the case for medication reconciliation patient stories originally presented to high 5s workshop oct...
TRANSCRIPT
![Page 1: The Case for Medication Reconciliation Patient Stories Originally presented to High 5s Workshop Oct 2010 by Margaret Duguid Pharmaceutical Advisor Australian](https://reader035.vdocuments.site/reader035/viewer/2022062422/56649eab5503460f94bb1aed/html5/thumbnails/1.jpg)
The Case for Medication ReconciliationPatient Stories
Originally presented to High 5s Workshop Oct 2010by Margaret Duguid
Pharmaceutical AdvisorAustralian Commission on Safety and Quality in Health Care
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Bruce’s Story
68 years of ageRetired engineerFormer smokerEnjoys his gardenGoes to club 2 -3 times a week Has COPD, hypertension and recently
diagnosed with AF
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Bruce’s Story
• Presents to ED with exacerbation of his COPD
• Admission history taken by RMO• Medication history taken with assistance
of GP referral letter• History documented in patient’s progress
notes
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Bruce’s Story
Medication history documentedAtrovent 2 puffs qidSeretide 250mg 2puffs BDVentolin 2puffs prnFrusemide 40mg mane & midiCardizem 240mg ODAmiodarone 200mg ODWarfarin mduParacetamol prn for joint pain Voltaren gel recently
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Bruce’s Story
Bloods takenINR 4
Treatment decision documented in notes “withhold warfarin until INR therapeutic”
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Bruce’s Story
Medication chartedAtrovent neb 4 hrly Seretide 250mg 2puffs BDVentolin neb 5mg 6 hrly prnFrusemide 40mg po mane & midiCardizem CD 240mg po maneAmiodarone 200mg po maneParacetamol 2 prn for pain Prednisone 25mg daily for 7 daysAmpicillin 1g IV 6hrly
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Bruce’s Story
5 days laterBruce seen by the teamDecision to dischargeAmbulance booked for 10am next day9am RMO paged to write D/C scriptScript written from current medication chart. 1
month supply ordered9.15am script arrived in pharmacy
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Bruce’s Story
• 9.30am ward staff ring pharmacy inquiring whether Bruce’s D/C medications are ready as ambulance arriving at 10am
• 1 month supply medicines dispensed• Bruce’s medicines list prepared in the pharmacy
from the discharge prescription and placed in bag with his medicines
• 10am ambulance officer collects Bruce’s D/C medicines from pharmacy
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Bruce’s StoryMedicines on D/C prescription, patient’s medicines
listAtrovent 2 puffs qidSeretide 250mg 2puffs BDVentolin 2puffs prnFrusemide 40mg mane & midiCardizem 240mg maneAmiodarone 200mg manePrednisone 25mg daily for 2 daysParacetamol prn
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Bruce’s Story
Bruce made an appointment to see his GP the week after he was discharged5 days following his discharge Bruce suffered a stroke was paralysed down one side and unable to speak
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Where Med Rec would have helped
• Improved documentation of plan– Allows for follow up during admission
• Med Rec on discharge– Warfarin should have been noticed
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Lillian’s Story85 years oldLives alone in retirement villageLooks after herselfType 2 diabetes, hypertension, hyperactivethyroid – recently commenced onpropylthiouracilFell over in street when shoppingHit her head , ? broken armTaken by ambulance to hospital
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Lillian’s Story
ED very busyLillian slightly confusedNurse took medication historyUsed Lillian’s medicine’s list from previous
admission in handbag Documented in nursing assessment form
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Lillian’s Story
Medication history in nursing assessmentMetformin 500mg tdsDaonil 5mg tdsKarvea 150mg ODTemaze 10mg prnPanamax 2 prn
RMO Medication historyDocumented - see medication chartUsed nurses history to write up chart
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Lillian’s Story
Medication chartMetformin 500mg tdsDaonil 5mg tdsKarvea 150mg ODTemaze 10mg prnPanamax 2 prn
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Lillian’s Story
Lillian admitted to hospitalSlight concussionBroken arm for surgery next day48 hours laterAgitated and confusedObservations
Heart rate Temperature
RMO called
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Lillian’s Story
Suspected sepsisBlood cultures takenFlucloxacillin commenced 1g IV qid48 hours laterSymptoms worsenedBloods taken T4Endocrinology consult ordered
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Lillian’s Story
Lillian became unresponsiveMET team calledDiagnosed thyrotoxic comaTranferred to HDUPropylthiouracil recommencedPassed away 12 hours later
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Where Med Rec would have helped
• Confirm history with more than 1 source– PARTICULARLY as Lillian was confused – Lillian’s list was out of date– GP/community pharmacy would have been able
to confirm PTU prescription/dispensing