medicines reconciliation
DESCRIPTION
Medicines Reconciliation. Rachel Urban Pharmacist Researcher Bradford Institute of Health Research/ University of Bradford [email protected]. Aims. What exactly is Medicines Reconciliation? Definition Patient Journey Where does it go wrong? How can we put it right? - PowerPoint PPT PresentationTRANSCRIPT
Rachel UrbanPharmacist Researcher Bradford Institute of Health Research/University of [email protected]
AimsWhat exactly is Medicines Reconciliation?
Definition Patient Journey
Where does it go wrong?How can we put it right?
To look at the evidence and see what’s worked in practice
Discuss practical points to successful implementation
Background
What exactly is Medicines Reconciliation?IHI Definition“the process of creating the most accurate list
possible of all medications a patient is taking — including drug name, dosage, frequency, and route — and comparing that list against the physician’s admission, transfer, and/or discharge orders, with the goal of providing correct medications to the patient at all transition points within the hospital” (Cambridge, 2008)
Patient enters
hospital
Drug History Taken, Chart
written
Validation of Drug History
Medicines Reconciliation
?
Patient enters Hospital
Drug history taken
Drug history verified
Dischargewritten
Discharge Information Communicated
Drug chart written
Patient moves wards
Patient counselled
Patient Discharged
Discharge Information processed
PharmacistTechnician
Via A&E Direct to Ward
Pre admissions
Doctor Nurse
Pharmacist
Doctor Pharmacist
NurseDoctor
Pharmacist
ITCHome Care Home
POD /MDSPatientEHR
Discharge infoCommunity Pharmacy
NHGP list
GPDNCPSSCare Home
GPDNCPSSCare Home
CP, GP, Admin Staff
Pharmacist, DN
Where does it go wrong?Medication history taking
Not using all available sourcesInaccurate prescribingLack of verification by pharmacy staffHandoverPatient counsellingCommunication
Not knowing what has been stopped and startedNot knowing why something has been stopped
startedTimeliness of discharge
What’s worked?EvidencePredominantly US studiesIsolated aspects of process
Predominantly secondary care Admission Discharge
Few primary careCare of the Elderly/ A&ERole of the Health Care Professional
PharmacistNurse
AdmissionA&E
Prescription chart initiated in A&E (Mills & McGuffie 2010) MR increased from 50-100% Rx chart from 6-80% Prescribing Error rate decreased from 3.3 to0.04
Encourage Ambulance to bring in PODS (Chan et al 2009, 2010) Percentage of medicines incorrectly prescribed
decreased from 18.9 to 8.8%
DischargeDischarge
Pharmacist discharge service (de Clifford et al 2009, Morrison et al 2004 )
Communication with community Pharmacists Pegrum et al , Cook 1995
Identification of discrepancies by CP (Paulino et al 2004)Counselling
Increases number of interventions (Karapinar 2009)Patient Information Proforma (Manning et al 2010)Decreases number of ADE after discharge (Schnipper
2006)Counselling on discharge by Community Pharmacists
(Hugtenburg et al 2009)
Primary CareLack of evidence on Med RecRobust repeat prescribing systemsEnsure systems for processing information
are robust
StandardisationForms/process
Pre-clinic questionnaire (Tattersall et al 2008)Med Rec form (Bedard et al 2010)
ITKiosk technology for DH taking (Lesselroth et al
2009)Nationwide on-line prescription records
(Glintborg et al )Natural language processing (Cimino et al )PAML builder (Turchin et al 2008)
Health Care Professional RoleHospital Pharmacist
Medication History taking (Nester and Hale 2002, McFadzean 1993 Carter et al 2006)
Presence of pharmacist on post-admission ward rounds (Fertleman et al 2005)
Pre-admission clinics (Kwan et al, Dooley et al 2008)Community Pharmacist
Faxing information to community pharmacies (Cook et al 1995, Cook and Choo 1997, Pegrum et al )
Counselling at discharge by community pharmacists (Hugtenburg 2009)
Community liaison pharmacist (Bolas et al 2004)
EducationImproving education for doctors
Bray-hall et al 2009, Lindquist et al 2008
Physician quality officerWalsh et al 2011
American Medical Association 2007 - Physicians Role in Medicines Reconciliation
RPSGB – Principles and Responsibilities for commissioners and providers plus minimum data set.
Common FactorsLeadership and Support
MD teamSimplification and standardisation of processClear policies and proceduresVisible processClarifying of Roles and ResponsibilitiesReporting and learning from errorsEducationFeedback and ongoing monitoring
Appropriate measures