© institute for safe medication practices canada 2008® medication reconciliation in long term care...

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

Medication Reconciliationin Long Term Care

Atlantic Node Collaborative

Margaret Colquhoun

SHN Intervention Lead

Sept. 2008


ISMP Canada

Mission:

To identify risks in medication use systems, recommend optimal system safeguards and advance safe medication practices.


Medication Reconciliation in LTC

Goal: Reduce the potential for adverse drugs events (ADEs) by identifying and resolving discrepancies and improving documentation in drug regimens at LTC care

transitions


Background

Incomplete/inaccurate medication information is reflected in growing number of LTC studies.

Alberta 2007:• 75% medication information was NOT

legible/complete • 90% information was NOT available to tell

prescribed medications appropriate for diagnoses.

• 40% medication information DID NOT arrive the same day as the resident’s admission.(1)

• [1] Earnshaw, K et. al. Perspectives of Alberta Nurses and Pharmacists on Medication Information Received. July 29, 2007


Background

• 2004 study “incidence of ADEs caused by medication changes at transfer between facilities was 20%.

• Most on transfer from acute to LTC

• Incomplete/inaccurate communication a factor

Broockvar K, et al. Adverse events due to discontinuations in drug use and dose changes in patients transferred between acute and Long-term care facilities. Arch Intern Med.

2004;164:545-550


True Story…

• Patient admitted for investigation of recent onset of jaundice

• Levothyroxine daily not ordered – missed for 3 weeks

• Returned to LTC with symptoms of hypothyroidism


Another…

• Admission from LTC with urosepsis successfully treated

• Three chronic medications not continued during acute care stay

• On transfer back to LTC experienced acute attack of gout secondary to furosemide use/not receiving allopurinol


Medication reconciliation in LTC

• A formal process of:

• At admission, creating a complete list of resident’s current and pre-admission medications – including name, dosage, frequency and route (BPMH).

• Using the BPMH to create admission orders or comparing the list against the resident’s admission orders, identifying and bringing any discrepancies to the attention of the prescriber for resolution.

• Documenting any resulting changes and communicating to relevant providers


Sounds Easy Right?

Complex interplay of documentation and cognitive

tasks


What’s so Different?

Lengthy stays

Treatment includes many medications• Average 9.8 meds, up to 12.7 meds including prn

Care by fewer professional staff• Limited on-site pharmacist time

• Variable availability of physicians


Terminology

• Best Possible Medication History (BPMH) - A current medication history includes all regular medication use

• Training

• Multiple sources of info

• BPMH compared to admission orders to identify discrepancies


Terminology

• Undocumented Intentional discrepancy is one in which the prescriber has made an intentional choice to add, change or discontinue a medication but this choice is not clearly documented.

• Unintentional discrepancy is one in which the prescriber unintentionally changed, added or omitted a medication the resident was taking prior to admission.


Terminology

• Most Current Medication List – The most recent list of medications (name of medication, dose, route and frequency) currently taken by the resident – Used for medication reconciliation at discharge


Core Measures

Mean number of UNDOCUMENTED INTENTIONAL Discrepancies (Documentation Accuracy)

Target: Reduce baseline by 75%.

Mean number of UNINTENTIONAL Discrepancies (Medication Error)

Target: Reduce baseline by 75%.

Percentage of Residents Reconciled upon admission

Target: 100% of residents at admission.


Keys to Implementation

• Secure leadership commitment/involvement• Project plan (map current process)• Educate staff:

• Why medication reconciliation?• How to reconcile• BPMH training

• Develop and test new process• Embed process so that it becomes “the way you

do things”• Measure & sustain the improvements you have

made• Spread to other areas / populations


Considerations

• Proactive vs reactive

• Admission, transfer, discharge

• Different disciplines

• Institution specific

• NOT about a form

• Engage patient & family


Supports

• GSK

• Atlantic node collaborative

• National calls

• Community of Practice – LTC section

• National Learning Series


Getting Started KitMedication Reconciliation in

Long-Term Care

• Step-by-step guide to the process

• Model for Improvement

• Tools and Tips

• Samples


Communities of Practice

SHN Website – Critical Success Factors: Education

• Standardize material

• Make use of “teaching” moments

COP – Critical Success Factor: Communication

• Speak language of audience

• Preparation and follow-up are critical

• Show-off your results

• Use your stories!!!!


Acute Care Learning

• Data, results, stories • Training• Leadership• One size does not fit all• Is a clinical function• Requires resident/family participation• Use different health disciplines

appropriately• Commitment!!

© institute for safe medication practices canada 2008® medication reconciliation in long term care...

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