workshop presentation 2015 - improving medication safety ... · workshop presentation 2015 -...
TRANSCRIPT
Improving Medication Safety on Transitions of Care
Ged Hawthorn-Snr Clinical Pharmacist Education and Training Shannon Townsend- Emergency Medicine Registrar Orange Health Service 2015
Orange Health Service
Med Rec- How do we compare?
• Using adapted QLD health MAP since 2008
• Adopted NSW Health MMP 2011
• 2012- Project Med Rec on admission
• Since then around 75% pts have MMP
• Discharge process
CEC Continuity of Medication Management Audit
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Omission Discrepancy Either Omission or Discrepancy
Percentage of patients with at least one medication omission or discrepancy at discharge – OBH 2013
A Series of Audits
96%
58%
46%
13%
61%
79%
0%
88%
69%
48%
13%
67%
82%
13%
100%
72%
50%
20.00%
73%
85%
18%
22%
0%
Patients taking medications with a discharge summary
Patients with more than 5 mediciens on discharge
Patients on medicines, that had one or more medications omitted
Patients with a discharge summary that had additionalunexplained medicines
Patients with at least one omission or discrepancy on theirdischarge summary
Patients on medicnes which were ceased, new or changed duringadmission
Patients with discharge summary that had a rationale for allchanges to medicines
Patients who received a patient friendly medication list
percentage of identical med lists and discharge summaries
1/01/2013 OHS
1/06/2013 OHS
1/06/2014 CCU
Time for Action
• Engaging Staff: Feedback, Highlighting risk, engaging,
empowering, pts story, solution focused
• The Team: Pharmacists, JMOs, Regs,
NUM, CNC, CNE, IT, Pt
Safety
• Combined Aim: Improve the accuracy of medication documentation and increase patient
education by 20% within 6 months
Planning & implementing solutions
Incorrect documentation and lack of patient education regarding medicines on discharge
D/C summary written in Latin
Communication
Pt verbally counselled but not documented Need pharmacist on round for direct and effective communication
No Multi-d communication tool
No template for meds in EMR
IT
No eMMP and discharge checklist Transcription
errors
JMO hands documents to ward clerk rather than to engage in conversation with pt.
Bed pressure, high turnover, not enough time to prepare d/c.
Weekend Discharges no reconciliation process
Busy staff conflicting tasks to do
Processes
JMO writing d/c unfamiliar with pt Underfunded pharmacist
FTE/ no redundancy Pt not seen by pharmacist on d/c
Staffing
Systems don’t integrate
Pharmacist not available on ward at time of discharge
No clear plan from team re meds
No formal multi-d discharge process.
Nursing not taking ownership of medication counselling.
Possible solutions High Impact Low Effort
Increase communication
Remove latin abbreviations
Develop medicine list template
Nursing flagging high risk patients
Create a Multi-D eMMP
Medication safety discharge checklist
Rostering pharmacist time
Discharge flow sheet for staff to follow
Possible solutions High Impact High Effort
• Customise eMR for useful discharge templates Costs $
• Education for nurses to do medication reconciliation Time
• Employ more pharmacists Attempting to
• Having one integrated eHealth system I’ll keep dreaming!
• Pharmacist increase med rec on discharge
• Streamline medical rounding
• Clinical streams for pharmacists to provide redundancy
Enablers | Barriers Smaller Hospital Motivated staff Consultant buy in SIBR Model Pharmacist med rec on ward Patient Focus Research demonstrating importance CEC toolkit MMP
Pharmacy not built into discharge process Staffing Multi-D engagement Med Rec Union’s and position descriptions Med Rec not seen as everyone’s business Individuals
SIBR In Action
Outcomes and evaluation
2015 Western NSW LHD Living Well Together Health Awards
Outcomes and evaluation
Sustaining change
2015 Western NSW LHD Living Well Together Health Awards
• Policies on medication reconciliation developed
• MMP, BPMH and HETI med rec training during orientation
• Cardiologists briefed to educate JMOs on discharge expectations
• eMMP is now in use in ICU and is available for ICIP across district
• Medication reconciliation is a large focus of all pharmacists work
• Engagement and results shown to new team on ward
How to gain support from the Exec
•Financial Savings Number of discrepancies per patient (1.55- from baseline audit data) x Number of patients per year through cardiovascular ward (1654- from health round table report) x Percent of patients with discrepancies that would result in an adverse drug event (9.4% of errors on a cardiology ward that could result in harm[1]) x Percent effectiveness of process (85% of discrepancies avoided through med rec process, global and local result) x Cost of an average adverse drug event ($2500 conservative)
= Annual gross cost savings ($512 100)
•Accreditation - helps to meet 15 standard 4 requirements.
•Strategic Fit
Financial model developed by Steven B. Meisel, Pharm D Minneapolis. [1] Magalha˜es GF, Santos GBNdC, Rosa MB, Noblat LdACB (2014) Medication Reconciliation in Patients Hospitalized in aCardiology Unit. PLoS ONE 9(12): e11549doi:10.1371/journal.pone.0115491
Questions