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Start to Finish Medication Reconciliation

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Title: PowerPoint Presentation Author: Jason Klincans Last modified by: Raymond Fung Created Date: 3/29/2005 9:21:24 PM Document presentation format – PowerPoint PPT presentation

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Title: Start to Finish Medication Reconciliation


1
Start to FinishMedication Reconciliation
  • Raymond Fung MD
  • Andrew Liu RPh
  • Toronto East General Hospital
  • May 27, 2013

2
Disclosures
  • Raymond Fung none
  • Andrew Liu - none

3
Outline
  • Introduction
  • Medication reconciliation setup
  • Results
  • Success factors and challenges
  • Future directions

4
  • Single site community teaching hospital
    serving southeast Toronto
  • TEGH has over 2,500 employees and 400 physicians

Inpatient Care Beds 510 Patients
admitted 14,673 Cerner - CPOE (2009)
5
Medication Reconciliation
  • Systematic way to prevent medication errors at
    transition points
  • Best possible medication history (BPMH)
  • Examine/update list at admission, transfer, and
    discharge
  • Effective communication of list to patient and
    next care provider at points of
    transfer/discharge

6
Why Medication Reconciliation
  • Medication Errors are common!
  • ISMP Canada
  • Voluntary medication incident reports
  • 30612 (2000-2008), 1169 caused harm or death
  • 67 prescription medication histories have errors
  • 46 medication errors occur on admission or
    discharge

Dialogue, December 2008
7
Medication Reconciliation
  • 3 hospitals in Massachusetts
  • 85 reduction in medication errors over 10
    months
  • Provides opportunity to reconsider
    appropriateness of patients medications and
    reduce polypharmacy
  • Required Organizational Practice (ROP)
    Accreditation Canada
  • Safer Healthcare Now priority

Dialogue, December 2008
8
Admission Med Reconciliation Process
9
Med Rec Process 1.Document BPMH
10
(No Transcript)
11
Completed Medication History
12
(No Transcript)
13
2. Add Admission PowerPlan
14
3. Admission Reconciliation
15
Admission Reconciliation Screen
16
Discharge Reconciliation Screen
17
Completed D/C Reconciliation
18
Prescriptions and Med Discharge Report
  • Print out prescriptions
  • Signature
  • Included CPSO No.
  • Limited use code
  • Medication Discharge Report
  • Instructions for patient to know which
    medications to continue at home/stop, etc
  • Can take it to their family physicians, pharmacy

19
Prescription
20
Custom Report Medication Discharge Report
Medication Discharge Report
Toronto East General Hospital 825
Coxwell Ave Toronto, ON M4C
3E7 Tel(416) 461-8272 04
-MAY-2011 Re Taking, Meds D.O.B
05-NOV-1944 Health Card Number
Address
Family MD

Family MD Phone

Inpatient
Attending MD FUNG MD, RAYMOND
Prescriptions 1. predniSONE 35 mg, Tablet,
Oral/Enteral Tube every morning taper by 5mg
until finished 2. ramipril 10 mg, Capsule,
by mouth once daily 3. rosuvastatin
(Crestor) 20 mg, Tablet, by mouth every night at
bedtime 4. tiotropium (Spiriva) 18 mcg,
Capsule, Inhalation once daily
Continue taking 1. Lantus 20 unit,
Injection, Subcutaneous every night at bedtime
2. Novorapid 8 unit, Injection, Subcutaneous
three times a day with meals 3. metFORMIN
1,000 mg, Tablet, by mouth twice daily with
meals Stop taking 1. acetylsalicylic
acid (Aspirin) 81 mg, Enteric Coated Tablet, by
mouth once daily 2. ramipril 5 mg, Capsule,
by mouth once daily Please take this list
to your Family Physician. If you have any
questions about your medications, check with your
Family Physician.
21
Challenges
  • Build challenges
  • Preferences not honored
  • Discontd, compld meds still showed
  • Orders package broke PowerPlan build tools
  • Accuracy of Discharge Medication Report
  • Prescription printing
  • Resend
  • End user adoption
  • Ease of use a barrier dispense quantity,
    updating BPMH
  • End user expectations have increased
  • Use was not mandated

22
Dispense Quantity
  • Necessary detail when writing prescriptions
  • On paper, MDs often put one quantity for multiple
    meds
  • Electronically, need to fill in detail for each
    med slow
  • Mandatory field Yes vs. No
  • Compromise fill in quantity on paper

23
Medication Discharge Report
  • When dispense quantity entered, medication showed
    in the Medications to Continue Taking That have
    Changed
  • Had to abandon this report and create own custom
    report
  • Custom report made into clinical note so that it
    can be saved, easy to look back

24
(No Transcript)
25
Medication Discharge Report
Medication Discharge Report
Toronto East General Hospital 825
Coxwell Ave Toronto, ON M4C
3E7 Tel(416) 461-8272 04
-MAY-2011 Re Taking, Meds D.O.B
05-NOV-1944 Health Card Number
Address
Family MD

Family MD Phone

Inpatient
Attending MD FUNG MD, RAYMOND
Prescriptions 1. predniSONE 35 mg, Tablet,
Oral/Enteral Tube every morning taper by 5mg
until finished 2. ramipril 10 mg, Capsule,
by mouth once daily 3. rosuvastatin
(Crestor) 20 mg, Tablet, by mouth every night at
bedtime 4. tiotropium (Spiriva) 18 mcg,
Capsule, Inhalation once daily
Continue taking 1. Lantus 20 unit,
Injection, Subcutaneous every night at bedtime
2. Novorapid 8 unit, Injection, Subcutaneous
three times a day with meals 3. metFORMIN
1,000 mg, Tablet, by mouth twice daily with
meals Stop taking 1. acetylsalicylic
acid (Aspirin) 81 mg, Enteric Coated Tablet, by
mouth once daily 2. ramipril 5 mg, Capsule,
by mouth once daily Please take this list
to your Family Physician. If you have any
questions about your medications, check with your
Family Physician.
  • Saves as clinical note look back
  • Once Cerner report printed once, dithered, cannot
    print again
  • Can modify type specific instructions within
    clinical note
  • Disadvantage need to go to another section of
    e-chart

26
How are we doing?
27
Medication History Completion
28
Medication History Frontline Report
29
Discharge Reconciliation -Trends
30
D/C Med Rates by Dept Mar 2013
31
Success Factors
  • Multidisciplinary team
  • Pharmacists
  • Physician assistants
  • Physician champions -specific
  • Integrated electronic process and reports
  • Reporting rates at departmental meetings
  • Timely reporting of real-time metric and goal to
    frontline staff
  • Competition participation in CHI ImagiNation
    Challenge

32
Challenges
  • Residents
  • Engaging different physician groups
  • Sustain enthusiasm
  • Technical
  • Outpatient/inpatient/conversion
  • Dispense quantity
  • Customizing to provincial formulary (LU)

33
Future Directions
  • Expanded ambulatory clinic areas
  • Expand into other inpatient areas
  • Incorporation into depart process/ discharge
    summary
  • Relook at technical challenges
  • Optimization of admission BPMH/reconciliation
    workflow
  • Prioritize and measure med rec in high risk
    populations

34
Acknowledgements
  • eChart team
  • Karen Hunter
  • Owen Osmond
  • Tina Price
  • Pegi Rappaport
  • Pharmacy
  • Valerie Leung
  • Jessica Ma
  • Kieu Mach
  • Carmine Stumpo

35
Questions
36
For more information Toronto East General
Hospital 825 Coxwell Ave. Toronto, Ontario M4C
3E7 Tel (416) 461-8272 Fax (416)
469-6106 www.tegh.on.ca
Above all, we care.
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