Transcript Integrated Medication Management to Prevent Errors
Royal Perth Hospital has been
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days without a Medication Error
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Integrated Medication Management to Prevent Errors
Barry Jenkins
Setting the scene
• Squire funded program for reconciliation • Short Stay Medical Unit (5E) • Mandatory reporting of KPI reconciliation rate • Goal: To establish a sustainable model for medication reconciliation.
• Medication reconciliation is a an important marker for integrated medication management
RPH Data
Recipe for IMM
• Performance Targets (APAC/PR/SQUIRE) • Functions & processes (Who does what) • Integrators (Brings people together) • Resources (mostly staff) • Monitor and evaluate (KPIs, surveys)
Performance Targets < 3%?
32.1% 16.7% < 3%?
Functions/processes
Doctor / Pharmacist Doctor Pharmacist Doctor / Pharmacist Pharmacist Pharmacist Pharmacist & Dr Doctor Patient Admission (Continuum) Medication History & confirmation Medication Chart Medication Reconciliation & Identification of Therapeutic Problems Collaborative Pharmacist & Doctor Action Plan Pre-discharge check & update Patient medication list Discharge prescription Discharge Summary Functions/processes TEDS Transfer of information to patient / carer and other health care providers.
LEGEND Position responsible TEDS Input TEDS Output Medication Reconciliation
Functions & processes (Who does what) • Who is the most effective?
• Who needs the least training?
• Which professional most suits the task? • Legislation?
• Hospital characteristics?
• Preferences and work-arounds
Successful integrators
• Software – TEDS (Dr and Pharm) • Ward round attendance (Dr/Pharm/Nurse) • Patient white board (Nurse/Pharm)
OLD TEDS
NEW TEDS Integrator - software
Discharge Summary
TEDS outputs
Patient Medication List Prescription
Resources: How many staff are needed?
• SHPA stds - bed:pharmacist ratio based on ward type. Eg. medical ward is category 4 = 30 beds/FTE • Only a guideline, no std or allowance for; – ED (RPH:10-15 med. history interviews & confirmations/day) – Pre-admission clinics?
– Short stay medical wards?
– PBS Reform.
– Admission/discharge rate.
– Mixed staffing models
Mixed pharmacy model
Duty
* = Main duty
Validation/docum. of pat. med. hx Assist in obtaining pat. Med. hx info. Reconciliation of medications on adm.
Entry of patient medications into TEDS Co-ordination of medication supply Ward round (collaborative action plan) Clinical review Reconciliation of medications on DC Generate DC prescription from TEDS Organise PBS and/or RPH outpat. Rx Liaison with community care providers Assist in discharge process Provide pat. med. list & advice on DC Clinical Pharm.
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Junior Pharm.
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* Pharmacy Tech.
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Monitoring and evaluation
• Main aim is to track progress whilst making changes.
• KPIs to measure effectiveness of changes/system • Medication reconciliation is the best stand-alone KPI • Survey for staff acceptance of process changes • Commitment to increase resources to reach target
The 4 stages of reconciliation KPI 120.0% 100.0% Reconciliation Steps
0.5CP 1 CP 1CP 1CP 1CP 0.4 JP 0.5 JP 0.5 JP 0.5 Tech
80.0% 60.0% 40.0% 20.0% 0.0% Jun 07 Jul-07 Aug 07 Sep 07 Oct 07 Nov 07 Dec 07 Jan 08 Feb 08 Mar 08 Month Med History Confirmation Admission reconciliation Discharge reconciliation
Satisfaction Survey questions
8. I believe the support provided by pharmacy to improve medication management and the processes that surround admission and discharge should be continued.
Strongly agree Agree Unsure Disagree Strongly disagree
Nursing
Medication Reconciliation Program on SSMU
100 90 80 70 60 50 40 30 20 10 0 Q 2 Q 3 Q 4 Q 5 Q 6
Questions
Q 7 Q 8 Q 9 Strongly agree Agree Unsure Disagree Strongly disagree
Medical
Medication Reconciliation Program on SSMU
80 70 60 50 40 30 20 10 0 Q 2 Q 3 Q 4 Q 5 Q 6
Questions
Q 7 Q 8 Q 9 Strongly agree Agree Unsure Disagree Strongly disagree
Conclusion
• “Invaluable” Registrar • “Excellent service; improves patient outcomes” Registrar • “Huge improvements. Best thing since sliced bread!!!” RN
Acknowledgments
Mern Low Quan Tran Lea Dias Robyn Hutchings Katherine Birkett Samantha Hilmi Chris Beer Jacquie Garton-Smith Stephen Witney