of aspirin 325 daily.
Patient reported taking 18
tablets of aspirin 325mg
daily for shoulder pain.
• This is almost 6,000 mg of Aspirin
• New pain regimen was discussed
About the WPSC
The Washington Patient Safety Coalition is dedicated to improving patient safety
and reducing medical errors for individuals receiving health care in Washington, in
all care settings.
Our Vision
• Safe care: every patient,
every time, everywhere.
Our Values
• Patient-centered
• Systems-oriented and
sustainable
• Evidence-based
• Inclusive
• Resource-sensitive
Our Goals
• We will improve safety within and
across all care settings by:
• Facilitating the exchange of
information about best practices
relative to patient safety.
• Disseminating new knowledge and
new practices.
• Supporting coordinated/collaborative
efforts and new partnerships.
• Raising awareness of the need for
safe practices.
www.wapatientsafety.org
The Concerns Around
Medication Safety
• 1999 IOM report: estimated that medical errors cause 44,000 to
98,000 preventable deaths and one million additional injuries each
year in U.S. hospitals, and cost over $850 billion.
• A 2006 follow-up to the IOM study found that medication errors
are among the most common medical mistakes, harming at least
1.5 million people every year. According to the study, each
year…
 400,000 preventable drug-related injuries occur in hospitals
 800,000 in long-term care settings
 530,000 among Medicare recipients in outpatient clinics
Improving Medication Safety:
Where to begin?
High Alert /
High Risk Agents
Drug Interactions
Adherence/
Compliance Barriers
Improved Packaging &
Labeling
Patient Education
Medication Errors
Prescriber Education
Transitional Care
Management
Patients at Risk
Nearly 40% of patients have ≥ 1
unintended medication discrepancy at
hospital admission!
A similar proportion are present
at transfer within a hospital and
in 14% of patients at hospital
discharge.
Cornish PL et al. Unintended medication
discrepancies at the time of hospital admission.
Arch Intern Med. 2005;165:424-429.
Medication Reconciliation:
A Definition?
No standard exists!
The Joint Commission recommends…
The process of verifying that a patient’s current list of
medications (including dose, route, and frequency) is
correct and that the medications are currently
medically necessary and safe.
Greenwald et al. Making inpatient medication reconciliation
patient centered, clinically relevant, and implementable: a
consensus statement on key principles and necessary first steps.
Jt Comm J Qual Patient Saf. 2010 Nov;36(11):504-13, 481.
ASHP-APhA
Medication Reconciliation Goals
 Medication reconciliation should be a patient-centered process,
taking into account the patient’s level of health literacy and
willingness to engage in his or /her personal health care.
 Target improvement in patient well-being through education,
empowerment, and active involvement
 Achieve by promoting communication among patients and
healthcare providers
ASHP – APhA Medication Reconciliation Initiative
Workgroup Meeting . February 12, 2007
Achieving Medication Safety Goals
via Medication Reconciliation
Drive Systems (Re)Design
and Process Improvement
Maximize Use of Technology
Facilitate Cultural Change
Catalyst
Driving
Change
• WPSC
• Regulatory
Organizations
• Reimbursement
Models
Healthcare Systems Design:
Must Support the Med Rec Process
Collect
Clarify
Change in…
• Care Setting
• Medications
Verify
Reconcile
Communicate
Educate
Medication Reconciliation: Not So Simple!
HOSPITAL ADMISSION PROCESS
DISCHARGE
PROCESS
COMMUNITY PROCESS
Medication
Info Sources
Pt & Family
Clarification/Verification
Physicians
Pharmacies
Care
Facilities
Medical
Records
Pre-Admit
Outpt
Medication
List
Pre-Admit
Outpt
Medication
List
Pre-Admit
Outpt
Medication
List
Pt & Family
Physicians
Outpatient
Medication
List
Inpatient Med
List
Inpatient Med
List
3rd
Party
Vendors
Patient
condition &
diagnosis
Discharge Medication
Reconciliation
Pharmacies
Care
Facilities
Real Life Example: Inpatient Admission
• Patient admitted through ED
– ED Not a good setting for collecting information
• Triage, stabilize, transfer or discharge
• Solution: ED Med Rec Techs
– Complete when admitted on unit?
• Nurses busy admitting patient
• Med Rec challenging and time consuming
– Use what was collected in ED? Verify but not thoroughly?
• Provider prints off what is in system
– Unverified, from last admission
– Errors perpetuated on Transfer and at Discharge
– Garbage In = Garbage Out
Real Life Example: Franciscan
Health System
• Patient Arrives at ED
– ED Med Rec Tech
• Interviews patient or caregivers
• Records medication information from patient medication bottles
• Calls outpatient pharmacies, queries available sources, GH Epic, FMG
Elysium, etc., contacts patient’s PCPs
• Clarifies information with family or caregiver
• Generates a complete and accurate home med list that is reviewed by
a pharmacist
• List provided to ED or admitting provider to complete medication
reconciliation.
– Accurate home medication improves transitions in care
– Provides a good foundation for Discharge Med Rec
Real Life Example: Group Health
Post-Discharge Medication Reconciliation
Discharge
Home
Primary Care
• Patients identified who
are high risk for readmit
• Pharmacist calls patient
1 - 3 days post-discharge
• Pharmacist updates
• Information sent to
Clinical Pharmacists for
follow up
• Med recon and
comprehensive
medication review
•Makes medication
recommendations
patient’s physician
80% of patients have at least
one discrepancy resolved.
Safe Transitions Involve Many!
• Safe transitions are best when we maximize a
multi-disciplinary approach
• Group Health: Specialty Medication Reconciliation
involves a variety of disciplines
– Medical Assistant: medication verification
– Specialist: medication review and hand-off to pharmacist
– Pharmacist: comprehensive medication reconciliation and
communication to patient and appropriate physicians
– Primary Care Provider: authorize prescriptions and carry
out ongoing care of patient’s therapy
INCENTIVIZING CHANGE
VIA REGULATORY PROCESS
Mandating change and prioritization
Technology Adoption
The Joint Commission
Medication Reconciliation Requirements
A 6-year journey to improve patient safety
2005
• TJC
introduces
NPSG 8
2006
• “Med Rec”
required for
accreditation
2007
• NPSG
minor
revisions
2008
• NPSG major
revisions
planned
2009
• Scoring
suspended and
some
simplification
2010
• New
standards
created &
released
2012
• Implementation
of new standard
TJC 2011
Medication Reconciliation
National Patient Safety Goal #3:
the safety of using medications”
“Improve
NPSG.03.06.01: “Maintain and communicate accurate patient
medication information”
Applies to:
• Hospitals, including Critical Access Hospitals
• Ambulatory Care
• Office (Ambulatory) Surgery
• Home Care
• Long-term Care
• Behavioral Health
The Patient Protection and
Affordable Care Act (H.R. 3590)
Value-Based Purchasing (VBP)
Core Measures
(Section 3001)
Healthcare-Associated
Infections (HAI)
(Section 3001)
Hospital Consumer
Assessment of Healthcare
Providers and Systems (HCAHPS)
(Section 3001)
At Risk: 1% in FY2013 growing annually to 2% in FY2017
(70% Core Measures + HAI and 30% HCAHPS)
Medicare Reimbursement
Hospital Acquired
Conditions (HAC)
(Section 3008)
5
At Risk: 1% reduction
beginning FY2015
At Risk: 1% reduction in FY2013 and will
Rise to 3% by FY2015
Readmission Rates
(Section 3025)
COPD, CABG,
PTCA, etc.
AMI, PNE, HF
Readmissions are…
Frequent
• 18% of all Medicare hospitalizations are 30-day re-hospitalizations
• Average rates are >20% for certain patient populations
Potentially avoidable
• 76% of Medicare re-hospitalizations were “potentially preventable”
Costly
• $15B annually in Medicare of which $13B may be unnecessary
Actionable for improvement
• Research and quality improvement initiatives have demonstrated >30%
reduction of 30-day readmission rates for a variety of populations
Medications and medication use are often implicated in
unexpected readmissions!
http://www.medpac.gov/documents/jun07_entirereport.pdf
MedPAC 2007 Report to Congress;
Promoting Greater Efficiency in
Medicare
Med Reconciliation & Readmissions
How much does a
hospital readmit cost?
$14,500
Our analysis shows
that for every 25
patients that receives
med recon postdischarge, 1 hospital
readmit is prevented.
For the 2012 calendar
year, the program will
save an estimated
1 million dollars
Readmission Rates
37%
40
30%
35
30
25
Number of
Patient 20
Readmits
15
21%
11%
10
Comparison: No Med Recon
5
0
Intervention: Med Recon
14 day
30 Day
Kilcup M, Schultz D, et al. Post-discharge pharmacist medication reconciliation: Impact on readmission
rates and financial savings. J Am Pharm Assoc. 2013: Jan/Feb, 53:1.
Opportunities for Pharmacy:
Readmissions Preventing Interventions
Phase of Care
Admission
Inpatient Stay
Discharge
Home
Pharmacy Service Provided
Perform Admission
Assessment
Determine factors in
admission/readmission
• Medication history
• Medication reconciliation
• Errors of omission (EBM)
• Adverse drug events (ADE)
• Medication adherence
• Medication access
Determine post-hospital
needs
• Where will patient likely
receive care?
• Who are caregivers?
• Barriers to care?
Care Optimization
Provide effective teaching &
enhanced learning
• Identify barriers to learning
• Medication management
• Disease self-management
• Medication adherence
• Use “Teach Back” method
• Provide tools
Optimize the medication
regimen
• Initiate indicated medications
• Discontinue unnecessary or
unsafe medications
• Simplify the medication
regimen
Prepare for Transition
in Care
Provide Appropriate
Post-Discharge Care
Medication regimen review
• Medication reconciliation
• Provide medication list and
related information to:
o Patient/caregiver
o Physician/medical team
o Pharmacy/pharmacist
Contact patient/caregiver
• Live or virtual visit
Verify appropriate postdischarge care plan
• Match discharge follow-up to
need (readmission risk
stratification)
• Ensure proper information is
provided regarding contact
information, action plan for care
and symptom or AE
management
Patient status and medication
review
• Medication reconciliation
• Medication adherence
• ADE surveillance
• Medication access
• Med management/ Disease
management
Communicate to other
providers any pertinent
medical information or
findings
Achieving Medication Safety Goals
via Medication Reconciliation
Drive Systems (Re)Design
and Process Improvement
Maximize Use of Technology
Facilitate Cultural Change
Catalyst
Driving
Change
• WPSC
• Regulatory
Organizations
• Reimbursement
Models
Achieving Medication Safety Goals
via Medication Reconciliation
Drive Systems (Re)Design
and Process Improvement
Maximize Use of Technology
Facilitate Cultural Change
Catalyst
Driving
Change
• WPSC
• Regulatory
Organizations
• Reimbursement
Models
“MY MEDICINE LIST”
A WPSC Sponsored Project
My Medicine List
Heighten Public Awareness
• Emphasize the need for patients to take an active role in
managing their medicines.
• The initiative’s goal is for every person to maintain an
up-to-date list and to share it with his/her health care
provider.
My Medicine List
What's in a “Medicines” List
•
•
•
•
•
Prescription medications
Sample medications
Vitamins
Herbal & Alternative Meds
Nutriceuticals & Dietary
Supplements
• Over-the-counter drugs
• Vaccines
• Respiratory therapy-related
medications
• Parenteral nutrition
• Blood derivatives
• Intravenous solutions (plain
or with additives)
• Diagnostic and contrast
agents
• Radioactive medications
Any product designated by the FDA as a drug!
How Can You Help?
Remember the 3 As
• ASK every patient about his or her medicine list at each
encounter.
• ADVISE your patients to carry a list
• ASSIST your patients with resources & tools
Refer your patients to
mymedicinelist.org
for information and resources
What you don’t know about your patients
could harm them!
Thank You!