MedsCheck Linking and Hospital Medication Reconciliation Improving Patient Safety Building the Community Pharmacy and Hospital Partnership Alice Watt ISMP Canada [email protected]

© Institute for Safe Medication Practices Canada 2007®

WHY?

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Computer Profile

Discontinue

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Linking MedRec to MedsCheck

The Pilot © Institute for Safe Medication Practices Canada 2008 ® © Institute for Safe Medication Practices Canada 2008®

Overview of MedsCheck/Medication Reconciliation Pilot - 2008

To facilitate the linkage of the hospitals across Ontario.

MedsCheck

program in community pharmacies with the medication reconciliation process in © Institute for Safe Medication Practices Canada 2008®

Pilot Objectives

To Improve :

• Communication of medication information • Continuity of care for the patient/client at transitions of care.

• Accuracy of medication ordering • Efficiency by reducing re-work For elective surgical patients with pre-planned surgical admission to hospital and at discharge.

© Institute for Safe Medication Practices Canada 2008®

5. Patient returns to community pharmacy for a

MedsCheck

Follow-up within 2 weeks of discharge 4. Patient discharged from Hospital with a comprehensive medication discharge list and prescriptions

LINKING Med Rec to MedsCheck

1.

Patient asked to obtain a

MedsCheck

from community pharmacy

2 weeks

prior to pre admission appointment 2. Pre-admission Clinician uses MedsCheck to create medication history (BPMH) 3. BPMH used to write medication orders at admission © Institute for Safe Medication Practices Canada 2008®

Community Pharmacists Role

• Book MedsCheck for pre-admission clinic patients when they ask or if contacted by the hospital • Perform MedsCheck using a systematic approach • Record all the medications the patient is actually taking. If it differs from the prescribed instructions then document the discrepancy in comments section. • Include all current prescription and over-the-counter medications. (aspirin, iron, potassium, eyedrops, creams, puffers) • Ask about medications dispensed from other pharmacies.

• Perform MedsCheck Follow-up at Discharge from hospital within 2 weeks © Institute for Safe Medication Practices Canada 2008®

Supports for Community

• “Enhancing help community pharmacists learn a systematic and standardized approach medication history taking that is accurate and reliable.

MedsCheck

” Presentation to © Institute for Safe Medication Practices Canada 2008®

Innovations to accommodate requests for MedsCheck

 Designated MedsCheck day each week - considered a viable business plan that pays for itself  SPEP Students - good educational experience  Scheduling daily time for MedsCheck  Accommodating patients who cannot get a MedsCheck from their own pharmacy  A ‘MedsCheck’ Pharmacist © Institute for Safe Medication Practices Canada 2008®

Innovations - Performing MedsCheck

• • • Using a MedsCheck form that has special area for OTCs/Herbals Using a MedsCheck form in the same format as the hospital BPMH form for patients going to surgery.

MedsCheck written in the patient’s native language © Institute for Safe Medication Practices Canada 2008®

Pilot Results

© Institute for Safe Medication Practices Canada 2008®

Results – Quality of

MedsCheck

• 113 MedsChecks collected • 180 discrepancies were identified between the BPMH and the MedsCheck • Average of 1.6 discrepancies per MedsCheck • Average time to complete the BPMH was not reduced ~ 12 minutes • Average of 8 prescriptions per patient • Limitations to this pilot © Institute for Safe Medication Practices Canada 2008®

Types of Discrepancies

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Comments from Hospitals

• The word “ profile

MedsCheck

” should be on the • Printed computer medication profiles that include repeated/refill medications are confusing and time consuming for the health care professional and/or patient to read and interpret.

© Institute for Safe Medication Practices Canada 2008®

Comments from the hospitals

• The variable quality of the makes it difficult for hospital staff to rely on them to create a BPMH

MedsCheck

© Institute for Safe Medication Practices Canada 2008®

However…….

• When the

MedsCheck

community pharmacies provided a lot of useful information to hospitals, especially when patients forget to bring in their medications. was complete, © Institute for Safe Medication Practices Canada 2008®

Coordinating MedsCheck and Medication Reconciliation in Ontario will:

Encourage hospital and community pharmacies to work more closely together to improve communication and patient care.

© Institute for Safe Medication Practices Canada 2008®

© Institute for Safe Medication Practices Canada 2008®